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Dr. Scarlett
Dr. Scarlett, Dog Veterinarian
Category: Dog
Satisfied Customers: 4110
Experience:  I am a practicing small animal veterinarian with 18 years experience.
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my dog who has cushings disease has been taking ketoconazole

Customer Question

my dog who has cushings disease and has been taking ketoconazole already for 2 weeks but the dose was only 2 pills a day 1 in am and 1 in pm total, the tech gave the bottle with directions. When I ran out, I found a RX in my recepit from ved for 60 tabs of this med but it said 1 ever 12 hrs for 1 week then 2 pills in am and 2 pills pm for another week. I called the vet office and said I followed directions on bottle for the two weeks with only 1 tab. the recep. said she spoke to the vet and said its ok and that I can start giving him the increased dosage so I did, it has been 1 week on increased dosage I do not see any changes, He is a doberman and is over 100 lbs. this morning my husband gave him a cup of his kibble he swallowed/ gobbled it up shortly afterwards threw up. The medicine did not seem to bother him for the time I have given it to him with the lower dose. He still seems to have appetite, too much of one. I asked if I should swith his diet, I was told no there is no specific diet. Is there not another diet I should be feeding him to help him out? Currently he is on Pedigree, but he also is crazy about apples and carrots as snacks, can that hurt him with the disease he has? Is his gassyness due to cushings? Can I give him something for that, he also sounds like he has sleep apnea when he lays down - he has had that for quite some time while he started getting fat. I am a little aggrevated with my vet since I saw him exhibit symptoms over a year ago, so I had the blood panel and urine test done which was inconclusive, was hopping it was thyroid. I asked if he could just have the cushings test the one that they inj with the hormone and check blood (6-8 hr test). My position was on the line with layoffs at the time and just wanted an answer, he just starting getting a bloated belly and loss of hair, I was told no he needs yet another test before this - so I did, ad it was inconclusive, I had to wait another 5 months due to now my loss of job, I had the all day test done - the test I orignally requested and voila as I knew it, it was cushings. Since he has had it over a year now can any med really help him or am I going to make his last years misreable? I have to go for another test to see if the keto, is working in a week, which is costly - I have spent close to 1K with his issues to let me know what I suspected. I do not see any changes, is there anything that I can mention to my vet (diet, along with another med to aid his gas problem and, if this med is not helping, is it going to make things worse for his day to day? Any questins or requests I should ask of my vet clinic? I had two dobes and my first dobe I lost at 6 years of age due to suddent serious heart problem. Had him for check up and his shots he was ok next week he was coughing, thought he ate a toy or something that was making him cough - his heart was failing and had to put him down - one trama for me after another, that is why I am hypersensative about this dobe - just want to make him as comfortable as possible if unable to cure. Thank you Viki
Submitted: 7 years ago.
Category: Dog
Expert:  Dr. Scarlett replied 7 years ago.


Cushing's can be a tough disease to diagnose sometimes. There are 2 typical tests that we can do to diagnose it--the low-dose dexamethasone stimulation and the ACTH stim. It is not uncommon for one test to be inconclusive and the other test have to be done. Sometimes both tests are inconclusive and yet another, newer test be run. But glad that you persevered and finally got the diagnosis. Did you discuss the different treatments available for dogs with Cushings? I have to say, ketoconazole isn't the treatment of choice as it can be very expensive for large dogs and may not be as effective as the other drugs.


As far as the appetite and diet, there really is no specific diet for Cushing's. I would recommend a low calorie, high fiber food, in hopes of decreasing the calories he is eating and helping keep him full. The excess steroids he is producing is making him hungry all the time, so measure out his dog food and then giving him lots of vegetables (carrots, green beans, etc) and 94% fat-free popcorn to help keep him feeling full. Apples are ok, but high in fruit sugar, so vegetables would be a better choice.


The gas could be just from eating a lot of food or from eating too quickly. It may also be a sensitivity to the Pedigree--you might try switching to a different brand and see if that helps. If you want to stick with grocery store brands, I would try the Iams light, Beneful light, etc. There are Prescription weight loss diets that might be helpful, but they are more expensive.


The breathing problems are likely due to the excessive weight. Not much else you can do about that, but try to slim him down. And that is hard with Cushing's dogs. Increasing his exercise might help. If you have a treadmill at home, maybe you can train him to walk on that.


If your vet hasn't discussed using lysodren (also called mitotane or op'DDD) as a treatment instead of the ketoconazole, I would highly recommend asking about it. While the ketoconazole is a safer drug, I'm not sure it is very effective in your dog. The lysodren will require more ACTH stim tests to be done to see if the Cushing's is under control and to start on maintenance dose, but once things seem to be going well and your dog is feeling good, doing the ACTH stim every 6 months should be sufficient.


Here is more information:


Please let me know if you have other questions--I'm not sure I found all the questions in your original message!