When is it time?

[bsel]

I have a 14 year old beagle, half blind, half deaf, and now appears to have Cushings disease. His main problem with this is he cant sit still and needs to go in and out of the house every 10 minutes. He drinks and pees all day. Other than that, he appears to be in good health and spirits. So my question: When does one decide his quality of life has deteriorated enough to think about putting him down? I would think this constant need to pee and drink would be all consuming. He chews off the diaper so we are constantly picking up accidents all over the house. I know with Cushings there is no cure and with his age, we don't really want to put him through the side effects of the medications. We also know there is no cure and he will continually get worse. My vet tells me putting him down sooner rather than later is better so it doesn't come down to a crisis time and he can go with some form of dignity. Thoughts?

[lulusmom]

Welcome to you and your precious boy.

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As for your question about quality of life, it sounds like your boy is happy and in good health despite his need to pee and drink a lot. Dogs with cushing's do lose the ability to concentrate their urine but they are not in any pain and it does not compromise their quality of life. It can compromise our quality of life when we have to clean up after them. In my experience, it is usually when a dog's symptoms become problematic that pet owners either decide to seek a diagnosis and treat the problem or contemplate euthanasia. I agree with your vet assessment that it is kinder to euthanize earlier rather than let a dog suffer but if your dog has cushing's, he's not suffering, he just has to pee a lot and drink a lot to stay hydrated.

Excessive drinking and peeing is associated with a lot of different medical conditions and sometimes it's simply idiopathic. One of my dogs had diabetes insipidus which did not respond to treatment so he drank buckets and peed lakes until the day he died. I washed a lot of hospital pads every day but my boy was a happy camper while I was toiling away. :D I have treated multiple dogs with cushing's and have followed thousands of threads on this site and I can tell you that most dogs, especially those who are being treated by an experienced vet and who have an educated owner, do fabulously on treatment with no ill effects. None of the dogs I cared for ever experienced side effects. Most dogs with cushing's are diagnosed at a pretty senior age and some are blind, some are deaf and some are both. Deciding whether to treat is a very personal thing and if I had a very senior dog who had already lived out their life expectancy and symptoms were not a problem for me or the dog, I probably would not choose to treat. Diagnostics are stressful and lots of needle sticks for blood draws necessary to monitor treatment. My first cushdog was only three year old when diagnosed so deciding to treat was a no brainer. My second one was up there in age but not old enough to not try to turn things around for him. He was a shelter dog with advanced disease and was one big infection. I marveled at the improvement in those dogs as well as a few rescue dogs, as treatment started working.

If you can afford the testing and you think your pup is up for some blood and urine tests, then you may want to consider pursuing a cushing's diagnosis because if your boy has cushing's, treatment can eliminate the problematic symptom you are dealing with and you will both continue to be happy. We'll be here for you no matter what you decide but from what little you've shared with us, I don't think your boy is telling you that it's time and I think your vet is way premature in telling you that it's better to put him down sooner than later.

Glynda

[bsel]

Thanks for your thoughtful post. We have already put him through many tests, all concluding that more testing is needed. Not that cost is the issue (but at some point it is), we have already spent close to $1000 in testing all concluding it is inconclusive. My vet said he needed to continue testing to come to the correct conclusion. For what I understand, Cushings is difficult to diagnose and I feel they are going to rule out everything else until cushings is the only thing left. Seems unreasonable. From what testings were done, they ruled out diabetes. But, since they have not concluded what type of cushings it may be so they are unwilling to give a treatment until all the testing is done. I got the sense we are looking at another $1000. I mean, the dog is 14, I have to believe there are other options but I can't seem to come up with any. We are tying some holistic methods but that doesn't seem to be doing the trick yet. I guess we will keep moving forward and see what is happens.

[labblab]

Hello and welcome from me, too! Glynda has already given you a great start, and I just want to add a couple of additional thoughts. First of all, we can surely empathize with the frustration of testing and the uncertainty that goes along with it. If you would care to be more specific about the tests/results that have already been completed, however, perhaps we can give you some helpful feedback re: the path forward.

As Glynda has said, we've seen many dogs who have been treated sucessfully and for whom the quality of their lives have improved. However, treatment does involve both a commitment of time and money, and it also entails additional vet visits and blood draws that your dog must undergo. So especially for senior dogs, there are lots of considerations involved, and how do you decide? :o

I recently read an article by Moira Anderson Allen that contained this great quote: "Your veterinarian is the best judge of your pet's physical condition; however, you are the best judge of the quality of your pet's daily life." In the case of my own dog, his Cushing's symptoms truly were making him so miserable that I would have treated him at any age and regardless of his fear of the vet's office. He was a big sporting dog -- a Lab -- and not only were his symptoms making him visibly uncomfortable, he could no longer do so many of the things that had always brought him pleasure. Muscle wasting and fatigue from the disease meant he could no longer run (couldn't even tolerating walking very far), he couldn't chase a ball or swim in the lake, he couldn't climb steps to even just sit in his yard or jump into the car to take rides. In addition to the excessive hunger, thirst, and urination, he panted constantly and could never seem to get comfortable: was constantly shifting around the house and searching for a cool spot to flop down. In terms of outward symptoms, unfortunately he was a poster child for the disease since he had so many. :(

But there is a great deal of variability in terms of the discomfort that is exhibited by dogs who are diagnosed with the disease. So that's why I believe every parent knows their own dog best, and can be the best judge as to whether the demands of diagnosis/treatment outweigh the actual issues that the disease is presenting for any specific pup. Having said all this, I'll return to my original thought: if you'd like some help with sorting through the diagnostic process, we'll be happy to do our best. But in order to be of help, we'll need to know which tests have been run so far, as well as any abnormal results. So on blood tests, for instance, we only need to know any values that were either too high or too low, along with the normal reference range. Thanks in advance for any additional info you care to provide.

Marianne

[molly muffin]

An ACTH or LDDS test is usually done to determine cushings, with an LDDS sometimes being able to tell if it is pituitary or adrenal type of cushings.
Either way if you aren't going to do surgery, which at 14, you most likely would not, then the treatment would be the same. You basically run a full blood panel and urinalysis/culture to rule out a UTI. The blood work should be able to rule out diabetes as you have already done and if you look at it and can see if a thyroid panel was run, you either can or cannot rule out thyroid problems which have the same symptoms as cushings.
If you have had the blood work done and can tell us what was high/low on the test (with range) then we can certainly help to talk over options.

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