Why Prednisone with Cushings Disease??

Julie (our mini Poodle 9 yrs. old)  had Cushings for quite a few years before it was confirmed in Feb. 09.  She was tested 4 yrs. ago & it was negative but I never believed that.
Julie started Trilostane 22.5 mg. in March. She was doing better in June with the blood test numbers & than got another attack of Pancreatitis, in 6 mos. time.  She stayed at the Vets for 4 days & came home better. The Ultrasound showed something (a shadow) on her heart/lung & her liver & gallbladder.  Next week I'll have another one taken to see if Pancreatitis caused it...I bet not. My Vet told me the radiology report of her xrays said tumors. He did not read the ultrasound. Thats why I am re-taking it. The other vets say they r not sure yet. I know that it's not gona be good.

Julie has slowed down so much. She can't exercise or play much. I don't know what the Trilostane is doing at this point. I will have her tested again for it this month sometime. I had to stop it for one week during her vet stay & I think that was trouble.  Her internal organs are enlarged also.
My vet sees a growth in back of her throat & she has a hard time breathing sometimes. Today I laid down with my little baby & cried at her congestion & breathing.  Than a few hours later she was better. I started her on Orbax today, an antibiotic...it may help her lungs. It seems so tonight.
I don't know what to do at this time, if anything. I won't put her on chemo for the tumors. She can't take it.

Anyhow, my question here is why are so many of you giving your dog Prednisone when thats a steroid & Cushings produces too much cortesol/steroid in dogs bodies?? I hear you say it helps & that floors me.
How come it works? I am really confused at this.  My Vet said NO NO NO to Prednisone & Dexamethasone etc. because of the above reason.  He said that can be lethal with too much steroids already in her body from her adrenal gland caused by Cushings.    I just don't get it. Does anyone know the true answer?

Thank you all for the posts that you write.  It does help to hear others talk about thier dogs.  I wish you all the best of luck & love with your pets.

[ginger899]

I'm not certain about this because I'm not a vet, and there's a heck of a lot I don't know, but wouldn't a blood test show up tumor markers? Surely, if Julie had cancer there would be definite 'markers' in the blood? (or at least, enough, if not to be able to make a firm diagnosis, to say it was highly likely?)
It depends what kind of tumors these are. Obviously, even if benign, that doesn't mean they can't cause problems, especially the one in her throat, which won't help her breathing.

I'm not saying hang onto false hope, but you could ask your vet about this.

I'm sorry because I don't know enough about Prednisone, or steroid treatment, but it does sound a little confusing, like you said. You could post on the "Ask a Vet" expert forum, see what the vet says?

Your poor girl. She is really going through the wars, isn't she? And you are too.
I'll pray for you and your Julie, Sandra. God bless you. He hears your worries, and your tears.

[meyan]

Hi Sandra, when I gave prednisone to my dog, it was for arthritis, otherwise she had a clean bill of health. Your precious one has a  predisposition to serious health problems that I think prednisone would probably enhance and make worse. I agree with Ginger why don't you get a vets opinion.  

[ggreg]

Dear Sandra,
You messaged me, so I shall reply.  The only thing I know about prednisone is it's used to relieve pain and reduce inflammation and swelling.  It is helpful to use with dogs that have endless itching, for example, and is even used for cancer and a variety of other illnesses.  I personally have taken it for insect bite pain and swelling, and it made me feel good.  But now, if you have a pancreatitis dog, my understanding is if they are on long-term prednisone, it must be stopped, becuz it can be the culprit in causing it.  Prednisone, it is generally believed, if used long-term will shorten a dog's life, among other drugs given to dogs.  

Now, the pancreas breaks down fat, is all I know about that organ.  I do not know what Cushings does to the balance of fat or anything else.  And how prednisone might damage the pancreas function and other internal organ functions, I have no idea.  I just know the drug carries risks.  But your dog was only on prednisone for a few months, not nearly enough time according to my general knowledge for it to damage organs.  On the other hand, since your dog tends to have pancreatitis attacks, logically I suppose a case could be made that the prednisone set it off in June.  Looks like there must be other drugs that could be used to help your dog's supposed Cushings, rather than the prednisone.  The last thing your pup needs is more misery on top of misery.

But I think the most important information you have now are the shadows on ultrasound and the growth in her throat.  Tumors can be slow-growing, and unless they cause distress, they don't necessarily signal disaster, with the exception of the growth in her throat, which is already causing her breathing problems, so I think it should be taken out.  And in general, I think your dog would do well with a diff treatment for Cushings so you can stop prednisone, plus a pain killer and/or tranquilizer for a little while at this point becuz everything she's got is uncomfortable to downright painful.  Some of those type drugs can affect breathing, but your vet will know how much is safe to use.
  
Since she's got a place on her throat, I assume you've switched foods and are giving her bland wet food and lo-fat broths and skim milk, whatever it is she's supposed to be able to have, that will also go down easy.  I think you should visit your vet, show him how miserable your dog is, and ask about 1) whether to stop prednisone if it looks like maybe her pancreas is actually what's making her feel ill at the moment, 2) ask about a replacement drug for Cushings, and 3) ask about giving her pain medicine or tranqs since she is feeling badly.  You should also ask about him perhaps go ahead ASAP and at least remove that throat bump.

I wish I knew more and could advise you better about Cushings and cortisol and adrenals and prednisone, etc., but I don't know.  I do know that I also cannot stand to watch a dog be sick.  Hopefully one of your vets can sort out her drug picture.  And maybe they can freeze that throat tumor off, like dermatologists do that for bumps people get on their face and body, which is relatively noninvasive and might not be a big deal to get rid of it and thus restore her breathing.  A lot of stuff has been piled on top of her all at once, and it's a matter of logically breaking this thing down and fixing stuff one by one.
Best wishes, GG

[kimpton]

Hi i there.

I'm not a vet...so these are just my thoughts.  I'm hoping this helps.

I'm wondering if the Prednisone is being used to suppress the adrenal system, because the Cushings is causing the pancreatitis through over production of corticosteroids. Maybe there's more value in suppressing the adrenal system with drugs while treating the Cushings at the same time.  And, is the Cushings overly suppressing the immune system through the production of those csteroids.  So much so that the immune system is having a hard time with other ailments?  

Also, could the growth in the back of the throat be an enlarged Thyroid gland?  That gland is part of the adrenal complex.  

Hang in there.  Kimpton

[Sandra_G]

Thanks so much for trying to help me.  There is a misunderstanding here. Julie is NOT on Prednisone...she never was on it.
I asked ggreg why her dog was on Prednisone while diagnosed with Cushings. Cushings is an over abundance of cortesol aka steroids.
Too give Prednisone on top of cushings,  is a no no...acording to my vet. Just last week I asked him that question.

Julie is going to her other Vets on Thursday, for another ultrasound.
That should tell alot.  I will say this, many of you gave me so much info with your opinions & I am going to ask the Vets all of it on Thursday.

Could that growth on her throat be her thyroid/adrenal?

Kimpton, Now that u say It, I was told that the last ultrasound showed the adrenal gland enlarged. Hummmmmmmm?????

Ginger, I will ask about the blood tests & cancer.  She had enough blood tests done for me to get some answers. I also never considered the tumors might be benign. Thats a good thought. I will try to find out as much as I can.  Hummmmmmmmm?????

ggreg...I will speak about taking out that bump/lump in her throat. I hope it can be done & I hope it will work. I never thought of taking it out & my Vet didn't say to do it. He knows that I don't want surgery for Julie but on the other hand, if her chances are good if she has the surgery done, I will do it. I am giving her soft foods & I cut up her healthy treat tiny tiny

Meyan...thanks for the input. I can't wait to get to the vet with all my questions. This may take an hour just for that.

I value everything you all said & I thank you so much. Please feel free to tell me anything that you may know.

[ggreg]

Dear Sandra,
I feel pretty dumb, but I guess when you asked about prednisone, I incorrectly assumed Trilostane was a corticosteroid, when in fact it's an ANTI-corticosteroid!  By the way, my dog does not have Cushings...she has allergies that she took Prednisone for, and when she wound up with Pancreatitis, the vet took her off Prednisone, which can cause it.  However, I see now that you figured since my dog had been on that drug, perhaps I knew more, which as I've already posted, I do not.  Anyhow, I found this link that may be helpful in the treatment of your dog's Cushings:

http://www.wedgewoodpharmacy.com/monographs/trilostane.asp

I hope your doggie gets better, hope they can get her breathing straight.  I shall think of you and Miss Julie and send prayers.  Thank you for including me in this discussion, dear one.  Sorry I couldn't help more.
GG

[Sandra_G]

isn't that something that u say to check out Wedgewood Pharmacy....thats where I get her Trilostane...since the beginning.  They are very good there.
Thank you for answering me.

[calliann]

Hi Folks:  Our best friend has Addison disease, vet refers to it also as Cushings?  My questions is this, she is 23 lbs and takes 5 mg  of prednisone per day.  This seens like as lot for a 23 lb dog.  Also is on percorten v 0.1 ml every 4 weeks, levels don't seem to change.  Any info or thoughts would be greatley  appreciated.

[bboostrom86]

I know I'm very late to the party.  But in case you were still wondering why prednisone can be used in combination with Trilostane here goes.  Trilostane (or an alternative treatment lysodren) can in some patients overly suppress cortisol production.  The signs of which may include GI upset- anorexia, vomiting, diarrhea- decreased ability to respond to stress and others. Prednisone (essentially synthetic cortisol) is often sent home with clients with instructions to be given if signs such as these develop.  Some vets may prescribe it at a low dose prophylactically.  The goal is to control cortisol production without allowing it bottom out.

Hope that helps!
Brendan
UC Davis Veterinary Student

[lindapalm]

Thank you Brendan for the excellent  explanation, I'm sure it will help answer a lot of peoples questions.