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Published: Saturday, 5/30/2009

More than one way to treat Cushing's

Dear Dr. Thompson: We have the sweetest 10-year-old medium-sized mixed breed dog that has recently been diagnosed with Cushing's disease. The vet administered blood tests in order to diagnose her symptoms and determined in March that her adrenal gland was responsible for the Cushing's. We began giving her Selegiline in March and increased the dosage last week. I am aware that it can take a few months to see improvement, but she is getting much worse. Can you offer any advice?

ANSWER: In Cushing's disease, the body overproduces the stress hormone cortisol. The resulting symptoms are all directly related to the excess of that hormone. The majority of cases involve a benign growth in the pituitary gland located in the bottom of the brain that sends excessive signals to the adrenal gland.

However, you mentioned that the blood tests suggested the primary problem is the adrenal gland. This is less common but carries a poorer prognosis becase it is usually a malignant growth overproducing the hormone. Blood tests are not foolproof in this regard and an ultrasound could help find a tumor.

Selegine showed some initial promise for dogs with the pituitary-dependent form when it was introduced years ago, but now it seems that only a small percentage of dogs respond to the medication. Lysodren has been the mainstay for treatment, but can be tricky at the outset due to side effects that can develop. Trilostane has been used for years in Europe to treat this disease and has recently been approved in the United States under the name Vetoryl. It is well-tolerated and is a very good option for smaller dogs to manage the disease. Ask your veterinarian which would be right for you.

Dear Dr. Thompson: I've had my dog since she was 8 weeks old and she is now 3. She loved to go for walks and ride in cars. A year ago she had a bad experience at the vet that scared her very much. Since then she won't let me put her collar on and runs away when I try. Every time I open a car door, she cries, shakes, and tries to hide. Obviously she is scared to death. She's due for her checkup and I don't know what to do.

ANSWER: Essentially, you are faced with a decision regarding which end of the leash is going to be in charge in your house. This is not to dismiss your dog's fears or whatever led up to this behavior. However, your dog needs regular preventive care to help avoid getting sick and she will certainly need treatment when she does.

If your concerns and her fearful behavior make trips to your veterinarian difficult, you will likely delay treatment and that can have potentially tragic outcomes. Simple problems that could be addressed early will balloon into advanced conditions that will be more difficult and expensive to treat.

This is not to say you drag her kicking and screaming into the office. It will not be pleasant for anyone. Your veterinarian would much rather examine a relatively calm, albeit scared, dog. This allows for a more thorough exam and keeps everyone safer.

It will take some work and possibly the help of a professional, but you can desensitize your dog to car rides and trips to the doctor. Ask your veterinarian if is OK to come in on a regular basis to just have the dog weighed, and the staff can say hello. However, be realistic about when is best for the office. If you walk in during the busiest time of the day it adds to everyone's stress level and is disruptive for the office. Over time, your dog will realize that it is not so terrible and will eventually be more manageable. You have your work cut out for you, but your dog's health and well-being depend on it.

Questions for Dr. Thompson can be e-mailed to askthevet@theblade.com or mailed to The Blade, Attn. Ask the Vet, 541 North Superior St., Toledo, OH 43660. Dr. Thompson regrets that he cannot answer individual letters.



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