Treatment or Not

[zeke]

I have an 11# shih tzu/bichon. He is 5 years old. We rescued him from a shelter at 9 weeks. He is probably a puppy mill dog. He has been aggressive his entire life. We take him to our state university vet behavioral program and he has been through group and 1:1 training several times. He does not have much carry over from training. He must be in a crate when visitors are present and no children can be around him. He bites. The state university behavioral vet has mentioned euthanasia due to his constant state of anxiety. (He has been treated with several anti-anxiety meds with no effect and currently is on Paxil.)

He began losing hair. He had a whole body yeast infection. Yeast has been treated and he recovered from that. He does not have hypothyroidism. Today we got the results of urinalysis which strongly indicates cushings. Tomorrow he will stay at the vet all day for the blood work testing.

I have several questions:

1) Will treatment of cushings that appears at 5 years old resolve his aggressive behavior?

2) which treatment side effects affect his already unstable behavioral issues?

3) what is the average cost of monthly treatment, including monitoring vet visits and tests?

Thanks. I want to do what is in his best interest.

[Squirt's Mom]

Hi and welcome to you and your baby boy! :)

It breaks my heart he has so many issues and nothing seems to be helping him. There is no telling what abuses he suffered or witnessed nor what problems he inherited from such breeding. :(

To answer some of your questions, behavioral issues such as your baby boy exhibits are not typical of a cush pup tho aggression is typical of a dog with hyPERthyroidism, not hyPOthyroidism. But I would assume both elevated and decreased levels have been ruled out. A cush pup can become restless and less interactive than they were before but aggression is not a typical sign so I wouldn't expect treatment to help much in that area. Having said that, tho, each of these little souls is unique so I won't say it is impossible that treatment might help.

Side effects seen from the drugs used to treat, either Lysodren or Vetoryl, are usually seen when the cortisol drops too low. Some pups do have a few days of withdrawal when the cortisol begins to lower to normal range but that passes rather quickly. The drugs bring our babies back to normal in regard to appetite, drinking, urination, panting, hair loss, and muscle development. Some of these are seen quickly, some take some time, and some never really return to normal even when the cortisol is within optimal range. But again, aggression is not a "side effect" of either drug.

It is not possible to give a clear answer on cost. Typically Vetoryl (Trilostane) is more costly to use because the dose changes more frequently than with Lysodren and with every dose change the testing schedule starts all over at 2 weeks, then 30 days, then 60, then 90. The ACTH is the test used to monitor treatment and the cost of that test varies all across the country and globe fairly widely. Here are a link from the forum polls concerning costs -

http://www.k9cushings.com/forum/showthread.php?1512-Index-for-all-of-the-Polls-regarding-veterinary-testing-costs

Can you tell us what signs you are seeing that caused the vet to test for Cushing's? What tests have been done so far? Would you please get copies of all the test results and post them here? That will help us a great deal in offering more meaningful feedback.

I'm glad you found us and look forward to learning more as time passes. And thank you for giving this baby a chance.
Hugs,
Leslie

[labblab]

Leslie has already done a wonderful job of welcoming you, so I only have a couple additional thoughts to add right now. Actually, the first is a concern relating to the validity of Cushing’s testing for your little boy. Unfortunately, there is no urine or blood test that can definitively diagnose Cushing’s. The testing measures cortisol production under different situations, and certain test patterns are consistent with Cushing’s. However, other illnesses or even stress alone can produce abnormally elevated cortisol levels. Therefore, test results have to be evaluated in conjunction with the presence or absence of other typical Cushing’s symptoms when arriving at a diagnosis. You’ve mentioned hair loss and yeast infection. Does your boy exhibit any other Cushing’s symptoms such as excessive thirst/urination/hunger, pot belly, hindend weakness or muscle loss, seeking out cool places to lie in, lack of exercise tolerance, excessive panting? If so, are these symptoms really problematic to him or to you?

Turning back to the test results, I’m especially concerned about your boy’s generally anxious state. I’m assuming the urine test that has been completed was the UC:CR (urinary cortisol to creatinine ratio). Stress can definitely skew the results of this test, so urine samples need to be collected at home when the dog is as calm as possible, as opposed to the vet’s office. Stress can also skew the blood testing, as well. So before proceeding with more testing, I’m thinking you will want to seriously evaluate your goal. As Leslie has said, I’m unaware of aggression (other than food aggression) being caused by Cushing’s. So unless your boy is exhibiting other troublesome symptoms of the disease, I don’t know that you would choose to enter into treatment at this time, regardless of the test results. At the beginning, treatment can involve numerous vet visits and blood draws, all of which may only serve to stress your boy further. So you’d want to weigh the pluses and minuses of proceeding.

Given his issues, you surely deserve our gratitude for caring for this little soul. I very much wish I could tell you that Cushing’s treatment would improve the quality of his life. But depending upon any other symptoms, I do not know that you’d be gaining a lot by moving forward right now. Still, we’ll do our best to support you whatever you decide to do.

Marianne

[molly muffin]

Hello and welcome from me too. Awwww, poor little guy, often they are aggressive in what is determined to be fear aggression and if so I would expect that would cortisol levels to rise (as this is a natural body response) and definitely could mess with results for cushing testing. Also you would want to make sure that he did not have the full body yeast infection, as that too would cause the cortisol levels to be elevated and the hair loss. So it's possible that it isn't cushings but could be other factors contributing.

Cost can be quite expensive during the diagnostic phase. If you do determine it is cushings and opt to treat, then it's best to go with the option that the vets are used to using and have the most knowledge of.