Letters from readers:

Cushings disease often
difficult to diagnose

Hello,
I have a 10-year-old female dachshund. The vet just tested her for thyroid problems and her thyroid was OK. Now they are going to test her for Cushing’s disease. From what I have read on the computer it sounds bad. She weighs 30 lbs and we have cut her back on her food and the rawhide chews we give her. I am feeding her Purina low fat dry dog food.

The description for Cushing’s disease seems like it covers my dog’s symptoms except she still holds her bladder good. The medicine for Cushing’s sounds like it is really rough on a dog too if I decide to treat her. What do you think I should do? If I don't treat the Cushing’s disease if she has it, what should I expect? Would she be suffering? She shows no symptoms of suffering now. I don't know what to do. I think the medicine is really expensive too. I am on a pension so don't know if I would be able to buy it either. Can you give me any answer what I should do, and what to expect if I don't treat this? Please answer right away I need advice what to do. - Faye

Hello Faye,
I am sorry to hear about your little dog. I have to say that if she does have Cushing’s and is not yet at a stage where she needs to go on medication, then there is no reason to start medication yet. But the treatment of course would depend on the type of Cushings present, if she does test positive. For anyone with the same prospects one good website to go to for advice is:
http://www.kateconnick.com/library/cushingsdisease.html

Basically it gives three reasons for Cushings - a pituitary tumour; an adrenal tumour; or too much medication with steroids. The last one can easily be reversed - simply stop giving your dog steroids. If the dog is on medication that you are unfamiliar with ask the vet what the medication is and check whether it is a steroid. You may have to INSIST that your dog has no more steroids. This could be awkward if the steroids are treating an unrelated condition – in that case discuss this with your vet and reduce steroids to the lowest dose possible.

If too many steroids for too long is not the cause, then a tumour of some type is indicated. They can be pinhead size and benign, or they can be malignant, so testing must be done to determine the type and size and method of treatment. Luckily MOST such tumours are not malignant. Treatment is not always clear cut and often the tumour is hard to find.

Whatever the outcome, do make sure your vet keeps you fully informed and do discuss everything with her/him and where you do not want a certain treatment make sure you tell the vet why, and discuss alternatives. If there are no tumours and the vet thinks the dog still needs some help, then NSAIDs (non-steroidal anti-inflammatories) are sometimes an alternative to steroids and may be a better option.

If the problem is pituitary-based then discuss with your vet the use of Selegiline (Anipril) rather than other medications. From recent case results it seems that this particular medication is one that does provide better results when started early and the improvement is very noticeable. With this type of Cushings it is better to start treatment early.

However, if the tumour is adrenal then the chance of it being cancerous is about 50:50. The treatment for the benign type may be surgical, depending on circumstances, and the same for the malignant type but expectations for recovery are mostly not good if the tumour is malignant. If you do opt for treatment the follow-up medications are very expensive and will not necessarily result in a cure.

As you see with this illness everything is relative and depends mainly on the type of  Cushings, but also on the age and health of the dog, what the dog's future quality of life would be like, and what the cost of the treatment would be. For example, if diagnosis was a malignant tumour you may have that tumour removed surgically and follow-up radiation therapy, but it is very expensive and the malignancy is most likely to have already spread to lungs, liver or other organs. Better to make the dog as comfortable as possible for the time left.

But with the other types of course the prognosis is much better and the dog can look forward to its normal lifespan. I hope this helps and that the news from the tests are all good. - Ed