7 yr dog just diagnosed! Vet says not to treat?....

[LoveMyPuop]

Hi everyone. Sadly our 7 year old female German Shepherd dog was just diagnosed with Cushings disease. She has been having symptoms for awhile now (increased thirst, frequent peeing, food obsession, etc). Our vet said that he doesn't really recommend the medication since you have to run tests several times a year and it all can be very expensive. Our family is on a very tight budget with another baby on the way and I'm just trying to get an understanding for how much all of it would really cost? He was saying it could be $4,000 - 6,000 by the end of it all. That's just not something we can afford. I love our pet so much though so I guess these are my questions:

1) How much did it cost all of you with a larger dog (90 lbs) to give medication, tests, etc?
2) Are they in pain? How will we know if things are getting unbearable for our dog?

I'm just totally lost and so sad right now... I don't know what to do. Any input would be so helpful! I don't want to watch her suffer but we also don't have the financial means to spend thousands on her either... it's heart breaking!

[Joan2517]

Hello and welcome. I'm so sorry for your heartbreaking news. It is very expensive, but there are ways to bring the costs down. Others will be along to share some of the ways in which it is possible, if you would like to give it a try.

We have all been where you are now. Please know that you are not alone.

[arentspowell]

Hello, I'm sorry about the circumstances that brought you here. We are also relatively new to Cushing's disease, our dog was diagnosed with Cushing's in June. Our dog is only 6 years old and we were devastated by the diagnosis as well. The more we read the more overwhelmed we became until we found the wonderful resources and people on this forum.

How did your vet arrive to the Cushing's diagnosis? We did a urinalysis and blood panel, then we did an ATCH stimulation test, and lastly an ultrasound. I would say the initial diagnostics cost us about $1,000 before we started any treatments.

After weighing our options we opted to treat with Vetoryl, which for our 60 lb Labrador cost about $75 for a 30 day supply.

Two weeks into the treatment we did another ATCH stim test. The first stim test after starting Vetoryl showed significant improvement so we continued for another 30 days on the same dose. At the second one though, her cortisol levels had risen so we had to increase the medication to a 60mg in the AM and 30 mg at night. I believe the 30 mg box was an additional $50 dollars AND we paid extra to have it overnighted to us. We test again in a little less than two weeks and the tests cost us about $285 each time.

Daisy also had a horrible outbreak of CC (skin condition associated with Cushing's) and we've had several vet visits and purchased prescription antibiotics and ointments to get it under control.

I am by no means trying to scare you or discourage you but it is very expensive, especially at the onset when you're trying to find the right dose. Our vet doesn't recommend using compounded Trilostane, which is a lot cheaper than the brand name one we are currently using, until we get the levels under control.

However, you've come to the right place. There are some really knowledgeable people here and there are other options out there for you. Hang in there, you're definitely not going through this alone!

[labblab]

Hello and welcome from me, too! First of all, congratulations on your new baby on the way! I am so sorry, though, that what should be a joyful time for you is clouded by worry over your furbaby. We all truly understand, and we will do everything we can to try to answer your questions and to support you as you make your decisions.

If you could give us more specifics about the testing that has led to the Cushing's diagnosis, that would be very helpful. If you've already had specific diagnostic testing performed, then at least that part of the financial expense is already behind you. If you still have more diagnostics ahead of you, we can talk over the options so that you can get the most "bang for your buck."

If your girl does have Cushing's, it is true that it can be an expensive disease to treat, and you have the needs of your entire family to balance. So nobody here will fault you in any way if the expense is simply more than you can shoulder. However, there can be a lot of variation in terms of how much dose "tweaking" and how many follow-up tests are required. Some dogs just have smoother courses of treatment than do others, and that greatly affects the costs that are involved.

Once the diagnosis is confirmed, the biggest expenses are the costs of the medication itself and also the monitoring blood tests. There are two different medications that are most effective: Vetoryl (chemical name is trilostane) and Lysodren (chemical name is mitotane). You can ask your vet which drug he would recommend if you do decide to move forward with treatment. With both these medications, the cost for the drug itself can be greatly reduced if your vet is OK with your use of a "compounded" version rather than the brandname drug. Just as arentspowell has written above, some vets prefer that owners stick with the brand drug when possible. But if the cost will otherwise preclude any treatment whatsoever, then a vet may be more flexible about this.

Of the two medications, Vetoryl (trilostane) is the one that is being prescribed more often here in the U.S., so I'll go ahead and talk about it in more detail. If it turns out that your vet prefers Lysodren, we'll talk about that, too. Anyway, the most widely recommended starting dose for Vetoryl is to use a formula of 1 mg. per pound. However, there is also research evidence that larger dogs may actually require a much smaller dose, by weight, than do smaller dogs. So if your dog were mine, even weighing 90 pounds, given your circumstances I would probably start with a dose as low as 30 mg. given once daily. This can lessen the likelihood of problems caused by overdosing. I just checked, and even if you bought the namebrand Vetoryl, you can get a 30-count box of 30 mg. capsules for around $50 from reputable online veterinary pharmacies.

It is true that you do need to perform the monitoring ACTH testing in order to see what effect the drug is having on the dog's cortisol, and unfortunately, this is not an inexpensive test. It is also important to periodically run a basic blood chemistry panel, as well. If you started out at a very low dose given the weight of your dog, however, you might be able to wait for 30 days to perform the first monitoring testing, as long as your dog appears to be well. At that point, you can then make informed decisions about increasing or decreasing the dose. After a dosing change, the ACTH must be repeated. But again, if you make only an incremental increase, you might be able to wait another 30 days before testing. And it is possible that it won't take a lot of tweaking to arrive at a dose that is good for your dog. At that point, the blood testing can be stretched to once every 3 months, or perhaps even a bit longer depending upon your dog's stability.

So these are the two questions I'd ask your vet right now. What medication would he recommend if you do decide to treat, and how much does he charge to perform the monitoring ACTH testing? If you can gather that info, as well as the specifics regarding any testing that's been done so far, we can all brainstorm further.

Marianne

[labblab]

Just wanted to come back and add that you do have plenty of time to arrive at a decision about all of this. For the most part, Cushing's is a very slowly developing chronic condition. It is true that uncontrolled levels of high cortisol can do serious internal damage to the body over time, and this is why treatment is so often recommended for younger dogs who still have the bulk of their lifetimes ahead of them. But typically these internal changes don't happen overnight, so the outward symptoms may be the biggest issue for you and your dog right now.

For instance, I realize that excessive thirst and urination can be very big issues for a big dog, especially if 24/7 access to the yard is difficult. So part of the pressure that you may feel about a decision may relate to your personal circumstances. How uncomfortable does your dog appear to you right now? How big a problem is the thirst/urination/hunger? If you can live with that for the moment, then you should have plenty of time to make additional decisions about the future.

Marianne

[LoveMyPuop]

Thank you all for the support! I so appreciate this especially when I feel like I don't know what I'm doing or where to turn. So a little more information: 3 years ago we moved overseas and brought our dog with us. She started losing all of her hair. I mean she literally was almost just skin. I mentioned Cushings at the time to the vet but she tested the urine and said it wasn't Cushings. No one knew what happened but figured it was the stress from the flight, living in a hotel till we found a house, etc. Fast forward 3 years and another international flight later. Her hair is all back but super brittle now and dull even though she's on a good grain free dog food (Taste of the Wild).

We started noticing a few months ago that she was drinking a lot of water and peeing a lot but figured it was just from the heat of summer and living in new england with no a/c in houses. We left for a trip and then got texts from our dog sitter saying that she was having accidents in the house. That was so strange to us considering she never had that issue before. Now I'm wondering if I just never noticed because I'm a stay at home mom and just let her out all the time with the kids etc.

She's also been insanely food obsessed, which I think along with the accidents and waking us up at night is the hardest part for us. I have to keep a mental checklist of everything I or the kids ever leave out or she's on it or will grab it out of the kids hands. She's a well trained German Shepherd but now she's just so crazy about food that she'll jump up to the table right before our eyes! Like she doesn't even care about the repercussions because she thinks she's starving.

So due to all those symptoms: excessive drinking, peeing all the time, accidents, hair loss, bloated belly, panting, food obsession along with a blood test that showed high liver things (sorry, can't remember the exact wording!!), the vet says he thinks it's Cushings. He then said to be more certain we could do that 9 hour test for $250. The we'd have to do the next test and then he mentioned she would be on Triclosan 120mg for $185/month and have to come back for testing 10, 30, 90 days and then 3-6 months. Each test is $350. So he said we'd spend somewhere between $4,000-6,000. He wasn't open to a compound version of the drug.

We have 2 little kids and a 3rd on the way and just don't have that kind of money. She doesn't seem to be in pain but she just has this anxious look in her eyes...I can't explain it. Like you can see the whites of her eyes a lot of the times. It has been very hard for me especially to deal with the constant trips outside and accidents and stealing of food... it's so hard to chase after kids all day and then have a dog that gives you no slack if you leave a scrambled egg pan on the stove or a spatula on the counter. I feel worn out honestly and torn in all directions. Getting woken up at night by kids and now our dog as well is taking a toll on us for sure.

[molly muffin]

Hello and welcome. Did they rule out a UTI (urinary tract infection) first? Also if they did a urine culture to check and that and a urnalysis, what was the specific gravity of her urine? (dilute urine can be hard to get a check on for bacteria as it's so dilute)

If they haven't checked for a UTI I'd have that done first. As it can be a easier thing to fix (antibiotics). There is the possibility of just doing a UCCR to see if there is cortisol excess in the urine. It won't say it is cushings, but could rule it out and is inexpensive.
yes it does sound like cushings and trilostane at 1mg/1lb dosage, could be obtained from an online pharmacy such as diamondback (compounded is cheaper and many of use this option, rather than the name brand vetroyl).

At best, you'd need to test to see where the cortisol levels are on the medication, but I wonder if maybe a small dose under the 1mg/1lb might or might not help and need less testing as you aren't at as high of risk of going too low in levels. Again just a thought and maybe something you could discuss with your vet.

Where any other values off on the blood work, like ALP, ALT, Glucose (assuming they ruled out diabetes).

[labblab]

Thanks so much for giving us this additional info. I do have some more thoughts to share, but I have to run some errands right now. I will try to get back again, though, either later today or early tomorrow. ;)

Marianne

[LoveMyPuop]

Hello everyone. I wrote a few weeks ago about our 7 year old German Shepherd that just recently got diagnosed with Cushings. She's had a voracious appetite until now and the last two days she's been eating her dry dog food very slowly and then not even half way through throws it all up. I know she's still hungry since she paces all day looking for food (probably due to Cushings as well). It looks like her throat bothers her maybe when she's eating... I don't know. Have any of you experienced this? Is this Cushing's related?

[DoxieMama]

Hi there,

I'm sure one of the admins will move these posts onto your other thread here (http://www.k9cushings.com/forum/showthread.php?t=8149) as we like to keep all posts in one place. That way everyone has the history readily available.

That said, do you happen to have any of the test results from before? I don't think what you've described is Cushing's related, but I will certainly defer to those with more experience if they've seen anything of the sort. But if she's not keeping food down, have you tried giving her a bland diet? White rice and cottage cheese is what my vet typically recommends. Oh - have you mentioned this to your vet yet?

When my dogs throw up, they get no food for a day or so, then a smaller meal of white rice and cottage cheese. If that stays down, then more frequent bland meals for a couple days, then gradually reintroduce their regular food.

Hopefully others will be by with their suggestions soon.

Shana

[Squirt's Mom]

This does not sound like Cushing's but I am wondering about the food itself. What is she eating - brand and kind (beef, salmon, etc)? Have you changed brands lately?

Vomiting up all the food is not normal and I would get her to the vet if at all possible. This could be a sign of something very serious and immediate. ;)

Let us know how she is doing, please.

Hugs,
Leslie and the gang