My 14 y.o. mutt has been having urination issues for about a year. It has progressed from having an occasional accident inside to peeing constantly. Thankfully, she goes on the towels I leave around for her. She is not struggling to go and not being able, she is leaving sizable puddles and drinking lots and lots of water. She has been to two vets, her regular one and a specialist. Diabetes has been ruled out and she does have some stubborn infection in her bladder right where the urethra exits the bladder. There were two ultrasounds, one about a year ago and one about a week ago. The specialist says she is leaning away from cancer but can’t rule it out. The dog is going in for an all day test for Cushing’s, a series of blood tests over time. Appetite…excellent, pooping…fine, overall quality of life…pretty good considering her age and problems she is having. She is having trouble getting up and going up and down stairs.
I’m wondering what it’s like treating Cushing’s in a dog (if that is what it is) and wondering if anyone here has had experience.
If it’s the end of the trail I can accept that but I want to feel like I’ve explored the possibilities and I don’t want to jump the gun on putting her down.
My friend had a dog with Cushings. I don’t know all the details, but I do know that she tried very hard to keep it under control. There were lots of vet bills, lots of blood tests and lots of meds. She had him relatively stable and on the way home from the dog park one day, her car was hit by a drunk driver and he was fatally injured.
She has said that she’s glad she tried to treat him and that he tolerated the veterinary work well and that financially, she struggled but did have the means, but should she be faced with another dog with Cushings that she would not do it again.
2 years ago this month, we lost our 13 year old Border Collie mix to complications from Cushing’s. We had just started the treatment (Vetoryl–very expensive) when, and I am not a vet, she started throwing seizures–a dozen or so over two days. She never woke up again, and we had to have the vet come out to put her down. We had been told she MIGHT have gone another two years on the med, but I think the tumor was in her brain on the pituitary and that caused the seizures. And I don’t want to alarm you, but I feel the stress of having that day-long blood test was too much for her. If your pup has Cushing’s and if the tumor is on the adrenal gland(s), you have a much better chance of saving your critter.
I used to be an endocrinologist for people. When our wonderful black lab was 13, she developed symptoms similar to what you’ve described. Testing was done for a number of potential causes including Cushing’s. At the end of the day, that was what the vet said the diagnosis was.
As an endocrinologist, I was interested of course in the test and the results. Bottom line is that unless dogs have a totally different pituitary-adrenal system than people (and I really don’t think they do), the tests were not just not diagnostic of Cushing’s, they weren’t even the right tests for Cushings (all IMO).
Subsequently I searched the internet and learned that there is considerable misunderstanding about how to diagnose Cushing’s Disease among vets. You really need to find a specialist - I know it’s expensive. As an alternative to that, if they suggest doing an ACTH test to diagnose Cushing’s, ask why in humans ACTH tests are used for the opposite purpose - to diagnose Addison’s. You can write me to discuss their answer if you like. (BTW, in humans, one diagnoses Cushing’s using a dexamethasone suppression test or by collecting the urine and measuring it for cortisol. Again, ACTH tests have NO role in humans in the diagnosis of Cushing’s).
I hope I don’t sound like a chauvinistic doc, because I really am not. In fact, I bit my tongue and didn’t say a word about the tests (or the treatments recommended as a result). And I never quibbled about the bill.
Very shortly thereafter it became clear that our doggie was not having much quality of life, and we put her down. I never challenged the vet about the Cushing’s. There never was really the time.
Had a horse (large pony actually) that had Cushings. Vet bills and cost for meds were huge, and the meds were not very effective. Ultimately we had to have it euthanized.
I have a lot of experience with equine “Cushing’s”, and it isn’t really Cushing’s disease as either dogs or humans get it. I REALLY admire Karlgauss’s ability to bite his tongue. In horses, it’s a pars intermedia tumor, in the divider of the horse’s pituitary. They are functionally diabetic, and grow hair, and lactate when they shouldn’t if they are mares. I kept two mares with it alive for five years.
I practice a good bit of human mostly reproductive endocrinology, and pituitary micro and macro adenomas are not that unusual. Cushing’s, in my world, is.
Practically the first thing I would do in your situation is ask for some estrogen for your dog- a lot of elderly spayed females both canine and human have peeing issues. I’m assuming a bladder infection has been ruled out. I did this for our Labbish when she had end stage osteosarcoma- it worked a charm, and had nothing to do with her other disease, just made her happier as she was truly embarrassed by her incontinence. Well, I think being spayed really young contributed to both, but that’s another tail.
Depending on how NE in Indiana you are and how far you are willing to drive, I can recommend an internal medicine specialist in the Indianapolis are. (I don’t work there anymore but he’s fantastic.)
I had a cow dog who had the Cushings. I had just moved to Boise and the evil vet (never trust a vet who wears a muscle shirt and a gold chain) talked me into a surgery to remove the adrenal tumor. The dog was a young 13 at the time.
The vet opened him up, decided he also had terminal liver cancer, and just closed the incision without doing anything. Had they told me this right away, I would have just told them to kill him while he was under. But they told me when I came to pick him up, and he was conscious, so I just took him home. Paid $2k.
Then a few weeks later, the path report came back. Not liver cancer at all. And theywanted to know if I wanted to pay another $2k for another surgery to remove the adrenal tumor. Told them to go…
So, I ordered some trilostane (Vetoryl) from the UK and treated the beast myself, and he lived another 5 years and ended up dying of something completely different. I made him a big doggie door and a ramp so he always had really easy access to the outside, and don’t regret anything except paying lots of money to have him gutted by a quack.
Hi, other KG. Yes, dogs and horses are the two domestic species known to have Cushing’s (I think cats too, but even rarer), and in both species (and cat) they’re different than humans.
The diagnostic disease that you mentioned for humans is not considered the gold standard for dog Cushing’s, the ACTH is. And yes, we also use the ACTH to diagnose Addison’s, just like in humans. ACTH is the gold standard that a specialist would recommend. Added: Actually, the low dose dexamethasone test is the gold standard (not high dose). Link from Veteirnary Partner, a good resource for all.
There is another test, the low dexamethasone suppression test, which can be used in dogs, and both that one and ACTH are the tests considered valid. Cortisol levels in the urine are also not used as diagnostic in dogs. Added: Just cortisol, no. The cortisol:creatinine ratio can be used, but only for screening, it is not considered a confirmatory test (per link above).
Now, high dexamethasone suppression test is not used in dogs and is not considered valid in dogs, but it IS the considered a valid diagnostic test for equine Cushing’s.
I can get more information, or perhaps a veterinarian with more experience in diagnosing Cushing’s can step by in the meantime.
But I just wanted to make you clear on that difference between humans and dogs (and horses and cats).
Interesting coincidence - my beagle was just diagnosed with Cushings and we started her medication today. I also had a beagle some years ago who had Cushings.
Things have changed in the last . . . 20 years or so in the treatment for canine Cushings. My old dog got Lysodren (mitotane), which worked well for her. Neither she nor my current dog had as severe symptoms as it sound like the OP’s dog has, though. My dogs didn’t have problems with incontinence, just heavy appetite, excessive water intake and frequent urination, and a pot-bellied appearance. I also understand that Cushings can cause muscle weakness/stiffness, which I do think my girl has now.
The current favored medication is Trilostane, which is an enzyme inhibitor and therefore theoretically less likely to cause an Addisonian reaction (although that still does occur in some small percentage of dogs). I hope it has the desired effect and improves the quality of life for Lily.
Interestingly my mother-in-law was diagnosed a few years ago with adrenal cortical cancer and I went with her on her visits to the endocrinologist. After startling the doctor by asking if the tumor was causing Cushings or Addisons and some questions on serum levels of cortisol vs. DHEA, I asked if mitotane was an option for humans (it was at this point that I revealed my ‘background’ in mammalian endocrinology ;)). Sure enough, mitotane is the major chemotherapeutic option for ACC in humans, although the treatment is usually surgery rather than chemotherapy.
Anyway, my old dog lived for years with Cushings disease (and heart disease) and was the usual beagle: running, jumping, sniffing, howling, eating and destroying my shit, and seemed happy with her life. She died of cancer, unrelated to the Cushings.
Again, thanks for the responses. I apologize for not responding much in this thread, in addition to the stress from my dogs problems I am in mid-move to another house and presently spending a lot of time maintaining both places as I move. I am reading all the replies.
My dog has had bladder infection and has been on antibiotics for about a year. It was off and on for a while and for the last couple months she has been on Simplicef (sp?) continuously. We tried cheaper alternatives but the Simplicef is the only one that has seemed to do anything. The specialist vet’s initial diagnoses based on the first ultrasound was an infection that had wormed it’s way deeply into the bladder wall. The bladder wall was thickened uniformly but no masses or obvious tumors. The recent ultrasound showed the bladder wall had returned to normal except for right where the urethra exits. She goes in for the Cushing’s test Tuesday.
She has been having muscle stiffness or weakness in her back legs.
Appetite is still good.
Still very interested in walks and sniffing other dogs poop!
My wonderful, beautiful cattledog had Cushings. I finally had him put to sleep because the suffering was more than he and I could bear. Before that though I had had him go through two surgeries (to remove items he had eaten because of pica). I felt, at the end, that I had spent tons of money and concern just to watch him go through several months of suffering. Iwish I had put him down earlier.
Update. I had an all day test for Cushing’s scheduled for last Tuesday (a week ago). On the Sunday night prior to the test she had a bad night and seemed to be losing strength in her back legs. I called the vet Monday morning and asked what the test was going to cost. I wasn’t so much worried about the money so much as my gut feeling that it wasn’t going to make much difference. $325. I decided against putting her through the stress of the test and putting her in the vet’s kennel for the day. She has been about the same since except for having more trouble getting up from wherever she flopped down. Some days since then have been better, some were about like Sunday night.
Today I made the call and made an appointment for her last vet visit for Friday afternoon. My gut feeling is that I made the right decision. She’s still eating, still barking at squirrels and still wanting to go for a walk everyday about 5-ish. I can tell she isn’t feeling too good, and she’s getting kind of grouchy. She seems pretty content to sleep on the couch most of the time. She’s been ready, and I’m there now too.
Thanks to all for the input. I’m confident I’m not jumping the gun and that I didn’t wait too long (provided there’s no big downturn between now and Fri.)
Honestly, she’s been one of the best things in my life but it’s time.
I had a dog that got Cushings disease at 10 years old. Treatment was very expensive and he went downhill so fast that it probably wouldn’t have been effective. His muscles atrophied so fast. Very sad. I understand what you are going through and hope it goes as well as can. Give her a hug for me.