To treat or not to treat? ( 6 y/o Lab/Pit mix )

[Bellamom]

I have a 6 yea old Lab/Pit mix that was recently diagnosed with Cushings although I believe she has had it now for a least 2-3 years but never diagnosed. She has nearly all the classic symptoms but each vet I talk to has a different opinion on whether she needs further testing or to go ahead and treat. The treatment is very expensive given the cost of meds and frequent blood work. I think her quality of life without would be better possibly than the treatment. She does not have frequent urination. She also suffers with pain from severe hip dysplagia and is very overweight. She also has high liver function tests. We are treating her with Tramadol and milk thistle. What opinions on withholding treatment can you give? Would appreciate any input.

[mytil]

Hi and welcome.

I am sorry you and your girl are having these troubles.

Please post the results of the tests performed recently as you were searching for a Cushing's diagnosis. The numbers speak volumes and will give us more information. There are so many conditions that have the same symptoms as Cushing's (thyroid issues, liver problems, diabetes for example) Have these been ruled out?

It is always frustrating when Vets disagree on things with you and your girl stuck right in the middle. How many vets have you been to? Is your girl having trouble loosing the excess weight?

Yes, these medicines are strong but they have to be to lower and keep the cortisol levels within normal range.

Keep us posted
Terry

[Harley PoMMom]

Hi and welcome to you and your girl!

To treat or not to treat is a personal decision, we are not here to judge any one, we are here only to help in any way we can, ok? ;) It's all about quality of life for our babies. I'm including a post from one of our Administrators, Marianne, with her response to a member with a very senior dog who was contemplating treatment:


Dear Lisa,

Welcome to you and Pepper, and WOW you've done a great job of keeping your girl healthy and happy up to age 17! First off, even though folks here do give various supplements to support healthy body functioning, there are no nonprescription drugs that will address the root cause of Cushing's and lower cortisol sufficiently to control the disease. So it really will take treatment with either trilostane (or Lysodren, the other Rx option) to control the Cushing's, assuming it truly is the cause of her symptoms. Having said that, at age 17, you may want to consider pluses-and-minuses of Cushing's treatment before rushing in to treat Pepper.

Cushing's is typically a slowly progressive disease but it does have the potential to cause systemic damage over time (from high blood pressure, vulnerability to pancreatitis and infections, high cholesterol, kidney damage, liver inflammation, etc.). So for a younger dog, I'd certainly recommend effective treatment so as to eliminate some of these risks, improve longterm quality of life, and allow the dog to live out his/her normal lifespan. However, for a dog of Pepper's age, immediate quality of life issues seem of paramount importance to me. And there are some trade-offs to treatment, especially for an arthritic dog since the arthritis may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort. Also, especially at the beginning, there can be numerous vet visits and blood draws which can be less than pleasant for a dog who's nervous at the vet (and also hard on the owner's pocketbook :o).

I don't tell you any of this to dissuade you from treating if you and your vet agree this is the best path forward for Pepper. But I do think you are the best judge as to how uncomfortable her current symptoms are to you both, and if they are not bothering Pepper all that much -- as I say, you may want to hold off on treating for the time being.

First things first, though -- as Lori says, it'll be great if we can take a look at those test results.

Marianne

The initial expense is during the diagnostic phase and once treatment is stabilized the cost does go down. Another cost-saving method is having the medication compounded, many of our members have been very satisfied using compounded products in treating their dogs.

As Terry has mentioned, getting copies of all tests that were done on your girl and posting those values that are abnormal would be great...thanks! What symptoms does your girl display? How much does she weigh? Is she on any other herbs/supplements/medications? What tests were performed to diagnose her Cushing's, and could you post those results too?

Sorry for all those questions but the more we know about your girl that better our feedback can be.

Please know we are here for you both, and do not hesitate to ask all the questions you want.

Hugs, Lori

[Bellamom]

Thank you for answering. Yes Bella has a lot of trouble losing weight. She is at least 20 lbs overweight even on hills metabolism formula for 6 months. Her results from he 8 hour low dose test are baseline 11.8. 4 hour 4.6 8 hour 10.9 her Alk phos level 763 ALT 206

[Harley PoMMom]

Her results from he 8 hour low dose test are baseline 11.8. 4 hour 4.6 8 hour 10.9 her Alk phos level 763 ALT 206

Those LDDS test results do point to Cushing's and to the pituitary type. Could you tell us exactly what the symptoms are that Bella is displaying? Is she on any other herbs/supplements/medications?

Hugs, Lori

[Bellamom]

Sorry forgot to tell you that Belka weighs 92 pounds. She is currently taking Tramadol for severe hip dysplagia in her rear legs and right front leg as well as 800 mg daily of Milk Thistle to try to help her liver. All other bloodwork appears normal. Her vet says her cushings is Pituitary but they have not done the high dose test. One vet says we need to do it the other one says it is not necessary based on the lab values from her first test.

[Bellamom]

Fatigue and drinks 5-6 large bowls of water a day and is constantly hungry but despite all the craving and begging for water she rarely asks to go outside and doesn't have accidents. She pants a lot too. No hair loss. Pot belly with thining skin on stomach.

[Harley PoMMom]

I see no reason for a HDDS test, that test is used to help differentiate between ADH and PDH, which Bella's LDDS test has already done. However, faced with other non-adrenal illnesses the LDDS test can yield false positive results.

If an ultrasound is feasible, that would probably be my next option.

Hugs, Lori