(Originally posted: 10/30/2011 — See update at end)
Just wanted to follow up on the October 1 post, Whose Dog Life Is It Anyway, as I’m still getting occasional responses.
I’m writing the follow-up because dogs like humans are now living longer, but as with humans, extended life is not necessarily quality time, and may involve living with chronic debilitating conditions that require extensive and expensive treatment. More owners of geriatric pets are faced with a dilemma. Is it better to treat or to let nature take its course, and at what point is euthanasia the best option? So I’m going to review Maizie’s treatment, its outcome, and lessons learned, in case this is useful for other people with geriatric dogs diagnosed with Cushing’s, who come across this in their web travels.
Maize, a Jack Russell mix, is (probably) 15 years old. While she had abnormal liver enzymes indicative of Cushing’s disease, she was asymptomatic until July when she began to drink excessive amounts of water and urinate all over the house. She also could no longer hold her urine while sleeping or lying down and would wake up wet.
Testing revealed it was indeed Cushings. The two most effective treatments are either Lysoderm or Vetoryl. Lysoderm is the older treatment. The medication itself is less expensive than Vetoryl, but dosing can be tricky. Both drugs require frequent and very expensive monitoring in the form of invasive tests. The little research I did, led me to think Vetoryl would be a better choice. The vet started Maizie on 60 mg a day, based on the Dercha’s (the manufacturer’s) recommendation for her weight. Had I been paying more attention to the very helpful Canine Cushing’s forum,, I would have insisted they start her on less. As one of the more experienced consumers later told me, despite Dercha’s recommendations, there’s “no rhyme or reason” to how dogs react to Vetoryl. A big dog may do well on 10 mg a day, while a Chihuahua might need 30. Within ten days the polydypsia and polyuria had abated. Her first ACTH test showed that her cortisol level had come down. A more experienced vet, might have noticed it came down too much and too quickly. She didn’t and neither did we. The vet, at our insistence also started her on something for the incontinence that was still ongoing when she was sleeping. The medicine was called Pro-in. This was another one I wish I’d researched more on the net. Pro-in is the same formula as the old formula for Dexatrim, an OTC diet-pill for humans. The formula was banned for causing strokes in humans. Anecdotally, at least, the same problem is seen in dogs. Maizie seemed to lose her appetite almost immediately upon starting it. We lowered the dose and then stopped it within a couple of days. In retrospect, the reaction may have been a coincidence, though who knows? In any case, she was going downhill. Her cortisol had crashed, and she was in an Addisonian crisis. After prednisone, IV fluids, and an overnight at the vets, she came home, tapered off the pred and was once again symptomatic for Cushing’s. More tests and she was restarted at 30 mg a day of Vetoryl and DES for the incontinence. (Yes, that DES). She crashed again. The second time was so bad that we couldn’t get her to take the prednisone and she had entirely stopped eating. A two-day stay at the vets with more fluids, and more prednisone got her eating again. The bill was astronomical.
She came home. Again we had to taper her off the pred. The vet wanted us to bring her back for an expensive test to see if she was permanently Addisonian. We declined. Clearly she wasn’t. Her thirst, appetite and peeing were back. She still had the Cushings. Rather than start her on an even lower dose of Vetoryl, we made another decision. I bought Wee-Wee Pads. As we couldn’t live with the polyuria and were heading toward euthanasia, this was a kind of a “hail-Mary pass.” To our astonishment, she figured out what we wanted her to do with them within two days. All it took was putting the pads over the areas where she was most likely to urinate, praising her when she went on the pads, and scolding her when she didn’t. Suddenly, we weren’t slipping in urine puddles. We weren’t upset. She wasn’t nervous. She still signals when she has to move her bowels or just wants the opportunity to troll the buffet that is Amsterdam Avenue. We still walk her several times a day.
I wouldn’t have thought we could live with the pads, but here’s the thing — her urine is so dilute it doesn’t smell and the pads really do absorb ten times their weight in fluids. It’s easier than dealing with cat litter.
At this point the only medication she’s on is the DES, which is still working the way it’s supposed to and keeping her from wetting herself in her sleep. What she can’t do is hold out very long when she’s awake.
We are also giving her melatonin as a supplement, which may or may not be doing anything, but is touted by some as a natural alternative, and may slow down tumor growth. We’ve also started her on wet food only. This also may or may not make a difference, but she’s old and she likes it.
The take away for us is: If we had known that the Vetoryl would bring her so close to death, and how expensive treatment would wind up being — not only because of the required ACTH tests, but because of the iatrogenic Addison’s, then we would not have started to treat her. While Cushing’s is progressive, treatment probably does not extend life in geriatric dogs, and the high cortisol levels actually help alleviate symptoms of other age-related conditions like arthritis. If we’d known how easy it would be to train her to use the pads, that’s what we probably would have done in the first place.
Because every case is different, I’m hesitant to give advice, but if your geriatric dog is diagnosed with Cushing’s, here’s what I would recommend:
1. Read the forum. The people there are consumers not vets, but some of them may be more knowledgeable than your vet regarding treatments and side effects. While I had looked at the forum, I didn’t realize how helpful it could be. The people there will ask you to give them your lab results. Give them the information and take their advice. Ask them questions before making decisions.
2. Both Lysoderm and Vetoryl have some pretty severe side effects, including permanent Addison’s. You might be better off finding out which medication the vet has more experience with and going with that. Also if your vet does not have extensive experience with Cushings, find one who does.
3. If the vet is using Vetoryl, insist they start at a much lower dose than Dercha recommends. They started Maizie at 60 mg. If she’d weighed a couple of pounds less, it would have been half that. I wish they had started her at 10mg. Treatment protocols call for testing after 10 days, so if the low dose doesn’t work they can gradually raise it. That does mean you’ll be living with the symptoms longer, but the cost to you and your dog will be less.
4. Consider NOT treating. Most people begin treatment only when the polyuria becomes a problem. Treated or not, most dogs with Cushing’s are dead within two years. The Cushings may be masking other problem like arthritis, especially in geriatric dogs, and per the earlier information the medications can be pretty nasty. If your dog is NOT symptomatic and Cushings is only suspected because of tests, consider starting some safe alternative treatments like melotonin and/or flax seed oil. Melotonin may slow the growth of the tumors that causes the cortisol to rise, delaying your dog’s becoming symptomatic. If your dog is symptomatic, consider whether or not these are symptoms that you and/or the dog can live with. In Maizie’s case the main symptoms are excessive urination and excessive drinking. The drinking isn’t all that excessive. That is, she doesn’t seem to be dying of thirst, just drinking about two or three times as much as she used to. The urination was making us all nuts until she learned to use the pads. We are all happy now.
5. If you aren’t blessed with a house in the country that features a doggie door, buy Wee-Wee pads. Even without Cushings, as your dog ages, she or he may need more walks than you can reasonably supply. They are far superior to paper, and as stated earlier, training and clean up are simple.
Update: 7/15/13 — Maizie crossed the rainbow bridge on Saturday, July 14, 2013. Euthanasia was a tough decision as there was no one “This is it” moment. She’d been having gastrointestinal issues for a while and losing weight. It finally reached the point where medication wasn’t helping to stimulate her appetite, and her sense of smell and taste were diminished to where she would reject anything that wasn’t loaded with sodium. Basically, her last week, she was eating only Chinese take-out duck, and chicken-shack rotisserie chicken, and even those reluctantly, with coaxing, and not enough. (Yes, we tried healthier alternatives including homemade foods.) At the same time, she seemed hungry, and we knew that must have been torturous.
She died of age-related conditions, that weren’t related to Cushings. Again, this is only our story, but I would urge anyone whose dog has been diagnosed to learn everything you can, find a vet you can trust (We changed vets after we decided to take her off Vetoryl) and consider both the age and temperament of your dog. In Maizie’s case, the stress level of frequent vet trips for the testing the medications require would have killed her even if the drugs themselves didn’t. We hope we gave her the best possible quality of life in the two years since her diagnosis, and are sure we made the right choice in taking her off the anti-Cushings meds.