An Update from Mooch’s Vet and a Difficult Decision

Libby's LDDST, that's the test they gave her, is consistent with Cushing's disease, a.k.a. hyperadrenocortisone.

Boy, that's a hard one to even say.

Based on the level of eight-hour cortisol, they weren't able to differentiate between adrenal-dependent ADHD, or pituitary dependent hyperadrenocorticism, PDH.

However, as we talked about earlier, hers is likely ADH since just her left adrenal gland is large and abnormal.

The treatment of choice for ADH is surgery to remove the adrenal gland.

However, There can be some serious complications during and after surgery.

The surgery would be done with a board-certified surgeon at a place like Vet West.

If you're interested in surgical removal, the next step would be to set up a surgery consult at West Vet so they can discuss all that is involved, cost, et cetera.

In cases where surgery is not an option due to cost, health status of the patient, et cetera, medical management with Vet-er-all can be used, although dogs with PDH tend to respond better to medical management compared to dogs with ADH, which is what Mooch has.

I have still seen it help in many cases, better control of symptoms and overall improvement in quality of life.

We seem to get better control of symptoms when veterol is given twice daily.

However, this also means more cost of medication per month.

For Libby, her starting dose would be 10 milligrams of veterol once daily or 5 milligrams twice daily.

According to our online pharmacy price, this would be $105 to $150 a month, respectively.

One important thing I want to make sure to iterate is that the medical control of ADH does not mean it will stop the tumor growth or potential spread in the body.

It's more about controlling the symptoms of the disease, which are significant and worth controlling, like muscle wasting, liver enlargement, putting extra pressure on the diaphragm, et cetera.

But the tumor can still cause problems just by being there.

Once a patient starts Veneral, we need to closely monitor cortisol levels to make sure we are not suppressing the adrenal gland too much.

This consists of an ACTH stem blood test two weeks and six weeks after the medication start date.

If there's an adjustment in medication, we check at the same intervals again.

We also use clinical signs as a mean to monitor.

Measure how well we are controlling the disease.

For example, if her ACTH stem is a little high, but she now only is urinating a few times a day instead of every hour, or she's panning less, it may not be necessary to continue increasing her dose.

Things like improved muscle condition and reduction in her liver size will take more time to notice.

Excess urine protein is very common in dogs with Cushing's.