Boomer...suspected of Cushing's

[robinef]

Hi everyone,

I'm new to the forum and thought it might be a good place to hear some stories. I have a Yorkie named Boomer. He just turned 12, and we (my mom, his vet and I) think he probably has Cushing's. We've noticed signs about a year ago, but because of his age, past health issues that I'll explain in a minute, and the expensive diagnosis, we chose not to look into it much further. My parents will be out of the town for the next month, leaving me alone with Boomer. About a week ago, he started dribbling urine or a liquid of some sort, and his belly felt a little bigger than normal. I asked my mom to take him to the vet so she can make sure everything is as OK as can be with him before they leave so I won't needlessly worry while they're gone. Let me break now to his past health issues.

When Boomer was 2, his belly filled with liquid. It was huge, to the point where he could only sit up or lay on his side. He couldn't even walk. Apparently what was happening was his intestines were leaking the digested food or whatever the by-product is. He had a transfusion, his belly drained, and probably a few other things that I can't remember, and has been on Pancreazyme and a low dose of cortizone ever since. He will randomly get an upset stomach (probably monthly) and will have bouts of diarrhea (usually two or three times a year) that seem to come out of nowhere. He takes some flagyl and is fine. Last year when he went for his geriatric appointment, the vet told us Cushing's might be developing because he was losing hair. Right around the same time we noticed he was drinking probably twice as much water as he was before. Those were the only two symptoms we noticed at the time. Fast forward to where we are today.

Again, we went to the vet last week, and while we didn't test for Cushings, his blood work shows extremely increased levels (2-3 times higher than last yr, which were already abnormally high... his triglycerides are in the 600s) of liver, cortisol, etc. He's 12 yrs old, and my mother believes that even if we were to treat him, he'd probably only live a couple of more years anyway, considering all of his stomach and pancreatic issues. In my opinion, however, because he has no other health issues that are life-threatening, he could live several more years perfectly happy. He is still so alert. When the vet saw him, before looking at his lab work and other symptoms, she said he had another 5 or 6 years left. People literally mistake him for 4 or 5 years old. More hyper than a lot of puppies and always has been. I'm starting to get more worried today because I've really noticed a bigger belly over the last couple of days. The doctor said she didn't think it was abnormally large, and she didn't feel any fluid. Today when we gave him his bath, when he was drying himself off, you could hear all of the sloshing inside his belly. And it looked a lot larger than I had seen it in awhile. He didn't want to eat his treat, which has literally never happened, but he seemed just as hyper as he would be after his bath normally. He has been urinating in the house and urinating MUCH more frequently and drinking MUCh more.. probably closer to 4 to 5 times his "normal" a few years ago. Things seem to have changed drastically in the last week. He does have a double yeast infection in his ears, so he really dislikes both me and my mom for giving him ear drops, so I don't know if that maybe has an effect on anything. And he's not wanting to play after dinner like he usually does. He definitely is acting a little different, and I don't know if it has anything to do with his belly being uncomfortable or if it's the Cushing's or nothing at all. And when I say his belly is big, it's not huge. It's not as big as many I've seen. It's just larger, like he has a full bladder. Throughout the day, his belly will fluctuate in size, going from normal to larger and back to normal.

OK, so after that terribly long explanation, I pose a few questions:
1. Does anyone know how long, on average, a dog will live while on treatment?

2. If we let Cushing's go untreated, how will he die? I know he could die of other causes, but assuming he doesn't, will it be liver failure? Or something terribly painful and awful? If it doesn't prolong his life, do you think it will drastically improve his quality of life? Right now, his biggest annoyance is probably his belly and urinating constantly.

3. Any holistic treatments? We have had him on melatonin for the last year, in hopes it will help regrow his hair. No more has fallen out anyway, but other symptoms seem to be on the rise.

4. Is it too late to treat if he's been showing noticeable symptoms for over a year?

Thank you all so much for reading this post. As you can probably tell, I'm really worried, possibly unnecessarily. If I had it my way, I would treat him, but if he's already 12, and it won't make his life terribly miserable, then maybe we should just let it go. I would really appreciate any input on any of this.

Thanks!
Boomer and his sister

[Harley PoMMom]

Hi and welcome to you and Boomer!

So sorry for the circumstances that brought you here but very glad you found us. To make it easier for me :) I have given my replies to your questions in blue.



OK, so after that terribly long explanation, I pose a few questions:
1. Does anyone know how long, on average, a dog will live while on treatment?

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!

2. If we let Cushing's go untreated, how will he die? I know he could die of other causes, but assuming he doesn't, will it be liver failure? Or something terribly painful and awful? If it doesn't prolong his life, do you think it will drastically improve his quality of life? Right now, his biggest annoyance is probably his belly and urinating constantly.

Unfortunately I know first hand the effects that untreated Cushing's has on a dog. My boy Harley was dx'd with kidney issues when he first started treatment with Vetoryl. Vetoryl did not create his kidney problem, he either had this issue before or the elevated cortisol was the reason. We decided not to treat the Cushing's because of the kidney disease. A short time later his liver started failing and then his heart.

3. Any holistic treatments? We have had him on melatonin for the last year, in hopes it will help regrow his hair. No more has fallen out anyway, but other symptoms seem to be on the rise.

I do wish there were holistic treatments for this disease but regrettably none exist. Trilostane (Vetoryl) and Lysodren (Mitotane) are the preferred medicines to treat Cushing Disease.

4. Is it too late to treat if he's been showing noticeable symptoms for over a year?

Absolutely it is not too late to treat Boomer. Cushings moves at a snails pace so one has the time to get a proper diagnosis and then treat.

Thank you all so much for reading this post. As you can probably tell, I'm really worried, possibly unnecessarily. If I had it my way, I would treat him, but if he's already 12, and it won't make his life terribly miserable, then maybe we should just let it go. I would really appreciate any input on any of this.

Thanks!
Boomer and his sister

The one thing that does concern me is that you have posted that Boomer is on a low dose of cortizone. Iatrogenic Cushing's disease means that the excess of cortisol has resulted from excessive administration of a steroid medication. This may occur from the prolonged use of oral or injectable medications. Although the injections or tablets are often prescribed for a valid medical reason, prolonged use or misuse can cause Cushing's disease as a detrimental side effect. Triamcinolone, prednisone, prednisolone, methylprednisolone and cortisone are some common corticosteroids that can cause Iatrogenic Cushing's disease.

The treatment for Iatrogenic Cushing's disease is to slowly wean the dog off the steroid medication, if possible.

Please know we will help you and Boomer in any way we can so do not hesitate to ask any questions.

Love and hugs,
Lori

[littleone1]

Corky and I also want to welcome you and Boomer.

Corky was 12 when he started being treated for cushings. He's 14 now, and I am really glad that we're treating him. His quality of life is so much better now. I would rather treat it than to have him suffer, as his internal organs would have been severly damaged.

Corky's clinical signs did go away after he started on Trilostane. Every-so-often, some of them will start to reappear, but as soon as his dosage is adjusted, he's back to his normal self.

We're here to help you in anyway we can. This is a wonderful group of very supportive, caring, and knowledgeable people. I'm glad you found us.

Terri

[robinef]

Thanks for your input! One of the main concerns we have with treating him is the cost. Approximately how many initial adjustments were there.before your dogs got the correct dosage? How much does the medication cost each month? I know it varies but if there's a ball park figure that'd be helpful. Did your doggies ever need their bellies drained? Any ideas about what the sloshing could be? I think I read cushings dogs train water do maybe its that. Thanks!

[robinef]

I meant retain water..not train. I'm writing from my phone :)

[lulusmom]

Hi and welcome to the forum.


The one thing that does concern me is that you have posted that Boomer is on a low dose of cortizone. Iatrogenic Cushing's disease means that the excess of cortisol has resulted from excessive administration of a steroid medication. This may occur from the prolonged use of oral or injectable medications. Although the injections or tablets are often prescribed for a valid medical reason, prolonged use or misuse can cause Cushing's disease as a detrimental side effect. Triamcinolone, prednisone, prednisolone, methylprednisolone and cortisone are some common corticosteroids that can cause Iatrogenic Cushing's disease.

The treatment for Iatrogenic Cushing's disease is to slowly wean the dog off the steroid medication, if possible.

This was a concern of mine as well as the ear drops you are administering at the moment. Can you please tell us the name of the ear meds you are using?

The need to drain a dog's belly is not normal nor is it common in cushing's. A cushdog's pot bellied appearance is caused by an enlarged liver, weakened muscles caused by the catabolic effect of excess cortisol and unusual redistribution of fat, also caused by excess cortisol. A cushdog's belly does not fluctuate during the day and it most certainly does not return to normal until well after effective treatment has been initiated.

The diagnostic phase of cushing's is the most expensive because none of the tests are all that great so you have to do multiples to validate one another and differentiate between pituitary and adrenal based disease. It makes it even more difficult to diagnose cushing's if a dog has an underlying non adrenal illness which can skew diagnostic tests.

Before treatment is discussed, a confirmed diagnosis must be made based on a number of tests as well as the dog's physical presentation. What symptoms associated with cushing's does Boomer have? Most cushdogs have a voracious appetite, they drink and pee buckets, thinning or loss of coat, muscle weakness, especially hind end weakness, exercise intolerance, panting, etc. Which of those symptoms does Boomer have?

My cushdogs are toy breeds like Boomer and besides the small poops, we can also be greatful for lower doses of Trilostane or Lysodren. The cost is dependent on whatever dose a dog is stabilized on and if Trilostane is chosen as the treatment of choice, you have the choice of FDA approved Vetoryl or compounded Trilostane which is much cheaper. Dechra, the manufacturer of Vetoryl did not have a dose small enough for my dogs when they first started treatment with Trilostane so we didn't have a choice. It worked out well because it saved me a lot of money. Three years ago I could get a three month supply of 30mg from Diamondback Drugs in Scottsdale, AZ for about $70. A number of our members use Diamondback for their pet meds. Please note that since Vetoryl was approved, compounders cannot compound any doses that are currently available for Vetoryl.

Glynda

[littleone1]

I also use Diamondback Pharmacy. I get 180-20mg capsules for $90.

Corky never had to have his stomach drained. As Glynda mentioned, this is not normal or common in cushpups. In humans, if they have liver disease, the fluids do build up, and they have to have their stomachs drained. I don't know if this is something that can happen to a furbaby.

Terri

[addy]

Hi and Welcome to you and Boomer,

My Zoe is on brand name Vetoryl. I pay $42 for 30 10 mg pills from Pet Apothecary. Boomer would likely need a small dose.

Glad you found us. Hope we can help with whatever you may need.

We are always here for support.:):):)

Hugs,
Addy

[robinef]

The ear drops are otomax. He seems so much better today that I'm wondering if it is cushings or not. His symptoms are:

- symmetrical hair thinning although it has stabilized over the last year
- increased thirst...probably 2.5 cups a day for a 5.75 lb dog. This has drastically increased over the last.month
- increased privation and having accidents in the house..this is new within the last week
- he's been panting much more frequently although I don't know if that's just because he's constantly thirsty or warm
- he's doesn't play as long as he used to but he is 12 and he still can and enjoys play
- his belly I think is still bigger than it should be but it varies..which I know is unusual. The vet suggested feeding him less which seems to have helped
- his skin is drier than it used to be and itchier. We've started a new shampoo that the vet thinks will help..she thinks its possibly allergies. His skin is also crepey like it has lost its elasticity.

The main reasons I think cushings is because he has been on prednisone for years but it really is such a small dose..a quarter of a 5 mg tablet every other day. I also know his liver is having a hard time because his test results were so high. His health is my main concern..ill clean his messes and fill his bowl but there's nothing I can do to help his vital systems without meds. I have an appt with the vet in s couple of weeks so ill get her opinions too. Compared to a lot of the stories I've read here, boomer seems like he's doing pretty ok. Thanks for your input..its all appreciated!

[jmac]

Hello-
My shih tzu, Hannah, is also 12, and we just got a Cushing's diagnosis in March. She is also in great health otherwise, and I would assume would have a few years left. She had very minimal symptoms, but enough that I noticed a difference in her eating and urinating. We are treating with Anyipryl right now successfully (her high liver values actually dropped after 6 weeks of meds), but we are open to something stronger if we get to that point. I would definitely pursue some treatment if Boomer is in otherwise good health. The large stomach with sloshing sounds concerning to me. From what I know, they develop the large potbelly stomach gradually, not over a period of days as you have described, although I don't have any firsthand experience with that. I would take Boomer to the vet to have that checked now because it sounds concerning to me. Also, the treatment with cortisone could be causing the Cushing's symptoms, so I would look into that too. If I were you, I would get an appointment and talk to the vet about some of these concerns. Good luck!
Julie & Hannah

[jmac]

This was a concern of mine as well as the ear drops you are administering at the moment. Can you please tell us the name of the ear meds you are using?


Hi Glynda,
Just wanted to check in about the ear drops. Hannah has had two ear infections since being diagnosed with Cushing's (which I have read is fairly common) and we have successfully treated with Tresaderm. I just wondered if you had a concern about a steroid in the drops, or if this was something specific to Boomer.

Thanks!
Julie & Hannah

[Squirt's Mom]

Some ear, and eye drops, contain steroids which can cause Cushing's signs and interfere with testing. There are also drops that are of the mycin family which can and do cause deafness - any drug of the mycin family has this potential, whether given orally or topically, in the eyes, ears or on the skin.

Hugs,
Leslie and the gang

[robinef]

Does anyone have a dog or know someone whose dog has/had Iatrogenic Cushing's? I certainly would love to ween him off of the prednisone to see if that relieves his symptoms, and it's something I'll talk with my vet about. But I was just curious if anyone has any personal testimonies about that working for them.

Thanks for all of your help :)