Izzy 9.5 y.o. Rhodesian Ridgeback Mix - Atypical

[mypuppy]

Dear everyone/anyone,
I have a very special request to make...I was recently introduced to a a new friend who's dog was diagnosed with Cushings, however, her pup has issues with his intermediate hormones and was put on the melatonin and lignans treatment. I just received an email from her almost in despair for her pup. He is throwing up, has open sores, has lost almost all his hair, is not energetic and says he's turning purple. Anyway, her dr. recommended treatment with trilo, but not until they address the issue of the intermediate hormones with the melatonin and lignans. I feel terrible for my new friend. She is a wonderful, loving furmommy, just like the rest of us here, and she seems quite overwhelmed right now as to what to do. She doesn't know what's going on with him and feels she's going to lose him. Apparently, he also suffers from a heart murmur. At any rate, this is where my special request comes in. I will paste a copy of her email to me at the end of this message which includes the test results from her pup's last full adrenal panel....I know there are some here who are/have treated with the melatonin and lignans, so I would only ask all the experts who have helped me personally get through my own ordeal, to help me help this new friend of mine and her baby. I would appreciate any comments on her pup's results. Here they are. Thank you all as always....xo Jeanette
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The full adrenal panel that Izzy had done on 12/02/09 showed
baseline of the following:
cortisol = 68.9 (normal is 2.0-56.5)
Androstenedione= 0.61 (normal is 0.05-0.36)
estradiol = 68.7(normal is 23.1-65.1)
progesterone= 0.41 (normal is 0.03-0.17)
17 OH progesterone = 0.08 (normal is 0.08-0.22)
aldosterone = 51.9 (normal is 11-139.9)

The first 4 are abnormal according to this test. Maybe I didn't give the natural stuff enough time, but he is in terrible shape....skin is turning purple. Maybe I should be giving him a higher amount of lignans. I don't know...I need to see where his levels are now. God, I really hate not knowing what to do. Thanks for the kind words.....i am going to do all I can.....and then leave the rest up to God.. :-)

luv, Francine

[labblab]

Hi Jeanette,

I'm so sorry your new friend is having such a tough time with her dog. Is there any way in which she can directly join our group? As you already know so well -- we are full of a million questions :o. And it is really difficult for us to be able to offer meaningful feedback without the opportunity to fill in the holes or gaps in our information. As an example, we would have to know the "post" results for each of the adrenal hormones that she has listed -- not just the baseline values. Without the "post" results, it is impossible for us to draw appropriate conclusions about the testing.

Do you think you might be able to coax Francine to join us directly?

Marianne

[jrepac]

Hi Jeanette,
your friend's situation is very upsetting! I am wondering why the vet would not start the trilo along with the melatonin and lignans? Although, I recall that trilo does raise one of those hormones (the andro, perhaps)...UTK advocates "combination" therapies..

Re: the melatonin and lignans, UTK will tell you that it may take a few months for them to "kick in" (like 3-4). Based on my own experiences, I actually added a 3rd mid-day dose of melatonin to her regimen. It seemed to make a difference...and I am now using standardized lignan caps rather than the flax. So far, so good.

But, if my dog was throwing up, losing fur and purple, I'd want to take some fast action.

Jeff

[StarDeb55]

Jeanette, to add to what Marianne has already told you, THE most important values are the post values. We also need to know the pup's weight & what dosage of melatonin/lignans they are giving, along with specifically what type of lignans. For example, a purified lignans capsule, flaxseed oil +lignans, or flaxhulls. How long has the pup gotten the melatonin + lignans therapy.

I totally agree with Marianne, it would much better if your friend would join the group & post directly to the members. If you can talk her into it, please have her include the pup's history, what type of symptoms led her to go to the vet, what other diagnostic tests were done besides the UTK panel. Does the pup have any other medical conditions including medication they might be taking? This will just help us to give Francine the most appropriate feedback possible.

Debbie

[mypuppy]

Hey Jeff,
Thanks for your post. I am with you 100%, she needs to act ASAP. She has scheduled a dr. appt. for tomorrow, and I'm hoping it's a productive visit for her. Thanks so much for reaching out to me and my friend...Best regards and will keep you informed....xo Jeanette

[mypuppy]

Marianne and Debbie,
I have forwarded your posts directly to my friend via email. I am trying real hard to convince her to join. I too feel it is a better way to communicate all her concerns, test results, etc. Thank you both for the concern. You don't know how much it means to me. My friend is taking her pup in tomorrow for evaluation, so either way, I will let you know what the status is. Take care and thanks again. xo Jeanette

[mypuppy]

Hi everyone,
Here I am reaching out to any of you who would like to share any info/experiences they have had using Ketoconazole on their pup. I'm not sure if any of you remember a week ago or so my asking your help in interpreting test results for a friend. Her pup's skin was turning purple. I'm sure that rings a bell with some of you. But anyway, she finally received his full adrenal panel results, (which she actually does not have yet in her possession), but her IMS suggested she start her pup on Ketoconazole for the skin condition. She is just a little concerned because she read some serious side effects with this drug (as with any, of course), but apparently it will address the skin condition he is experiencing. On another note, i.e., Cushings note, her IMS and Dr. Oliver discussed his results, and apparently his cortisol levels were not high at all to the point where they seem to think he's not even Cushionoid, but Dr. Oliver stills recommends starting him on lysodern with the melatonion and lignans against trilostane which was the orignal plan. Her IMS says to just start the ketoconazole. Needless to say, my friend is extremely confused right now with all this new info. she has received. I am sorry that I have not been successful at getting my friend to join the forum. As I said, she went through a period of TMI with an a previous pup, and is just afraid of falling into that predicament again. Nevertheless, if there is any pertinent info I can get here for her, it's all worth it for me. I know it's hard for anyone to give great advice here without having test numbers, etc., but I do remember on someone earlier posts (not sure who's), they had used the ketaconazole, and just would like to know their experience with it, side effects, reactions, effectiveness or NOT, etc. Thanks to anyone who wants to give this a long shot....Best regards, xo Jeanette

[StarDeb55]

Jeanette, Dr. O is the world's foremost expert on Atypical cushing's & I would go with his recommendations over anyone else. When lysodren is used to control Atypical, you do not go through a loading period as one does with PDH. The lysodren is given as a maintenance dose only. If Dr. O did not suggest keto, I would like to hear what the IMS's reasoning is for using keto & not going with Dr. O. Keto is a good drug when used for the appropriate problem, but it can be extremely harsh on the liver that's why the liver has to monitored very closely. Can you tell us exactly what the IMS has diagnosed besides with Atypical? That might help us understand what the reasoning is behind using keto.

Debbie

[mypuppy]

Hi Debbie,
You made very good points, and I am in total agreement with you as to which opinion to go with. I do not know what final diagnosis my friend's IMS came to, but she basically recommended the keto strictly for his skin condition. I believe this med is used to treat fungi, so I presume, (not totally sure here), she wants to address the skin. My concern is that her IMS did not address how to treat the cortisol levels, even though she said they were not high, but don't they need to still treat with the symptoms? My friend seems to think perhaps the melatonin and lignans has worked a bit since his levels went down, so that's where she is so torn. She feels why can't he just stay on the mela. and lignans treatment. I will ask her again, if she missed mentioning something her IMS said. Thanks for your reply. Totally appreciate your help...Regards, Jeanette

[lulusmom]

He Jeanette,

You are correct, Ketoconazole is an anti-fungal treatment that was discovered quite by accident to be effective in limiting the synthesis of adrenal steroids and hormones in humans. If your friend's IM has confirmed a diagnosis of yeast or fungal infection by way of culture, then s/he may want to kill two birds with one stone so to speak. As I recall, your original description of the skin condition sounded like the pigment of the skin on the belly had changed to a purple color. This does not sound like fungus or yeast so I'd be interested to know what the exact diagnosis is. If s/he is throwing keto at the skin problem in the hopes it will help, I'd take issue with that approach.

The most serious adverse affect listed when using this drug as an anti-fungal, at doses of 5 to 7mg per pound, is liver toxicity. Dosing for cushing's, including atypical, can be almost double that dose, so I'd be very concerned about this side effect. Plus, a fair number of dogs, approximately 20% to 25%, do not respond to the drug. It is thought that those dogs that do not respond have a problem with absorption through the GI tract so the drug just doesn't get into the bloodstream.

I think another reason for going with lysodren versus keto is cost and convenience. In the long run, I believe that keto may be less cost effective as it must be given twice daily, whereas a maintenance dose of lyso is usually twice a week.

Glynda

P.S. Thanks for providing the name of the shampoo and conditioner. I'm going to give it a try with Lulu. She seems to be pretty itchy lately and is constantly scratching at her stomach. She bruises so easily and the area right below the rib cage is horribly bruised.

[mypuppy]

Wow Glynda,
May I ask a very personal question? How do you know all this stuff? Are you a vet, dr., genius, what? I am amazed at how you and so many others here are so knowledgable with all these issues, meds, treatments. Gosh, I feel so fortunate, to say the least, to be able to get all this valuable info. at such a low fee (free!)--lol. Even my IMS never took the time to explain things the way you and the others do. I'm just flabbergasted and feel truly blessed. I have forwarded your post and Debbies to my friend, via email, in the hope that she can continue to do her research on the options given her by her IMS and Dr. O. and in order to help her make the best decision for treating her pup. And your very welcome on the shampoo. I hope you get great results for Lulu the way I did with Princess. No reason any of our pups should be in discomfort with itchy skin. Good luck and thanks again. xo luv ya, Jeanette

[gpgscott]

Jeanette, she is just a geek, ask her.

Our dear Glynda, came to us quite by accident and we are unable to drive her off:D

She is a gift:)

Scott

[Squirt's Mom]

She is a gift

So very, very true! Brother John calls her The Oracle! :D

[mypuppy]

Leslie and Scott,
Hysterical! Glynda the Geek! haaaaaaaaaaaaaaaaaaaaaaaaa....BTW, I believe there are no accidents or coincidences in life. She was just meant to be where she is. And although I don't know her personally, I can sense she is full of love and b/c of that, she is truly loved by all of us, and that goes for every single one of you here guys. I can go on and name them all, but I wouldn't want to leave anyone out because you are ALL wonderful. I LOVE YOU DEARLY....tight ones. Jeanette

[lulusmom]

Scott was not lying....I am a geek!! I am an insurance professional who writes and negotiates contracts for a living but you can find veterinary medical texts in between my insurance law books. I don't understand a good deal of it but I get the gist of it. I have developed a really bad case of OCD since Lulu was diagnosed in 2005. I hold the record for making the most people want to shoot themselves in the head rather than listen to me rattle on about my dogs, rescue dogs and canine diseases. Have you ever watched somebody's eyes roll back in their head? I have....several times. :D:D:D

G.

P.S. I love you too!

[mypuppy]

Well Glynda,
Truth be told, I love dog talk. And well I'd prefer listening to someone rant all day about their furry friends than hear someone rattle on about themselves...haaaaaaaa....So on that note, rattle away as you do, and I try not shoot myself in the head or roll my eyes...:eek::eek: Haaaaaa....I noticed a very cool bumper sticker a long time ago..."The more I know people, the more I love my dog"...makes sense sometimes...Nevertheless, there are always the exception--you and so many others. Yeah I know I tend to over-compliment at times, but only because it's what I feel in my heart. Keep up the great work, and I promise I won't tell your boss you are moonlighting in between those insurance law books...haaaaaaaaa. Take care of you...Best regards and lov ya bunches...xo Jeanette

[gpgscott]

Best regards and lov ya bunches...xo Jeanette

She's still a geek:eek:

[mypuppy]

haaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

[mypuppy]

Hi everyone, This is the latest on my friend and her pup. Would anyone like to response? Thanks all. xo Jeanette
===========================================
Dr. Oliver was the one who suggested using ketoconazole or lysodren. He didn't say he preferred one over the other. He did mention that whichever one I chose would be a low dose. I did have a chance to compare this new test results to the last one. Izzy's cortisol and estradiol levels are now in the normal range. The problem is that now his androstenedione went up instead of down(it went up .17 points) and his progesterone is still high, but better than it was. So, I don't know why the andro went up. The flax hulls and melatonin is definitely making a change for the better except for the andro...If it wasn't for that specific hormone and his skin condition and muscle wasting getting worse, I would just keep giving him the natural stuff. I just don't understand why he looks worse if his overall levels are better. Could it be the andro doing that much damage? I am wondering if he should get his testosterone levels tested. When I adopted him, they were never sure if he was actually neutered or if his testicles never descended. They could not find a scar from surgery.....they did an ultrasound at that time, but said they couln't be sure either way.

I am leaning to giving him the keto just because of his skin condition......plus, I don't want him to go addison's.....especially because most of his levels are now normal and I am suppose to continue giving him the flax hulls and melatonin. Either way, I am not going to give him anything until he is done with antibiotics....that's over in 2 weeks.

I just hate to give him those heavy drugs when we are talking about just one hormone.....

[lulusmom]

Hi Jeanette.

What is Izzy's breeding and did you ever find out if the skin condition was in fact fungal or yeast related? Aside from the purple color on his belly, what is going on with the skin? Has Izzy's thyroid values been checked?

Unless you know a dog's complete history, it is extremely difficult to tell if a dog has been castrated or if he has bilateral crypotchidism (neither testicle descended). Most vets will do an abdominal ultrasound and/or check testosterone levels to help make this determination. If it were my dog, I would certainly want to know as cryptorchid dogs are at a much higher risk for testicular and other cancers plus if Izzy does have his testicles, having them removed could be a cure for atypical cushing's.

It sure would be nice if your friend would become a member here and start her own thread. I fear your and Princess' thread is going to become confusing for some members like me who have to go back and refresh our memory.

[mypuppy]

Hi Glynda,
You beat me to it when you said my thread may become a bit confusing for everyone since I'm not posting info on Princess. I was going to post another message asking one of you who maintain the forum, if there was a better way to handle this particular situation since my friend does not feel comfortable joining at this point? Should I open another thread named "MYPUPPY's friend" or even "IZZY's". Would love to get some guidance as to what to do so that you and the others and myself do not assume the info is related to Princess. In the meantime, I will copy/paste a copy of your latest post to my friend and will post a reply once I hear back from someone here as to where to post again related to Izzy. Sorry for the mix up. I feel so helpless and want to help my friend and Izzy in the worst way, and thought this was the only way for now. Thanks for your reply. Luv ya, J.

[Squirt's Mom]

Hey Jeanette,

You might let your friend know that we are a relatively new group, small at the moment, so she might not get as overwhelmed with info from us as she was before.

One of the first cush groups I joined absolutely overwhelmed me with their first post. It was FULL of links, none of which I could even begin to understand on my own and my questions were answered in technical terms with more links I couldn't understand. So I can feel her pain in that respect.

It really would be in her pups best interest (and yours) for her to join. Tell her we promise to be gentle. :)

Hugs,
Leslie and the girls - always

[gpgscott]

Hey Jeanette,

You might let your friend know that we are a relatively new group,

Well, this site is only about a year old, but it was set up and populated with persons with many years of experience.

You will not find a site with more 'hands on' experience or resourses.

Scott

[Squirt's Mom]

:o Didn't mean to imply that we were not knowledgeable, just not a large group.

Thanks for clarifying, Scott.

[mypuppy]

Leslie,
I will relay your message to my friend, Francine, btw, and I will continue in trying to persuade her to join. Thanks for your concern. Luv ya, Jeanette

Scott,
I couldn't agree with you more. I feel so confident with all the advice I've received from everyone here. Thanks. J.

[lulusmom]

Hi All,

I have started a new thread for Jeanett'e friend, Francine, and her dog Izzy. Jeanette sent me Izzy's UTK results as well as blood chemistry done on 1/30/10 and I have posted those results below.

UTK - 12/02/09

Only three values increased at baseline - all stimulated results were within normal range. UTK recommended melatonin, melatonin implant and lignans
Androstenedione= 0.61 (normal is 0.05-0.36)
estradiol = 68.7(normal is 23.1-65.1)
progesterone= 0.41 (normal is 0.03-0.17)

UTK - 2/10/10

All but baseline androstenedione and progesterone are normal. UTK recommends that low-dose ketoconazole or maintenance Lysodren be added to the melatonin and lignans.
Androstenedione= 0.78 (normal is 0.05-0.36)
estradiol = 57 (normal is 23.1-65.1)
progesterone= 0.30 (normal is 0.03-0.17)

Abnormal Blood Chemistry - 1/30/10

AMYL (high) - 1129 U/L Ref. Range 290 - 1125
PHOS (low) - 2.3 mg/dL Ref. Range 2.5 - 6.0

T4 (low) - 0.7 Ref. Range 1.0 - 4.0

LYMPHS (low) - 9% Ref. Range 12 - 30
NEUT SEG (high) - 83% Ref. Range 60 - 77

All in all, I think Izzy has less abnormalities than my dogs so he's looking pretty darn good to me. Those words would mean a lot more coming from Debbie so I hope she'll be by to give you her feedback.

[mypuppy]

Hi Debbie/everyone,
Glynda was generous enough to transfer all the info. related to my friend's pup, Izzy, from my thread to this new thread.

Debbie, I was hoping if and when you had a moment to spare (what's that?), if you can possibly interpret Izzy's latest test results and post any comments or anything that looks unusual to you. Based on all of Izzy's symptoms, even though the test results may not seem totally out of control, Izzy's IMS cannot pinpoint what else may be going on with him--she is baffled at this particular case. I know you have so much experience interpreting these test results and your input is extremely valuable to Izzy's well-being. Perhaps you will see something Izzy's doctors may have missed. Izzy's mom says she's mostly concerned about a lot of muscle wasting and the skin situation. As always, I appreciate your help. Thanx Debbie and everyone. Best regards, xo Jeanette

[StarDeb55]

I agree with Glynda's assessment of how Izzy is doing. When it comes to the low T4 result, I absolutely would have a free T4 by equilibrium dialysis done to confirm the low result. There is a thyroid problem associated with Cushing's called sick euthyroid syndrome that when the Cushing's is adequately controlled, the low thyroid values will normalize. The only way to make sure you are truly dealing with a hypothyroid situation in a cushpup is to run that free T4. In light of Izzy's skin issues, if I remember, I think the free T4 is a necessity.

Debbie

[mypuppy]

Dear All,
My friend's pup Izzy just received his results for his full adrenal panel. He has been on the flax lignans and melatonin for several months only to find treatment has not been successful and his levels are up again. Her IMS is suggesting to start him on 30mg of Vetoryl, and her husband is dead set against Vetoryl. Would someone be able to read the copy of his adrenal panel results and make some sense of it so I can relay it to my friend? I actually copied the image as a picture on my profile. I really appreciate any help for my friend so she can decide what's best for her pup. Thanks all. Warm regards, xo Jeanette

[labblab]

Hi Jeanette,

Just noticed your post, and am hoping to "bump it up" again so that those who are more experienced with elevated estradial may weigh in with some thoughts. If I'm seeing the UTK results correctly, that seems to be the most significantly elevated intermediate hormone (in addition to some elevation of the cortisol)...

Here's a link to your photo of the results:

http://www.k9cushings.com/forum/album.php?albumid=224&pictureid=1761

Do you know what treatment recommendations were made by UTK in Izzy's case after this most recent panel?

Marianne

[mypuppy]

Hi Marianne,
Thanks for your response on Izzy. I am not sure if my friend has received Dr. Oliver's recommendation, but I do know her IMS wants to start Izzy on Vetoryl (30mg) weighing 74 lbs. I have received Lori's input, and she recommends light dose of ketaconozole with flax lignans and melatonin. I know that option was given to Izzy's mom several months ago, but she steered away from it due to the possible risk on his liver therefore she just kept him on the flax lig. and melatonin with little or no success as you can see from his recent panel. She is really torn on what to do from here and her husband is against treating with Vetoryl. If you come up with anything else to add I welcome it. Thanks so very much for your constant support. Luv ya bunches. Xo Jeanette

[StarDeb55]

Jeanette, everything looks pretty good on this latest panel except for the cortisol & estradiol. The cortisol is really a mild elevation, nothing that severe. IMO & if Izzy were mine, I think I would want to add a maintenance dose of lyso to the flax+melatonin mix. Dr. O has previously said that you can try trilo, but you must keep in mind that it will eventually elevate the 17-OH progesterone, & possibly a couple of others. Now, whether or not this becomes a problem is going to depend on the pup. A maintenance dose for a 74 lb. pup would be between 840-1680 mg. weekly. Since lyso comes in 500 mg tablets, Izzy could be given 3 500 mg tabs weekly. Maintenance dosing should be 25-50 mg/kg, & the 1500 would put the dose at 44.6 mg/kg.

Just my nickel's worth.

Debbie

[mypuppy]

Debbie,
Your nickel's worth is worth a heck of a lot more, thanks. I was actually on the phone with Izzy's mom when you posted, and I read her your comments. Instead of starting Izzy on Vetoryl, she is going to try to speak to Dr. Oliver about all her options and then decide which way to go. Thanks as always for your concern. Xo Jeanette

[Harley PoMMom]

One note with the Lysodren, it does not always suppress the estradiol. Ketoconazole, according to the UTK Option Sheet, can.


LysodrenTM, traditional treatment for Cushing’s disease. Very effective in lowering cortisol, progesterone, androstenedione and 17-hydroxyprogesterone levels. NOTE: Estradiol is not always suppressed by LysodrenTM. A baseline estradiol level 1 month post-Lysodren will determine efficacy.

Ketoconazole. Cushing’s disease treatment. Effective for increased cortisol and sex steroid levels. Consider 6 to 12 mg/kg, BID along with melatonin and lignan as above....

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201005.pdf




Ketoconazole; Combination of Melatonin, Lignan, and low-dose ketoconazole

In cases of Atypical Cushing’s disease, with increased intermediate adrenal steroid levels, and elevated estradiol levels, consider using ketoconazole at a conservative dose (see article by Lien and Huang, "Use of ketoconazole to treat dogs with pituitary - dependent hyperadrenocorticism: 48 cases (1994-2007)", JAVMA, 233:1896-1901, 2008) plus melatonin and lignan.

http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php