Looking for answers (Jackson) 6 y/o Golden Retriever

[wilsonc2]

I have a 6 year old Golden Retriever named Jackson. About a year ago he started having excessive panting, seeking cool places to sleep, and later on hair loss, excessive water consumption and urination. He has had x-rays, heart ultrasounds, and numerous blood tests which all came back normal. My vet finally did an endocrine blood profile at the University of Tennessee in December and he has normal levels of cotisol but slightly increased estradiol and progesterone. He was diagnosed with atypical cushings disease. The suggested treatment was a melatonin implant and flax seed w/lignans. He had a melatonin implant put in about 1 month before I received his test results to hopefully help the hair loss and by the time I received his test results he was actually doing better. I started him on the flax seed w/lignans around Christmas and about 2 weeks ago he started with the panting again and is getting progressively worse (panting most of the time now). He has an appointment next week to have another melatonin implant put in. Could his symptoms be getting worse because the implant has been in for 3 months and about ready to be replaced? Should I consider having a new inplant put in at more frequent intervals? Has anyone tried anything different that has helped their dogs? My vet has never mentioned checking him for any type of adrenal or pituitary tumor. Should that be a next step? I should also mention that he has inflammatory bowel disease so I have to be careful in what I give him as to not aggravate that issue. He is on ZD dog food, steroids (weaned off of the steroids to do the endocrine test), and probiotics for his IBD. I hate watching him pant constantly and seem uncomfortable all the time so any help or suggestions would be greatly appreciated!

[jrepac]

I can't speak to the melatonin implant...perhaps it "ran out" prematurely? I've been using melatonin capsules for several months now and just switched from flax w/lignans to lignans in capsule form.

you could always get your pup retested, but see what they say first re: the melatonin implant.

[gpgscott]

Welcome to you and Jackson.

Six is young and with the right treatment you can expect a normal life for Jackson.

Atypical is easier to treat than conventional Cushing's when cortisol is the out of range hormone but it takes patience and a lot of tailoring of the treatment.

My pup is atypical with elevations of estradiol only. We started with oral melatonin, switched to the implant which we did twice and then switched back to oral melatonin. I prefer the oral as there is a wide difference in opinion as to the life of the implant.

On the lignans would you please post information of the type and of the concentration of SDG. SDG is the active component in the lignan which helps to control estradiol. Please also indicate your dose.

It would be helpful for us and for you also to have the results of the UTK full adrenal panel. There will be six hormones listed and a pre and post stim number for each.

Some atypical pups with elevations of progesterone do not respond as well to this treatment and in cases like this a maintenence only dose of Lysodren is sometimes added to the treatment. This is usually only done after giving the melatonin/lignans treatment several months to work unless symtoms are severe.

Thanks for joining, there are lots of people here with similar issues who look forward to helping others understand and advocate for their pups.

Scott

[Harley PoMMom]

Hi!

Welcome to you and Jackson from me and my boy Harley...so what is your name, if you don't mind me askin! :p:)

Good job on the UTK panel :D Now could you post the results from that test? and the treatment summary notes made by the Doctor, it should say something like ~ Comments: Values are increased as indicated. Consider items 1 through 5 on the treatment option sheet attached. It should also say ~ These results: (there are 3 boxes here that can be checked, which one is checked)

My boy Harley has very elevated estradiol and he takes the oral Melatonin and the flax hull with lignans. It takes a long time for that estradiol to come down because that is secreted in other places besides the adrenals.

I am not sure about the Melatonin Implants, I do know that they have to be changed regularly, we do have members that did use them.

I don't think the panting is anything to worry about but when was his last UTK done with an ACTH?

One thing I need to mention, the flax hull with lignans, or any lignans, have alot of fiber, that maybe what's bothering your pup, is his IBD bothering him right now?

Has Jackson had any bloodwork done lately...CBC/Chemistry profile, if so, could you post any abnormal results here with the reference ranges.

The more information we have about Jackson the more meaningful the feedback we will be able to give you.

Hugs,
Lori

[wilsonc2]

Hi Lori,

My name is Cindy. I should have put that on my original post.

Test results are as follows:

Test: Baseline, Normal, Post ACTH, Normal

Cortisol 8.6, 2.0-56.5, 94.3, 70.6-151
Androstenedione .30, .05-.36, 2.07, .24-2.90
Estradiol 89.8, 23.1-65.1, 77.4, 23.3-69.4
Progesterone .05, .03-.17, 1.90, .22-1.46
17 OH Proges .03, .08-.22, 1.4, .25-2.63
Aldosterone 38.3, 11-139.9, 307.9, 72.9-398

Box checked is "Indicate presence of increased adrenal activity (marginal)"

Comments: Values are increased as indicated. Typically several steroids are elevated, not in this case. Estradiol elevations are moderate and marginal respectively, that of progesterone is marginal. Although estradiol may contribute to clinical signs it is not a good indicator of adrenal activity. Various treatment option considerations are attached. Some veterinarians consider items 2-4 for estradiol control if symptomatic.

Those treatment options are melatonin, melatonin implants, and lignans.

I put Jackson on flax seed with Lignans but did recently take him off of them because his IBD flared up recently and I had to put him back on steroids (budesonide). Since the flax seed was his only diet change that could be the reason for his stomach issues.

His last CBC was in October I believe and my vet said everything was normal but I have not seen the actual results. He has had 3 ACTH stim tests and all have been normal (his last one in December).

Where do you get your melatonin and flax hull w/lignans? I am sure some are better than others.

Thanks so much for your time,

Cindy

[gpgscott]

I put Jackson on flax seed with Lignans but did recently take him off of them because his IBD flared up recently and I had to put him back on steroids (budesonide). Since the flax seed was his only diet change that could be the reason for his stomach issues.
Cindy

Thanks for this Cindy and another welcome to you both.

With the IBD you will want to find the lignans with the highest percentage SDG so you administer the least bulk as too much fiber exacerbates IBD.

You, I think also need advice from a nutritionalist who can help balance all of this. We have a member here who pays particular attention to this and I hope she has some advice, her name is Leslie. Also, Louise has a pup with pancreatic issues and pancreas and IDB overlap.

I think you are having way to many stims based on Jackson's results, costly for you and stressful for you both. I am suspecting you are being treated by a Dr. for whom this diagnosis is not common.
Scott

I will place some links to the members I have mentioned.

Leslie, aka squirts mom http://www.k9cushings.com/forum/member.php?u=32

Louise, aka minishauzersmom http://www.k9cushings.com/forum/member.php?u=18

[Harley PoMMom]

Hi Cindy :)

My boy Harley has pancreatitis also, he is also Atypical + PDH and is being treated with a maintenance dose of Lysodren + the Melatonin and the flax hulls with the lignans. Since he has these many health issues I've had a diet formulated for him by Monica Segal.

I buy Harley's flax hulls here:
http://www.flaxhulls.com/new_page.html

I do highly suggest, if it is feasible, to have a diet formulated for Jackson, like I've mentioned before the fiber content is very high in the flax hull with lignans and if you can a diet formulated with this in mind than it makes it alot easier. I have to be so very careful with my boy also, protein, fiber and fat are the main things that I have to look out for. :eek:

Harley's estradiol when it was first done in April 09 was 132.2 :eek: it is now down to 98.6 (11/27/09)...still elevated but it is coming down.

As far as the Melatonin, just make very sure that it is the regular Melatonin...NOT the fast-acting kind or the rapid releasing kind, just plain Melatonin, I buy mine from The Vitamin Shoppe...link below :)

http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=VS-1336

Hope this helps and if you have anymore questions, please feel free to ask.

Here is another link that might interest you :eek::) this is from our Resource Thread Section.

Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's"

http://www.k9cushings.com/forum/showthread.php?t=198

Love and hugs,
Lori

[Squirt's Mom]

Hi Cindy and welcome to you and Jackson! :)

One thing that caught my eye is the use of steroids - which I understand is necessary in Jackson's case for his IBD. But the things you are seeing like the panting and such can very easily be caused by steroid use and therefore may not be connected to the Cushing's.

My Squirt is also Atypical and she is doing really well! We use melatonin in either capsule or pill form as I can't trust the life of the implant or know that it is supplying a steady, consistent dose. Plus the idea of that huge needle in her little body....:eek: :o So, we stick with the old fashioned way. ;) Your thinking on the loss of effectiveness in the current implant could also account for the renewed signs you are seeing.

We use flax hulls as well as capsule forms of lignans. As Scott mentioned it is the amount of SDG you want to look at in the product. SDG is what works on our Atypical babies and it is found in lignans but not all lignans are created equal.

Atypical pups may or may not have a pituitary tumor causing the excess production of hormones, so that is probably why your vet hasn't mentioned a tumor in Jackson's case. Since his cortisol has been normal, I wouldn't worry overly much about tumors just now. ;)

IBD can be very difficult to get a handle on, but once you do, it is wise not to go about changing things, as I'm sure you already know! Since Jackson is going to need the lignans, which will necessitate a change in his fiber intake, you really need to work with either a canine nutritionist or at least a nutritional consultant to get a good balance established for him that includes the extra fiber. I will send you a couple of recommendations via your PM (Private Messages). You may need to introduce the lignans very slowly and not start with the full dose; this might let his system adjust to the fiber increase a bit better.

I am really glad you are here and very proud you and your vet knew to do the UTK panel for Atypical when his ACTHs kept coming back normal.

Hugs,
Leslie and the girls - always

[littleone1]

Hi Cindy,

Corky and I would also like to welcome you and Jackson.

I'm sorry I don't have any advice to give you, as Corky has an adrenal tumor and is being treated with Trilostane.

As you can see from what others have posted, you have found a wonderful group of people who have a wealth of knowledge.

I hope everything goes well for Jackson.

Terri

[Franklin'sMum]

Hi Cindy,

Welcome to you and Jackson! :) You've been given some great info and links to help you out.
My knowledge of Atypical wouldn't overflow a thimble, but just wanted to pop in and say hi and welcome. Hope everything goes well for Jackson (and you).

Jane and the gang xxx
________
Blowjob sounds (http://www.fucktube.com/video/35099/wet-moaning-sounds-with-her-deepthroat-blowjob)

[labblab]

Hi Cindy,

I'm going to throw a "wild card" out here, but I am wondering whether there would be value in performing a LDDS blood test (low-dose dexamethasone suppression test) or abdominal ultrasound in order to rule out the possibility that Jackson may suffer from Cushing's caused by an adrenal tumor (rather than a pituitary tumor which is more commonly the cause). If I am reading his history correctly, he has not yet had an abdominal ultrasound that allows for visualization of his adrenal glands. And even though his ACTH tests have not indicated abnormally elevated cortisol, the ACTH often fails to give a "positive" result in the face of adrenal Cushing's. The LDDS is an alternative diagnostic blood test which can be a more accurate indicator of the adrenal form of the disease.

You mention that Jackson has had "heart ultrasounds," so maybe full abdominal ultrasounds have been performed as well? But if not, the ultrasound may actually be your best place to start, because it will allow for visualization of Jackson's adrenal glands (looking for masses or other abnormalities), as well as internal organs other than the heart. But to be of real value, the ultrasound should be performed using high-resolution equipment and interpreted by a specialized professional -- the adrenal glands can be difficult to visualize properly. So this type of ultrasound may likely require a referral by your regular vet.

As I say, just two more diagnostic steps for you to consider in your effort to get at the bottom of Jackson's problems...

Marianne

[wilsonc2]

Jackson is a bit of a challenge due to the fact that he has the inflammatory bowel disease as well and it flares up quite often. I recently took him off the flax seed for just that reason. I also hate putting him on steroids (due to their own side effects) but has been unavoidable at times.

He has not had an abdominal ultrasound or the LDDS test. I have an appointment to see his regular vet next week so these suggestions have certainly given me some things to discuss. I had him to an internal medicine specialist about 6 months ago but when I suggested cushings (based on my own research and his symptoms) I was told he was "too young" to have cushings disease.

I also think the suggestions for a nutritionalist would be very beneficial for him since he has more than 1 issue to contend with. You don't want to fix 1 thing and make the other worse.

Thank you for all of the input and suggestions. I have been trying to get a diagnosis and treatment plan for him for over a year now and it has been quite frustrating at times. Nobody knows better than their "mom and dad" when their babies aren't feeling well. It is comforting to hear from others who have had the same challenges but who are finding things that work.

Thanks so much,

Cindy

[Harley PoMMom]

Hi Cindy,

One other point I wanted to mention was that Cortisol is a stress hormone, one of the "fight or flight" hormones, so any excessive stress and/or any non-adrenal illnesses can create false positives on any Cushings tests.

Seeing that Jackson's IBD is not under control, which causes a pup stress, I really believe Marianne's suggestion of an ultrasound being done would be the next step to take. It was on Harley's first ultrasound that showed that he had prior bouts of pancreatitis :eek: and I never knew this :eek::eek: it also showed that he has a nodule growing on his right adrenal, the nodule was 7.3mm and at his 2nd u/s it grew to 8.0mm. Harley's u/s report lists so much more and that is why this diagnostic tool is so very helpful.

Love and hugs,
Lori

[MiniSchnauzerMom]

Hi Cindy,

A belated welcome to you and Jackson from me. I've read your posts about Jackson over and over and wanted to ask you a question. Was Jackson on the budesonide for his IBD a year ago when he started having symptoms? I know he was diagnosed with atypical which can cause the symptoms you mention and after looking up budesonide it also causes polyuria, polydypsia, increased appetite and changes in hair coat. Just a thought because I'm no vet and not qualified to do any diagnosing but possibly poor Jackson has been getting a double whammy on those symptoms because of the atypical/budesonide combo.

This may not apply to Jackson at all but my Munchie became intolerant to chicken. Anything with chicken wreaked havoc with the poor guy's tummy and bowels. His specialst suspected IBD at first but before doing any biopsy he was put on a novel protein/carb diet that did not contain chicken and no more problems. He is currently on a homemade fish/potato diet formulated by a Veterinary Nutritionist. All his health issues (and he's got several :( ) were taken into consideration when formulating the diet and he is monitored 2-3 times a year to see that the diet is still meeting all his needs or if an adjustment is necessary. He has done very well on this diet.

I am going to give you a couple of links to sites with recommendations for veterinary nutritionists. A Veterinary Nutritionist differs from a consultant in that Veterinary Nutrition certification, sanctioned by the American Veterinary Medical Association, requires at least a BS, MS, DVM and American College of Veterinary Nutrition (ACVN) Diplomate status (www.acvn.org/ ). Most Certified Veterinary Nutritionists also have a PhD in animal nutrition as well.

American College of Veterinary Nutritionists
http://www.acvn.org/site/view/103264_NutritionResources.pml

The link on the page for UC Davis was incorrect so I have added the correct link below.
http://www.vetmed.ucdavis.edu/vmth/small_animal/nutrition/faq.cfm

I also agree about the abdominal ultrasound. Good luck at your vet appointment next week. Will be watching for your update.

Louise