Aloha! You're speaking to Dr. Michael Salkin
Sorry for the delay. I'm in Moab, Utah visiting Arches and Canyonlands National Parks. You're correct to be concerned about soft tissue healing in an untreated cushingoid dog. Soft tissue injury is more common because muscles
, ligaments, and tendons weaken in the face of hypercortisolemia which, of course, is the result of Cushing's. If that weren't enough, healing is delayed because the fibrosis - scar formation - is altered. Intervertebral disk disease (a "slipped disk") in his neck should be a consideration as well because both front legs
have been symptomatic. He's a good candidate for not only tramadol - the new dosing recommendation is 2-5 mg/lb every 8 hours if need be - but also a nonsteroidal antiinflammatory drug (NSAID) such as carprofen or meloxicam.
I agree, unless a cancer is causing his lameness
, X-rays may well be for academic reasons only. If you believe that the treatment will be worse than the "cure", then, yes, not treating his Cushing's makes sense. Keep in mind that Lysodren also needs to be very carefully monitored. The prognosis for pituitary dependent (the most common form) Cushing's treated with Lysodren is a median survival of 23 months; average 30 months.
Please respond with further questions or concerns if you wish.