The vet has outlined the various drugs that are available to treat the disease, with a recommendation that we do nothing. Most dogs with the disease are not 'critically ill', in the sense that vomiting, diarrhoea, pain, seizures and bleeding are not typical concerns. Most dogs with Cushing's have signs that slowly progress, they are not problems of an acute nature that are imminently life threatening; and for many vets that, and the fact that treatments are generally very expensive (over £100 a month) and potentially dangerous is enough to stall action until symptoms become much worse. Also, Jacks age (14) was a factor in the recommendation.

Cushing's is rather like an insidious cloak that gradually envelopes the sufferer, and where previously there stood a floodlight, a light bulb gradually takes its place. The light still burns, but not as brightly. I feel as though we are at a crossroads and that we can either exalt the passionate entreaty of Dylan Thomas to his father in, Do Not Go Gentle Into That Good Night to "Rage, rage against the dying of the light." And take action. Or else betray Jacks own brand of passion in which he has lived to progressive decline, incontinence and loss of dignity.

There are a number of drugs that can be used to treat Cushing's, and your vet is the best judge of which are most viable; but looking at the fairly extensive literature that is available on the internet there seem to be three main options:

1/ Lysodren - Otherwise known as Mitotane or op-DDD - This is the most commonly prescribed drug for treating Cushing's. It works by destroying the outer layer of the adrenal glands, thus limiting their ability to produce cortisol in response to the signals of the hyperactive pituitary gland. It is effectively a chemotherapy treatment, and as such is toxic, and should only be administered with extreme care; as it is possible to overdose the dog and possibly kill them. The vet who diagnosed Jack thought that the figure was 5% (off the top of his head); of dogs are overdosed. Figures from studies on the internet put the figure at 5% of dogs being mildly overdosed during the loading phase of therapy, and 32% being overdosed at sometime during the therapy; with overall death from over dosage being seen in less than 2% of dogs. These figures are significant, and treatment cannot be entered into lightly, or carelessly. Constant and effective monitoring has to be the byword if a course of treatment is undertaken. It does have the benefit of being probably the most effective treatment available for Cushing's (good to excellent response in 80% of the dogs treated with mitotane according to several studies); but the toxicity, possible side effects, and the fact that it's use results in the partial or complete destruction of the adrenal glands (which could then give the dog Addison's Disease) are real issues.

2/ Ketoconazole - The literature seems to indicate that it is less effective than Lysodren, also has side affects, and needs to be administered twice daily for life. It is also more expensive. It does however seem to have the advantage that because its effects are obtained as the result of enzyme blockage (rather than at last partially destroying the adrenal glands), its effects are reversible.