Louie (10yo Maltese x, possible Cushing's)

[louiesmum]

Hi everyone,

I am new on this group and thought I would introduce myself. My name is Shierly, and my dog Louie (a 10 yo Maltese x) had a blood test done on Tuesday last week before his dental treatment. The test results came back with high liver enzyme (over twice the limit?), so the vet mentioned he might have Cushing's disease and suggested to put off the dental treatment. They did an ACTH test instead, but the results still came back within range, although vet said it did not rule out Cushing's.

Louie is a very happy, active dog for his age, although after getting so many information (both from vet and the internet, including this group), he does show symptoms of Cushing's:
- Thinning hair on his body (it has been gradual, nowhere as bad as pictures you see of some dogs with Cushing's but we have noticed it for a while, although we had no idea it might indicate Cushing's).
- Increased thirst (my housemate just mentioned to me a while back how much Louie has been drinking)
- And with that, increased urination (he is still good most of the times, but I have caught him a couple of times peeing on the carpet and where he wasn't supposed to, I just thought he was being naughty)
- Pot belly (we just thought he was fat!)
- Being hungry all the time (but again, hard to tell as he's been that way for as long as we can remember)
- Excessive panting sometimes

He doesn't have difficulty walking or anything, and he seems very healthy apart from the extra weight he's carrying, so I was surprised when the vet first mentioned it to me. I have spent days crying and worrying about him, and the negative ACTH results haven't really put me at ease. He is at the vet clininc having a LDDS test done today.. so hopefully we'll get the results soon.

I guess at this stage I just have a few questions, some of them I have found on the links from this website, but there are also a lot of different articles and facts about cushing's disease you can find on the internet, some of them contradictory.

My questions for now (while waiting for his results) are:
- Do I need to change his diet at all? Is there anything specific he should or shouldn't eat?
- I have read that dry kibbles are bad for dogs with Cushing's, is this true?
- Is it true that life expectancy of dogs with Cushing's is only about 2 years? It makes me cry every time I think about it!
- If the LDDS test came back negative, along with normal ACTH test, would it mean he doesn't have cushing's? What other problems could he possibly have for high level liver enzyme?
- If the LDDS test came back positive, does he definitely have cushing's even though the ACTH results are still within range? I have read about false positives and I guess I'm worried about starting him on medication if he doesn't really have Cushing's.
- Would he need more tests done after this LDDS test? The vet initially suggested ultrasound, but then changed her mind because she thought LDDS would be more accurate (albeit more invasive), and even after ultrasound he might still need the LDDS test done.

I'm sorry if some of the answers can be found on the links on the forum that I may have missed. The amount of information I've been reading the past few days have overwhelmed me!

Thanks!

Shierly

[Harley PoMMom]

Hi Shierly,

Welcome to you and Louie! Sorry for the circumstances that brought you to us but so glad you found us.

I have responded (in blue) to your questions and remember we are here to help in any way we can.



Hi everyone,


My questions for now (while waiting for his results) are:
- Do I need to change his diet at all? Is there anything specific he should or shouldn't eat?

Dogs that have Cushing's can be more prone to pancreatitis so a diet that consists of a high quality protein, low in fat and moderate fiber is usually what is recommended but if Louie is doing well on his diet now, then I would not change it as of yet.

- I have read that dry kibbles are bad for dogs with Cushing's, is this true?

Not true, a dry kibble that is of a high quality protein is fine. All dogs are different and their diet should be what works best for that particular dog, whether it be dry, canned, home-cooked or raw.

- Is it true that life expectancy of dogs with Cushing's is only about 2 years? It makes me cry every time I think about it!

That myth is not true at all, Cushing's is NOT a death sentence, when a dog receives a confirmed diagnosis of Cushings; with proper monitoring, keen owner observation and the owner being educated on Cushing's plus a GP/IMS that has experience treating Cushing's, a dog can live out their normal life span.

- If the LDDS test came back negative, along with normal ACTH test, would it mean he doesn't have cushing's? What other problems could he possibly have for high level liver enzyme?

- If the LDDS test came back positive, does he definitely have cushing's even though the ACTH results are still within range? I have read about false positives and I guess I'm worried about starting him on medication if he doesn't really have Cushing's.

Elevated liver enzymes can be caused by many things. A Cushing's diagnosis is confirmed with strong clinical symptoms and positive results from the Cushing tests. Could you get copies of all the tests that were done on Louie and post the results here as that will help us to provide you with better feedback, ok?


- Would he need more tests done after this LDDS test? The vet initially suggested ultrasound, but then changed her mind because she thought LDDS would be more accurate (albeit more invasive), and even after ultrasound he might still need the LDDS test done.

I believe an ultrasound is a very useful diagnostic tool, not just for diagnosing Cushing's but because it can show many other issues that might be going on with the other organs.

I'm sorry if some of the answers can be found on the links on the forum that I may have missed. The amount of information I've been reading the past few days have overwhelmed me!

Thanks!

Shierly

Please do not hesitate to ask any and all questions, as I mentioned before, we are here to help in any way we can. :)

Love and hugs,
Lori

[louiesmum]

Thanks very much, Lori! When I get Louie's test results back, I will ask for a copy of the detailed results and post them here.

I just haven't been able to stop worrying!

[addy]

I am so glad you found us, Welcome!! Louie sure is a cutey pie.

I see Lori has you off to a good start. It is natural to worry, we all did and sometimes still do. The more you learn the calmer you will feel.

Read as much as you can here on the threads and our Resource section. And remember to breathe!!!!! Sometimes it is alos good to just lock up Cushings in a drawer and walk away for a weekend.

[louiesmum]

Louie had his LDDS test done yesterday, and we're currently still waiting for the results.

The vet has given me a lot of information, including treatment pricing, what to expect, etc, should he really have Cushing's, and she has quoted approx $695 for 100 capsules of Trilostane (to treat a Maltese x). I'm not actually sure how many mg it is. It sounds very high, especially after scouring the web and finding other people only paying about $255 for 100 capsules (not sure how up to date it is, etc).

I was just wondering if anyone else in Australia know/has any experience with Trilostane and how much it costs on average (for different doses). Is $695 reasonable? And also if anyone knows of any good compounding pharmacies that does it for a reasonable price?

I don't mind spending money on my baby, but I do mind spending too much money unnecessarily if I can get the same meds for cheaper elsewhere.

Thanks!

[Squirt's Mom]

Hi Shierly and a belated welcome to you and Louie! :)

Is that $695 US dollars???!!!!???? :eek: Holy COW! :eek::eek::eek: That seems truly exorbitant! Unless, of course, Aussies normally earn $10,000.00 a week, that is. :p

No, that is not a normal price for Trilo and I would call the vet and ask them to explain how they came up with that cost. That is extreme even for a very large dog... and a tiny Maltese? Well, something is hinky. ;) Surely, someone hit the wrong key on the calculator.

Double check with the vet and if they insist that is the cost, I would go to another vet and see what they have to say. You will have to check to see if Trilo could be shipped from the US or Canada into Australia and if so, then you can more than likely get it much cheaper!

Hugs,
Leslie and the gang

[lulusmom]

Wow, that is a ridiculous amount of money for Trilostane. Are you sure you didn't make a typo? :eek: I would recommend that you call the local compound chemists in your area and ask if they compound Trilsotane and if so, get a quote from them. Then all you need to do is to figure out which chemist you want to use and get a script from your vet.

Here's a URL for a site that lists compound chemists in Australia.

http://aca.ninemsn.com.au/article.aspx?id=1065708

[BestBuddy]

Hi Louie's mum and welcome.

I am in Aust. and had a cushing dog that passed away a few years ago so I have been there but it was a while ago. When I was buying Veterol it was hard to get regularly and it was expensive. My first order I was able to get direct from the UK but the rules changed and it was to hard to get the paperwork needed and I believe that only one importer had the licence and they then sold onto the vets. Not sure if this has changed.

The other option that has been mentioned is compounding and a script from the vet is all that is needed to deal direct with the chemists that can do this. This should be much cheaper if you are willing to go this route. My last few orders were from a place called Stenlake Pharmacy but as I said it was a while ago and I don't know if they are still compounding trilostane and the prices.

Good luck.

Jenny

[louiesmum]

Thanks everyone for the info!

Louie's LDDS test results came back yesterday and they were actually negative! At this stage the vet is recommending to wait and do another blood test in 6 weeks and see if the liver enzyme levels will come down. I'm still crossing my fingers that everything will be ok then and that he doesn't have atypical cushing which, from what I've gathered, is very tricky to diagnose (have to send the blood samples to UTK in Tennessee for testing?)

I asked her if I should change his diet to something more specific, and she recommended Hill's Prescription l/d. Has anyone had any experience with this? I've read some reviews and dog food analysis that says it's actually cr@p? Apart from home cooked diet (which I can give him sometimes but not very practical or cost effective to do every day) can anyone recommend any other good dry/wet food to control liver enzymes?

I've been reading up on Canidae (not widely available in Australia, but can get them online and from a couple of stores) and they seem to have mostly good reviews. Would you recommend it, or should I just get him the Hill's l/d instead?

Thanks again for all your help so far. And yes , $695 for 100 tablets of Trilostane I thought was extortionate!!! I'm glad I don't have to put him on meds at this stage, but if I ever do, I'll be sure to shop around for compounding chemists.

[frijole]

Yeah, great news! I'm sure others will chime in re diet for liver but I can share that I am a believer in milk thistle. My cush dog had alk phos at 2000 (normal was around 200 I think) and that was AFTER treating her for a couple years with lysodren. I added milk thistle (just bought it at the drugstore) to her regular food morning and night and her level went down to 700 within a couple months. I was so excited.

I gave my dog prescription dogfood for years and they were lethargic and my groomer asked what I was feeding them. She said you must try this food. It was Holystique from Solid Gold. The change in their energy levels and skin was so drastic that my 30 yr old brother even noticed it! ha. Anyway.. there are many great dog foods out there - way better than those the vets prescribe (can you say revenue stream?) .... Kim

[addy]

Glad to hear the test was negative. My Zoe was on ID for a few years but the canned not the dry. If you have to feed it feed the canned. When I spoke with a holistic vet whom also advised good foods and did not use the perscription diets, she said that the canned ID, if it was the only food Zoe could tolerate (she had coltiis) it was not the worst of the perscription Hills food. But again, that was canned, the dry is all corn.

[louiesmum]

Thanks Frijole. I've been reading up a bit about milk thistle too. Can I just feed him milk thistle supplements for humans, or does it have to be specific for dogs? What is the dosage?

[louiesmum]

Thanks Addy, yeah I did think the canned food would be a bit better than the dry one. If i can't find anything better, I might start him on the canned food and add some milk thistle.

[frijole]

Thanks Frijole. I've been reading up a bit about milk thistle too. Can I just feed him milk thistle supplements for humans, or does it have to be specific for dogs? What is the dosage?

That is what I used. Took a capsule and put 1/2 on am meal and the other half on pm meal.

[louiesmum]

I just gave Louie his first dose of milk thistle tonight. We'll see how it goes.. hope I didn't give him too much! Will keep an eye out for diarrhoea etc.

Also found this recipe for home cooked liver diet:
1/4 lb of ground beef (not lean chuck)
2 Cups cooked rice
1 hard cooked egg, finely chopped
3 slices of white bread, crumbled
1 tsp powdered bone meal for feeding (if you can’t find this, substitute calcium carbonate)
1/4 tsp lite salt
1 tsp corn oil
100 IU vitamin E capsule
1 gram fish oil nutritional supplement
1 tsp Metamucil
1 Centrum vitamin-mineral supplement

Sounds pretty simple so will start feeding him that once I have all the ingredients.

I still want to mix in a bit of dry kibble if possible though, since it's supposed to be much better for his teeth?

Is there any kibbles that are healthier (and suitable for his liver condition) than the hill's l/d?

[Squirt's Mom]

ummmm....please be very careful with diets you fine online. Human vitamins and mineral supplements are not geared toward a dog's body - they are based on human nutrient needs which are vastly different from a canine's. ;)

If I were you, I would stick with a high quality commercial feed - or if you truly want to cook for Louie, get with a canine nutritionist who can design a diet for Louie based on Louie's labs, environment, and current health status. ;)

Hugs,
Leslie and the gang

[louiesmum]

Hi Leslie,

That diet is actually very similar to the one that my vet recommended if I wanted to make him home-cooked meals (minus all the extra vitamins etc but I'm going to add them in anyway).

That's why I wondered if I should still mix in some commercial kibbles, but I don't know what a good quality one that's safe for his liver conditions would be. Any suggestions?

[lulusmom]

Hi Louie's Mom

Why has your vet recommended a liver diet? Was Louie diagnosed with primary liver disease which was confirmed by way of a liver biopsy and/or bile acid test? Is it the ALT liver enzyme or the ALKP that is severely elevated? If the ALKP is really high and the ALT is mildly elevated, this is the pattern we see in cushdogs. With primary liver disease, it is the liver specific ALT that is elevated. This enzyme is triggered by destruction of liver cells. Dogs with primary liver disease do not become symptomatic until there is a 75% loss of liver function. It is not until this point that you should restrict protein. There was a time when the rule of thumb was to restrict protein if a dog has primary liver disease but studies showed that restricting protein early in the disease is actually detrimental to the dog.

It is not uncommon for gp vets to misdiagnose dogs with severely elevated ALKP, especially if suspected causes have been ruled out. Not all dogs with cushing's will yield a positive result on the acth stimulation test or the LDDS test so if this elevation in ALKP is being caused by steroids, the dog does not have liver disease due to destruction of liver cells but rather the accumulation of glycogen in the liver. This is a reversible condition once stabilized on treatment. It would help us greatly if you would please obtain copies of all of Louie's blood and urine tests and post the results here. With respect to bloodwork, you need only post the abnormal values, including the normal reference range.

I will be checking back in on your thread and will look forward to receiving more information on your precious guy.

Glynda

[louiesmum]

Hi Glynda, thanks, it's actually a very useful info. I don't have all the numbers with me at the moment, but I am taking my other dog, Mario, to the vet tonight for vacs, so I will ask for Louie's records then and post it here!

[louiesmum]

PS both ALKP and ALT were elevated enough for them to suspect Cushing's (as far as memory goes it was both over twice the limit), but I will get you the exact test results later this evening.

[louiesmum]

Ok here are the numbers.

Initial blood test:
ALT 214 (normal range: 10-100)
ALKP: 567 (normal range: 23-212)

ACTH results:
Resting: 51 nmol/L (range: 20-165)
Post-ACTH: 444 nmol/L (range: 150-470)

LDDS test:
0 (hours) : 64
3 or 4 : <10
8 : < 10

[lulusmom]

Thank you for the additional information. Were there any other abnormalities on the bloodwork, such as cholesterol, glucose, triglycerides and T4? Louie's ALT is not that elevated so unless your vet did bile acid test or a liver biopsy before confirming a diagnosis of primary liver disease, I would question the recommendation to restrict protein in his diet.

A lot of the symptoms you listed are shared by Cushing's and Hypothyroidism. Was hypothyroidism ruled out?

[louiesmum]

I don't think it's been ruled out (or even mentioned). I might ask the vet next time, if his liver enzymes don't come back down to normal in 6 weeks time.

I did ask the vet if it would be harmful to put him on liver diet, and she said it should be fine?

[louiesmum]

PS the report didn't show any other abnormalities apart from the ALT and ALKP, so I assume they were all normal, although I wasn't given any numbers.

[louiesmum]

Hi again all,

Last night I noticed there were tiny droplets of reddish urine on the carpet where Louie's just been, and then it reminded me that it's not the first time I've seen it. It doesn't happen constantly.. most of the time he pees are normal (the last time I saw it was like a couple of weeks ago and I didn't even know which dog it was from because I also have another one!) but it raised a red flag last night since it happened again. I asked my mum who has been staying with me for the past couple of weeks and she said now that I mentioned it, she did notice same droplets are Louie's toilet spot occasionally but definitely not every day. They were rare occurrence that she forgot to mention it to me.

I had to go to work this morning so my brother took him to the vet for some tests, and he just told me they found traces of blood and stones(? or calcium deposit? Hard to know for sure as I wasn't there in person ) so it sounds like he has kidney stones and they've put him on antibiotics, and they're going to call us back with special diet that we should give him until it clears up.

I was just wondering if his kidney problem might've caused the elevated liver enzymes? Does anyone here have any experience/ know anything about it?

Or could it be the other way around, that his undiagnosed (atypical?) Cushing's could might've caused the kidney issue?

I read that in humans at least, UTI may cause elevated liver enzymes.

[Harley PoMMom]

When a dog has Cushing's disease, the excess cortisol will cause the ALP and ALT to be elevated in most cases. Dogs with Cushing's disease are prone to stone formation.

Kidney stones, I believe can cause increases in the ALP but I'm not sure about the ALT.

With kidney stones it is very important to know what kind of stone one is dealing with such as Struvites or Calcium oxalate.

Diet can help stop the formation of struvites but not oxalate. However, diet still plays an important role when a dog is know to be prone to forming oxalate stones.

My non-cush dog, Bear, has had to have 2 operations to remove oxalate stones. He is on potassium citrate and I make sure he drinks a lot of water.

Here is a link to a good article about oxalate stones which also has a link to an article about struvites: http://dogaware.com/articles/wdjcalciumoxalates.html

Hope this helps.

Love and hugs,
Lori

[Skye]

hello!
have been following your thread.........uhm,........I believe the comment about revenue stream, speaks loud and clear. I would suggest following some good advice given with facts and knowledge on nutrition than from someone who is all for it because they get "kick backs" from product. Also most general practice vets only get 3 hours education in nutrition when in school, loads of information from employees that have attended weekend seminars to learn about a product to sell to doctors. Me and my girl went through ALOT of this last year, I gave up on processed foods, sought the guidance of a nutritionist and now home cook. By the way...lol, WELCOME!!!!! and trust me when i say.....you have a place where you will be forever more walking with angels. Folks here are amazing, caring and loving, and the support and knowledge is ceaseless.

[louiesmum]

Thanks for the responses, everyone.

I just called the vet office, and the nurse explained Louie has calcium oxalate crystals in his urine, and they actually did an ultrasound this morning and it was large so it will have to be surgically removed. :(

She said according to the vet notes he can stay on his current liver diet, and the vet will give me a call back re: details on his conditions and surgery.

They said he will need another more thorough ultrasound and x-ray with bile acid test? I guess I'll wait until she calls me with more details.

I've read that dogs who have had bladder stones are prone to get more in the future. Is there something special I can feed him to prevent that?

The last couple of weeks have been very stressful for me thinking and worrying about my baby :( And I still hope he doesn't have atypical cushing's!!!

[Squirt's Mom]

And I still hope he doesn't have atypical cushing's!!!

Morning,

If a pup has to have Cushing's, Atypical is the one you want. ;) It is the easiest to treat and has the least risk for organ damage since the cortisol is NOT elevated with Atypical. Only the intermediate, or sex hormones, are elevated in Atypical. So there is absolutely no reason to fear Atypical Cushing's.

In true Cushing's, the cortisol IS elevated, and the intermediate hormones may be elevated as well as the cortisol. Anytime the cortisol is elevated, you are looking at true Cushing's, not Atypical. Controlling the cortisol requires much stronger medications, much more diligence and testing than Atypical.

I hope they get the stone out without any difficulty and Louie is home doing much better soon. My Crys had struvite crystals most of her life and was on antibiotics off and on as well as a special diet - but the two stone/crystal types are entirely different (struvite and oxalate) and what helps one can actually make the other worse. Cush pups are prone to oxalate stones, tho. ;)

Keep in touch and let us know how things are going!
Hugs,
Leslie and the gang

[louiesmum]

Hi Les,

I'm glad to hear about atypical cushing's being easier to manage. Isn't atypical a lot trickier to detect though?

Louie had his ultrasound this morning... poor baby was so cute. I dropped him off half an hour before the appointment time because vet said he might need to be sedated for the ultrasound. I left to have a quick breakfast, and when I came back I was told Louie was very unhappy being left in a cage today, so he was sitting on the vet's lap in her office. Ha! He got them wrapped around his finger.

So anyway. He definitely had a stone in his bladder that needs to be surgically removed. His bladder wall didn't look very good either, it was thick and full of big ridges, although they thought it was most likely due to infection and inflammation from his bladder stone. There were a couple of smaller ones that were lodged on top (beginning?) of his prostate so it must be quite painful for him. :(

Now, on to his liver. It definitely looked enlarged, although they couldn't see any obvious mass or tumor or anything sinister that could be causing it. The adrenal glands also looked ok (not Cushing's). The left one had a large-ish node but they think it's most likely benign as the right one is a normal size (if it is malignant usually the right one would be smaller in size).

So the good news is that he is most likely negative for (typical) Cushing's, but he does have a bladder stone that needs to be removed and the liver is enlarged for some reason not yet known.

He's having liver profiles and bile acid test done today to determine if his liver functions are ok, so he can go on anaesthetics for his bladder surgery.

I am crossing my fingers now that his liver enzyme levels and everything would be back to normal or at least not worse.

They are also suggesting to get a liver biopsy done while they have him open for the bladder stone removal, but they did say there is a small risk the liver might bleed out. (they're going to do a clotting test first)

Does anyone here have any experience with enlarged liver in dogs with no obvious/visible cause?

[louiesmum]

Hi everyone,

I joined this forum two years ago when my dog Louie was suspected to have Cushing's. The tests came back negative/inconclusive so we decided not to treat him as he was asymptomatic (the vet only suspected because of his high liver values).

It's been almost two years now and during the time his liver values have been fairly stable. I've just been giving him milk thistle and Denosyl. They even went back to within normal range at one point, but the past few months they have been going back up again. It's nothing too major (ALKP was 323 and top end of normal range was 210) but enough to get the vet concerned.

Ultrasound confirmed his adrenal glands are enlarged, and so is his liver (his liver was enlarged 2 years ago too, but the adrenal glands weren't as prominent).

Specialist recommended ACTH test and if results came back >= 450, to start treatment. His results came back 433. The results from two years ago was 390. My vet thinks he is definitely on his way to be clinically Cushing's, but not just yet, so we'll just monitor him for now.

My question is, would Melatonin and/or Lignan be beneficial in his case? Would there be any side effects if I started giving them to him as supplements?

Any other supplements you could recommend to prevent/slow down the progression?

Thank you!

[molly muffin]

My IMS has suggested the same thing to try lignan and melatonin to help the liver. I don't know if it will work or not. It won't lower cortisol, or not by much anyhow and that is what makes the adrenals and liver enlarged, like a by product of cortisol production.
Our liver enzymes are much higher than yours, and I'm going to retest and then give the lignans/melatonine a shot. Probably for about 4 months and if that doesn't work, either move to trilostane or a maintenance dose of lysodren, as one would for atypical cushings.
Are any other values elevated on his blood work?

Sharlene and molly muffin

[louiesmum]

My IMS has suggested the same thing to try lignan and melatonin to help the liver. I don't know if it will work or not. It won't lower cortisol, or not by much anyhow and that is what makes the adrenals and liver enlarged, like a by product of cortisol production.
Our liver enzymes are much higher than yours, and I'm going to retest and then give the lignans/melatonine a shot. Probably for about 4 months and if that doesn't work, either move to trilostane or a maintenance dose of lysodren, as one would for atypical cushings.
Are any other values elevated on his blood work?

Sharlene and molly muffin

Thanks Sharlene! I think his ALT was a bit high as well, but only marginally. All the other values were normal I think. He had thyroid test done two years ago and they also came back normal (but doesn't necessarily mean it would be the same now).

Interesting as I've read somewhere that melatonin could help lower the cortisol production, although I understand it won't be nearly as effective as Trilostane or Lysodren. If there are no side effects for melatonin/lignan I might give that a shot too and see how he goes.

I am in Australia and there is a homeopathic clinic that sells the Cushing's Homeopathy Pack. I asked them for ingredients list and this is their reply:

Homeopathic CUSH - ACTH, Nat Mur, Ars Alb, Cortisone, Formic Acid, Pituitary Anterior – brain,Basophilic Adenoma of the pituitary, Glonoinum, Thyrotropin releasing hormone, Sulphur, Hepar Sulp, Thallium Acetas, (NV) Brain nutrition formula (NV) Adrenal tonic, (NV) Relax formula (DR) Hepatitic (liver), Conium Ma), Selenium, Hydrophobinu), Strychnos Gaulth 12), Quercus Robu), Flor de Piedra 12C, Thyroidinum, Iodum, Uranium

Herbal CushAid Tonic - Gingko Biloba, Burdock, Astragalus, Dandelion, Tumeric, Chastetree, Tumeric, Cats Cat, and Comfrey with added homeopathics

Anyone familiar with any of the ingredients? I'm thinking of starting him on it as well.

Thanks!

[labblab]

Generally, a good piece of advice is to start only one new medication or supplement at a time. That way, if side effects occur, you will be able to identify the source and decide whether/how to proceed. So if I were you, I'd add nothing more than the melatonin/lignans combo at this time.

Additionally, I must tell you honestly that the ingredients listed in the Cushing's Pack scare the crap out of me! It is such a broad combo of hormonal agents, etc., some of which sound totally inappropriate to me. Like ACTH and cortisone? The last thing a dog with elevated cortisol needs is even more steroid release, or steroid itself in the form of cortisone. A professional trained in herbal medicine may be able to specifically tailor a program of supportive supplements for your dog's personal situation. But I would be very wary of a hodge-podge of ingredients such as this, some of which could very well do more harm than good.

Marianne

[louiesmum]

Generally, a good piece of advice is to start only one new medication or supplement at a time. That way, if side effects occur, you will be able to identify the source and decide whether/how to proceed. So if I were you, I'd add nothing more than the melatonin/lignans combo at this time.

Additionally, I must tell you honestly that the ingredients listed in the Cushing's Pack scare the crap out of me! It is such a broad combo of hormonal agents, etc., some of which sound totally inappropriate to me. Like ACTH and cortisone? The last thing a dog with elevated cortisol needs is even more steroid release, or steroid itself in the form of cortisone. A professional trained in herbal medicine may be able to specifically tailor a program of supportive supplements for your dog's personal situation. But I would be very wary of a hodge-podge of ingredients such as this, some of which could very well do more harm than good.

Marianne

Thanks Marianne! Do you happen to have correct/recommended dose for melatonin and lignan? I saw on a website it's 3mg every 12 hours for dogs under 30lbs, but then other websites recommends only 1mg for smaller dogs? Louie is only about 10-11lbs.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about melatonin and lignans into Louie’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[labblab]

The dosing guide I am most familiar with is this publication from Univ. of Tennessee at Knoxville. They have been at the forefront of research related to elevated adrenal hormone levels other than cortisol.

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201107.pdf

I see they recommend 3 mg. every 12 hours for dogs <30 pounds, so this may be the paper you've already seen. I've never used melatonin/lignans myself, so I am not sure whether there are other alternative dosing protocols out there. Plus, the dosing recommendations may differ depending on the reason for using the melatonin (e.g., for sedation vs. hormonal treatment). Hopefully, some other folks who are more familiar with melatonin will soon stop by to chime in.

Marianne

[goldengirl88]

Just curious how you are making out with Louie. What dosage is he on now? How are things going with him? Hope you are both well. Blessings
Patti

[louiesmum]

Just curious how you are making out with Louie. What dosage is he on now? How are things going with him? Hope you are both well. Blessings
Patti

Hi Patti,

Louie is doing well so far. He hasn't had another ACTH test yet, but I've started him on Melatonin (just once a day) and Lignans. I've also spoken to a holistic dietitian and switched him to organic raw diet. I will get him another blood test in a couple months' time and see what his liver enzymes are like!

[goldengirl88]

That sounds great that he is doing well. Just watch for the obvious signs, the panting, the water drinking by buckets, the diluted urine etc. He is such a cute little fellow, I hope he continues to do well. How does he like his new diet? Blessings
Patti

[louiesmum]

Hi all,

I haven't posted here for a while as Louie had been fairly stable.

However, he suddenly went blind 1.5 weeks ago (and I think completely lost his vision around Friday last week as up til then he was still managing to navigate around the house ok, now he's bumping into everything and very disoriented). I took him to the opthalmologist and he suspected 95% SARDS. It is to be confirmed with ERG on Monday next week.

He also had LDDS test yesterday and it came back positive for Cushing's
CORTISOL RESTING 258 15 - 170 nmol/L HIGH
CORTISOL 1ST POST <28 nmol/L
CORTISOL 2ND POST 90 nmol/L
1ST POST DOSE TIME 4 hours
2ND POST DOSE TIME (1) 8 hours

However, the vet said that a lot of SARDS dogs exhibit the same symptoms as Cushing's (and even have positive Cushing's test results) around the time of onset of blindness, but things tend to settle down on its own after a few months and no Cushing's treatment is necessary. She recommended waiting a couple of months and retesting before treating him for Cushing's, as apparently treating SARDS dogs for Cushing's too early may actually cause Addisonian?

Has anyone had any experience with this?

He's not showing any PU/PD. His coat is still thin but not as bad as a lot of Cushing's dogs. He's got some pot belly but even the vet doesn't think it's nearly as bad as classic Cushing's dogs. He is panting sometimes, but it's not too bad.

It has been the most difficult time watching him struggle with not being able to see. I've been crying a lot the past few days, but I do try to stay positive in front of him.

How many users here have SARDS dogs? How are they getting on? I'm worried that his SARDS may cause further health issues (I read that some dogs develop kidney failure etc in the months following).

Any advice would be greatly appreciated. Thanks.

Shierly

[Squirt's Mom]

The vet is correct about SARDS and Cushing's - but SARDS is SUDDEN blindness and you have been trying to figure out what is going on with Louie since 2012 - so SARDS is unlikely to be the cause for his signs all of that time. ;) Here is a link on SARDS from the Helpful Resource section -

http://www.k9cushings.com/forum/showthread.php?t=213

I am mom to 2 completely blind babies, to one who is bind in one eye, and to one who is going blind. Dogs can adapt very well to their dark world. Be consistent in everything you do; keep things in the same place at all times and don't rearrange furniture, etc; never move his food or water bowls; speak to him before touching him; talk to him constantly especially when walking with him; use scents and varying naps on throw rugs to help him tell one room from another as he enters; watch him carefully and he may well teach you how to best communicate with him; and know that he is alright even tho he is now blind. This transition is often as hard, if not harder, on us than it is on them. Some depression is expected in the beginning as is fear but you can help him get thru that with your TLC and confidence.

Hugs,
Leslie and the gang

[labblab]

He also had LDDS test yesterday and it came back positive for Cushing's
CORTISOL RESTING 258 15 - 170 nmol/L HIGH
CORTISOL 1ST POST <28 nmol/L
CORTISOL 2ND POST 90 nmol/L
1ST POST DOSE TIME 4 hours
2ND POST DOSE TIME (1) 8 hours
Hi again! For the benefit of our U.S. readers, I am translating Louie's LDDS results in the units of measurement that are most commonly used here:

Resting cortisol: 9.3 ug/dL
4-Hour cortisol: <1.0 ug/dL
8-Hour cortisol: 3.3 ug/dL

You have not given us your laboratory's normal range for the 4 and 8-hour results, but typically it is around 1.4 or 1.5, with an 8-hour value higher than that resulting in a "positive" Cushing's diagnosis. So Louie's 8-hour result is definitely elevated and consistent with the diagnosis. Plus, if he does truly have Cushing's, his results are consistent with the pituitary form of the disease.

Having said all that, it is true that the combination of SARDS and Cushing's abnormalities can present a diagnostic challenge, especially when the blindness and onset of other symptoms occurs within the same time frame. However, as Leslie has already noted, Louie was exhibiting nonvisual abnormalities for a significant period of time prior to the onset of the blindness. With that fact in mind, I do think many vets would go ahead and proceed with Cushing's treatment on the basis of these LDDS results. But that doesn't mean it is wrong to go ahead and wait a bit longer, since you are in the midst of dealing with the acute visual issue. Certainly, it will be helpful to receive the benefit of the formal eye diagnosis, and to see whether the problem is truly SARDS. Once you have that information in hand, you can proceed to considering the next step.

We have had several members who have dealt with SARDS. If you use our forum “Search” feature and enter SARDS as the search topic (choose to search “threads” rather than “posts”), you should see a number of threads coming up that deal with SARDS in one fashion or another. Some of the dogs who have been diagnosed with SARDS were also treated for Cushing’s; some were not at the time their owners posted here on the forum. SARDS is an area where much more research is still needed.

Please update us as soon as you get those formal eye results.

Marianne

[louiesmum]

Thanks all.

Sorry I should've posted more of the info I got from the test results:

General Interpretive Guidelines
Normal dog:
* baseline cortisol 15-170 nmol/L
* 4 hour post-dexamethasone cortisol <28 nmol/L
* 8 hour post-dexamethasone cortisol <28 nmol/L

Hyperadrenocorticism (hyperA):
* 8 hour post-dexamethasone cortisol >38 nmol/L consistent with hyperA
* 8 hour post-dexamethasone cortisol 28-38 nmol/L equivocal

* a small percentage of hyperA dogs may show normal suppression in a LDDS test.Repeat testing in 2-3 months time or an ACTH stimulation test may be useful.
* adrenal function tests, such as the LDDS test, may yield a false ppositivetest result (i.e. failure of suppression) in:
* a sick or stressed dog with non-adrenal disease
* a dog being treated with an anticonvulsant such as phenobarbital * in cases where there is failure of suppression due to non-adrenal disease orphenobarbital, the deviation from normal is usually not very pronounced

Localising hyperA:
* where there is failure of suppression 8 hours post-dexamethasone pituitary-dependent hyperA may be diagnosed if any one or more of the following three criteria is met:
* 4 hour post-dexamethasone cortisol <38 nmol/L
* 4 hour post-dexamethasone cortisol <50% of the baseline cortisol
* 8 hour post-dexamethasone cortisol <50% of the baseline cortisol

* if none of these criteria is satisfied, the LDDS test does not differentiate between pituitary and adrenal-dependent hyperA (an endogenous ACTH assay, abdominal imaging or a high dosedexamethasone test may be useful for further assessment). For the endogenous ACTH test, please contact the laboratory for the specialsample collection protocol.

So it does look like it's consistent with pituitary dependent Cushing's.

I will keep you posted of the ERG test results.

The vet thinks since he is not exhibiting PU/PD and all his "symptoms" are fairly mild/manageable it is best to wait until the SARDS "settle down" and see how he goes?

His liver values had actually come down to pretty much within the normal range up til earlier this year when it started climbing up again, and I did read that months leading up to onset of SARDS "symptoms" may start to appear? e.g. Cushing's like symptoms, elevated liver enzymes, lethargy, muscle weakness etc. I did notice he was slowing down quite a bit the past couple of months, that's why even though he wasn't showing PU/PD I had still planned to get him retested for Cushing's anyway.

[louiesmum]

I was also advised somewhere to get his sex hormones levels checked before commencing treatment with Vetoryl/Trilostane in case he has Atypical Cushing's. Is this true? Does anyone have any knowledge/experience with it?

[Harley PoMMom]

When a dog has Cushing's the chance of their hormones being elevated is almost guaranteed, if this were me, I wouldn't bother with an adrenal hormone panel as they are a bit pricey so I would save that money to use on something else.

Hug, Lori

[louiesmum]

Thanks Lori, would it make any difference in a course of treatment at all if it is Atypical Cushing's? If it doesn't then I guess I wouldn't bother.

[Squirt's Mom]

Yes, it would make a difference in treatment if Louie were Atypical and not conventional. Atypical means this - the cortisol is normal but other hormones, the intermediate or sex hormones, are elevated. If the cortisol is elevated the pup does not have Atypical but has conventional, or true, Cushing's even if the other hormones are also elevated. The key is the cortisol.

If a pup is Atypical the treatment is lignans, either flax or spruce, and melatonin. The pup is given 2-4 months on this protocol and if the hormones are not dropping, then Lysodren is added as maintenance only, no loading. Vetoryl, Trilostane, is not recommended for Atypical pups because it has been shown to cause elevations in the intermediates already elevated in an Atypical pup.