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Good Morning and welcome! I am Dr. Loretta, a licensed veterinarian and I am happy to answer your question.
I am so sorry to hear about sweet Casey's condition...I know it is hard to see her in pain.
The only other medication you can give is Rimadyl which is an anti inflammatory medication. This along with Tramadol and the joint tablets and fish oil, is all that can be given to a dog suffering from Cushings disease. This medication can affect the liver so when Casey is on this, your vet will want to check liver enzymes often. I know this barking that Casey is doing is because of the pain and adding Rimadyl may really help as long as your vet is careful.
Does that make sense to you?
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Oh my...I am so sorry!! You have to do what you can to keep Casey comfortable. I certainly understand what your vet is saying but he may change his mind now that Casey is in such pain.
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You are welcome! Have a great day!