Possible Cushing's and itching
Q: Dear mike
Furher to my report on kiki with her supposed cushing.
After testing her urine for a second time it was diagnosed by prof. Rijnberg in utrecht As non cushing.
He advised me also to go to dermatology to try to findout what the real Problems were.in the meantime no cortisol injections for kiki, It has been exactly 30 days since her last shot,, and we all suffered, Kiki and we too, because of the contious scratching from kiki and Unable to sleep
Yesterday we went to dermatologu, they are going to take some skin tests And we have to come in 3 weeks.in the mean time we got antibiotics For the infections kiki had all over her body. We got cefa-cure 200 mg 2 x daily. But no cortisol, because if we want to complete the test period we shpuld not take cortisol.
Do you know will the sefa cure the itching ? we are hesitating what to do, and not sure if the antobiotics will cure the itching.
If we will not follow the complete testing program and decide to go to Cortisol the doctor advised us to take pills instead of in jections.
Thank you for your attention
Cefalothin antibiotics do not have a direct effect on itching. They do often decrease the itchiness in skin disease, though. This happens because skin infections are itchy and if the antibiotic can suppress the skin infection there will be less itchiness. In many instances control of the infection is sufficient to stop the itching, but not always.
It is generally better to use corticosteroids such as prednisone in the oral form rather than by injection. It is easier to control the dose with oral medications.
It is hard to make it through the time periods necessary to ensure accurate test results when dealing with itchy skin conditions but it is worthwhile if you can stand it.
I sure hope that the antibiotics are helping and that Kiki is feeling better by now.
Mike Richards, DVM 7/12/99
Q: thank you for your earlier reply regarding kiki.as you mentioned in your email, besides lysodren there are no approved medicine here available.
our vet suggested to wait and see what happens with kiki she has been getting an injection for the scratching etc. but from injections once a month we are goiing to every 2 to 3 weeks. she is scratching very badly and develops bad spots all over her body.
since our vet does not give us a concrete plan how to proceed I am contacting you again.
can we continue with the injections(cortisones) on shorter periods ? the injections help well but the time period in between gets shorter and shorter.
what is the other alternative ? we are getting desperate what to do. kiki is scratching constantly and does not sleep very much at night and keeps us awake too.
we would appreciate if you could advise us what the best way is to continue
I am somewhat confused by the use of corticosteroid injections in a dog that has Cushing's disease. This is a disorder in which the body's natural cortisone levels are too high --- so it would seem to be counterproductive to give additional cortisone.
I do understand one situation in which the use of cortisones is occasionally very tempting, though. There is a condition known as calcinosis cutis. It is associated with Cushing's disease. It is sometimes VERY itchy. Since cortisones reduce itchiness in most dogs, there is a strong temptation to use them for this condition, especially if the Cushing's disease diagnosis has not been made or is questionable. However, when a dog on corticosteroids continues to be itchy in the face of the medications and especially when this dog may have naturally occurring Cushing's disease or even artificially produced Cushing's disease signs due to the administration of cortisones, the best course of action is usually to stop the injections and try treating for the Cushing's disease. It is very easy to get into a cycle of giving more and more cortisone instead of looking for a reason why it isn't working very well.
I have made that mistake in my practice. I have done this when a dog had been responding well to cortisone injections on a periodic basis for allergic dermatitis. When the injections had to be given more frequently I just did it. When they stopped working entirely I did skin biopsies and the pathologist found calcinosis cutis. Stopping the injections did not resolve the problem but eventually we were able to diagnose naturally occurring Cushing's disease and treat the problem.
I really think you need to get a second opinion from another vet or discuss this carefully with your vet and ask about the possibility that the cortisones are actually making the problem worse in this case.
Mike Richards, DVM 6/10/99
We have a westhighland terrier called KIKI , she is almost 10 Years old.
We have had problems with her for years that she is scratching Her back , her behind , her leggs etc.she developes sore spots On her body and scratches badly.at night she also pants heavey And does not sleep much.
We always thought this was caused by fleas and have treated her Occasiously with frontline.furthermore she has received a small shot of somekind of medecin from the vet in her back. This releaved her for a while, but the vet did not want to give this to her to often
Several weeks ago we had her blood and urine tested through Our vet at a vet university.the diagnosis came back as cushing Decease in her hipofisis - pitietary glands.
We have read dr mike's email letters through my daughter From boston.but I have several questions.
Our vet tells us that in holland the general treatment for cushing is to have the hipofisis stop working completely and give the dog Additional medicin to compensate.they use lysodren for this And I think probably so much to stop the hipofisis .
But our vet tells us,that the cure maybe worse than the disease, Because it is a chemo treatment and the site effects will be considerable.
When I asked him for alternatives, he said there were none, he did not know about other medicins for this disease and felt that they are very advanced with this disease in the netherlands.
One alternative there was he said, lately the university has gone back o operate the dogs with cushing and to remove the Hipofisis or part of this.
We don't want to consider this alternative at all.
Our question to you now is : is there an alternative to this Method of having to stop the hipofisis completely, can a medicin Be used in smaller doses and are there alternatives to lysodren ?
We sure would like to help our dog, but our vet clearly does not Know how, and we don't know either.
Some suggestions from you would be appreciated.
A: Dear Kees-
There are three medical treatments used for Cushing's disease in the United States.
The first is Lysodren (mitotane). In the United States it is most commonly used on a continuous basis to control Cushing's disease. By checking cortisol levels in the blood stream on a regular basis it is possible to give enough Lysodren to control Cushing's disease but not enough to totally wipe out the adrenal gland. Some veterinarians here, and in other countries, recommend going ahead and using Lysodren to completely destroy the adrenal gland. This causes the opposite condition, known as Addison's disease. Then the vets just regulate the Addison's disease. Their reasoning is that Addison's disease is easier to treat and to monitor. There are potential complications with either method of treatment but many vets are familiar with this medication and continue to use it as a first choice for Cushing's disease.
The second treatment is to use l-deprenyl (Anipryl Rx in the United States). This medication is available in other countries and may be approved for use in the Netherlands. It is recommended here in the United States for uncomplicated cases of Cushing's disease. We have used it a couple of times and it seems to work well, after a couple of months of administration. It is a relatively new medication, so we do not have a lot of experience with it. This medication has less side effects than Lysodren and there is much less monitoring of labwork associated with its use. It is fairly expensive here in the United States, though.
The third medication that is sometimes used for treatment of Cushing's disease is ketaconazole. This is an antifungal medication that inhibits release of adrenal hormone as a side effect. Since this is a useful side effect in this case, some vets use this medication when the others won't work or when Lysodren seems dangerous for a particular patient.
About 80% of Cushing's disease patients have the pituitary dependent form, in which the brain is producing too much of the hormone that stimulates the adrenal glands. The other 20% have adrenal gland cancer. In the dogs with cancer, removal of the adrenal gland can be curative, although it is considered to be a high risk surgery.
I have seen a small amount of research material on surgery to remove a portion of the pituitary gland in the brain as a treatment but it was from Utrecht in the Netherlands (I copied it below). To the best of my knowledge, this has not become a standard treatment in the United States.
These are the options for treatment that I know of. If you don't want to have surgery done (and I can understand not wanting to) it would be worth trying one of the medical options since this disease is causing discomfort for your dog. We like the l-deprenyl treatment based on very limited experience with it. I wish that I had a list of where medications were available and where they are not, but I don't. You'll just have to ask your vet to research that one a little.
Good luck with this. Thank-you for subscribing to the VetInfo Digest. It helps us maintain the website and hopefully will be interesting reading, too.Mike Richards, DVM 4/17/99
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...