Life with Canine Cushing’s Disease

If losing a pet can have a silver lining, for me it was the connections I developed with online support groups. In 2012, my husband and I fostered a silky terrier with Cushing’s Disease. For three years, his disease was managed by medication. When his health began deteriorating, I joined the online K9cushings.com. Although we lost Gizmo only a few months later, I kept active in the group to learn more about the disease. Below is a summary of my conversations with seven members of the support forum who were only too willing to share their knowledge of what can be a life-altering canine disease.

What exactly is Cushing’s Disease? Considered one of the most common endocrine disorders to affect dogs, Cushing’s is the overproduction of cortisol—a hormone that helps canines respond to stress, fight infection, control weight, and maintain stable blood sugar levels—due to a pituitary tumor or enlargement of the pituitary gland. Tipper and Squirt Care For Cushing’s Fund Inc writes that Cushing’s is considered a disease of middle age and older canines, although the disease can strike dogs as young as two, and the average age at the time of diagnosis is around six or seven. Veterinarian Medicine states that close to 100,000 new cases of Cushing’s disease are diagnosed in geriatric dogs each year.

TobyHandled properly, most pets only experience mild or occasional setbacks. Treatment often scares many people away, due to an abundance of horror stories; however, treatment can literally be a life saver when done properly. From a practical standpoint, there is no way around it, this disease is expensive to manage.

–Renee, Mom of Toby

What are signs that a dog might have Cushing’s? Gizmo came to us at the age of ten having been diagnosed at least a year prior with Cushing’s, so I can’t speak from personal experience. The forum members I spoke with, however, reported the following symptoms that prompted the trip to the vet that resulted in a diagnosis of Cushing’s Disease.

  • Excessive drinking and getting pot belly. We went to our vet and he wanted to test for Cushing’s. I had never heard of it.”
  • Noticed that he was drinking a lot and he had bilateral hair loss.
  • Mostly … incontinence. He gained weight after I switched him to diet food and more activity/exercise.
  • I noticed, over time, that T.C. drank a LOT of water and could pee for a very, very long time. We actually timed him once and he peed for three minutes straight. When he got up in the morning, he went straight to the water bowl and would drink about 16 ounces non-stop.
  • She developed lesions which were biopsied and confirmed as calcinosis cutis. CC is generally presumptive for Cushing’s. In addition, she had the more common symptoms of [urinating and drinking more than normal], extreme hunger, muscle loss in the back legs, and chronic [urinary tract infections].
  • An IM specialist spotted Haleth’s adrenal glands were enlarged during a routine re-check.

One owner also created this flier about Cushing’s Disease and graciously allowed me to post it here.

CanineCushingDisease

How is Cushing’s Disease treated? According to Insights into Veterinary Endocrinology, since first approved for use in dogs by the FDA in 2009, trilostane (Vetoryl) has become one of the most popular drugs used to treat Canine Cushing’s. “By blocking these adrenocortical enzymes, trilostane acts to actively interfere with the adrenal’s metabolic pathways and decreases the synthesis of the adrenal end products, including both cortisol and aldosterone”. Vetoryl was one of the drugs prescribed to Gizmo. Four of the dog owners I talked with also used it. Other drugs used to combat Cushing’s are Selegine and Lysodren. One owner wrote about switching to Lysodren after using Vetoryl for 18 months: “[Vetoryl] could never get rid of his excessive drinking and urinating symptoms, although his lab results showed super tight cortisol control. I pushed my vet to send off blood for an adrenal panel at the [University of Tennessee], and all of his [secondary] hormones were off the charts, so we switched to Lysodren. He was well-managed on Lysodren.”

Katherine&TankThe first few months are the most difficult. You will be overwhelmed most of that time. During that time, don’t let the fear of the unknown prevent you from being in the moment as much as you can with your dog(s). They are most content when their owner is living life with them in the present. If a dog is controlled with medication for 6 months then that dog will most likely die from causes unrelated to Cushing’s. The medications work. Patience is a must; it sometimes takes a few months.

–Katherine, Mom of a Cushing’s dog

Cushing’s was not Gizmo’s only health issue. When Gizmo came to us, he was taking a total of eight drugs, supplements, and vitamins. Later when his appetite waned and it became a struggle to keep his weight up, we made continual adjustments to his medications in an effort to find the perfect balance between health and appetite. The majority of the pet owners I talked with didn’t have to deal with drug regimens as complicated as Gizmo’s; one did mention using milk thistle to treat her dog’s liver.

Yet the other pet owners still needed to closely watch symptoms and recognize the red flags. Day-to-day observation and appropriate timing of the necessary ACTH tests were key. One owner described the importance in this way: “I measured water intake daily on my calendar. I also watched him like a hawk when he ate, purposely trying to say his name and to see if we would stop eating while we were doing a lysodren loading phase. Regular ACTH stim testing during the start of medications and periodic stim tests (we did every 6-8 months) to make sure cortisol wasn’t creeping in either wrong direction.”

Elke1Bday06Don’t give up hope. Cush dogs with proper treatment can live a long time. It is not a death sentence. My girl lived to be a little over 16 years old.

–Barb, Mom of Elke

During his few years with us, Gizmo suffered from multiple afflictions common to older dogs. His eyesight was failing, as was his hearing, and he needed daily treatment for Cushing’s. Nearer to the end of his life, he also began to experience regular attacks of pancreatitis. For that reason, I asked the others what health problems, if any, their dogs suffered from in addition to Cushing’s. One mentioned a scare with acute adrenal crisis that required a trip to the ER, but noted that recovery was quick. Two owners cited weak back legs. Other health problems included: bouts with acute pancreatitis, chronic cough, deafness, enlarged heart and liver, nuclear sclerosis, as well as a stroke. While some of these (such as deafness) are not related to Cushing’s, others may be, and most certainly made it more difficult to treat their dogs’ Cushing’s.

Dogs can live for years with Cushing’s. Managing the disease is a constant struggle. The emotional rollercoaster ride resulting from Gizmo’s health was a new experience for me. Prior to this, all of my dogs had been healthy until close to the end. And I asked the other pet owners about their rollercoaster ride. What follows are their varied answers:

  • Watching my dog act 5 years younger after a month of treatment. It’s sad to think so many dogs go undiagnosed because the symptoms mimic the ageing process. My dog is very lucky. He hasn’t experienced too many bad days and his overall quality of life has significantly improved with treatment. I have educated myself and am fully aware of what this disease is capable of. I have to always be observant of any changes with him.
  • She did well on the medication. Some minor skin issues. Once you have a Cush pup you are always watching your other dogs for water intake.
  • Gosh, so many ups and downs, always. We have a good run every now and then, but something always seems to come up. I am definitely hyper aware of my girl and anything out of the ordinary.
  • The diagnosis and the medication adjustments can become trying. However, once you find the right medication and the right dose, it can be pretty smooth sailing. The biggest worry which Cushing’s meds is the fear of over control, destroying the adrenals completely, and having a very ill dog. The ups are that when properly managed, you get your dog back!”
  • The ups will come when the medication starts showing a positive effect. The downs are the symptoms like excessive peeing and drinking, weakness in the back legs, and the many skin infections she’s had. Her reaction to 50mg Trilostane, increased lethargy and loss of appetite, were additional downs.
  • Too new to say, it is expensive but he is worth every penny.”

When I first started planning this article, I read all the information recommended to me by those on the K9cushings.com forum. Yet because we had Gizmo for such a relatively short time, I felt it important for you to hear from those how had dealt with the disease from beginning to end. I want to thank the pet owners who responded me for their contributions, and leave you with their parting insights. Foremost, becoming an educated advocate for our pets is the best defense. Second to that is to have a vet who is experienced in the diagnosis of and successful treatment of Cushing’s, and who listens and welcomes questions. One owner elaborated, “I know that my vet had to have thought I was crazy a few times, but in the end, I turned out right. He even wrote in a note after TC passed that, ‘TC always kept me on my toes and refused to follow the book. I learned a lot simply by having him as a patient…. and he was a good one at that.’”

TCDon’t panic, it’s certainly not a death sentence. Typically, it’s “other” old dog issues that finally force us to say goodbye to our furry friends, not Cushing’s disease. Also, properly treated, the dog you thought was just “getting older” may gain a few years.

–Nancy, Mom of T.C.

Guest Post: Canine Cushing’s Disease

Reprinted with permission from Tipper and Squirt Care For Cushing’s Fund Inc, a 501c.3 Nonprofit Charity, Copyright 2015.

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He’s not only your buddy, your best friend, he is a member of your family… and you are worried about him. Last night, like every Monday night during football season, you took the Coke, popcorn, and Milk-Bones to the couch, calling out to your buddy to join you as usual. But for the first time since he was very young, eight-year-old Rover could not jump on the couch without help. His back legs acted as if they could no longer propel his weight up and forward to his customary seat beside you. As you lift your buddy up to the couch, you recall other changes in Rover over the last few months.

He seems to be hot all the time, lying on the floor vents and in front of the fan on the linoleum. He pants, heavily at times and often, as if he’s been running but Rover hasn’t wanted to run and play much at all lately, tiring after a short walk some days. Even though the temperatures are falling and he should be putting on his winter coat, Rover is shedding as if it were spring. He constantly begs for food and every time you turn around the water bowl is empty again – Rover has even had a few accidents recently, to his utter humiliation. To top it all off, Rover has developed a rather large pot belly yet the bones in his face are showing more. You decide to call his vet and make an appointment.

Two months and $2000 later, the vet tells you Rover has hyperadrenocorticism. The vet further tells you it will cost a minimum of $200 a month for the medicine to treat plus regular testing to monitor the medication. The monitoring tests would need to be performed an average of four times a year at $267 a pop but might be needed as often as eight times a year or more. The vet then gives you the bad news – in spite of the best efforts on their part and yours, Rover may well develop one of several serious complications which would shorten your best friend’s life dramatically.

Welcome to the devastating, life-altering world of canine Cushing’s.

Squirt
Squirt

Canine Cushing’s disease (hyperadrenocorticism) is a condition that results from the chronic overproduction of too much cortisol, a glucocorticoid, in the body. In the normal dog, the pituitary gland produces a hormone called ACTH (adrenocorticotropic hormone), which stimulates the adrenal gland to produce the glucocorticoid hormones necessary for the function of many systems in the body. If something goes wrong in the
pituitary gland or adrenal gland and too much glucocorticoid is produced, then Cushing’s disease develops, presenting with some common, varied signs.  This is one of, if not the, most complex canine diseases with a wide range of symptoms.

Cushing’s disease is considered a disease of middle age and older dogs though dogs as young as two (2) have been confirmed. The usual age of contracting the disease is around six or seven years with a range of two to sixteen years. There is equal distribution between males and females and although all breeds are at risk, some breeds reported to be at greater risk include: poodle, Yorkshire terrier, beagle, Boston terrier, boxer, dachshund, German shepherd dog, golden retriever, Labrador retriever, Scottish terrier and terriers in general.

Canine Cushing’s can present with many different signs. It is not uncommon for the dog owner to think the dog is simply aging instead of sick. The most common signs in canine Cushing’s are:

  • increased/excessive water consumption (polydipsia)
  • increased/excessive urination (polyuria)
  • urinary accidents in previously housetrained dogs
  • increased/excessive appetite (polyphagia)
  • appearance of food stealing/guarding, begging, trash dumping, etc.
  • sagging, bloated, pot-bellied appearance
  • weight gain or its appearance, due to fat redistribution
  • loss of muscle mass, giving the appearance of weight loss
  • bony, skull-like appearance of head
  • exercise intolerance, lethargy, general or hind-leg weakness
  • new reluctance to jump on furniture or people
  • excess panting, seeking cool surfaces to rest on
  • symmetrically thinning hair or baldness (alopecia) on torso
  • other coat changes like dullness, dryness
  • slow regrowth of hair after clipping
  • thin, wrinkled, fragile, and/or darkly pigmented skin
  • easily damaged/bruised skin that heals slowly
  • hard, calcified lumps in the skin (calcinosis cutis)
  • susceptibility to infections (especially skin and urinary)
  • diabetes, pancreatitis, seizures
Tipper
Tipper

There are two primary distinct forms of the disease – pituitary dependent hyperadrenocorticism (PDH) and adrenal dependent hyperadrenocorticism (ADH), both caused by tumors.

PDH involves the over-secretion of ACTH by the pituitary gland. ACTH is a hormone that stimulates the adrenal gland to produce glucocorticoids. In PDH a microscopic, usually benign, tumor on the pituitary gland in the skull causes over-secretion of ACTH, ignoring the adrenal glands’ response. The majority of dogs will have PDH (80-85%).

The adrenal-based form of the disease, ADH, is the result of an adrenal tumor that causes an over-secretion of glucocorticoids. Adrenal tumors are responsible for around 15-20% of the cases of Cushing’s disease. ADH can be cured via surgery called adrenalectomy if the dog is a candidate for this highly involved operation.

A third form of Cushing’s is called Atypical in which the cortisol is normal but one or more of five intermediate hormones are elevated. This form is controversial as studies have shown most dogs with elevated cortisol also have elevated intermediate hormones. Atypical has a unique treatment that initially involves the use of supplements VS pharmaceuticals.

There is also a form of the disease called Iatrogenic Cushing’s that occurs as a result of the use of steroids. In this form of the disease, symptoms of Cushing’s disease will usually go away once the dog is weaned off of the steroids if possible.

Cushing’s disease can present with a variety of symptoms and may also be involved with several different disease processes. Therefore, it is recommended that any dog suspected of having Cushing’s disease should have a complete blood count (CBC), blood chemistry panel, and urinalysis performed as a routine part of the diagnostic process. Common abnormalities in these tests include increases in alkaline phosphatase and ALT (liver enzymes), increased cholesterol, decreased BUN, and dilute urine (low specific gravity).

There are several different tests that can be performed to get a definitive diagnosis of Cushing’s disease. Many times the veterinarian may perform more than one test to help confirm the diagnosis or to determine which form of the disease is present. A diagnosis of Cushing’s disease, however, should never be made on the basis of laboratory tests alone. The dog should be showing signs of the disease as well and have a medical history consistent with the diagnosis. Most veterinarians will not start treatment on a dog that is not showing signs.

The three most common “screening” tests are the urine cortisol: creatinine ratio (UC:CR), the low dose dexamethasone suppression test (LDDS/LDDST), and the abdominal ultrasound. Other tests often used are the ACTH and the full adrenal panel from the University of Tennessee in Knoxville. The HDDS, or high dose dexamethasone suppression test, is rarely used since other tests can now help differentiate between PDH and ADH.

Treatment consists of several different options, depending on the form of Cushing’s diagnosed and the general health of the dog. If an adrenal tumor is identified, then surgical removal may be a viable option if the dog is a candidate. Currently researchers are working on a viable surgical option for the pituitary form but little progress has been made in recent years. Both ADH and PDH can be successfully treated medically.

Non-surgical treatment is the most often used treatment for cases of canine Cushing’s disease. There are currently four different pharmaceuticals (drugs) being used to treat canine Cushing’s disease. Mitotane (Lysodren), Vetoryl (Trilostane), Anipryl (Selegiline) and Nizorol (Ketoconazole). Of these, Mitotane (Lysodren) and Vetoryl (Trilostane) have proven to be the most effective.

This information is not meant to be a substitute for veterinary care. Always follow the instructions provided by your veterinarian.

This fund is In Loving Memory of Tipper and Squirt who both suffered from Cushing’s Disease.

This fund was born out of a depth of love and grief that defies language. It is an endeavor in honor of Tipper Stalma and Squirt Richards, who suffered with Cushing’s, as well as all cush babies around the world, past, present, and future. Through this fund, Tipper and Squirt, will live on with each cush pup who is assisted.

The mission of the Tipper and Squirt Care for Cushing’s Fund, Inc. is to financially aid families who are struggling to pay their dogs’ medical costs associated with the diagnosis and treatment of this complex disease.