Cushing's disease in old dog...getting desparate...

[chicknmania]

WEll, that's weird. She might not have been that young, I can't really remember...but he's been telling us she has Cushing's disease for several years. And I know he did bloodwork.
She has had a LOT of health issues so it's hard to keep everything straight. But she has had the skin problems (itching) and the incontinence for at least the past two years that I remember.
And probably longer. And a year ago at LEAST, he told us what she would start doing..the pacing at night, the restlessness, the wanting to go out and then come right back in, the incessant drinking, itching an increased incontinence. He told us these were symptoms of Cushings and that they would become more evident as she got older. And they have.

So anyway I talked to the vet's office who's taking his cases while he's gone. The staff member from there said she would take our dog's file, and give it to their vet to review.
They hopefully can tell when he made the diagnosis, and whatever else they need to know, and they can then decide, based on that, if either of the meds you mentioned will make a difference for our dog. I was hoping they would be able to do that without us having to take her for another eval visit. She is 14 y.O. and I think it would be unfair to put her through a lot of testing and etc, and also I am not sure we could justify the cost since she is that old. I'lll see what they say.

Again, thanks for your guidance.

 

[SunnySkies]

Grr... That is very frustrating. I wonder why he did not offer any treatment.

There are three drugs used:
Mitotane
Ketoconazole
Trilostane, the newest one, most expensive, but the fewest side effects. I have seen this be like a miracle drug for several dogs. We have 5 Cushings dogs now, all on it, and the owners all say it is like having their dogs back.

 

[chicknmania]

I don't know. Every time she came in for anything, which wasn't too often, he'd ask me if she was drinking a lot of water yet. Which she wasn't. She didn't start doing that until a couple of months ago. Her itching stopped and the drinking started. And he was having us treat the itching with herbal shampoo and stuff, which worked pretty well, plus we switched her diet to top of the line food.

As you might expect, the substitute vet would have nothing to do with writing a prescription, even though they had the file. I told them I'm not bringing her in for a consult either. Not to them.

 

[SunnySkies]

Then you have two options:

Wait until your regular vet comes back
Get copies of your files with all bloodwork results and go elsewhere.

If your regular vet refuses to treat, I would question him and question hard. There are at least two treatment options available, plus it would be useful to know if it was adrenal versus pituitary...the former is completely treatable.

I have a 14 year old patient that underwent surgery for an adrenal tumor in December. It changed his life, and I fully expect he will live and give his owner joy for a few more years.

 

[chicknmania]

Ok, thank you, I had pretty much decided to just wait til he comes back. Due back the 14th, and in this cool nice weather, she's doing
ok, for the most part, though she sleeps most of the time. Did howl all night last night. Do you think it's ok if we give her Five Flower most nights before bed? It calms her down and helps her sleep, of course, but it does have a lot of alcohol in it.

If she does have a tumor I'm not sure we would go the surgery route. But at least know I will know how to proceed with questions.
I will let you know how we get on, and what the end result is.

thanks.

 

[RHRanch]

I think sunnyskies makes some good points, and if I were you I would consider a second opinion at another vet office. Some of the vets in your currant office may not want to step on any toes, maybe that's part of why you are not getting anywhere. I think the new bloodwork.tests are worth putting your dog thru it can't be worse than the suffering she is undergoing with her disease not being managed/under control. You may discover that she has been misdignosed, or maybe she will get better treatment even if she wasn't mis-diagnosed.

 

[chicknmania]

There's only one vet in the office, and the other substitute vet, idk, maybe they don't want to step on toes.
I'm not sure that whatever new meds they might describe would stop the muscle atrophy, would it? And that's a real
big problem for her, too. She is getting so atrophied in her hind quarters that she is beginning to have difficulty standing.
I don't doubt that she has Cushings, she has all the symptoms and furthermore, he told me in advance what symptoms
she would develop over time, and she has done exactly that. Yes, there is a question
of what kind, but I think his initial diagnosis was correct. My guess is that he probably was unaware of the medication,
because I'm pretty sure he would have offered it. He is an older vet, and we live in a small town. I will talk to him when he gets back.
Even if I took her to another vet here, the area is rural and I would probably run into the toe-stepping issue anyway.

Thanks for the input.

 

[chicknmania]

I just am reluctant to get into a lot of testing. My daughter did that with her cat. And she lives in a bigger city. What happened was she ended up
spending hundreds of dollars, on tests, at different vets, and the bottom line was, they didn't know what was wrong with her. And it was obvious.
The cat was just young too, only a year. And after all that stress, she ended up having the cat euthanized anyway. Sometimes, it is just better to
let it go....not that testing isn't appropriate in a lot of situations.

 

[SunnySkies]

What I have seen about testing is this.

Owner takes pet to see vet A. Vet A makes their tentative diagnosis and suggests testing to confirm or rule out a problem. Testing is equivocal and vet A suggests more testing.

Owner thinks about it and takes pet to see vet B. By then, the bloodwork is old, the pet is in worse condition, or new symptoms have started. Vet B recommends testing, and new results come up, or again, it is equivocal.

Owner either goes back to Vet A or sees Vet C. And we play the game again. Meanwhile, diagnosis becomes muddy and often impossible. Often the chart is confusing after seeing various vets, all with their own ideas and predispositions and recommendations, and the labwork is inconsistent, etc.

Usually they take a long time between visits, so the bloodwork is old. They often don't follow up with any of the vets, so the picture is not clear. It truly complicates matters. I'm not saying this is what happened here, but I am saying that often testing consistently is required to make a diagnosis. And yes, sometimes we don't get a diagnosis (and I would just about bet money that cat had FIP, difficult to diagnose while alive in some cases because there is not a great test for it).

Something else I have seen is owner misunderstanding the diagnosis completely. Yeah, it happens. Owners say and think all kinds of things. Sometimes they are correct. Sometimes, they are so wrong. Either they do not hear it correctly, they assume something, or we assume they know what it means and do not follow up with client education. Sigh.

I have a case right now that the owner is not accepting the diagnosis (healthy cats are fat because of overfeeding and limiting exercise by caging them all day) and so owner is taking them elsewhere. That is fine..I am not upset about it....but I know the other hospital will run labwork too, and all of this will cost a lot of money. I have seen more than one pet as a second opinion myself. Sometimes I have some ideas the previous vet didn't, sometimes not.

I have also run into cases where either vet or owner says, based on symptoms, Fluffy has X disease. Well, maybe Fluffy has X, but Fluffy might have Y too. But owner refuses testing. Or vet doesn't offer testing. But then I'm either asked to use a crystal ball or provide substandard care, or Fluffy might even get no care at all, none of which help anyone at all.

Again, I'm not saying this happened. I'm just saying there are so many permutations that saying because X happened to my friend/family member, I don't want to do Y does not make sense. The situations are likely very different. Your dog has a diagnosis of some sort. My question would be is it the only issue going on, how severe is it, and why has there been no treatment offered.

I also run into a lot of hospitals that don't refer like they should. Case in point: the 14 year old dog I mentioned earlier. I suggested he go see the specialist. Owner declined at first, but I insisted. The vet I work relief for scoffed. Owner finally went in and specialist with ultrasound discovered a huge adrenal tumor causing all his symptoms. He isn't the first I referred and he won't be the last, but this vet gets irritated every time I refer...well, my thinking goes like this: alive, they come in to see us, dead, they don't need anything we can offer. So if I am not sure, or I want my thoughts confirmed in a difficult case, I refer.

What I am puzzled about with your case is mitotane is a treatment that has been used for years. It is not without side effects for some patients, enough that I actually have never used it after getting out of school (I did use it in school while under the supervision of the residents) but it is right there in some old books I have. Ketoconazole is one I used quite a lot when I got out of school more than 10 years ago. So the treatments are there and definitely not new. The third option is newer but has fewer side effects than the first two for many dogs.

Treatment might slow the muscle loss. It might not reverse it though. But when my own dog was nearing the end, he trembled a lot too, simply from weakness. We had maxed out on trilostane, so I knew we were coming to the end of the road for him.

 

[chicknmania]

That is really strange. Because in the past re treatment of any animal he's always given us the options of treatment, the approximation as to cost, his personal recommendation, and let us make the decision. He's been around forever and we've taken Java (our dog) to him since she was a puppy. A few years back she got violently ill....trembling, vomiting...and it was on a weekend. We took her to the ER vet, and they charged us $800.00 to tell us what they though she had..and I can't remember now what they said. They would not release her to us, but only to our vet, which was ridiculous, I thought. Well, our vet poo pooed their diagnosis, and I think he was right. They let her rest in a quiet exam room for a few hours, prescribed an antibiotic for a minor UTI, and she was fine after that. She has had a long medical history including parvo which she acquired from the shelter where we adopted her. I really kind of think that he might just be burned out on this dog. There are days when I am.

She's been hit by a car, kicked by a deer, (or something), had a multitude of illnesses including chronic ear infections. That's why I'm a little fuzzy on details.

I think a lot of her problems have tied in to the Cushing's disease, assuming that's what she has. I will certainly ask him why he has not offered treatment. She was on Proin for a long time, for the incontinence, until it ceased working and started making her very nauseous..in fact that might have been the issue with the ER. I researched it on line and found a lot of people have found that that stuff is poison over time. So he just told me to take her off it, and didn't offer any recourse.