Milo - Atypical Cushing, looking for help to understand

[daushieowner]

Hello all,
New to Cushings and the forum. My Milio has just been diagnosed with "atypical cushings" whatever that is. Searching for info and advice.


Mod note...This message was copied from a visitor message to help this new member introduce herself and her cush pup.

Hi all,
Here is some basic info. Milo is almost 11yr old male dachshund. 26 pounds and was neutered at 6months. His only medical condition until now has been IBD.. He is on venison/potato diet for that. Has not had a flare in 5 years since he was put on that food. He also had a hemilaminectomy 5 years ago and has had a full recovery thankfully. His supplements are Glycoflex(glucosamine for arthritis) /cranberry extract and Vit C for UTI prevention. I took him in for his annual visit and questioned teh PU/PD that he has been experiencing the last few months. They did a Ua and metabolic panel and he did have a UTI. treated that and third culture remains negative. His urine is very diute with a Sp G equivalent to water and his Alk P is elevated slightly. Thyroid was WNL. My regular vet did a Dex Sup test which came back negative and was out of suggestions, I went to U of Penn for an eval by one of the internal med specialtists. His US was that of a cushings dog with an enlarged lived and adrenals were on the high side of normal . (he does not have the pot belly or alopecia or skin issues that cushings typically presents) . Bile acid was normal and his Alk P has increased a bit. They sent the panel off to U of Tn and called yesterday. Most of his levels were elevated somewhat. So we discussed the melatonin and Lignans as a conservative route before the trilostane. He feels that he will eventually need the trilostane but is fine with trialing the nutracels for now. I emailed him asking some questions about the biavailability of sublingual vs oral melatonin pills in canines as well as purchasing the lignans in capsule vs powder form. Waiting to hear back on that.
You can ask all the questions you need, lord knows i have a million of my own.
One of my main concerns is ....is this a death sentence for him ? I just love him so much.
I had been very active on dodgerlist forum with my other paralyzed dog and found it to be a wealth of information. Glad I found this site for him.
Helen

[Squirt's Mom]

Hi and welcome to you and Milo! :)

My baby, Squirt, is Atypical, too. She has been on melatonin and lignans plus some supplements for over 2 yrs. now and is doing quite well.

We tend to play 20 Questions with our new family members so be patient...we don't get really nosy until we get to know you a bit better! :p

What breed is Milo? I assume male? Is he neutered? If so, at what age was this done? How old is he and how much does he weigh? Does Milo have any other health issues that you are aware of? Is he on any meds, supplements, or herbs? If so, what are they, what are they for, how much does he take and how often?

How did this diagnosis come about - what caused you to take him to the vet or what caused your vet to test for Cushing's? Was/is he showing any signs? If so, what were they? What tests has he had done? Do you mind posting the actual results of those tests along with the units of measurement (ug/dl, nmol/l, etc) and the normal values? What were the recommendations from the Uni. of TN in Knoxville (UTK) for treatment? (These are usually listed at the bottom of the results sheet as numbers; as in - "your vet may want to consider numbers 1, 2, 3, or 5") Have you had enough questions for now? :p

The more info you can provide about Milo the better the feedback we can offer!

For now, know that you are in very good hands here and we will do all we can to help you and Milo along this journey. I know other members will be along to welcome you...and ask their own questions! :eek:;):D

I am glad you found us and look forward to hearing from you again soon!

Hugs,
Leslie and the girls :D - always

Some links about Atypical Cushing's:

Atypical info:

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

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20100810-LIGNAN-Write-Up-Revision03.pdf

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


Link to our Helpful Resource section:

http://www.k9cushings.com/forum/forumdisplay.php?f=10

[Squirt's Mom]

Hi Helen,

I only have a minute but wanted to thank you for the extra info and to tell you one quick thing...

No, this is not a death sentence! :D So sit back, take a breath, and get ready to meet the best bunch of folks in the world - literally! ;)

Hugs,
Leslie and the girls :D - always

[daushieowner]

So I guess my first question is .... I am looking to purchase the flax hulls lignans. The vet said they have to be the hulls, not the oil. I emailed a local holistic vet to see if he carries it. Can I start the melatonin before I get the lignans? If I haveto order it online, it may take a few days to get it.

[lulusmom]

Hi and welcome to the forum.

I see that Leslie answered your first question about atypical cushing's and has provided links to reference material that an help you understand the condition better. To answer your latest question, yes, you can start giving Milo the melatonin while you find a source for the lignans. To help you with that, I've included a link to a pdf file on the the U of Tenn website that provides a lot of resources for lignans. Also, make sure that you have just plain old melatonin, no fast acting or timed release.

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20100810-LIGNAN-Write-Up-Revision03.pdf

Glynda

P.S. Oops, I see that Leslie already provided the link for the lignan info. Oh well, duplication is not a bad thing sometimes.

[daushieowner]

Thanks Glynda, esp for the tidbit on the melatonin. Didnt know that. Will stop at whole foods tonight for that. I printed all of the reading material. I have a lot of reading to do :)

[apollo6]

Would like to welcome you and Milo
I am Apollo's mom-Apollo is a 12 year young, 10 lb dachie, has pituitary cushing-there are three kinds see attached quick explanation:
http://www.kateconnick.com/library/cushingsdisease.html

Apollo is on Trilostane since June 2010.
It is important to know which cushing Milo has as to the right treatment and medication.
Hugs Sonja and Apollo.

[daushieowner]

Hi Everyone,
Better late than never. Here are the labs and US results you asked for. It is not allowing me to post attachments so I have to type it all in. please excuse any typos.
ALT=111
Alk Phos=412
Cortisol=164.0(norm-70.6-151)
Androstenedione=>10 (norm -.24-2.90)
estradiol=78.9 (norm 23.3-69.4)
progesterone=2.22 (norm .22-1.45)
17 OH progesterone =4.36 (norm-.25-2.63)

The note says these results indicate the presence of increased adrenal activity.

The US reads: Liver is Abnl with diffusely hyperechoic with severe round hypercechoic poorly marginated nodules ~10mm.
Gallbladder abnl with slight amount dependent echogenic sludge
right adrenal abnl with upper limit of normal thickness (7.5) with heterogenous echotexture. Small hyperechoic nodule within.
Left ADrenal abnl with upper limit of normal thickness (7.5) with heterogenous echotexture.

I started him on the melatonin yesterday. Still searching for the lignans. The problem is the dosage. He needs 25 mg a day and the ones I have been looking at on your list would require a ridiculously small amount of the powder and i dont even have a measuring device thet small. :) If I give a little more than the dose required, would that cause problems? :confused:
Thanks
Helen

[jrepac]

Hello Helen,
Your baby's results are very similar to what I was dealing with on my Aussie...re: lignans, you may want to try the capsules..ultimately they are easier and you have better assurance of the amount of lignans. Although my Mandy enjoyed getting her flaxseed w/vanilla yogurt every night, I was always unsure if she was really getting enough lignans. With the capsules, you need to look at the mgs on the bottle and realize only 20% is true lignans...so if 70mg, then each capsule provides 14mg of lignans. The back of the bottle will tell you the standardization percentage. We had a good debate on this some time back on the board..it's funky math! You can get these online or at your local Vitamin Shoppe...they were the best in terms of having them in stock...

http://www.vitacost.com/Source-Naturals-Lignan-Extract

good luck to you!

Jeff & Angel Mandy

[addy]

Hi Helen,

Welcome from me and my Zoe!

Zoe is on melatonin and lignans. It should not be a problem if you give a little more, however, keep in mind the SDG lignans are fiber and may cause loose stools here and there. That is what I am dealing with at the moment with Zoe. She also has colitis and durring her colitis flare, she cannot tolerate the SDG lignans so we had to stop them for now.

If that would be a problem for you, you could switch to the HMR lignans. They are not a fiber.

Hugs,
Addy

[daushieowner]

oh thanks . That is helpful.
He does have inflammatory bowel syndrome and we have not had any issues in such a long time, I hate to flare it all up again.
Are the HMR lignans just as effective and are they listed as "HMR" on the bottle?

[addy]

UTK does not have as much research on the HMR lignans but do reccomend it as well as the SDG lignans. Here is the link:

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20100501-LIGNAN-Write-Up-Revision01.pdf

(Don't know if I did that right :o)

It will also give you sources to purchase. I introduced the SDG lignans slowly to Zoe and she was fine for 2 months but then durring this last flare up, they bothered her. I used the Vitacost capsules as the are 8 mgs of lignans per capsule. Since the capsules have other ingredients, Zoe might be better off with a different lignan with a higher SDG content so I use less powder or I will switch her to the HMR lignans. Oh, decisions!!!!:) All you can do is try one and see how it goes. Your pup may be just fine.

Hugs,
Addy

[daushieowner]

Hello all,
Just ANOTHER question..... If the lignans and melatonin are for treating the symptoms of atypical, what if they cant tolerate the lignanas... is it necessary to treat with trilostane since it is only the symptoms that are being treated?
Helen

[Squirt's Mom]

Hi Helen,

Did the Uni of TN recommend the Trilo for Milo or is this your vets recommendation? I ask because Trilostane is known to cause elevations in the intermediates which are already elevated in Milo. Lysodren is usually the preferred treatment for pups with elevation in the intermediates as it will lower all the values with the exception of estradiol sometimes, which is where the lignans and melatonin come into play.

Since Milo's cortisol is elevated, he is not considered to be an Atypical pup, but rather he has true Cushing's. (Atypical pups do NOT have elevated cortisol.) So the focus of treatment is the cortisol using Lysodren.

As for your question about the lignans with intestinal problems - supposedly the HMR lignans do not have the same effect as the SDG lignans. They claim the HMR lignans are not fiber.

I look forward to hearing who recommended the Trilo for Milo.

Hugs,
Leslie and the girls :D - always

[daushieowner]

Hi Leslie,
Interesting question. Yes, the vet recommended it. Actually it was the "resident" so now that I know what you have suggested, I will certainly ask about this when we go. They told me do the supplements a few weeks and see if he has any imrovement. The lignanas are on the way. Started the melatonin about a week ago. I havent noticed any improvements just yet since he peed all over the other day adn he would NEVER do that in the house.
He did tell me that he can forsee Milo needing medicine but there was no harm in trying this approach first and the medicine he mentioned was trilostane. I remember this because we have a few of them on it in the rescue and I know how expensive it is. I just love thsio forum. It is very helpful.
Helen

[missbeagle]

Helen -

Welcome to the Cushing's Board. There are great people here who are a super help to all of us.

Your pup sounds like mine. ALL of my dog's horemones are out of whack. My Rusty's intermediate (sex) hormones are elevated as well as his Cortisol levels.

My Rusty is taking melatonin that I get at Wal Mart. Make sure it's NOT the extended release kind.

Dr. Oliver (Cushing's guru from Univ. of Tenn in Knoxville) sent me to Swanson Vitamins for Rusty's HMR lignans. He weighs 60 pounds and Dr. Oliver told me that 40mg would be OK for my pup.

Welcome.

Gretchen and Rusty in NC

[addy]

Hi,

The SDG lignans did not cause my Zoe's flare, just exacerbated it somewhat. Don't cross the bridge until you have to, so to speak:)Maybe introduce the SDG lignans slowly not all at once and see how it goes. You can always stop and switch to the HMR. I will try the SDG one more time and if Zoe can't do it will move on to the HMR. The trilostane will elevate the estradiol and the aldosterone but some vets feel the most important thing is to bring down the cortisol. The problem is you can get Cushing symptoms from elevated estradiol and aldosterone, so sort of a catch twenty two some of us find ourselves in. My IMS and I are both worried about Zoe getting gastro problems from lysodren. I wanted to try a maintenance dose to see if she could tolerate it. IMS thought it would be better to load her if we go that route.

We take it one day at a time. It is all we can do because we don't know sometimes what the next day will bring. I was so sure Zoe would be fine until the end of November for her retest but here we are:eek::eek:

I hope I did not upset you, just wanted you to know that the SDG lignans some times can cause a problem:o

Hugs,
Addy

[lulusmom]

Hi Helen,

I think your vet's approach is a sound one. After looking at the UT results, I don't believe the cortisol is not high enough to confirm a diagnosis of typical cushings so trying the melatonin and lignans first sounds logical to me. From everything I've read, these supplements are not that effective, something like 40%, and when they do work, it often takes a few months to see any improvement. One of my cushdogs was on lignans and melatonin for a year and it did nothing for her. Every dog is different so you just never know.

Your vet is probably thinking that Milo's cortisol will probably continue to climb and at some point require Trilostane or Lysodren. Both are very effective.

Glynda

[daushieowner]

Thanks all for your info. I ordered the sdg lignans from heartland because they had the capsule with the closest dose for him and we'll see how it goes for awhile.