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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 28958
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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Dr. Salkin. I have a 9yr old Boston Terrier with Cushing's.

Customer Question

Hi Dr. Salkin. I have a 9yr old Boston Terrier with Cushing's. He was diagnosed this past December. He was unable to tolerate Trilostane and I have not been treating his cushing's since then. He's been doing quite well until a week ago when he injured his left shoulder. He can barely walk and doesn't want to put any weight on his front left leg. The same thing happened to his right leg just prior to the cushing's diagnosis, but his right shoulder healed within a few days. I guess my concern now is has the cushing's progressed enough that his left shoulder won't heal? I can't pick him up without him letting out a yelp. He shakes in pain from this injury. I've given him 2 doses of Tramadol 25mg that the vet gave me the last time this happened. Debating to take him in and get an x-ray, but even if they found something, what could be done? I don't think he's well enough for surgery. He's eating well, but only when I put the food right in front of him. It's too painful for him to stand and eat at the moment. If this injury heals I've been considering putting him on Lysodren to see if he does better, but I go back and forth if all of the vet visits, constant testing, etc is going to really improve his quality of life that much. He hates the vet office and part of me thinks he might be happier just riding this out without treatment and without the added stress. Any input would be greatly appreciated. Thank you.
Submitted: 2 years ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 2 years ago.
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.
Expert:  Dr. Michael Salkin replied 2 years ago.
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin