Cushings treat or not treat

[Rockysmom]

I have been reading so much information on this wonderful site but I'm still so indecisive, I have a 12 1/2 yr old, 22 pound poodle that is the love of my life. A year ago we were told after blood work that an enzyme indicating possible cushings was slightly elevated. Just recently in January at an appointment for an ear infection I mentioned that and the fact he seemed to be drinking more and panting without exertion. So more blood work was completed and yes that enzyme was a little higher so we agreed to do the 8 hour test. We were told that he had cushings and the pituitary kind, led to believe that it had to be treated asap. Rocky was placed on 30mg a day of Vetoryl. After a week we noticed his bowels were a little loose and 3 days later it was nothing but diarrhea and blood. I didn't give him the meds over the weekend and immediately took him back to the vet on Monday. This time the appointment was with the owner and she didn't think that the blood was caused by the Vetoryl but possibly just a stomach bug and gave him fluids and a prescription for Flagyl. I asked about the need for treatment and she indicated that she doesn't treat her patients for cushings until it is bothersome to the owner. I really feel like the medicine caused the diarrhea and blood and am very scared to start him back up on the Vetoryl. The more I read the more confused I become, but at the same time will feel even worse if I don't do the right thing and cause my baby more problems.

I've been trying to keep better track of the drinking and panting. He has had issues for a long time chewing his feet and scratching his face. He pants a lot after an episode of that, after walking about 2 blocks outside panting will start but settles down when we get back home for a little while. Drinking a full bowl of water in a day. No peeing accidents, although I am fortunate and work close enough to go home for lunch everyday. Any feedback or thoughts would be greatly appreciated.

[Squirt's Mom]

Hi and welcome to you and Rocky! :)

You were wise to stop the Vetoryl. Do NOT restart the Vetoryl just yet, ok?

Did the vet who saw him first do an ACTH or check his electrolytes? How is he now - has the diarrhea cleared up? Did he ever lose his appetite or seem lethargic to you?

The dose of Vetoryl was right as long as he was taking it once a day and not twice a day but even with the correct dose some pups can't handle Vetoryl...or Lysodren...and need to switch. BUT we are not at that point yet. ;) So let's chat a bit, ok? (which means I am going to ask loads more questions! :D )

Can you tell us what signs you were seeing before the Cushing's testing was started? Were the excess drinking and panting the only things you saw? No change in appetite or urination, no loss of ability to jump, no decrease in exercise tolerance, no hair loss or failure of shaved areas to regrow hair?

Does Rocky have any other health issues like arthritis or anything else? The feet chewing is a hallmark sign of allergies - has this been discussed with his vet? Panting can be seen with pain, excitement, worry, nausea, and stress as well as with diseases like Cushing's and other conditions.

Could you please get copies of all the testing done to diagnose the Cushing's like the 8-hour test (called a LDDS) and a wellness check that shows organ function in things like the ALP, ALT, GGT, CHOL, BUN, etc? Was an ultrasound performed? If so please tell us all the comments from that scan.

Is Rocky taking any other meds and if so, what for?

The normal amount of water for a dog is 1/2 - 1 oz of water per pound - so Rocky should normally drink between 11 and 22 oz of water per day. More water intake can be expected during summer OR if we keep our houses warm in the winter.

For now I would not worry about restarting the Vetoryl until he is finished with the Flagyl at the least. Cushing's is not usually life threatening and there is no need to rush into treatment. It is MUCH more important to be as sure as possible of the diagnosis before starting treatment as both drugs used to treat are very powerful. So let's start with the questions I listed above and any others that members may have and go from there while he finished this current prescription. So take a deep breath and try to relax - you are in good hands. We will be with you all the way...you will never be alone again. You and Rocky are part of our little family at K9C now.

Hugs,
Leslie

[Rockysmom]

Hi Leslie

The diarrhea has cleared up, stool is pretty normal once in awhile just little soft. I think the Flagyl really helped. Rocky was only taking the Vetoryl once a day in the morning.

The only symptoms we saw were the drinking and panting. We had just returned home from Myrtle Beach back in November and he was favoring his one back leg. I started him on Cosequin DS in November to see if that would help because he has had trouble once before that they believed was arthritis. The only reason I asked about the testing was because of them previously mentioning it and the fact that he had started panting and drinking more than usual.

We have discussed the chewing and scratching several times; he has been treated a few times with prednisone years ago and apoquil last year. They believe it seems to be seasonal and here in Maryland with our crazy weather seasonal is about all year round.

I can certainly get a copy of the test. No ultrasound has been done. Just bloodwork and the 8 hour test. My husband and I had been giving thoughts of scheduling a follow up with the Owner vet that stated she doesn't usually treat until the symptoms are bothersome to the owner, like waking in the night etc.

I greatly appreciate your quick response and feel a little better having someone to talk with that understands :)

Best regards, Michele -Rocky's Mom

[BrittanySpanielsRule]

I'm sorry to hear about your dogs diangnosis. Its never easy to hear. My girl Summer was diagnosed a year ago. She was already 14 at that point and the medications don't prolonge their life it just makes the symptoms more bearable for them. Decided that the side effects of vet meds, cost coupled with her age made me look at other options. I found a herbal med called adrenal harmony and a daily mixture with her food helped curb some of the ailments that accompany the symptoms of Cushings. It's a year later and she still enjoys her walks, treats and still gets excited when I come home. Shes 15 and fighting but it's tough sometimes. She will leak a bit of urine while sleeping and every once in a while loose her balance. It's hard to know if it's old age setting in,cushings or a combo of the both. It's sad I've had her for almost half my life and I know every day we are coming closer to the end of our journey together. I will take care of her until she lets me know she's ready or she passes on her own. My advice would be to do what your heart tells you. Look into all your options and weigh the pros and cons. Enjoy every day, every wet noses kiss and cuddle and cherish it. Im learning to make the best of every day I have left with her. Do the same.

[DoxieMama]

Hi Michele, welcome to you and Rocky. The others have covered the thoughts that I have for now. Hang in there!!

Shana

[labblab]

Hi from me, too, Michele!

As Shana has said, you’ve already been given some very helpful information. I’m gonna chime in by adding a copy of a reply I posted elsewhere that conveys some of my thoughts about treatment considerations for older dogs. Hopefully they may add some food for thought.

First, though, I do want to point out one possible issue related to Rocky and his Vetoryl. I see he weighs 22 pounds but was started out on 30 mg. of the medication. I do think it’s possible that this dose was simply too high for him, and that he might do OK in the future on a lower dose. In the past, a starting dose of 30 mg. would not have been considered excessive, but dosage recommendations have been revised in recent years. Currently, both the drug manufacturer as well as specialized clinicians recommend that initial dosing not exceed a formula of 1 mg. per pound. So in Rocky’s case, if you decide to resume the Vetoryl in the future, combining two 10 mg. capsules (20 mg. daily total) would likely be a safer starting point. We can give you links to resources that discuss this lower dosing protocol, if you think that would be helpful. In the meantime, here’s my promised post...


Given her age, Gidget has now entered her senior years. That being the case, there may be pros-and-cons to Cushing's treatment that you'd want to think over. In my own mind, the decision whether or not to treat any dog depends on a number of factors: age of the dog, apparent discomfort, severity of symptoms (both external and internal), etc. Cushing's is typically a slowly developing syndrome, and the decision to actively treat may come sooner or later in the process. The primary goals of treament are to control the troublesome observable symptoms (things like excessive thirst, urination, hunger, panting, muscle wasting), and also to halt/delay silent internal damage. Untreated Cushing's can make dogs more vulnerable to things like high blood pressure, high cholesterol, protein-losing kidney disease, blindness (as a result of high blood pressure), pancreatitis, ligament damage and slow healing, chronic infections and skin issues, GI disturbance, etc. Not every dog will suffer from all or even many of these issues, but the disease can make them happen. For a younger dog, I would want to provide as many quality years of life that I could, and that would mean putting a stop to the development of the internal systemic damage as well as relieving the uncomfortable outward problems.

However, since the damage usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly. Instead, my biggest concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I might choose not to treat, especially if my senior dog suffers from inflammatory conditions like arthritis that may actually be soothed by the elevated cortisol level of Cushing's. Treatment also involves frequent vet visits and blood draws, especially at the beginning. So again, if vet visits are really stressful for a senior dog, I'd also factor that into my treatment decision.

Marianne

[Rockysmom]

Thank you so much for your response Brittany. You have no idea how much everyone's responses help me with this. I'm learning new information and getting great advice. Rocky is my life and I just want to do whatever is best for him. I'm thinking not treating at this time is the best decision, he seems so much better now that he has been off the Vetoryl. I hope that your Summer continues with success and hangs in there for some more years. They are our babies :)

[Rockysmom]

Thank you so much, Shana

[Rockysmom]

Thank you for letting me know about the changes with dosage of Vetoryl. I am still definitely planning on a follow up appointment to discuss all of this and my concerns with the vet. I'm not opposed to taking Rocky for a second opinion as I just want to do what is absolutely best for him and his health as long as I have him. He already has a mild heart murmur and allergies (scratching his face and chewing his feet) He even has a few bumps that they refer to as old man bumps and 2 fatty cysts. The message you shared from Marianne really puts things in perspective as well. Thank you again! All of you on here are helping me tremendously and I'm so thankful that I found this site.
Michele