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View Full Version : To treat or not treat Cushing's



Grandma of Maggie
06-17-2016, 05:24 PM
Ten years ago we adopted a lab/chow mix from the dog pound for our grandsons. Our dear Maggie has been a wonderful friend, protector and family member. She and my grandsons have grown up together, and the mutual love they have for each other is unconditional.

My husband noticed a small lump on her chest and took her in to have it checked. That was just fatty cells, but other blood work lead to us get more done and it’s suspected she has cushing disease. We will have the longer test on Monday to make a determination.

Mags has demonstrated that she may have artitistis in her legs, but that could also be the cushing. She is over weight, not active, always looking for food, but she pretty has been most of her adult life. She doesn’t appear to have the need to go potty more often. She has slowed down greatly, but then again she is 10 years old. She doesn’t have a problem sleeping, taking a nice nap right now. Not sure about the panting more, but perhaps she does.

My husband and I are at a loss. We’ll get the last test on Monday and wait for the results to either confirm or rule out cushing disease. I need some solid input relative to what direction to go.

Truth is we can’t afford $1,200 a year for meds. I guess I’m hoping others have faced this situation, didn’t do the meds, and can share their dog continued for some time happy and comfortable.

Thank you for letting me share.

DoxieMama
06-17-2016, 07:04 PM
Welcome to you and Maggie, though I'm so sorry for the reasons you've joined us. We understand how difficult the process of diagnosis is, and determining what to do in the face of a confirmed diagnosis is a hard question for many. I believe there have been those in the same situation who have chosen (for financial or other reasons) to not treat their dog, and I hope they will see your thread and respond.

Do you happen to have the results of the blood work that was done, so you could post the results which are abnormal? This can help the admins and other knowledgeable folks here provide better feedback.

Shana

Harley PoMMom
06-17-2016, 07:22 PM
Hi and welcome to you and Maggie!

Maggie sure sounds like a sweetheart and she is a lucky gal to have found such a loving home, and bless you for giving her a forever home.

We surely do understand and sympathize with you regarding the cost. The initial expense is during the diagnostic phase and when a dog becomes stabilized on treatment the cost does go down considerably. However those ACTH stimulation tests, which are needed to monitor a dog on treatment, are quite expensive. The medications used to treat Cushing's can be compounded too and this does help with keeping the cost down.

Cushing's is typically a slowly progressive disease but it does have the potential to cause systemic damage over time, so for a young dog I would certainly recommend treatment. Now, with elder dogs that are near their normal life span I believe one has to look at the pros and cons of treatment. Cushing's is when a dog's body is producing an excessive amount of cortisol. That extra cortisol has anti-inflammatory properties so with treatment arthritis can be unmasked and may even worsen. For me quality of life is paramount when making the decision to treat. I don't tell you this to dissuade you from treating Maggie and I truly believe that you are the best judge in how uncomfortable or comfortable she would be with treatment.

If you would get copies of all the tests that were or are being done and post those results here that would be great. With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. Does your girl have any underlying illness that she is taking medication for? And if so, what is it and what is the medication? Is she taking any supplements or herbs?

I sure am sorry for the reasons that brought you here but glad you found us and we will help in any way we can.

Hugs, Lori

Grandma of Maggie
06-18-2016, 07:51 AM
Thank you for your kind words. Her levels were at 41 and should of been 25 or so. She has demonstrated no other issues and has had no other medical issues. Again, come Monday we'll do the more extensive blood testing and wait for the results.

She has gotten slower, but if one of "her" boys calls she moves quickly and continues to protect them.

I'll post the outcome of the test from Monday. I'm just trying to wrap around this in advance to make an informed decision. It's not just Maggie we're concerned with, it's our grandsons who will be devasted, not to mention myself, my husband and my daughter.

Again, thank you for responding.

Grandma of Maggie
06-18-2016, 07:52 AM
I'll post the results from Monday's test when I get them. Thank you so much for responding

lulusmom
06-18-2016, 11:12 AM
When you have the test done on Monday, can you please ask your vet for copies of all testing that has been done. Lori and Shana have already asked if you could share the results of the blood chemistry and complete blood count (CBC). These as well as a urinalysis are part of senior screenings and definitely screenings done if cushing's is supected. It sounds to me that in the absence of the usual symptoms commonly associated with cushing's, your vet has opted to pursue a cushing's diagnosis based solely on lab abnormalities. If so, this is concerning to us which is why you've received so many requests for the same thing. You mentioned a level of 41 which I assume to be a post acth stimulated cortisol reading. You vet mentioned a number 25 which is the threshhold that would be consistent with cushing's. If this is a post stim number and the reporting unit is ug/dL, that high result is certainly evidence of unquestionable hyperadrenal activity. Can you please look at that test result again and confirm that this is the results of an acth stimulation test and that the reporting units are ug/dL?

Lori has already given you some really good information to think about when asking yourself whether to treat or not. I'd like to give you some more info that is straight out of a veterinary textbook that is used in teaching hospitals. I typed this excerpt and saved it for people like you who may be in a quandry whether it be quality of life issues or financial hardship. Both are very much important considerations.


To Treat or Not to Treat

The “urban legend” exists that survival is the same whether or not a dog with HAC is treated. That statement has never been scientifically evaluated. It may be true for some dogs, but likely not all. Importantly, treatment typically greatly improves quality of life for both the owner and dog.

On the other hand, not all dogs with positive tests for HAC need to be treated and the decision should be made on a case-by-case basis. In deciding when to treat, consideration should be given to the dog, quality of life, the owner, and clinical signs. None of the drugs are cheap and neither mitotane nor trilostane are benign; therefore, treatment is not to be taken lightly. If the only clinical sign is a benign clinicopathologic finding (e.g. elevated serum ALP activity) treatment is not warranted (neither is testing). If the issue is only cosmetic (e.g., poor hair) or very mild (e.g., slight increase in thirst and urination), a frank discussion should be had with the owner of the risks and benefits. In making the decision, further questioning of the owner on issues that might relate to clinical signs (e.g., the dog has stopped jumping on furniture –a sign of possible muscle weakness) can be helpful, as well as seeking evidence of clinical signs that the owner might not note (e.g., serial evaluation of urine samples collected at home for consistent suggestion of polyuria/polysipsia). It is also important to test for proteinuria by measurement of a UPCR and for hypertension by measurement of blood pressure. Both can damage the body; so if either or both are present and due to HAC, treatment may be more imperative. On the other hand, clinical signs may be recognized in retrospect; for example, an owner attributes decreased playing to old age, but when HAC is treated, the activity increases. Treatment of HAC can unmask diseases that may be inapparent due to the anti-inflammatory effects of hypercortisolemia. For example, clinical signs of atopy or degenerative joint disease may develop with treatment of HAC as cortisol concentrations decrease.

Therapy without knowing whether AT or PT
At times the differentiation between PDH and AT is not possible due to such issues as owner financial constraints or inconclusive or conflicting results on differentiating tests. In such a situation, given that the vast majority of dogs have PDH, therapy can be initiated accordingly. However, the owners should understand that an accurate prognosis cannot be given and that attempting to differentiate between the forms once therapy is started is quite difficult, if not impossible.

The textbook from which I copied the above text is not used to school general practitioner vets so you may want to share this with your vet so that you are both on the same page on your decision to treat as well as being informed of those things that should be monitored if no treatment is ultimately decided. To be honest here, if Maggie were my dog, I don't believe I would opt for treatment in the absence of problematic symptoms in which case I'm not sure I would even spend money on additional testing that isn't normally done on asymptomatic dogs. The rationale for my decision is that Maggie is of a breeding that I believe puts her at or near her life expectancy and she seems to have a great quality of life right now with no symptoms. Even if she were overtly symptomatic, knowing that senior large breed dogs whose quality of life can be greatly diminished by hip dysplasia, would I really want to reduce cortisol which could be masking this problem and making her life miserable? With cushing's being such a graded disease and even if I could afford treatment, would I want to subject Maggie to the stress, poking and prodding of multiple vet visits that will be necessary to monitor treatment?

I will be looking for your update after Monday's appointment. Please be sure to discuss the information we've discussed with you with your vet so that you leave no stone unturned and that you both are on the same page and for the same reasons.

Glynda

P.S. I forgot to mention that overweight dogs are at higher risk than dogs with cushings's for pancreatitis, diabetes and orthopedic problems Getting that extra weight off of Daphne can make a big difference in her activity level and ability to go up steps, jump on furniture, etc. I know from lots of experience that fat dogs are food driven so I wouldn't automatically assume that an overweight dog with a voracious appetite has cushing's. If Maggie pants a lot, that too can improve greatly with weight loss.