Medications for my dog’s Cushing’s disease and recurrent coughing aren’t working. What should we do to improve her condition?

Original Question: Hi I have a 10-year-old Cocker Spaniel, with the exception of an eye infection she has been healthy until a month ago. She had a benign tumor removed from her side and was tested for Cushing’s disease. She is now on Vetoryl for this disease but it does not seem to be working well. Her dose has been reduced to 30mg from 60mg. She also has bouts of coughing especially after drinking and episodes of wheezing when I pick her up or when she gets excited. She is taking Theophylline for the wheezing and coughing and we are so sad to see her like this. At times she seems better but then relapses and cold air seems to help her. Is there anything else we can be doing for her? - Debbie

Medications for my dog’s Cushing’s disease and recurrent coughing aren’t working. What should we do to improve her condition? Mar 5, 2018

Hi Debbie,

Thanks for your question.

You are in the middle of a complicated medical case so I’ll start by saying any advice I give should only be secondary to the treatment plan administered by your veterinarian. From your question, you are currently dealing with two issues. The symptoms and maintenance of Cushing’s disease and this other issue of coughing. I think these are different conditions to be addressed.

Cushing’s disease, also known as hyperadrenocorticism, is a complicated disease process. It is a disease of the adrenal gland which produces hormones that impact many of the body’s processes. The symptoms are increased thirst, increased urination, increased appetite, fluctuating energy levels, and over time hair loss, a potbelly appearance and metabolic complications. The symptoms cause a decline in quality of life so the goal of treatment is to reduce these symptoms. To accomplish this, there are multiple treatments for this disease.

It sounds as though the symptoms of Cushing’s disease are not under control. To assess the effectiveness of treatment, I recommend an ACTH stimulation test that essentially stimulates the adrenal gland and measures it’s response by detecting cortisol levels. The test results indicate whether the treatment is keeping the adrenal gland under control. You mention in your question that the dosage of Vetoryl has been reduced but yet the symptoms are still significant. It’s important to keep in close contact with your veterinarian when trying to regulate this disease. The blood results are quantifiable, but the symptoms are very important to pay attention to as well. In veterinary school, there is a saying…it goes, ‘treat the dog, not the data’. What this means is that it’s just as important to manage a disease based on the clinical symptoms that a patient is showing as the numerical blood results that are generated from tests. The test can look like a disease is under control, but in reality, the symptoms are persisting and necessitate re-evaluation. Speak to your veterinarian about the fact that the symptoms are still present and not improving and have them consider an adjustment in dosage to control them.

The coughing is another matter. Theophylline is a medication that opens the airways. It can help when there is constricted airways, but it tends to be supplementary and is a drug that is supportive rather than resolving the primary cause. If I were to guess, it sounds as though you have not investigated the primary cause with diagnostics. A persistent cough could be caused by tracheal collapse, heart disease, chronic bronchitis, primary lung disease or infection. It would take some investigation to determine which of these may be present in your dog so that the correct diagnosis can be made and the right treatment can be implemented.  There are medications that can suppress a symptom like coughing regardless of the cause. I would encourage you to speak to your veterinarian about stronger cough suppressants rather than airway medications like theophylline. This may improve quality of life even if it is not addressing the underlying cause well enough.

You are doing a great job assisting your dog in improving their quality of life. If you feel more can be done and you are frustrated by the results so far, I encourage you to share this concern with your veterinarian and seek their honest advice on these next steps.

I hope this helps.

Dr. Clayton Greenway

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