New diagnosis - questions for other readers

[Audrey]

I am new to this group. I have a 13 3/4 year old Golden Retriever who we believed to be relatively healthy until he received the diagnosis of Cushings. He had been referred for an ultrasound after high liver values in his bloodwork. This was seven months ago and a liver mass was also found when the ultrasound was done. Last week he had another ultrasound and the liver mass had grown and there was a new mass which was 7 cm in size. So in addition to Cushings he has these two fast growing masses. I want Vinny to be comfortable and I have assured him that I will do the best for him. No vet can tell me if the excess cortisol he has circulating in his body is part of what keeps him feeling good at his age or what the effect of excess cortisol would be on the liver masses. The internal medicine vet told me that there is ongoing research about how the cortisol might effect the masses and I have signed Vinny up to participate in the research.

I guess my question to people in this forum is how their dogs felt pre-treatment vs. post-treatment. The vet mentioned that once the cortisol level is correct any arthritis that Vinny has might feel worse. This makes sense as cortisol has an anti-inflammatory effect. Vinny's arthritis is not too bad considering his age and his weight (60 lbs. and fit) and I do not want him to live his last months in pain.

Does anybody know of dogs who had side effects from the treatment?

Is everybody using trilostane or are there any other medications in play?

Thanks for reading this.

[labblab]

Hello and welcome to you and Vinny! I’m very sorry to hear about those liver masses, but it sounds as though you’ve got a specialized veterinary team in place to help guide you through the steps ahead. First of all, congratulations to you for keeping Vinny so healthy and happy for almost 14 years — that’s a huge achievement for a Golden :-). As far as the Cushing’s, given his age and the circumstances, I must admit that I’m surprised that the internist is encouraging you to treat Vinny unless he is visibly suffering from outward symptoms of discomfort such as excessive thirst, urination, hunger, etc. The wild card about which I have no knowledge, however, is your mention of a possible link between liver tumor growth and cortisol level. If there would be a possible benefit in that regard, then that may indeed be a treatment consideration.

Otherwise, for senior dogs whose only Cushing’s symptoms are abnormal lab values, the “cons” of treatment may outweigh the “pros”: the need for frequent blood test monitoring, the risk of unwanted side effects if the cortisol level drops lower than desired, and the possibility of increased arthritic pain as you’ve already noted. In younger dogs, the benefits of Cushing’s symptom resolution and the lowered risk of long term systemic damage typically outweigh the cons. But to be honest, if my own older dog was generally asymptomatic, I’d really have to think twice.

But once again, there may be more to Vinny’s treatment picture than I’m aware. Is he experiencing discomfort from the Cushing’s? And can you tell us more about this research study? Thanks so much in advance for any additional information. And once again, we’re really glad you’ve found us!

Marianne

[Audrey]

Thank you so much Marianne for your response. When I first started typing this 6 hours ago we had already decided to get Vinny tested and to go ahead with treatment. Now we have changed our minds and I have called to cancel tomorrow's appointment for testing. Your response helped us with some issues and we are very appreciative. Vinny does not seem to be experiencing any discomfort from the Cushing's however he slipped down the bottom 6 or 7 steps onto a concrete basement floor about 40 hours ago. He is now on gabapentin. Pain killer choices are limited due to the liver disease. As of this morning he appears to be his old self thank Heavens. He had been going downstairs with my husband and the other dogs so my husband could do obedience training with the young ones. Vinny likes to go down also and my husband throws the dumbbell for him a few times.

We are comfortable with this resolution about treatment. I am so glad somebody referred me to this forum. We are in this together for the (hopefully) long run

[Audrey]

I forgot to answer your question about the research study. All I know at this point is that it is being conducted at Cornell University by the "liver guru" as other vets call her. My internal medicine vet is going to contact the guru for me. I will post any information about it that becomes available.

[labblab]

Audrey, we’ll really appreciate hearing more about the Cornell study. Thanks for looking into that for us. Poor Vinny, falling down the stairs like that! So glad to hear that he seems to be doing much better again already.

So just to clarify, Vinny is suspected of having Cushing’s but has not yet been given one of the actual diagnostic blood tests for confirmation? Is that what had been scheduled for today? The two tests are either the ACTH stimulation test or the LDDS (Low Dose Dexamethasone Suppression test). Each of the two tests has strengths and witnesses, and one or the other may be preferred depending upon the specific health history of any given dog.

Focusing back on Vinny, does he exhibit any observable symptoms of Cushing’s such as excessive thirst/urination/hunger, hair loss (especially on bilateral hair loss on flanks and haunches), pot belly, seeking out cool places when at rest? Has the internist been actively encouraging you to test and treat Vinny, and if so, do you think it’s because of the Cornell study? As I wrote above, I would have personal reservations about treating my own older dog, but I also don’t want to wave you off prematurely if there’s some specific reason why the internist believes that treatment would be of particular benefit to Vinny.

Marianne

[Squirt's Mom]

Hi Audrey! Welcome to you and Vinny!

If I were in your shoes I would simply forget about Cushing's. For one thing, the liver mass can cause false-positives on all the cushing's test. These tests can only tell us IF the cortisol is elevated but not WHY. My own Squirt got false positives on the LDDS, HDDS, ACTH, and UTK panel due to a tumor on her spleen. Once that tumor was removed her cortisol returned to normal. So I would question any positive test result for Vinny with two masses on his liver. For another, liver disease can cause signs that mimic the Cushing's signs so another point of confusion. And finally, the drug most often chosen to treat Cushing's these days is Vetoryl which cannot be used in dogs with renal or hepatic disease. So that leaves only Lysodren as a treatment option....and even tho it is my personal drug of choice most vets are very hesitant to use it. All of these thoughts are in addition to the fact that you don't start treatment on a dog who does not display fairly strong signs since the signs are used to help determine if the treatment dose is working or not. So I would focus on the liver solely myself.

It is exciting to hear someone is researching cortisol for any reason! So thank you for sharing this information with us and I hope you will be able to keep us updated on the trial and anything you learn. It seems Cushing's and cortisol research always takes a back seat to all other diseases so this is great news to hear indeed!

I'm glad you found us and hope you stick around regardless whether you choose to treat or not. You and Vinny are now part of our little family here. ;)

Hugs,
Leslie

[Audrey]

Thank you Leslie. I certainly do plan to stick around! Interesting statement about liver masses possibly causing false positives on all of the tests for Cushing's. I did notice that Vetoryl was not recommended for dogs with liver disease but the wording on most sources is "primary liver disease" whatever that means. I did mention that to the internal medicine vet who saw Vinny and she pooh-poohed that.

Did you know about the tumor on Squirt's spleen before the Cushing's testing? Poor baby having to go through all those tests. Poor you because those tests are pricey. I trust she is doing well now.

[Squirt's Mom]

No we didn't know about the tumor when we were doing the tests prior to the ultrasound. It was the last test we did and that is when we found the tumor. The testing bothered me more than it did her! LOL She was a tough little thing and I miss her dearly.

She had to leave this life in May of 2014 and tears still fall when I talk about her. She was my Sweet Bebe, my Beloved, my heart-n-soul dog and I can't wait til I get to hold her once again. It is in honor of her that I continue to work on this forum and the Facebook pages and that I co-founded and manage a non-profit devoted to helping families in need who have a dog with Cushing's. In these small ways I keep her close to me and am able to share her with others.

[Audrey]

I can feel your love for Squirt in your words. Hugs.