My Poopsie...(Atypical) & Diabetic

[ssmarilyn]

He's been undergoing atypical cushings treatment for a couple of years now via the U of MN and is on melatonin and flax oil with lignans. He's been doing real well, but has started to form scabs all over his body and is itching the ones on his belly raw. I can't really afford to go back to the U as every time we go there it's about $400 or so. Our local vet doesn't know how to treat this kind of cushings. Any advice?

He's also diabetic.

[Harley PoMMom]

Hi and welcome to you and Poopsie!

Mange can form scabs and there are several different types of mange, with the two most common types being sarcoptic mange or scabies and demodectic mange. Both are caused by tiny parasitic mites that burrow into the skin, which results in skin irritation, hair loss, and crusting or scabs forming.

To find mites, it is necessary to obtain skin scrapings from affected areas. A punch biopsy may be needed if skin-scraping results are negative and the index of suspicion for demodicosis is high.

Could you post the results of all test/s that confirmed Poopsie's Atypical Cushings, please.

Usually dogs are not given the flaxseed oil because the lignan content is low. Here is a link to a lignan list from the The University of Tennessee lab: http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20100810-LIGNAN-Write-Up-Revision03.pdf

We are here to help you in any way we can, so please feel free to ask any questions.

Love and hugs,
Lori

[addy]

Hi and Welcome from me and my pups,

Glad you found us though sorry to hear about Poopsie. University of Tennessee has updated their recommended lignans. The link Lori gave you should give you enough information to find a new lignan as the flaxseed oil is no longer on the list. If you are unsure of the dosage just check back with us, we can help you figure it out. I was using Vitacost SDG capsules but had to switch to Heartland powder. My Zoe has colitis and the fill in the capsules (she had to take 2) bothered her. She had no problem with the powder as she only took 1/8 teaspoon.

I think Lori is exactly right in suggesting a scraping or punch biopsy. Poopsie could have a skin infection.

Hang in there and ask any questions you want.

Hugs,
Addy

[ssmarilyn]

Thanks for the welcome gals! I don't have any numbers on his test results from the U of M, just a written letter saying his cortisol levels were fine but his sex hormones were too high for a neutered male dog. The vet there said he had atypical cushings and to retest him sometime soon to see if he had progressed into 'true' cushings.

Poopsie has had this skin problem a couple of times before and its from his diabetes I'm told. I'm going to call our local vet tomorrow to see about getting an antibiotic for him, but that won't get rid of it entirely. Seems it has to run its course, but looking back, I can't remember exactly how long it lasted. Poor guy is so itchy and stinks to high heaven!

If he shouldn't be on the flax oil anymore, what is the suggested replacement for that? He weighs about 10 lbs.

[ssmarilyn]

Hi and Welcome from me and my pups,

Glad you found us though sorry to hear about Poopsie. University of Tennessee has updated their recommended lignans. The link Lori gave you should give you enough information to find a new lignan as the flaxseed oil is no longer on the list. If you are unsure of the dosage just check back with us, we can help you figure it out. I was using Vitacost SDG capsules but had to switch to Heartland powder. My Zoe has colitis and the fill in the capsules (she had to take 2) bothered her. She had no problem with the powder as she only took 1/8 teaspoon.

I think Lori is exactly right in suggesting a scraping or punch biopsy. Poopsie could have a skin infection.

Hang in there and ask any questions you want.

Hugs,
Addy

I need a liquid or powder that I can mix in his food because those big capsules are too much for him and he chokes on them.

[addy]

Hi,

The Heartland Powder is what I switched Zoe to and when I used the capsules, I just opened them up and dumped them in her food.

If you go back to the link Lori gave you, it will tell you the doses. It varys depending on the SDG lignan content.

I bought the Heartland powder from Flax Naturally and the SDG capsules from Vita Cost. Both are on line.

Hugs,
Addy

[lulusmom]

Hi and welcome to the forum.

Dogs with atypical cushing's have many of the same symptoms associated with typical cushing's. Aside from the skin problems, what symptoms did Poopsie have that led your vet to suspect cushing's and to have the UTK adrenal panel done? What other tests were done to confirm a diagnosis? Please ask your vet for a copy of the UTK adrenal panel and post the results here. Please also post the abnormalities of any bloodwork done, to include the normal reference ranges. Was a urinalysis done and if so, please post those results too. If you don't have copies of any of Poopsie's test results, your vet should be happy to give them to you.

You mention that Poopsie stinks. It sounds like she may have a yeast infection. Has your vet given you a prescription shampoo to use frequently?

Glynda

[Squirt's Mom]

Hi and welcome to you and Poopsie! :)

My Squirt is also Atypical and she is on lignans and melatonin along with a maintenance dose of Lysodren 2x/week. The Lyso was just started several months ago as her signs kicked into high gear. She is doing much better now, tho!

I use NSI brand of lignans and they are in a capsule form. Squirt, at 14 lbs, gets 3 caps a day and I just open them and pour them into her food and stir - the melatonin, too. I am not familiar with the powered form of lignans but those in capsules or tablets are standardized - meaning the cap/tab doesn't contain the full amount listed. To explain - the NSI lignan is a 40mg capsule and the product is standardized to 20%. That means that the 40mg capsule only contains 20% SDG, which is the factor that works on our atypical babies. This means there are only 8mg of SDG per capsule. (40mg x 20% = 8) So when determining how much a pup needs, the standardization has to be considered in the formula. If the powdered form is standardized, it will say so on the bottle.

I am glad you found us and look forward to seeing Poopsie's test results that diagnosed the Atypical.

Hugs,
Leslie and the gang

[addy]

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

This page will break it down for you. Example:


Heartland Natural (www.heartlandnatural.com). Capsules/Powder.
90 Capsules per container. 33 mg of SDG flax hull lignan per capsule.
5.3 ounce concentrated SDG flax hull lignan powder. 6 grams of this product contains 223 mg of SDG lignan.
One standard-sized teaspoonful contains 5 grams, or approximately 185 mg of SDG flax hull lignan.
One-half teaspoonful would contain 93 mg of SDG flax hull lignan.

Zoe is 18.5 pounds and I gave her 1/8 teaspoon of the Heartland Natural Powder. Figure 1 mg per pound and it does not have to be exact,

Hugs,
Addy

[ssmarilyn]

Hi and welcome to the forum.

Dogs with atypical cushing's have many of the same symptoms associated with typical cushing's. Aside from the skin problems, what symptoms did Poopsie have that led your vet to suspect cushing's and to have the UTK adrenal panel done? What other tests were done to confirm a diagnosis? Please ask your vet for a copy of the UTK adrenal panel and post the results here. Please also post the abnormalities of any bloodwork done, to include the normal reference ranges. Was a urinalysis done and if so, please post those results too. If you don't have copies of any of Poopsie's test results, your vet should be happy to give them to you.

You mention that Poopsie stinks. It sounds like she may have a yeast infection. Has your vet given you a prescription shampoo to use frequently?

Glynda

I'm trying to remember now, what all his symptoms were in '08 when he was diagnosed with cushings by our regular vet. She also diagnosed him with hypothyroidism and was treating him for diabetes. He lost all his torso hair, had a distended abdomen and was losing weight. Our vet here put him on Trilostane, which he couldn't tolerate, so that was stopped in 2 days. At this point our vet said the treatment for cushings was worse than the disease so we shouldn't treat him at all. This is when I called the U of Minnesota and set up an appointment. They did the U of T test that our regular vet had never heard of. They also said Poopsie didn't have hypothyroidism and his insulin dosages were way too strong. We finally got his insulin from 6 & 6 down to 2 & 2 and he does fine on that.

I looked closer at the vet's letter to us and do see some numbers for the Adrenal panel test. I don't know how I missed them. This test was done 2 years ago... still want the numbers?

I have to take Poopsie to the vet to get some antibiotics for his skin, then I'll come back here and read the comments more closely and maybe learn something new!

[lulusmom]

Can you please clarify a few more things for me? Your title states that Poopsie was diagnosed with atypical cushing's yet your old vet prescribed Trilostane, a drug which is used to treat "typical" cushing's not atypical cushing's. Did the U of Minnesota tell you that your old vet misdiagnosed Poopsie? It would help if you could post the results of the UTK panel. How long has it been since you have checked the adrenal hormones. Did you have a second UTK panel done after starting the melatonin and lignans two years ago to determine if these supplements have been effective? Has Poopsie had any recent bloodwork done? If so, can you post those results too?


Glynda

[ssmarilyn]

Can you please clarify a few more things for me? Your title states that Poopsie was diagnosed with atypical cushing's yet your old vet prescribed Trilostane, a drug which is used to treat "typical" cushing's not atypical cushing's. Did the U of Minnesota tell you that your old vet misdiagnosed Poopsie? It would help if you could post the results of the UTK panel. How long has it been since you have checked the adrenal hormones. Did you have a second UTK panel done after starting the melatonin and lignans two years ago to determine if these supplements have been effective? Has Poopsie had any recent bloodwork done? If so, can you post those results too?


Glynda

I didn't put that in the title, someone here did, but yes, our regular vet isn't aware of the U of T tests and that there are two types of cushings, so she was treating him the only way she knew how. The U of M gave him a correct diagnosis, but didn't come right out and say our regular vet missed the ball. We haven't had a second panel done since he's been doing well on the current treatment of melatonin and Barleans flax oil with lignans. He hasn't had any bloodwork done for cushings since his diagnosis.

Here's the numbers:

12/12/08
Cortisol:
Baseline: 64.4 ( normal 2.0-56.5) Note from U of M vet: 'The 'cushings' hormone: Mild changes often seen in uncontrolled diabetes, not diagnostic for cushings at this level in Poopsie's case. (this was when our local vet had him on insulin of 6 and 6 and it was too much for him.)

Post ACTH: 206.2
Normal Range: 70.6-151.2

Estradiol:
Baseline: 87.7 (normal 23.1-65.1)
Post ACTH: 82.4
Normal Range: 23.3-69.4 Note from U of M Vet: Sex hormone, abnormally elevated for a neutered male dog.

I was really absent minded when his skin broke out and I thought it was his cushings. He's had this happen before, the latest was last November and the U of M said it was from his diabetes. I have mental-pause more often than I like to admit and forgot about his problem in November because hubby took him to the U by himself. He went to our local vet today and got an antibiotic shot and some Orbax to give him for the next several days, plus he got a bath in a special shampoo for bacterial skin infections, then a spray for the same thing. He seems to feel better, but he still feels hot and stinks!

[lulusmom]

Thank you for posting those test results. With no follow up testing after starting melatonin and lignans, in my opinion, there is really no way to determine if these supplements were responsible for the improvements you have seen in Poopsie. Is there any reason that neither your vet or U of M felt it was not necessary to do follow up treatment monitoring?

I am one of a few members who question an atypical cushing's diagnosis based solely on the results of an adrenal panel. There is no proof that elevated hormones cause clinical symptoms in every dog so the results of any adrenal panel must be interpreted in light of a dog's full medical history, to include abnormalities on screening tests, overt clinical signs and an awareness that nonadrenal illness and stress can cause an increase in adrenal hormones.

For instance, at least one recent study was done that proves that normal dogs, including neutered males, often have elevated estradiol with no clinical symptoms of hyperestrinism (has same symptoms as typical cushings). It is possible that the abnormalities on Poopsie's tests were skewed by the diabetes and excessive amounts of insulin that were being administered or it was possible that like the normal dogs in the study, Poopsie had elevated estradiol which wasn't necessarily causing the symptoms you were seeing. Diabetes and cushing's definitely have overlapping symptoms so it may be possible that once you got the diabetes controlled, Poopsie's symptoms resolved and melatonin and lignans had nothing to do with it?

I think melatonin and ligans are fairly benign but if my dogs didn't really need them, I'd prefer to leave them out of their already heavy regimen of daily meds. My little Lulu was on melatonin and lignans for over a year and she is in the majority of dogs who don't benefit from them.

[ssmarilyn]

Lulusmom, you've definitely given me alot of food for thought. Our regular vet doesn't know much about atypical cushings, so we won't even bother to consult her on it and the U of M vet did say we needed to do another panel a few months after the first one was done, but it's so darned expensive, something like $450 and then we pay the U of M cost, about $100 or more, so we didn't go back to have it done. He's doing so well except for the periodic skin infections. I'm definitely going to do some deep pondering on what you said about maybe Poops problems being due to uncontrolled diabetes. I would love to have another panel done...and still might. We have 5 dogs, so just the yearly vet maint bills can be huge! I'm just so thankful that we did go to the U of M and they got his diabetes straightened out and said he did not have thyroid disease. Will out of control diabetes also affect thyroid numbers?

[lulusmom]

Hi and sorry for taking so long to respond to your question but I was without computer access for the last couple of days. I went through terrible k9cushing's withdrawal too. :D To answer your question, yes, uncontrolled diabetes can cause low thyroid.

Glynda

[ssmarilyn]

Hi and sorry for taking so long to respond to your question but I was without computer access for the last couple of days. I went through terrible k9cushing's withdrawal too. :D To answer your question, yes, uncontrolled diabetes can cause low thyroid.

Glynda

Okay, so that explains the U of M saying he didn't need any thyroid meds. Now I'm wondering how much his uncontrolled diabetes affected his U of T panel test. Wish I could have it done again, but really can't take him back to the U of M unless he looks like his cushings is getting worse...if he has it, that is....

I'm trying to cut down my time on the puter so I can get to sleep at night before 3am. Staying on this all night prevents my brain from making the melatonin it needs to make me sleepy. I'm my own worst enemy!

[lulusmom]

Please see my comments below in blue.


Okay, so that explains the U of M saying he didn't need any thyroid meds. Now I'm wondering how much his uncontrolled diabetes affected his U of T panel test. Wish I could have it done again, but really can't take him back to the U of M unless he looks like his cushings is getting worse...if he has it, that is....

Uncontrolled diabetes would have affected the UTK panel but unless Poopsie is displaying overt cushing's symptoms, I wouldn't worry about having another one done. No symptoms = No treatment so save your money.

I'm trying to cut down my time on the puter so I can get to sleep at night before 3am. Staying on this all night prevents my brain from making the melatonin it needs to make me sleepy. I'm my own worst enemy!

Hey, I've used those same exact words. I must say that since I have been without internet service at home for the last four days, I have gotten an amazing amount of stuff done and I've managed to get to sleep at a reasonable hour. Of course, I'm not used to doing that much physical work so when I sit too long, my muscles seize up and I hobble around like I'm 100 years old.

[ssmarilyn]

I'm slowly changing my computer habits. I make a living on the computer so have to be here some of the day, but not all day like I have been for years now.

Thanks for all the eye-opening information. I think you're on to something about the uncontrolled diabetes affecting his test results. I wonder if I should just leave things as they are....... keep giving him his melatonin and flax oil.....or...... I think for now I'll leave things as they are as they seem to be working for him!

Leaving for a 10 day vacation on the 5th. Packing up all the dogs and the RV and heading up the glorious North Shore of Minnesota!

[ssmarilyn]

Just remembered I had a pic to show you...before and after treatment at the U of MN.

http://stallionstation.com/eagles/poopsiecushings.jpg Click on it to view it larger.