Is your middle-aged or senior dog drinking and urinating more than usual? Does your dog have a pot-bellied appearance? These are just a few signs of Cushing’s disease in dogs (also known as hyperadrenocorticism). Integrative veterinarian Dr. Julie Buzby shares symptoms, diagnosis, medications, prognosis, and life-expectancy for Cushing’s disease in dogs.
“Have you ever heard of Cushing’s disease in dogs?” I asked my new veterinary client, the loving parent of a 15-year-old Labrador Retriever, Jake. I knew it was important that we discuss Cushing’s disease at that appointment because Jake’s symptoms were textbook for the condition.
My client had mentioned noticing Jake’s thirst, urination, and panting were increased. These are three cardinal symptoms of Cushing’s disease in dogs. Also, while we were talking, I sat rubbing the thin skin of Jake’s pot belly. (Yes, thin skin and a pot belly are two more cardinal symptoms.)
By the end of our conversation, my client had a good idea of what Cushing’s disease was, tests for Cushing’s, and what the diagnosis could mean for his dog. And I hope you come away from this article on Cushing’s disease with a better understanding of the condition, too.
What is Cushing’s disease in dogs?
Cushing’s disease in dogs (i.e. hyperadrenocorticism) occurs when an older dog’s adrenal glands produce too much cortisol, a stress hormone. Cortisol is the body’s natural steroid and is absolutely essential for day-to-day life. Normally, the body regulates cortisol levels very carefully. But if the amount of cortisol gets out of whack, as occurs in Cushing’s syndrome in dogs, bad things can happen!
What causes Cushing’s disease?
This increase in cortisol levels can occur for three main reasons—a pituitary tumor, an adrenal tumor, or the administration of steroids. Let’s take a look at each of these three types of Cushing’s disease in dogs.
Pituitary-dependent Cushing’s disease in dogs
Approximately 80% of dogs with Cushing’s disease will have pituitary-dependent Cushing’s disease. This type occurs when the dog develops a tumor in the pituitary gland. The pituitary gland is a tiny structure located at the base of the brain that controls the secretion of various hormones.
One of the many hormones that comes from the pituitary gland is adrenocorticotropic hormone (ACTH). This particular hormone, ACTH, is what tells the adrenal glands (paired bean-shaped glands located near the kidneys) to produce cortisol. When a pituitary tumor releases more ACTH than normal, the adrenal glands obediently make more cortisol. And the end result is pituitary-dependent Cushing’s disease.
Do not fear, though! While the phrase “brain tumor” is frightening when used in the same sentence with our beloved dogs, these tumors are usually small and do not spread. Only occasionally does a dog have a larger tumor.
Overall, smaller breed dogs (e.g. Bichon Frises, Miniature Schnauzers, Yorkshire Terriers, Lhasa Apsos, or Jack Russell Terriers) are more likely to have pituitary-dependent Cushing’s disease. And they tend to be middle-aged or older (at least 7 years of age).
Adrenal-dependent Cushing’s disease
In the other 20% of dogs, a cortisol-secreting tumor grows on the adrenal gland instead. This tumor can be benign or malignant (i.e. cancerous). Since the adrenal glands make cortisol, functional adrenal tumors also lead to elevated levels of cortisol in the body. The official name for this form of Cushing’s disease is adrenal-dependent Cushing’s disease.
Unlike pituitary-dependent Cushing’s, adrenal-dependent Cushing’s is more common in medium or large breed dogs. And the average age at the time of diagnosis is 11 years.
Iatrogenic Cushing’s disease
While the pituitary-dependent and adrenal-dependent forms of Cushing’s disease are the two naturally-occurring varieties, there is also a third reason dogs can have Cushing’s disease—iatrogenic Cushing’s disease. The term “iatrogenic” indicates that a medical treatment or procedure accidentally caused the condition.
In the case of iatrogenic Cushing’s disease, the administration of prednisone for dogs or other corticosteroids causes the Cushing’s disease. These drugs mimic the action of cortisol in the body, so they can cause identical symptoms to adrenal or pituitary tumors. However, this is not to say that every dog who takes steroids will develop iatrogenic Cushing’s disease.
What are the symptoms of Cushing’s disease in dogs?
If you have ever taken a steroid (for example, prednisone) for a medical condition, or your dog has been on steroids in the past, you may have some idea of the symptoms of Cushing’s disease in dogs. They tend to be very similar to the side effects that humans and dogs may experience while on steroids.
Changes in thirst, urination, appetite, and behavior
Dogs with Cushing’s disease may change their normal habits or behavior. Some common signs include:
- Increased thirst in dogs (i.e. polydipsia)—occurs in 80-90% of dogs
- Increased urination (i.e. polyuria)—occurs in 80-90% of dogs
- Leaking urine
- Increased appetite (i.e. polyphagia)
- Restlessness, which may include senior dog anxiety at night
- Panting
- Circling, seizures in dogs or other neurologic signs (mostly seen if the dog has a larger pituitary tumor)
- Being a lethargic dog
Affects of Cushing’s syndrome on a dog’s back legs
Since Cushing’s disease can cause muscle wasting or lack of muscle mass, you may notice that your dog’s back legs are collapsing or your dog looks weak. Additionally, due to loss of muscle mass, dogs with osteoarthritis in dogs who develop Cushing’s disease may suddenly have an worsening of the signs of arthritis in dogs.
Senior dogs with Cushing’s disease may have trouble getting up from lying down, be more prone to slipping on the floor, or generally look more wobbly than normal. Additionally, these changes in the muscle mass, especially of the back legs, can make dogs reluctant or unable to continue their normal activity levels.
Changes in skin or abdominal contour
Additionally, you may notice Cushing’s symptoms related to your dog’s appearance, including:
- Weight gain
- Pot-bellied dog appearance
- Thinning skin
- Hair loss
- Dark pigmentation of the skin
- Comedones (i.e. blackheads)
- Poor hair regrowth (may be more noticeable if your dog was shaved for some reason)
- Firm areas of the skin (i.e. calcinosis cutis in dogs)
Increase in conditions related to poor immune system function
Since steroids suppress the immune system, dogs with Cushing’s disease may be more prone to various infections. Skin infections (i.e. pyoderma in dogs) and urinary tract infections (UTI in dogs) seem to be the most common. In fact, about 50% of dogs with Cushing’s syndrome have a UTI at the time of diagnosis, although they may not be symptomatic.
What are the stages of Cushing’s disease in dogs?
While there aren’t well-defined stages of Cushing’s disease in dogs, more and more symptoms may appear the longer a dog has Cushing’s disease. In the early stages of Cushing’s disease, you may notice that your dog is drinking more, urinating more, and eating more but otherwise looks fairly normal.
However, over time the excessive cortisol from Cushing’s disease may weaken the abdominal muscles, cause more fat to accumulate in the abdomen, and increase the size of the liver. Together, those changes can lead to the pot-bellied appearance.
Additionally, as Cushing’s disease progresses, you may notice changes to your dog’s skin and haircoat, increased panting, or more obvious muscle weakness. And your dog may be more prone to infections or show some changes in behavior.
In the final stages of Cushing’s disease, the dog’s symptoms may be severe and greatly impacting his or her quality of life. Your dog may be extremely thirst and hungry all the time or having accidents in the house from producing so much urine. Other symptoms of advanced Cushing’s disease in dogs include struggling to get around due to muscle weakness, painful, inflamed skin, or frequent infections.
How is Cushing’s disease diagnosed?
Sometimes you may see symptoms of Cushing’s disease and schedule a vet appointment. Other times, your vet may suspect Cushing’s disease after talking with you at an appointment. In either situation, the vet will select the diagnostic testing that he or she feels is right for your dog.
Testing to rule OUT Cushing’s disease
Sometimes, I recommend that my client starts with a simple and relatively inexpensive test called a urine cortisol creatinine ratio (UCCR). The UCCR test measures the ratio of cortisol (the hormone overproduced in Cushing’s syndrome) to creatinine (a normal component of urine).
Since cortisol is normally secreted in times of stress, for best results, the client should collect the dog’s urine sample at home, at least two days after a vet visit. This way, the dog doesn’t get anxious from a visit to the veterinary clinic, secrete a bunch of cortisol, and skew the results. Additionally, the first urine sample of the morning seems to provide the best results.
Before I run the test, I always want my clients to understand that the UCCR test rules OUT the diagnosis. But does not definitively rule it IN. In other words, an elevated UCCR doesn’t prove that a dog has Cushing’s syndrome. But a dog with a normal UCCR has a very low chance of having Cushing’s disease. Thus, the UCCR does a very good job of ruling OUT the diagnosis.
This may seem counterintuitive, but it’s actually quite valuable. If the UCCR is normal, we can cross Cushing’s off the list as a possible diagnosis. Then we can move on to figuring out what else could be causing your dog’s symptoms.
And if the dog has an elevated UCCR, this is an indication that we should perform more specific tests to confirm the diagnosis.
Testing to confirm Cushing’s disease
Tests to rule IN Cushing’s (i.e. confirm the diagnosis) are blood tests for dogs. There are three main tests—the ACTH stimulation test, a low dose dexamethasone suppression test, or a high dose dexamethasone suppression test.
ACTH stimulation test
The ACTH stimulation test involves drawing a blood sample to determine a baseline cortisol level. Then the vet will administer synthetic ACTH, which should stimulate the adrenal glands to release cortisol. In dogs with Cushing’s disease, post ACTH blood cortisol levels are usually elevated above what would be expected for a “normal” response to ACTH.
This test is positive in around 80-85% of dogs with pituitary-dependent Cushing’s disease and 60% of dogs with adrenal-dependent Cushing’s. It cannot distinguish between the two types. The ACTH stimulation test is, however, the test of choice for diagnosing iatrogenic Cushing’s disease.
Low-dose dexamethasone suppression test
For the low-dose dexamethasone suppression test (LDDST), the vet will draw a blood sample to obtain a baseline cortisol level. Then he or she will give the dog a low dose of the steroid dexamethasone. In a normal dog, the dexamethasone should tell the body to make less cortisol. However, in dogs with Cushing’s disease, a low dose of dexamethasone will not suppress cortisol production.
The test is positive in about 90% of dogs with Cushing’s disease. And about 50% of the time, it can distinguish between pituitary-dependent and adrenal-dependent Cushing’s disease.
High-dose dexamethasone suppression test
The high-dose dexamethasone suppression test is performed in the same basic way as the LDDST, except it uses a higher amount of dexamethasone. The goal of this test is not to determine if the dog has Cushing’s disease but to attempt to distinguish between the adrenal-dependent and pituitary-dependent forms. Sometimes it is able to do so, but not always.
Each of these three tests has some pros and cons. Your vet will select the one that he or she thinks is right for your dog. In some situations, your vet may recommend more than one of these tests. This is especially likely to be the case if he or she is trying to differentiate between the three types of Cushing’s disease.
Some dogs require further diagnostic testing
Occasionally, the results are still not conclusive. In order to nail the diagnosis, the vet may recommend an abdominal ultrasound to assess the adrenal glands. Or she or she may suggest an MRI or CT, further bloodwork, or other tests.
In addition to tests to rule out or confirm Cushing’s disease, your veterinarian may also recommend a urinalysis and/or urine culture. These tests look for evidence of urinary tract infections, which can be “silent” and accompany Cushing’s disease, especially in female dogs.
How is Cushing’s disease in dogs treated?
In most cases, Cushing’s is a lifelong disease that often requires daily treatment and careful monitoring by your veterinarian. It is a commitment and it can be daunting. However, the good news is that there are several treatment options to help your dog feel better.
Medical treatment for dogs with Cushing’s disease
Often, medications to control cortisol levels are the treatment of choice for managing a dogs with adrenal or pituitary-dependent Cushing’s syndrome long-term. (Treatment for iatrogenic Cushing’s disease just involves carefully weaning the dog off of steroids.)
Common medications used to treat pituitary or adrenal dependent Cushing’s disease in dogs include:
Vetoryl
Vetoryl® (trilostane for dogs) is currently the only veterinary-approved product on the market that treats both the pituitary and adrenal-dependent forms of the disease. It blocks the production of cortisol to bring cortisol levels back to normal.
While side effects of Vetoryl are fairly common, they are thankfully usually mild and only last for a few days. Some of the potential side effects include nausea (which can be decreased by giving Vetoryl with food), vomiting, decreased appetite, lethargy, diarrhea, or weakness.
Lysodren
Another treatment option is a drug called Lysodren® (mitotane). It targets the adrenal glands, which are over-producing cortisol. This medication keeps the glands from producing as much cortisol by selectively killing some of the cortisol-producing cells.
Typically, but not always, the vet will use a two-phased approach to treatment. The first phase, induction, uses higher doses of Lysodren. It is important to watch your dog carefully, especially during this phase. If your dog isn’t eating as much, has vomiting or diarrhea, becomes lethargic, or isn’t drinking enough water, promptly contact your vet. Those symptoms indicate it may be time to switch to the maintenance phase, which uses lower doses of mitotane long-term.
Overall, dogs in either phase may experience side effects such as decreased appetite, lethargy, weakness, vomiting, or ataxia (i.e. unsteady gait). If you see these side effects, it is best to check in with your vet.
Selegiline, ketoconazole or melatonin
Selegiline for dogs, a drug used to manage canine cognitive dysfunction, is also approved to treat the pituitary-dependent form of Cushing’s disease. Also, there are some off-label medication options for Cushing’s disease such as ketoconazole and melatonin for dogs.
However, melatonin and ketoconazole are not approved to treat Cushing’s disease. So they must be used with care and with the understanding that they may not be effective. Plus, if you choose to try melatonin for your dog with Cushing’s disease, please be aware that some products, especially melatonin gummies, may contain xylitol, which is toxic for dogs. Always check the label for xylitol (i.e. birch sugar) before giving melatonin to your dog.
Surgical treatment for adrenal-dependent Cushing’s disease
Additionally, if an adrenal tumor is the cause of the Cushing’s, the affected gland can be surgically removed. This is not a simple surgery and is ideally performed by a board-certified surgeon. Risk of hemorrhage from surgical removal of the gland is significant, as is the risk of other post-operative complications.
Depending on the study you look at, between 10% and 25% of patients may not survive surgery and post-op period. Thus, many pet parents opt to treat their dogs with medical management to avoid the cost and risk of surgery.
What sort of monitoring do dogs with Cushing’s disease require?
It is important to know from the outset that dogs taking medications such as Vetoryl or Lysodren require close monitoring with frequent lab work.
Sometimes these medications can work TOO well and cause the opposite condition—hypoadrenocorticism (i.e. Addison’s disease in dogs). If you notice signs of Addison’s disease such as vomiting, diarrhea, lethargy, tremors, or loss of appetite, contact your veterinarian immediately. Addison’s disease can be life threatening, so it is critical your dog gets veterinary attention right away.
On the other hand, if it seems like your dog’s Cushing’s symptoms aren’t resolving, or if they go away and then come back, you should also give your vet a call. This may be an indication that the Vetoryl or Lysodren dose isn’t sufficiently controlling your dog’s Cushing’s disease. Or it could mean that your dog has developed a concurrent condition with similar symptoms, such as diabetes in dogs.
In addition to monitoring your dog’s symptoms, you will need to bring your dog back to the vet periodically for an examination and follow-up bloodwork. This is important so the vet can determine how well the medications are working.
In the interest of full disclosure, these vet visits can represent a significant financial and time commitment. When initially starting therapy and when making dose adjustments, your vet may need to examine your dog and run bloodwork as often as every few weeks or months.
How can I help comfort a dog with Cushing’s disease?
In addition to treating your dog’s Cushing’s disease and keeping up with the necessary monitoring, here are five more things you can do to be vigilant in managing your dog’s condition.
1. Keep your dog’s water bowl full of fresh clean water
Always have fresh water available. As I mentioned, Cushing’s causes increased thirst and urination, so your dog will want to drink more and need to go out frequently for potty breaks. Make sure you refill the water bowl often and give your dog plenty of opportunities to go potty.
2. Be on the lookout for signs of skin problems
Keep a sharp eye on your dog’s skin. If you notice signs of skin infection such as bumps, crusts, hair loss, or red irritated skin, speak with your vet. It is important that skin infections are addressed promptly. In some cases, your vet may also prescribe antifungal and antibacterial shampoos and wipes to proactively help combat skin infections.
3. Know how to recognize the signs of a UTI
Watch for signs of urinary issues such as increased frequency of urination, foul odor to the urine, straining to urinate, and/or blood in the urine. If you observe any of these signs, take your dog to your veterinarian. For dogs with Cushing’s, urinary tract infections are nearly impossible to prevent. However, you can help your dog by seeking treatment promptly.
4. Partner with your veterinarian
Keep in close contact with your veterinarian about any changes in your dog’s symptoms. You see your dog every day and know your dog better than anyone else. So you are in the perfect position to spot signs that may signal you dog has flipped over to having Addison’s disease or indicate the medications aren’t working. Trust your instincts and reach out to your vet if you have any concerns.
5. Address mobility issues due to Cushing’s disease
If your dog is having mobility issues due to muscle wasting, look for options to minimize discomfort and falling. I recommend the following to many of my clients:
- Keep your dog on carpet
- Avoid slick floors
- Learn how to relieve arthritis pain in dogs
- Choose a soft bed for your dog’s comfort (Consider a memory foam dog bed)
- If possible, avoid stairs
- Consider laser therapy for dogs and physical therapy
- Teach your dog to use ramps
- Additionally, I’ve had many patients with muscle wasting due to Cushing’s syndrome thrive using ToeGrips® dog nail grips. The non-slip grips fit on dogs’ toenails to improve traction on hardwood floors, preventing sliding and falling.
Is my dog in pain with Cushing’s syndrome?
While you are thinking about how to keep your dog with Cushing’s disease comfortable, it is understandable to wonder if Cushing’s syndrome is painful. Thankfully, Cushing’s disease doesn’t cause pain in dogs in the traditional sense of the word. It isn’t like a torn ACL in dogs or intervertebral disc disease (IVDD) in dogs. However, I would argue that it can negatively impact quality of life. Hear me out.
Dogs with uncontrolled Cushing’s disease are thirsty all the time and need to urinate frequently. Sometimes they may have accidents in the house if they can’t make it outside in time. That can be hard on a dog’s dignity. It may also be more difficult for them to rest peacefully since they are prone to panting and pacing.
We can’t know for sure the emotional impact those changes have on a dog. And I’ve seen hundreds of “untreated” Cushing’s patients over the years who seemed fine. However, living with symptoms of Cushing’s is not ideal for the dog nor their family. The good news, though, is that treating your dog’s Cushing’s disease will help get those symptoms under control. This can greatly improve your dog’s quality of life.
What is the prognosis for dogs diagnosed with Cushing’s disease?
The prognosis and life expectancy for dogs with Cushing’s disease can vary depending on which form of Cushing’s disease they have and how well they respond to therapy.
Life expectancy for pituitary-dependent Cushing’s disease in dogs
With pituitary-dependent Cushing’s disease, the moderate-term prognosis is good with treatment. Median survival time (i.e. the point at which 50% of dogs with the condition are still alive) is 2 – 2.5 years. Most of the time, the majority of the clinical signs will go away quickly after starting medication. But it may take about three months for the skin-related signs to resolve. And sometimes symptoms like calcinosis cutis don’t fully disappear.
Unfortunately though, there is a small number of dogs with pituitary-dependent Cushing’s who don’t respond as expected to treatment. Thus, their prognosis may be worse. Additionally, if the dog has a large pituitary tumor rather than the more common tiny tumor, the prognosis is also worse. This is especially the case if the dog is showing any neurological abnormalities.
Life-expectancy for adrenal-dependent Cushing’s disease in dogs
For adrenal-dependent Cushing’s, the method of treatment and whether the tumor was benign or malignant (i.e. cancerous) both impact prognosis and life expectancy. Benign tumors and those that are small and less invasive usually carry a better prognosis. Overall, the median survival time is 1.5 – 4 years (depending on the study) with surgical removal of the tumor. But average life expectancy is closer to one year with Lysodren or Vetoryl therapy.
Concurrent conditions may impact quality of life
Additionally, your dog’s prognosis for either form of Cushing’s disease will also depend on any other conditions your dog may have. If your dog has concurrent medical problems such as diabetes or arthritis, the symptoms from those problems can compound with the symptoms of Cushing’s or make Cushing’s harder to manage. This can contribute to a decline in quality of life.
Knowing when it is time to say goodbye
Despite the fact that dogs with Cushing’s disease have a reasonably high chance of having a good year or several good years, the time may eventually come when you need to consider when to euthanize your dog with Cushing’s disease.
Some dog parents may start preparing for their dog’s euthanasia when they begin to see symptoms of advanced Cushing’s disease that are not controlled by medication. Others may decide to say goodbye because their dog is no longer taking pills well or tolerating the frequent vet visits. Or dog parents may know it is time when the financial toll or pet caregiver fatigue become too much to bear.
Sometimes it may also be a different medical problem, not the final stages of Cushing’s disease, that ultimately mean setting your dog free is the kindest course of action.
There isn’t one universally right time or right reason to make that decision. But your trusted veterinarian and your close friends or family members can help you determine what is right for your dog and your family. And they can help support you as you grieve the loss of your dog.
Don’t lose hope
I know that these statistics and the discussion of the final stages of Cushing’s disease and when to say goodbye may seem grim. But I want you to know that Cushing’s disease in dogs is not a hopeless diagnosis. Yes, your dog may need a risky surgery or daily medication and frequent rechecks with the vet. But once Cushing’s disease is under control, your dog can often have an excellent quality of life for years. And that is huge.
Let me remind you too that you can play an important role in your dog’s health. Watching him or her carefully for symptoms, keeping up with all medication monitoring appointments, and working closely with your vet can all help your dog feel his or her best despite having Cushing’s disease.
This is exactly the pep talk I gave to Jake’s mom when I diagnosed my sweet senior Lab patient with Cushing’s disease. I’m optimistic that he has several happy years ahead. And I look forward to partnering with his mom to provide him the longest, healthiest life possible. The same may be true of your dog too. So don’t lose hope!
What questions do you have about Cushing’s disease in dogs?
Please comment below.
Hello, I know that this is an odd request, but I have a few question.
My husband and I have a 3 year old American Bully mix and she’s a the most wonderful girl, but when we adopted her they ARL in our neighborhood informed us that she has been on antibiotics and prednisone prior to her realize for adoption.
Fast forward to two years later, and we’ve had a few bouts of trouble with her so far.
We don’t have a lot of extra money on hand and in fact we are on a very strict budget, so we’ve taking Ellie to see a sponsor vet, because we qualified for a few grants because she’s a rescue. Anyhow, she gets the worst and I mean the worst allergies. She will constantly lick and chew herself until she bleeds. Whimpers and whines because she’s so terribly uncomfortable ,and my heart just hurts for her. So 5 different occasions in two years we’ve taken Ellie to the same vet and they always prescribe her a high dosage of 750mg cephyalexin and 20mg prednisone. And while she’s on the medication she seems to be better, and she’s more like her happy go lucky self. But within days of her last dosage, her symptoms are 3x worse than before the vet visit. My husband and I have has several disagreements about this, as I’ve pretty adamantly put my foot down that for the 10 days she’s medicated ,and healing are not worth the price of how significantly more miserable she is after. I’ve asked and asked my vet if there are any other options, if any other kind of care can be administered. They’ve suggested a brand name allergy pill, by Zoetis, and it’s very expensive, and doesn’t seem to help her much. And when I mention the Streep price and the i affordability of it, they just tell me that that the grant program doesn’t cover anything but prednisone and antibiotics,
Right now, we’re 3 weeks out of the office, and she’s just gets worse each day. I’ve tried medicated shampoos, antifungal shampoos and conditioners. I’ve tried literally everything I can think of. Changed her diet, adapted new walking routines to avoid certain types of grass, increased excessive, and decreased it, but with no avail. She is covered in big scratchy bumps, and lately she is just not herself. She doesn’t want to play, or eat, or go outside, or even chase the cats around like she normally does. This morning she won’t even accept her favorite treats of Kong filled peanut butter. I’m at my wits end. I’m terribly worried and I can’t stand the through of her being so miserable, but I’m still very reluctant to take her back and get more prednisone..
Is there anything you.d recommend.
. Anything I can do to help her., that is even moderately affordable? I wish we had more options in our neighborhood tel help her. I do hope you might have some suggestions. Any think at all would be greatly appreciated .
Thank you ,
Amy Crawford
Hi Amy,
I am so sorry your girl is struggling from severe allergies. Unfortunately, skin issues are common in bully breeds and allergies are the most difficult thing I treat on a routine basis. There is no magic cure, and this will be a lifelong battle. The best treatment for allergies is combination therapy. Most pets that are well controlled have a year-round routine of oral allergy medication, weekly shampoos, spray or another topical to use between bathing, and then antibiotics or steroids for when flare ups occur. The goal is to get to a maintenance state and then treat the flare ups when the first signs are noticed. I know cost is an issue. But the best way to get things under control would be to schedule a consult with a dermatology specialist. There would be a significant cost up front, but once you reach a maintenance routine you would actually save money in the long run by preventing all the frequent vet visits. Here is a link to another article with more information: Allergy Medicine for Dogs: 9 Solutions to Calm Your Dog’s Itch
I hope you can find the answers you need to give your sweet girl some relief. Praying for quick answers and a positive outcome.
I have had 2 male galgo rescues from Spain.. They both showed signs of Cushing’s after 7 years old..The first was on lysodren and did well .The second had been on vetoryl which finally stabilized his Cushing’s at 40mg 2X daily He was due to go in for bloodwork and due for the ACTH stim test. He also took gabapentin for atopia and trazodone pre vet due to fear.He also took telmisarten for HBP and cloplidgil to help prevent clots. He had had a toe removed due to possible cancer and had been in for a bandage change and some strong local medication. .He came came home, ate some food then stretched out on his favoirite leather chair. My husband went to wake him a couple of hours later and he seemed dead. We still rushed him to the ER.. He was starting to rigor at the front I was going to have a necropsy done but a local pathologist seemed a little sketchy and through my regular specialty $5000 to $1000. My husband and daughter said to let it go as it would not bring him back. I am still in schock and cannot believe this has happened twice. He was my 24/7 dog and will always be with me. Maybe I have to switch to females only.; never had this problem in any of my greyhounds, It is so frightening, like something out of a horror movie.
Dear Catlin,
I am so sorry for the sudden and tragic loss of your sweet boy. Since I did not examine your dog myself, I really can’t make specific conclusions. Galgo’s are rare and not much is known about genetic predispositions or common health problems in the breed. I would be more inclined to think that it may be something with the breed/blood line rather than an issue with male dogs. My heart goes out to your while you grieve over your pup. I hope with time your heart will heal. May his memory be a blessing as you continue along life’s journey.
Dogs temperature: How to tell if the dog has a fever?
Hi Trissten,
If you are concerned that your dog may be sick and have a fever, I recommend you take him to your vet. At the veterinary clinic, a dog’s temperature is taken rectally. “Normal temperature” for a dog can vary with their activity level and the environment, but typically it will range anywhere from 99-102.5 degrees Fahrenheit.
Thank you so much for your article!
I have a 14 yo Jack Russell female, diagnosed (in the context of another disease) almost two years ago. She was basically asymptomatic but we started treatment with Trilostane but had to discontinue after three weeks. A year later, her thirst and hunger increased and we started with incontinence. Now she pees every 2-3 hours max.
Due to the prior issues with Trilostane, we started treatment with a fungicide that had proven to be efficient in Cushing’s (discovered by mistake), as a last resort.
We have been in treatment and under strict vet control for several months but meds seem not to be working.
I love my dog, we love our dog. I work from home so I adapt my schedule to her needs. I sleep in the living room with her so we have time to make it outside during the night. In average she urinates three times per night (7 hour sleep). This has started to take a toll on me but I would do anything for her.
My question is (I apologize for the long intro), how do I know when it’s time? To be fair, she is more active (could also be the winter) but she rarely wants to be outside. Sometimes she does play, but my preoccupation is about her anxiety. She is absolutely obsessed with food, to the point she can cry for six hours non stop if I cook something. She has her pot belly, pants when gets all excited or nervous, and although her character has changed, she still interacts with us.
Does this anxiety with food harm her? Is this an ok quality of life? I love her to death but I don’t want her to suffer.
Thank for your time and your wonderful post.
Virginia
Hi Virginia,
I know how difficult it can be to evaluate your dog’s quality of life and make decisions about when to let go. Honestly, it’s different for every dog and every owner no matter how many times you have faced this situation. It might be a good idea to have a consult with a veterinary internal medicine specialist to see if there are any other medication options that would benefit your senior girl. Ultimately, you have to take your own quality of life into account. Even if your sweet girl could hang on several more months, if it will leave you frustrated, exhausted, and possibly bitter, saying goodbye while things are still happy might be the most loving option. Eventually the stress can cause hard feelings that can break the bond with a beloved dog. I will attach some links to other articles that might offer new information. Some of the articles deal more with canine cognitive dysfunction, but I believe the advice on evaluating quality of life rings true in all situations. No matter what you choose, know that allowing your girl to find peace and rest is the most difficult and loving decision you will ever make. I wish you the best as you navigate this difficult road ahead.
1. Signs Your Dog is Dying: A Caring Message to Bring You Peace
2. Dementia in Dogs: When to Euthanize Your Beloved Senior Dog
3. Dog Hospice Care Can Bring Peace and Dignity to Your Dog’s Final Days
4. Dog Euthanasia: Knowing When to Say Goodbye
Hi. I wanted to say thank you. I found your article really interesting!
I have a (nearly) 12 yr old small cockerpoo, who was diagnosed with Cushings about 9 months ago. Her symptoms were extreme lethargy and fur loss (she had allergic bumps/growths/fatty like globules on her skin for about a year before diagnosis of CD, which I think are CD related, but my vet does not appear to familiar with all CD issues, and they were just classed as an allergic reaction to ‘something’? along with the initial fur thinning – a few ‘growths’ were removed an tested to check they were benign, she has also had a cyst removed which was just under the skin). The CD symptoms increased to drinking more, extremely dry flaky skin and having a good appetite, whilst diagnosis was occurring. She never had a pot belly.
After lenghty urine samples, then checking her blood samples to confirm CD we started off at 10mg Vetoryl, but then cortisol levels were still alleviated so increased to 15mg (I’m in the UK, and Vetoryl isn’t so easy to get in very specific doses here).
All has been reasonably ok (but with continued hair thinning) until about a month ago when the lethargy started to return. She’s always been a fussy eater (at first diagnosis her appetite was unusually good, which for her was a plus), but now she’s refusing to eat most things. Trying to tempt her is very difficult. She may eat something one meal and refuse to eat it that thing again for days or not at all. Though she looks hungry and goes to her bowl to see if there’s anything interesting in it – boiled chicken was working for a few days, but now she will eat only a tiny bit, tho she can be tempted by a few treats up to a point, so I’m never sure if it’s fussiness or lack of appetite. She unfortunately has a delicate stomach and has been on a specific diet for years, which she now wont touch (stomach complaint caused, I think, by continual bad cases of giardia picked up in our local park when she was young – treated with Panacur, of which complaint she has never quite got rid off), so when she has nothing in her stomach it gets upset and she brings up bile, and has an upset stomach/diarrhoea etc. So I have always fed her 3 times a day, small and often as she will fussily never eat much in a single meal anyway. Therefore, initially I thought her being off her food was just another Giardia bout, although it’s been quite a while since she has had one. I dosed her accordingly a few weeks ago, then tried a follow up course in the last few days. However, she now wont eat much at all, has no bad diarrhoea (not much feces at all, since she isn’t eating much), is drinking more, and is extremely lethargic. In the last few weeks she’s also showing classic signs of dementia (CCD?). Just in the last 2 weeks she seems to get confused about where she is, gets lost in corners/behind furniture and wandering in a circle. She’s also going blind (her eyesight was never great). ? She doesn’t seem in pain, or particular discomfort. I took her to the Vets last week for a brief check incase it was anything obvious, since she’s lost weight and her loss of muscle (which I didn’t know was a symptom of Cushings until I read your article). But she can go from looking alert to flaked out from one moment to the next. She was looking ok at the Vets, and they found nothing obvious!
I’ve booked her in again at my Vet on Monday to do more blood work and check her cortisol levels. But I wondered possibly, as mentioned in your article, if she’s swung the other way and now her cortisol levels are too low? I’m having difficulty getting her to eat the Vetoryl pills, as I hide them in treats, as she’s taken to refusing. Opening her jaws and popping them in may lose me a finger as she’s going a bit snappy in her old age when forced to do anything she doesn’t want to (in general she has very good manners).
Just thought I’d ask for a general opinion, as my Vet never seems to have struck Cushings before and is just looking it up in the basic manual, though she is doing her very best. Lack of appetite does not seem a CD issue, and she might obviously have another underlying condition as well.
Any thoughts?
Thanks
Hi Fesans,
Your girl is very lucky to have you as her advocate. You are right to be concerned about these new changes to her symptoms. Since I have not examined your dog myself, I really can’t make any specific recommendations. I am glad you have an appointment scheduled for Monday with your vet. It does seem like blood work needs to be rechecked to look for changes. Many times, when a dog has been well regulated on medication and then suddenly becomes ill again, it can point to a new issue that may not have been present at the time of diagnosis. Also, it may be a good idea to get a referral to a veterinary internal medicine specialist in your area. They have lots of practice managing complicated cases as it sounds like your girl fits this category. I hope you can find some answers with the lab work and can figure out how to get your pup’s disease regulated again. I wish you both the best and keep us updated on her progress!
Wow, it’s like you have been watching but what I’ve been going through in my living room with my dog. Your story is identical to mine in every detail. I adopted him when he was 10 and he’s always had weird gross on him but in the last year they’ve become crusty and disgusting and sometimes bleed. His muscles are weaker. My vet has never explained that both of these things could be caused by Cushing’s. This article was wonderful and this person‘s inquiry has brought me to tears but I also feel more sane now. Seems to me that my dog is quite advanced in a disease with which he was never even diagnosed, trying herbal remedies but in my heart I feel like it might be too late. He’s 14 according to the timeline I was given, but who knows how old he really was when I adopted him at 10. ?
Hi Isabella,
I understand your concern for your sweet senior guy. It does sound like he has some issues that probably need to be evaluated by your veterinarian. Since I haven’t examined your pup myself, I can’t make specific recommendations or really make any guesses as to what the actual diagnosis would be. It is very common for senior dogs to lose some muscle mass as they age and therefore experience some weakness. Also, Cushing’s disease does not necessarily cause lumps or tumors to form on the skin and any growths that are bleeding or oozing should be checked by your vet. While it is possible that your dog could in fact have Cushing’s disease, it does make me suspicious there are other problems that need to be addressed. I hope you can figure out the best way to help your boy live out his senior years with grace and dignity. I wish you both the best.
Hello. I have a 10-12 (estimated) old miniature schnauzer with Cushings. I rescued him from the pound 2 1/2 years ago. His only symptom of Cushings was a severe pot belly, ravenous appetite and some mobility issues. He never drank or urinated excessively. The vet tested him and confirmed Cushings. He has been on 30mg of Vetoryl since. Nothing much has changed in the past 2 1/2 years. Some additional mobility worsening and skin issues are the only new things since his initial DX. My husband and I have been away for the past week. My house sitter, whom he adores as she is also my housekeeper and is here with him daily, called me mid trip to say he was drinking massive amounts of water and had a couple of accidents. By the time we got home he was not able to control his bladder at all, He has been peeing massive amounts right in front of me. I put a pad under him last night and it was soiled this morning along with several accidents. He drank water all night and this has continued all day today. What would cause this sudden onset of bladder in continence and excessive water intake ? He also threw up the food he ate yesterday evening this morning. It was undigested. But he has eaten great all day and has not vomited. He does act if he doesn’t feel great but he’s not lethargic by any means. His urine is still yellow and clear.
Hi Amy,
These new symptoms in your Schnauzer are of great concern. There could be an additional disease process at play that is making the Cushing’s appear to be worsening. I highly recommend you have your senior guy examined by your veterinarian as soon as possible. They will probably want to run some lab work or other tests to rule out a diabetic crisis, pancreatitis, etc. Anytime you have a dog that has been well regulated on medication, that all of a sudden becomes unregulated, it could be a medical emergency. I hope you can figure out what is happening with your sweet boy and get him comfortable again. Best wishes to you both and please keep us updated!
My 14 year old Schnoodle was diagnosed in June and confirmed with Cushings. Her meds were increased gradually. Now we are taking 17.5 mg Vetoryl, gabapentin, and melatonin but her symptoms remain. The Vetoryl is split between morning and night. What’s next if her symptoms are not being managed? My vet is very diligent, but I’m still searching for answers. Thank you!
Hi Carolyn,
Sorry to hear that your Schnoodle recently got diagnosed with Cushing’s. It sounds like your vet is doing a great job of trying to manage her symptoms. Sometimes it does just take time to get to the right dose of Vetoryl since you have to increase gradually like you said. However, other times, it ends up that there is some other underlying factor that is making the Cushing’s harder to manage than usual. This is where having an appointment with an internal medicine specialist can be helpful. They can be a great resource for managing the more complicated cases because of their focus on these sorts of diseases and specialized training. I would suggest talking to your wonderful vet about your concerns and seeing if he or she thinks it is time to consider an internal medicine consultation or if you should stay the course a bit longer first. I hope that you are able to get your sweet gals symptoms under control. Hang in there as I know it can be difficult to be several months out from a diagnosis and still trying to fine tune treatment. ❤
My sweet rescue dachshund Barley (about 8 yrs old) has been diagnosed with Cushings. In addition to this, he has a heart murmur (4/6), gall bladder has been removed (11/2020) and his liver enzymes are elevated. Those values haven’t responded to Denamarin (4 rounds) or antibiotics. Symptoms include excessive thirst and frequent urinating, and a pot bellied appearance. My concern is treating with Vetoryl and risks of meds on top of his other issues. I fear overwhelming his system and possibly creating a worst situation for him. Can you help me with my concerns?
Hi Cynthia,
Sorry to hear that your sweet Barley is facing so many health problems. I can definitely understand your concern with adding Cushing’s treatment on top of everything else. Since I can’t examine him, look at his bloodwork, etc, I can’t make any definitive recommendations about if it is or is not a good idea to pursue treatment with Vetoryl. I think that the best way for you to get the information you need to feel comfortable with the plan (whatever it ends up being) would be to make an appointment with an internal medicine specialist. These vets have spent years studying and treating problems such as liver disease, gall bladder disease, and Cushing’s. They also have lots of experience with balancing the treatment for multiple problems, and in some cases may work in a facility that also has a cardiologist they could consult about the heart murmur if needed. I hope this helps you find some answers for your sweet boy!❤
I have an 8 yr old Boxer mix girl. She has Cushings that currently is not controlled. She was started on too high of a dosage of Vetoryl and her cortisol dropped to .7. She has been off Vetoryl for 6 weeks. ACTH test shows we are ready to start back up with a lower dose. In the meantime she has been diagnosed with Laryngeal Paralysis and probable pancreatitis. We have an appt Aug 19 with a surgeon for tie back surgery consult. However, due to switching her to a low fat diet I haven’t been able to start the Vetoryl yet. I’m so confused. Should I reschedule the surgeon appt? Does the Cushings need to be under control before we can proceed with surgery? She also has CCD and spinal arthritis. Thank you.
Hi Debbie,
Sorry to hear that your sweet girl has been dealing with so many health problems recently. I understand how complicated balancing multiple concerns, treatments, and appointments at once can get. Without being able to examine her and look at her bloodwork and history, I don’t feel like I can correctly advise you on how best to proceed. However, your current vet and the surgeon should hopefully be able to work together to formulate a plan for your pup, whether that is managing the pancreatitis and Cushing’s first then going for the surgery consult, going forward with the consult now, or something else. I would recommend getting in touch with your vet and the surgeon now to get the ball rolling so you will know what to do about the surgeon consult appointment.
Also, if you haven’t already, you may find this articles useful:
Laryngeal Paralysis in Dogs: The Ultimate Guide
Canine Laryngeal Paralysis: A Veterinarian Answers Your Questions
Tie Back Surgery for Dogs with Laryngeal Paralysis
Pancreatitis in Dogs: Do You Know the Signs, Risk Factors?
Best of luck to you and your sweet girl as you navigate these health concerns and appointments! ❤
My dog, a 12 year old cocker spaniel, was diagnosed with Cushings (after the 4 hour blood test and the 8 hour blood test) about 2 months ago due to highly elevated cortisol levels. She was prescribed 2.5mg of Trilostane (she weights 30 lbs) to begin with and her symptoms did not sufficiently abate. After the first month, her cortisol levels were measured with the ACTH stim test which showed continual excess cortisol levels and her symptoms had not abated so she was moved up to 5mg/2x day. The results of the ACTH stim teast after 3 weeks were 6.7 pre test and 13.1 post. She then was put on 7.5mg 2x.day of Trilostane and her results after 3 weeks were 4.6 pre and 11.4 post. We are now up to 10mg 2x/day. Shes’ been on that dosage for 4 days and her symptoms remain relatively steady: She is ravenous all of the time, is putting on weight, and she pants a great deal even at rest. Each blood test costs $400 and it seems we are making very little and very slow progress. Any recommendations? It is hard to witness her being in such prolonged discomfort.
Hi Nina,
It can definitely be difficult to watch your dog continue to be symptomatic for Cushings as you and your vet continue to work together to figure out how to get her Cushings under control. Some dog seem to be easier to get under control than others, and it can definitely be a long process sometimes. It sounds like your vet is doing a good job of gradually increasing the dose and rechecking the ACTH stim to get an idea of how it is working. Since it sounds like she is one of those dogs who may be a bit more difficult to regulate or who may end up requiring a higher dose to get regulated, you could also consider having her seen by a vet who specializes in internal medicine. These vets can be a great resource for the complicated cases and by virtue of being a specialist, may have more tools at their disposal to figure out if there is some underlying reason why she isn’t responding yet. Hope you are able to find a dose that works for her soon!
I would like to invite you to join the face book group (Dogs with Cushings Support and Information.)
I am sorry that you are having problems with her meds.
I couldn’t find this website, but I found “dogs with Cushing’s”…
Is this a good option?