Leaving Cushings Untreated?

[Tipper]

Our dogs name is Tipper, a mut with some beagle mix, 13.5 years old. About 35 lbs.

About 8 months ago we confirmed our dog had Cushings through urine and ACTH. The next step was going to be confirming whether it was adrenal gland or pituitary gland. An ultrasound would be next. We decided not to take that step and live with the Cushings. At our dog's age we didn't want to put under (vet said sedation may be necessary) and put him through the trauma since he is a very nervous traveler and patient.

We also did not want to run the risks of the medicine used to treat the Cushings and the more dangerous potential Addison condition which could develop.

So we decided to live with the symptoms (dog exhibits almost every single Cushings symptom) and were told that down the road some diabetes and liver problems could develop, but the dog could live about the same amount of time with treatment as without.

Tipper has been doing well, all things considered. About 2 months ago we started giving Tipper Cushings Crusher, a natural power to support the glands and promote more normal cortisol production.

I took Tipper to the vet for a check up, he was doing well. I really just wanted to see if the Cushings Crusher was doing anything internally as the external symptoms were all unchanged.

I took in a urine sample and that tested fine (no protein, no signs of infection, normal color, etc). They did a blood test and compared to our Jan 2011 tests all the enzimes were much higher. AP went from 432 to 1024, ALT 232 to 301, GGT 37 to 72. The vet said this is a concern, but didn't seem too too worried since the high levels of cortisol in Tipper's system will do this to the liver.

As a result, he recommended we try some milk thistle and maybe SAM-e. He said that they sell denamarin containing extract of both, but said it would be much cheaper and likely just as effective if we find some milk thistle at a local drug store and give to Tipper like that.

So that is basically where we stand. I will be looking over the other posts here to see how our situation applies to other's. Just wanted to post what we are going through.

Are we way off base for deciding not to treat the Cushings the conventional way?
Has anyone else experienced those high liver enzyme levels and has milk thistle been a good remedy for that?

Thanks.

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[mytil]

Hi and welcome to our site.

I am sorry your Tipper was diagnosed with Cushing's. When you get the chance post the test results of the ACTH test performed. Cushing's can be difficult to diagnose as the symptoms are also symptoms of other conditions, so that is why testing is very important. Take a look at these links for further information on testing.http://www.k9cushings.com/forum/showthread.php?t=180. The least invasive and expensive is the UC:CR testing (described in the information link). It does not diagnose Cushing's but rules it out.

It is always a personal choice on treating, but I also wanted to give you this link so you will be very informed on what happens with untreated Cushing's - http://www.k9cushings.com/forum/showthread.php?t=195.

I have not come across any natural "medicine" for Cushing's that works. Some mask symptoms and some may relieve some symptoms for a period of time, but they cannot stop what is happening with the excess circulating cortisol to the internal body....just like with human Cushing's.

Keep us posted
Terry

[addy]

Hi and Welcome,

I am sorry to hear about your pup. Choosing to treat for Cushings is an individual choice we have to make. The following link has some discussion on the subject that you might find helpful.

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=672663

Making sure of the diagnosis is important as Terry has already explained.

We are here to help any way we can.

Addy

[Squirt's Mom]

Hi and welcome to you and Tipper! :)

Choosing whether to treat or not is an individual decision but it should be made on facts, not fear. ;) Facts will come with education. So start learning asap by reading the links provided by Terry and Addy. Then keep asking questions and we will help you understand anything that is unclear.

As for Cushing's Crusher - you are wasting your money and possibly harming Tipper. :( This product claims to be able to treat both Cushing's and Addison's. That is the first clue this is hooey. Cushing's and Addison's are polar opposites and require polar opposite treatments. There is NO product that can treat both. What benefits one condition, makes the other worse. ;) Another clue is the lack of an exact list of ingredients. You may have that info once you purchase it, but I have not been able to find them listed where this product is for sale. There are nutriceutical things you can do that may help Tipper - herbs, supplements, diet - but Cushing's Crusher is not one of them. If this is how you wish to approach treatment, seek out a Holistic vet to help you. ;)

The drugs most often used to treat Cushing's, Trilostane (Vetoryl) and Lysodren (Mitotane), are life-saving drugs for our cush babies. Yes, they can be scary at first, especially when we first start learning about them. But the risks with these drugs do not lie with the drugs themselves. The risks lie with a vet who isn't knowledgeable about Cushing's or it's treatments and who do not follow the protocols. Properly handled, these drugs are miracles for a cush pup. ;)

I'm glad you found us and look forward to learning more as time passes. Keep reading and asking questions!

Hugs,
Leslie and the gang

[jrepac]

Milk thistle and Sam-e are often helpful for liver support; we used them for some time. You may want to talk to your vet about Anipryl; it has very few side effects and may offer some relief of symptoms (if your pup responds to it, it's kind of 50/50).

Jeff, Angel Mandy & the Girls

[Tipper]

Thank you all for your replies and information. I am still reading through everything.

I do not have documentation on all the test results which led to the conclusion that Tipper had Cushings, but I will ask next time I speak with the vet.

I just noticed this morning that Tipper has some sort of skin mark (infection?) by his neck. Must have just developed in the last 24 hours. This would be his first skin infection. I will have to call the vet about it tomorrow. I posted a photo of it.

http://i74.photobucket.com/albums/i242/ev700401/IMG_7496-1.jpg

We (my wife and I) thought that at Tipper's advanced age we were fine letting nature take it's course. And through the last 8 or so months that we have known he has Cushings he has seemed to be very happy still with the loss of common playfullness being his only personality change. But he still has energy and mentally seems like the same dog. Now with the high liver enzyme levels and this mark on his skin (infection?) I am starting to worry a bit more.

I am comfortable with our vet (we actually changed to a different one from the same place a couple years ago), however it is really nice to find a place to just talk things with other people and read the experiences and recommendations of others.

I don't know if any of you can tell from that photo if that mark on the skin might be related to Cushings or not sure what else or why it would be there...

[Tipper]

Oh, by the way, on the Cushings Crusher, we started it's use from the testimonial of a local pet owner who has had their Cushings dog on it for 3 years without conventional medicine treatment and just through that product alone I'm told the dog currently has no Cushings symptoms. Our dog has been on it for a little over 2 months with no positive or negative signs noticed. Our vet neither recommended nor advised against it, he just said if we wanted to pursue other treatment options that is could be one to consider.

[Tipper]

My wife thinks that the mark on Tipper is a bruise rather than an infection.

[Squirt's Mom]

It's difficult to tell from the pic but there is a condition that sometimes comes with Cushing's, especially untreated, called calcinosis cutis. Here is a link that shows a pic of it -

http://en.wikipedia.org/wiki/File:Calcinosis_cutis_dog.jpg

Hugs,
Leslie and the gang

[Harley PoMMom]

So we decided to live with the symptoms (dog exhibits almost every single Cushings symptom) and were told that down the road some diabetes and liver problems could develop, but the dog could live about the same amount of time with treatment as without.



Dog's that are treated for Cushing's with either Trilostane/Vetoryl or Lysodren/Mitotane have a much better chance to live out their normal life span.

My boy, Harley, was diagnosed with kidney problems while starting Vetoryl. His IMS and GP thought that treating him could put him in kidney failure so the Vetoryl was stopped. Not long after this Harley went into liver and heart failure, elevated cortisol wrecks havoc on a dog's system.

Please keep us updated and wishing you all the best of luck, remember we are here for you.

Love and hugs,
Lori

[Tipper]

Been doing alot of reading and thinking today. Wife and I talked and we are going to speak to the vet tomorrow.

If we decide to go after treatment, my #1 concern right now is, is it too late? Tipper is really doing quite well I think all things considered, so I would think that not too much damage has been done. But we suspect he has had Cushings for maybe 10-11 months or so (the vet tests that indicated Cushings earlier this year was in Jan/Feb).

Thanks for caring enough to supply all the info and comments you have provided. What do you think on our timeframe to potentially start treating the Cushings now?

[Tipper]

It's difficult to tell from the pic but there is a condition that sometimes comes with Cushing's, especially untreated, called calcinosis cutis. Here is a link that shows a pic of it -

http://en.wikipedia.org/wiki/File:Calcinosis_cutis_dog.jpg

Hugs,
Leslie and the gang

Thank you for this. I looked into the calcinosis cutis this morning and right now I do not think that is it. My wife might be right that it is a bruise and maybe I overreacted based on everything I had been reading.

[Harley PoMMom]

If we decide to go after treatment, my #1 concern right now is, is it too late?

No it is definitely not too late to start treatment. Cushing's is a slow progressing disease but left untreated for a period of time the elevated cortisol damages a dog's system especially the internal organs.

It can take months for one to get a confirmed diagnosis of Cushing's in their furbaby and a confirmed diagnosis is vital. Trilostane/Vetoryl and Lysodren/Mitotane are life-saving drugs for dog's with Cushing's disease.

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!

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

Love and hugs,
Lori

[Tipper]

Thanks again. I will keep checking in and reading all the info here.

I did find a note I made from his urine cortisol-creatinine ratio was 38. Vet said over 13 would prompt more tests. I didn't have anything on the ACTH results, but will find out. Just know Vet said it was indicative of Cushings. That was the last test we had performed.

[Harley PoMMom]

I will keep checking in and reading all the info here.

There is a wealth of information in our Resource Forum which I will provide a handy link to:
Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?s=&daysprune=&f=10) ;):)



I did find a note I made from his urine cortisol-creatinine ratio was 38. Vet said over 13 would prompt more tests. I didn't have anything on the ACTH results, but will find out. Just know Vet said it was indicative of Cushings. That was the last test we had performed.

Yes, please post the results from the ACTH test...Thanks!

[ShannonJ92]

I find your questions about Tipper rather interesting as I am currently feeling in a similar boat - debating about whether to treat or not to treat (in my case my 9-yr-old Yorkie Pebbles, diagnosed last month). While I know I would be very cautious with Lysodren or Trilostane regardless, Pebbles has underlying issues that may be complicated with either drug. Plus we've gotten differing opinions on which drug would be best for her which makes making a decision even harder. I'm sorry you are in the midst of trying to determine what to do as well, we want what's best for our furkids yet sometimes we don't know what that is. Just do as much research as you can and you found a good place here to talk about things. I'm still rather confused about everything (in terms of what to do or not do, very overwhelming) but it's of some comfort knowing I'm not alone and have found support here. I hope you do as well and I wish you and Tipper the best. Keep us updated and good luck.

~Shannon

[Tipper]

First off, we are quite sure the mark on Tipper is a bruise. We'll see how it heals.

I did speak to our vet today. Tipper's ACTH result was over 30, vet said anything over 20 shows the dog has abnormal cortisol production/regulation in that test.

The next step would be an abdominal ultrasound to check for a tumor. I asked about the low and high dose dexamethasone tests and was told those have fallen out of favor in the testing process of UC-CR, ACTH, x-ray/ultrasounds. The low/high dose dexamethasone tests I am told are not accurate enough to say with certainty if it is pituitary or adrenal. Basically he said if there is no tumor on the ultrasound of the adrenals then it is pituitary.

If we go down the road of treatment, he seems to think that Trilostone/Vetoryl is the best drug over the lysodren. I asked about Ketaconazole and said it can be toxic to the liver and kidneys and does not think it is best for a dog Tipper's age in treating Cushings.

I also asked about Anipryl and he said that it doesn't work. That response didn't surprise me from what I've read in the conflicting support that drug receives.

He basically says our decision for treatment comes down to quality of life. If we think that Tipper is doing well at his age maybe we would decide not to treat. If we think his quality of life is suffering from the Cushings then treatment would certainly be recommended at that point.

Just a tough decision for us because I don't know if we can expect him to live past 15 for sure, or even if he would get to 15. He'll be 14 next May so while I value the outcome of treatment, I also question the effort and potential side effects Tipper would encounter with treatment that might lower his quality of life short term. I'm not sure there is much long term left for him anyway.

Still unsure about what decision we should make even with a much much better understanding of what we are up against now after spending some time here. It is hard to sit by and do nothing and understand that the result of that decision will likely cause a life threatening condition down the road.

But on the other hand he will have some kind of life threatening condition arise due to his age at some point in the not so distant future anyway.

[lulusmom]

First off, we are quite sure the mark on Tipper is a bruise. We'll see how it heals.

I am pretty certain what you are seeing on Tipper's neck is a bruise from a blood draw. Dogs with cushing's bruise easily and from my experience really big. One of my cushdogs is a bald Pomeranian so it is very easy to see the huge bruise on her neck whenever the vet does a blood draw from the jugular vein. It takes a long time for these bruises to go away too. The good news is that you aren't dealing with calcinosis cutis or some other skin lesions.


The next step would be an abdominal ultrasound to check for a tumor. I asked about the low and high dose dexamethasone tests and was told those have fallen out of favor in the testing process of UC-CR, ACTH, x-ray/ultrasounds. The low/high dose dexamethasone tests I am told are not accurate enough to say with certainty if it is pituitary or adrenal. Basically he said if there is no tumor on the ultrasound of the adrenals then it is pituitary.

Your vet is correct that the high dose dexamethasone suppression test has fallen out of favor. This is due to the fact that if a dog fails to suppress on the low dose dexamethasone test, they will fail to suppress on the high dose as well. The low dose dexamethasone, however, remains the gold standard in diagnostics for cushing's. It is the acth stimulation test that has fallen out of favor. Per reknown expert, Dr. Mark Peterson, the acth stimulation test is poorly specific, with only 50% to 60% of dogs tested having an exaggerated response of greater than 25 ug/dl. You can find more information on this on Dr. Peterson's blog. This blog is for petowners and veterinarians so please feel free to share the link below with your vet.

http://endocrinevet.blogspot.com/2011/02/diagnosing-canine-cushings-disease.html


He basically says our decision for treatment comes down to quality of life. If we think that Tipper is doing well at his age maybe we would decide not to treat. If we think his quality of life is suffering from the Cushings then treatment would certainly be recommended at that point.

Just a tough decision for us because I don't know if we can expect him to live past 15 for sure, or even if he would get to 15. He'll be 14 next May so while I value the outcome of treatment, I also question the effort and potential side effects Tipper would encounter with treatment that might lower his quality of life short term. I'm not sure there is much long term left for him anyway.

Still unsure about what decision we should make even with a much much better understanding of what we are up against now after spending some time here. It is hard to sit by and do nothing and understand that the result of that decision will likely cause a life threatening condition down the road.

But on the other hand he will have some kind of life threatening condition arise due to his age at some point in the not so distant future anyway.

I certainly understand the quandry you are in and I'm not sure I wouldn't do the same in your shoes. The risk of adverse reactions to treatment can be mitigated and usually completely avoided if the pet owner is educated and the vet is experienced. My two cushdogs have treated with both Lysodren and Trilostane. Nothing about either of those drugs is a mystery to me so if I decided not to treat, it would not be for fear of the drugs. A dog's quality of life can be greatly improved with treatment. My dogs are a living testimony to that but for a very senior dog, the question is how stressful will it be for the dog to undergo the necessary testing required to monitor treatment, do I have the money or access to financial assistance to pay for those tests and what if severe arthritis or any other painful and chronic problem is unmasked once cortisol has been reduced?

My first cushdog was diagnosed and started on Lysodren at 3 years old. She is now 10 years old and doing great. My second was diagnosed about four years ago. We rescued him from a shelter so we don't know how old he was at diagnosis but I'm pretty sure he's at least 14. The two years life expectancy with or without treatment would be a pretty accurate guesstimate if a dog is at or within a few years of life expectancy for their breed. However, young dogs have a whole lot of living yet to do so deciding whether to treat is not difficult.

Bottom line, the goal of treatment is to remedy the symptoms, symptoms that are usually more problematic for the pet owner than the pet. If Tipper's symptoms are not a problem for him or you right now, then wait until they are before revisiting the decision to treat. In my non professional and very layman opinion, a very senior dog with mild symptoms is probably more likely to pass away from a non adrenal illness before cushing's could progress enough to shut down internal organs. That's just my opinion.

[jrepac]

It's always tough when you have a senior dog; if the symptoms are mild and tolerable, you may only want to give Sam-e and milk thistle and call it a day. But, they are bound to increase over time. You have to balance out quality of life factors; treatment might make your pup much more comfortable, if you can afford the cost.

I too, had an older dog, and opted for a fairly mild course of treatment, which alleviated the symptoms and made her last few years good ones.

Cushings is very slow moving, so it is not too late to start treatment. It's not unusual for it to take many months to diagnose (or to reach a point where it is easily detected, given the nature of the disease).

Your vet's course of diagnosis seems reasonable; hopefully the ultrasound will rule out a tumor. I can't speak to trilostane (have only used lysodren & anipryl), but many here have had great success with it. Keto and anipryl are pretty much fall back options, as their track records are spotty/conflicted, but you'll find a few folks who had success with them.

Best of luck

Jeff, Angel Mandy, & the Girls.

[HarrysMom]

Our dog was initially diagnosed with elevated estrogen, but no Cushing's per U Tenn adrenal panel. His symptoms progressed, but we waited 6-8 months for the LDDS test, and we finally started the treatment. Unfortunately, by then, he developed diabetes. I was not aware that untreated Cushing's causes insulin resistance - leading to Type 1 diabetes. Had I known this, I would have treated right away as it is NOT fun to deal with diabetes.

[Tipper]

I think in a week or so we've come full circle. If Tipper was even 2-3 years younger the decision would be much easier to treat.

We just think right now he is happy I'm quite sure. He can go up stairs still with effort (not gotten worse for several months now) and shows good (although short lived) excitement and enthusiasm when we arrive from being gone. He follows us everywhere in the house and I wouldn't say anything visual makes us think he is uncomfortable (except when it is warm in the house during summer, he has hard time resting). While showing all the obvious signs of Cushings, if he can stay at this current level for the near term I think we will be ok knowing that at some point in the not too distant future something is going to get him, Cushings related or not.

Having come here and read alot of the information provided I feel much more educated on what the condition consists of as well as the advantages and drawbacks to treatment along with the risks and dangers of not treating.

Right now, the only thing we are considering is either some milk thistle or the SAM-e product or the specific Denamarin to support and promote a healthier liver since the Cushings is causing high enzyme levels.

I really do appreciate you taking the time to post in the thread and giving me somewhere to ask questions and seek advice. Decisions like this aren't easy, it really is nice to have a web forum like this. It's a resource I will continue to learn from I'm sure.

[labblab]

Thanks so much for your update. I do think your decision is a reasonable one. I agree with Glynda's earlier comment that, at Tipper's age, I would be less concerned about slow chronic systemic damage and more concerned about immediate quality of life. It is obvious that you care deeply about Tipper and are watching him closely. So you will know if anything changes dramatically for him. In the meantime, I wish you all the best and hope you will continue to stop by with continued updates.

Marianne

[mytil]

Please do continue to let us know how things are going.

Terry

[Polkaroo]

We delayed treating our female, Bazil (JRT) until May 2010 (diagnosis was ~2008). As a result, she ended up diabetic, blind (glaucoma) and died of an aneurism May 2011.

After seeing what this disease did to her (or rather the consequences of not treating her sooner), as soon as our male, Farfalle (JRT) starting showing signs that he too may have Cushings, I had him tested (confirmed) in Oct 2010 and began treatment(Trilostene) immediately. He is responding well to treatment (last ATCH was 72 pre, 260 post--his best numbers since diagnosis!). I just have to get the weight off him now; he has gained 3kg since he started showing symptoms. It is hard thought as he has severe arthritis so he can't walk as much as he used to. I can't cut his diet down any more as he barely eats a cup of food daily as it is (severe food allergies and picky eater). But for us treating him was a no brainer. I can't go through what I did with Bazil again and I don't wish that on any owner or dog.

Good luck with whatever you decide to do.

[Tipper]

Just wanted to give an update.

It has been over a year that we have known our dog has had Cushings which we have left untreated.

As he approaches his 14th birthday we have not noticed any troubling advancement of the disease and Tipper seems to be very much like he has been the past several months. While exhibiting all the classic symptoms, he can still go up stairs (slow and sometimes reluctantly, sometimes quicker and enthusiasticly depending on the time of day),can still jump on low furniture (like footrests) and doesn't have an unending unbearable thirst. I think actually his water consumption may have decreased just from casual observation. More water at night, not a ton during the day.

The only change to me appears that he is not able to hold his urine quite as long. Before we figured he is good 5-6 hours, now at times it is more like 4-5 hours. He has lost a few pounds, but still has strong appetite, healthy looking BMs and no vomiting ever or anything that would be obvious cause for concern.

A recent trip to the vet with blood and urine testing revealed some slightly higher liver enzyme levels from October last year, but not alarming given his condition. He has been on Denamarin to help protect the liver so that may have kept some of the test results down a bit. He has no skin or urine infections yet. The only other product we give him is the Cushings Crusher powder which the vet didn't outright recommend, but in an unscientific opinion he thinks it might be a contributing factor from keeping the Cushings from advancing further.

I valued the information and advise I received on the site and figured I should provide an update on my situation that many of you offered your insight on. 5 months from my last post not much has changed for which we are thankful.

Here is a recent picture:
http://i74.photobucket.com/albums/i242/ev700401/IMG_8135.jpg

[Buddy'sMom]

I know your last post was over a year ago, but I'm curious as to how this last year has gone for your fur baby?

[Benny's mom]

Just got confirmation that my 7 yr old beagle has Cushings. Found it with a fluke pre op visit for something else. Now that i know what to look for, the symptoms seem mild. Vet is giving me the option to delay treatment with trilostane, or to start it now. Help please... what would you do with a young dog with mild symptoms that you happened to catch on a fluke?

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Administrative Note: For members who wish to reply directly to Benny's Mom, she and Benny now have a thread of their own: http://www.k9cushings.com/forum/showthread.php?t=6137