Laser treatment for Cushings?

[RUpdegrove]

My soon to be six year old Sheltie has been diagnosed with Cushing's by my vet. He has proposed using a laser treatment that he says will be less toxic than traditional medicines. My Sheltie was always pretty sensitive to antiobiotics and I wondered how he would do with such medications. I can't find many articles that look at the success of such a treatment and wondered if any users have had any experience with this.

I have an appointment next week to see a specialist in vet. internal medicine. My vet says to expect that they will propose the traditional medications.

[Squirt's Mom]

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[Squirt's Mom]

Hi and welcome to you and your baby! :)

This is a very drastic first step to take if it is what I am thinking. It is possible to remove pituitary tumors that cause Cushing's via surgery, possibly using laser, but that is not a typical approach at all. Adrenal tumors that cause Cushing's can also be removed surgically and MUCH more easily than pituitary tumors, and I suppose lasers could be used here as well. But most cush pups have the pituitary form and for your vet to suggest brain surgery over medicine is shocking to me to say the very least - IF that is what they are referring to.

The pituitary tumors that cause Cushing's are typically microscopic and remain that way for the duration of the pup's life. Some do start to grow for unknown reasons and become what is called a macroadenoma, or macro for short. This is NOT the norm, tho, and surgery to remove these tumors shouldn't be take lightly.

If this is what your vet is talking about, I would be running for the door with records in hand as fast as I could to start the search for another vet. ;)

Can you tell us more about your baby and how this diagnosis came to be? What signs did you see? What tests did the vet do? Would you mind getting copies of all those tests and posting the actual results here? Does he have any other health issues that you know of? Is he on any meds, supplements, or herbs? How much does he weigh? Is he neutered? Nosy, ain't I? :p

The more you can tell us about your baby's health history, testing and background the more meaningful feedback we can offer. We LOVE details so don't be afraid to say too much.

I'm glad you found us and dearly hope your vet is talking about some brand new approach to treating Cushing's and not brain surgery.

Hugs,
Leslie and the gang

[RUpdegrove]

Dear Leslie,

Thank you for your prompt response. No, the intent of the laser treatment would not be to destroy the pituitary gland but to somehow stimulate in such a way that it would return to its normal output. I don’t understand how it works. I guess the concept is a bit like shock therapy for depressed people in which the shock treatment puts the brain’s functions back in order. Here is one vet’s explanation of the process:

http://www.vomtech.com/vetcoldlaser.html

This all began a month ago when I took my Sheltie, Happy, to have his teeth cleaned. The vet did a blood analysis as part of the process and told me afterwards that one item ALKP was at a very high level – 1421. He had me give him milk thistle pills each day and asked me to bring him back for another test in a month. I did that a week ago and the ALKP was listed as greater than 2000. He then recommended a low dose dexamethasone test which was given all day on Monday. The beginning cortisol sample was 3.7; four hours later it was less than .7 but 8 hours later it was 1.7. The vet said that indicated Happy has Cushing’s Disease with a tumor in his pituitary gland.

He then proposed the cold laser treatment.. He said he had successfully treated two dogs for Cushing’s with it and it was a lot less harmful than the two major drugs for Cushing’s. I found a vet with a speciality in internal medicine and am to visit him on Wednesday for what I am told will be a three hour exam. My vet said he will undoubtedly put Happy on one of the two major Cushing’s drugs and that would be for life.

[Roxee's Dad]

Hi and a belated welcome from me too :)

This is a very interesting concept, I am very interested in learning more about this. Does your vet have any case studies on the success rate of cold laser treatment on cush pups? I haven't found any yet I and many others would be very interested in reading it.

If you do follow through with this, I would suggest getting and ACTH test before treatment and after to compare the success of the treatment. The ACTH will measure the cortisol level and is the tell tale measurement of the success of treatment.

It would be wonderful if this works, please do keep us updated on this treatment.

[labblab]

Hi and welcome from me, too! Boy, it would indeed be great to find a simple noninvasive way to treat Cushing's, but I'm afraid I would throw out a cautionary note about this laser treatment. I wish I had more time to research it myself right now, but I'm afraid I do not. However, I notice that the link you've given us is dated back in 2004. So apparently this is not a brand new technology, and if it was producing great results in Cushing's treatment, I'd have to believe we'd be hearing about it in scientific journals during this past decade. I can honestly tell you this is the first I've ever even heard it mentioned, and I've been a member of this and related Cushing's forums since the date of that article.

From a physiological standpoint, it is very hard for me to understand how the laser can solve the issues associated with pituitary tumors unless it is actively burning away the tumor itself. And it doesn't sound as though that's the case. I'm really glad you will be consulting with a traditional specialist before moving forward with a decision. And before opting for the laser treatment, i'd definitely want a very complete and thorough explanation of exactly how it alters the ACTH feedback loop and lowers the adrenal hormone poduction.

Sorry to be a doubting Thomas :o, but I do want to give you my honest opinion. Please do keep us updated, though, as to what you find out. Because it's true that every new treatment has to start somewhere. ;)

Marianne

[Sugar]

Very interesting reading about laser treatments as an alternate to meds for Cushings and thinking that it sure would be a wonderful to have something other than the expensive drugs and the who knows side effects.

Maybe the over production of coritsol could be associated with blood sugar imbalance which produces too much coritsol and could be treated with a diet high in protein to help regulate blood sugar. Relora, an herbal supplement, is known to significantly reduce cortisol. Perhaps the present contents or lack of proper nutrition in manufactured dog food is the problem.

We need to find out what is causing such a high incidence of Cushings Disease in dogs.

[Mel-Tia]

I did wonder if it had anything to do with whether they have been spayed or had their bits off (can't think how to spell word)

[molly muffin]

The only other thing that I could find was this skeptvet site that is skeptical directly of the site that you linked to. This is from 2010.
http://skeptvet.com/Blog/2010/05/cold-laser-therapy/

I agree, that an ACTH before and after any such treatment would be the tell all of if it is working or not. Basically with a pituitary tumor, the response to suppress cortisol production is not longer working. Not sure how a laser would address that. So, interesting.

Sharlene and Molly Muffin

[RUpdegrove]

Thank you for all of your comments and advice!

I shall be regularly reading this wonderful site and shall contribute my experiences as I go forward with my dog.

[molly muffin]

Another of our members is considering using cold laser treatment on her dog for muscular problems that often goes along with cushings, a wasting of muscles. I think this is makes more sense that it is used to treat a cushings symptom than that it would actually be able to have any affect on a tumor. Over stimulated a pituitary tumor to me could be risky, because what if you are stimulated it to grow, then you'd end up with a macrotumor, which would be more risky than treating with a lifelong medicine.
I just don't know enough about it I think. I know the medical of the pituitary and the adrenal and how that affects the cortisol levels, but other than having surgery and removing an adrenal tumor I don't know of any cure and all the experts say that there is in fact no cure for cushings. Only treatment of symptoms. So based on that, maybe this doctor is using cold laser to treat cushings symptoms. On the other hand, if you know for sure that you have a dog with cushings that is over producing cortisol and that underlying problem isn't addressed, then you open up more risk factors going forward, of damage to other internal organs.
The good news is that you usually have time to try to figure out what direction you want to go with no rush to treat. So..:) Will be looking forwarding to hearing of your next steps.

Sharlene and Molly Muffin

[Roxee's Dad]

I just had one more question, most pups (about 85%) have PDH based cushings, which is a small tumor on the pituitary gland. My question is .... was ADH ruled out? There is about a 15% chance the tumor is on the adrenal gland.

[RUpdegrove]

I first posted about two weeks ago when my five year old Sheltie's vet suspected he had Cushing's after a routine blood test for teeth cleaning. He later did the low dex test which showed an elevated figure. He wanted to do some type of laser treatment and I had asked this group if anyone had any experience with that sort of thing. No one was familiar with it and everyone was skeptical.

Yesterday, I had a three hour appointment for a second opinion with a vet who specialized in internal medicine. I told him that my dog really didn't seem to display any of the classic symptoms of the disease and his water consumption was only two cups a day (he weighs about 38 pounds). He did both a physical exam of him and an ultrasound look at all of his organs. He said that everything looked fine, except that his gall bladder had some sandy like content inside. My dog's blood pressure was normal. The vet was pretty sure that Happy has Cushing's but is an an early stage. He said he could go two more years without showing much outward evidence of the disease but then I should start seeing some of them. He said if it were his dog, he'd start him on trilostane. He was going to talk to my regular vet to see if he had that medication. Otherwise, he said, he could treat him.

I wasn't sure if most dogs are usually treated by a specialist in internal medicine or if a generalist could handle this.

I guess I need to start looking at some of the posts on this site to see what people's experience with trilostane has been.

Best wishes to all. I am astounded by all of the postings that were made in such a short time. I guess a lot of dogs have this condition. Neither of my vets could explain why dogs get it so much. I always worry about the effects of giving drugs like Interceptor (heartworm) or Frontline (flea/tick) every month for a dog's lifetime or of all the vaccinations.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about Trilostane use in a younger dog into Happy’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[labblab]

Did the specialist tell you whether the adrenal glands were enlarged at all on the ultrasound? How about the liver -- any abnormalities there? I'm assuming not, or else you would have mentioned it.

Leslie is right, there are currently differing opinions re: initiating drug treatment for dogs in early stages of Cushing's. If I had a younger dog and had a high degree of confidence in the diagnosis, I suspect I would go ahead and opt to treat early in order to minimize the longterm risk of developing/worsening issues such as vulnerability to pancreatitis and infections, kidney damage, high blood pressure, high cholesterol, etc.

However -- and this is a big however -- I'm not yet feeling really confident about Happy's Cushing's diagnosis. In the absence of overt symptoms and any adrenal imaging abnormality, it sounds as though the only red flag is the elevated ALKP of only a month's duration, and a LDDS test that I suspect was only barely "positive" (you didn't give us the normal range for Happy's test, but usually it is anything less than 1.4, and he tested 1.7). There are other things that can cause elevations in the ALKP, and some are only transitory. Plus, whatever "it" is that has elevated the ALKP may also have skewed the results of the LDDS.

If it were me, I believe I would hold off on treatment for the time being and continue to monitor Happy's behavior and also repeat the bloodwork in three months in order to see whether the ALKP changes either for the better or worse (or sooner if you don't feel comfortable waiting that long). As Leslie has indicated, starting the Cushing's meds are not a trivial matter. We are very grateful that they are available to help dogs for whom there is a high degree of confidence in the diagnosis. But I would not want to start treating a dog for whom the diagnosis still seems "iffy."

Marianne

[RUpdegrove]

Thank you both for your thoughts.

Leslie, wouldn't a reduced ALP level in a later blood test be a indicator as to whether the Trilostane was working?

And Marianne, the second vet said the ultrasound showed that both the liver and the adrenal glands were normal. He said that because of that, he ruled out any problem coming from either of those organs and thus inferred by the test results that it must be coming from the pituitary gland. But everything he looked at seemed to be normal, except for the fact that he saw some sandy like "sludge" in his gall bladder. He asked me about how he was at home. The only symptom we could come up with that might indicate he had the condition was the fact that when he's off the leash in the woods, he tends to always be looking for things to eat. But I thought a lot of dogs are like that.

Both of you suggested my holding off; perhaps that is what I shall do. I just hope there won't be some damage to his organs if I do.

I keep wondering if that high level was simply due to the stress he felt being at the vet. I could see he was stressed when they took him into another room away from me. He is used to being with me.

[labblab]

Thanks so much for the additional information. It is true that the lack of abnormality in the adrenal glands seemingly rules out an adrenal tumor, but it also doesn't help validate the pituitary form of Cushing's since the majority of dogs with a pituitary tumor will exhibit enlargement of both adrenal glands (although as many as 30% of dogs with PDH will not exhibit enlargement, especially in the early stage of the disease). So the normal ultrasound does rule out adrenal Cushing's, but the lack of enlargement does nothing to help confirm the diagnosis of pituitary Cushing's, if that makes sense.

I'll let Leslie add her own answer re: the ALKP, but my personal response is that it is not a sensitive enough indicator by which to gauge Cushing's medication dosing. It is true that with Cushing's treatment, over time one hopes to see improvement in elevated liver enzymes. But some Cushpups never see enzyme levels return to baseline normal, and it is the day-to-day monitoring of behavior that is of immediate value and importance as far as determining the safety and efficacy of treatment (e.g., are you seeing a healthy reduction in excessive thirst, urination and appetite as opposed to lethargy, vomiting, or diarrhea).

I do understand your dilemma in that you don't want Happy to suffer chronic ill effects. But Cushing's is traditionally a slowly-developing syndrome, and so I think it is reasonable to choose watchful monitoring for at least a short while longer. By no means am I suggesting you ignore the ALKP, but you may not want to leap into Cushing's treatment yet, either. Here's an article that I've found quite helpful in making sense of liver diagnostics:

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=325515&pageID=1&sk=&date=

And here's a quote from that article that may be relevent to Happy:


Corticosteroid ALP isoenzyme is produced in the liver and is located on the hepatocyte plasma membranes lining the bile canaliculi and sinusoids.3 Corticosteroid ALP has a similar half-life to liver ALP. Corticosteroid ALP contributes to total serum ALP in dogs exposed to exogenous corticosteroids or in cases of spontaneous hyperadrenocorticism.3 However, increased corticosteroid ALP activity has also been associated with chronic illness, possibly secondary to stress and concomitant increases in endogenous glucocorticoid secretion.1,3,8

One other thing I keep forgetting to ask: does Happy have any other laboratory abnormalities aside from the elevated ALKP (in terms of either bloodwork or urinalysis)? It is true that high stress can affect the results of both of the diagnostic Cushing's blood tests (LDDS and ACTH), so that is why I am still searching for any other corroborative abnormalities besides the elevated ALKP.

Marianne

[Squirt's Mom]

Marianne covered the ALP very well so there isn't much to add other than to share with you what our IMS had to say about Squirt's very high level. He is not the least concerned about it because so many things can make this level go up. He said this value (ALP / ALKP) are from living liver cells while the other liver values - AST, ALT, GGT - indicate dying liver cells. For comparison, Squirt's ALP was off the chart at the time, too high to register (10+ x normal), but everything else was ok so her IMS didn't bat an eye at the ALP.

[RUpdegrove]

Per your advice, I guess maybe I'll wait a bit.

Marianne, no, there were no other abnormal indications, other than the sandy material in his gall bladder, which the second vet thought might be related to Cushing's. His staff wasn't able to get a urine sample from him. He had such high academic credentials (Vet school at Univer. of California at Davis, and specialization at Cornell and internship at the Univ. of Pennsylvania) that I was inclined to believe his diagnosis. He said he had treated many dogs with Cushing's and one of his dogs had it. But it is really hard to accept when I don't see any symptoms in my dog and he seems to be healthy and happy to me.

His assistant called me this afternoon about starting treatment and suggested that I come in by myself before they start so they could talk about Trilosene, saying it was a dangerous drug. That really made me feel terrible.

[lulusmom]

Hi and a belated welcome to you and your precious pup.

You've gotten some very good feedback from members but I'd like to throw my very non-veterinary professional comments into the mix. I am always very wary of a cushing's diagnosis when a vet dives headlong into expensive cushing's diagnostics based solely on elevated alkaline phosphatase. It's almost like some vets go blind when they see high alk phos. They see IT'S CUSHING'S, IT'S CUSHING'S, IT'S CUSHING's like huge neon lights flashing in their head and they just can't help themselves. :D:p :D

Based on everything I've read thus far, if it were my dog, my focus would probably not be on cushing's, and I am pretty sure I would not be accepting of any recommendation to treat for cushing's without a good reason. The primary goal of treatment for cushing's is to remedy problematic symptoms, which is why symptoms are such a huge component of a confirmed diagnosis. Your dog has no symptoms associated with cushing's; his liver and adrenal glands are completely normal; he is a breed genetically predisposed to gall bladder disease and his gall bladder was the only organ with abnormalities noted on imaging. Yes, his alkaline phosphatase is very high but that isn't uncommon in gall bladder disease and lastly, there's the matter of the LDDS test, which is highly likely to yield false positive results, especially if there is something else going on with the internal organs..... like perhaps gall bladder problems?

Did either vet recommend a bile acid test? Granted, a good number of cushdogs do have high bile acids at diagnosis but pre and post meal are usually mildly high and very rarely over 50. Since the vet with an interest in internal medicine was the one who said he saw something sandy in the gall bladder, I'd ask him to have a board certified radiologist look at it and give you an accurate interpretation. What does sandy looking stuff mean? Is it sludge? Is it mucocele? What is it? Then I'd discuss a bile acid test and/or putting the dog on ursodiol and liver support, then recheck bloodwork in a month or two to see if ALKP has improved. That's my two cents worth for the day.

Glynda

[molly muffin]

Hi. A lot of good opinions have been offered. I think the one thing that I would remind you of is that only you know your dog best. You have to determine if you are seeing symptoms and if you think those symptoms and the risks of treating vs not treating are weighed and you feel comfortable with the decision you make.
There is certainly not a hurry to treat cushings, especially in very early stages, so you have time to make an informed decision.
Knowledge is your greatest asset. Learning all you can about the disease, signs and symptoms, medications and risk factors of treating and not treating, testing, will allow you to be the greatest advocate for your sheltie. Being able to discuss with your vet all of these issues so that you make an informed decision will make you feel a lot more comfortable with whatever that decision may be going forward.
Motto of the day, Knowledge is a good thing! :) The more you rule out, such as any possible gall bladder issue as one example, the more comfortable you will feel.

Sharlene and Molly Muffin

Sharlene and Molly Muffin

[labblab]

I just want to "second" what Sharlene has written above. I hope we have given you some helpful information to think over and to discuss further wth your vets. But please bear in mind that we are not trained professionals ourselves -- just laypersons who have experienced and learned a lot with our own dogs and also the many other stories that have been shared here.

We would never want you to make a decision about treatment solely on our opinions. Instead, I hope we are offering out some additional thoughts and information for you to clarify with your vet. As Sharlene says, you need to feel comfortable with your own decision. And you are the one who sees your dog every day, and who notices any changes. And you are the one who will be doing the worrying :o!

So from our own learning experiences, I hope we've thrown out some ideas that can help lead you further down the diagnostic/treatment road, so you can feel as comfortable as possible with the decision you end up making.

Marianne

[RUpdegrove]

Thank you Glynda and others for your advice.

Glynda, the internist said the material in the gall bladder was like sludge. I'll ask about the test you mentioned.

[labblab]

Per your advice, I guess maybe I'll wait a bit.

Marianne, no, there were no other abnormal indications, other than the sandy material in his gall bladder, which the second vet thought might be related to Cushing's. His staff wasn't able to get a urine sample from him. He had such high academic credentials (Vet school at Univer. of California at Davis, and specialization at Cornell and internship at the Univ. of Pennsylvania) that I was inclined to believe his diagnosis. He said he had treated many dogs with Cushing's and one of his dogs had it. But it is really hard to accept when I don't see any symptoms in my dog and he seems to be healthy and happy to me.

His assistant called me this afternoon about starting treatment and suggested that I come in by myself before they start so they could talk about Trilosene, saying it was a dangerous drug. That really made me feel terrible.
i just went back to reread your earlier reply, and I am glad that you have the opportunity to go back and talk with the specialist before starting treatment. As you say, this will give you the chance to to ask about the advisability of additional gallbladder diagnostics. Also if it were me, I'd want to ask this question: In the absence of any other corroborating evidence (and knowing the LDDS can give "false positives" in the presence of stress or diseases other than Cushing's), why is the specialist so convinced that Happy does indeed have Cushing's? By lack of corroborating evidence I mean no overt symptoms, no abnormal bloodwork other than the ALKP, no urinalysis results were obtained, no adrenal enlargement nor liver abnormality on ultrasound. I'm not saying this as a little miss smarty-pants ;) -- I would truly want to know the answer if Happy were my dog. You are right that the vet's credentials sound awesome. So I am wondering if there is something that we are missing here that is fueling the diagnosis. I would also want the specialist's opinion as to whether he feels there would be significant harm in just continuing to monitor the ALKP for a while longer at this early stage of diagnosis.

Also, I fear that we've made you overly terrified of trilostane :o. It is certainly true that it is a powerful drug with the potential for ill effects, especially if not used and monitored properly. But the worldwide trend has shifted towards trilostane, and many dogs are being treated very successfully with an excellent quality of life. The keys are a knowledgeable vet and a vigilant owner. And we already know you've got the "vigilant owner" part totally covered! So if the ultimate decision is to treat with trilostane, you will be in very good company here. The majority of our members do use that drug, and we have tons of helpful resources to offer out. Dosing is a big issue, however, because recent recommendations are to start with much lower doses than were initially used. Given your vet's training, I would have to guess that he's already aware of that. But at any point in the future, be sure to question if any vet wants to start Happy at a dose any greater than a formula of 1 mg. per pound.

OK, that's enough of my blabbing for this morning. I hope you and Happy can enjoy the rest of your weekend. Because above all, that's the most important thing for any one of us -- to treasure the time we are able to spend with our furred ones!!!!!

Marianne

[lulusmom]

Hi again.

With two vets in agreement that your dog has cushing's, I agree with Marianne that it seems that we are missing something very vital and convincing. Is the second vet who interpreted the abdominal ultrasound a board certified internal medicine specialist or is he a general practitioner with an interest in internal medicine?

When you talk to your vet about the gall bladder, you may want to print out a paper entitled "Gallbladder Mucoceles in Shetland Sheepdogs" written by Mary B. Mahaffey, DVM, MS Chair, ASSA Research Advisory Committee March, 2011.

http://www.assa.org/documents/Gallbladderarticle-webmarch2011.pdf

There is also an abstract of 10 year retrospective study here:
http://www.ncbi.nlm.nih.gov/pubmed/17605668

[molly muffin]

Hi, how was your weekend? Hope you and Happy had a good one. Just wanted to check in and see how you're doing.

Sharlene and Molly Muffin

[RUpdegrove]

Good morning!

I visited my primary vet yesterday afternoon to talk about the feedback I got from k9cushings and the report of the second vet. He surprised me by saying that he agreed that we should not start any treatments until Happy started showing ouvert signs such as excessive drinking or eating. He said, "He may not have the condition at all (which surprised me because earlier he had given me a diagnosis of Cushing's based on the dex suppression test) or you may be back here in three or six months because he is drinking like crazy."

I told him that I had read that Trilostane is toxic to humans and one should not handle the pills directly and it made me feel terrible to give that to Happy. But he said he preferred to treat - and had good results with - Lysodrene which he admitted was "old school." He said that a few of his other vets preferred to use Trilostane.

So I have decided to do nothing for the moment which makes my wife very happy. I will continue to look at your site to learn as much as I can.

Thanks!

[Squirt's Mom]

Mornin'!

Sounds like a good visit with the vet and I'm glad to hear he isn't ready to start treatment just yet. I think the advice he gave is spot on! ;) And this is a GREAT opportunity for you and your wife to start learning about the condition so you are ready when, IF, the time comes that Happy does start to show strong signs. Any time either of you have a question, please come here and ask!

I just gotta know....how did Happy get his name? In my mind, I can see a goofy grinning face and bouncy, playful poses. :D

Hugs,
Leslie and the gang

[labblab]

Sounds like a great vet visit to me, too! One thing I'd add, though, is that if it were me, I'd want to repeat a general blood panel and urinalysis in at least three months regardless of whether or not you are seeing overt symptoms. I still think it will be good to check the progression or emergence of any lab abnormalities that remain consistent with Cushing's or which instead point in a different direction. As you know, Happy's ALKP has been significantly elevated and I do think you want to keep an eye on that. Articles that I have read suggest that you do want to keep monitoring any liver value that is elevated more than three times its norm.

One other tiny note to clarify for the benefit of other readers, too, is that NEITHER trilostane nor Lysodren should be handled extensively with bare hands by humans. This is not an unusual warning, though, especially when hormonal action is involved. If you listen to drug ads on T.V., you'll often hear them rattling off warnings about the drugs not being taken or handled by anyone other than the patient (I just now heard an ad for testosterone supplementation for men with very specific warnings against exposure to women and children). This is not because the drugs are poison, but because their therapeutic action (whether it be hormonal or whatever) needs to be reserved solely for the person (or animal) who is suffering from the specific imbalance or illness. You do not want to risk birth defects in an unborn child, and you don't want to alter organ function or hormonal balance in a healthy person. Also, the powder from the drug may even just be irritating to the skin if directly handled.

Marianne

[molly muffin]

yay, so glad to hear that you had a good productive visit with the vet. I like a vet that will take the time to talk things over and discuss thoroughly before moving forward with treatments.

You can learn tons of stuff here, not only through the Resource section, but I would encourage you to read the various threads as much can be learned by what others are going through. We have dogs treated with vetroyl and others with lysodren.

Sharlene and Molly Muffin

[RUpdegrove]

Leslie,

Happy is indeed a generally happy and playful dog. I try to give my dogs cheerful names. Like most Shelties, he doesn't have a mean or aggressive bone in him. He is very social and he especially loves little children.