Melatonin & lignans for typical cushings?

[daisygirl8]

Hi, I have an 8 year old female Boxer recently diagnosed with pituitary Cushing's. bloodwork: baseline 1.8. 4hours 1.0. 8 hours 2.5. Cortisol. Vet said this is mild? So id like to treat with melatonin 6 mg 2x day and lignans (which are best?). Her symptoms are a couple of small hard skin lumps drinking a bit more and urinating a bit more. Please help with any advice! Thanks in advance, I truly appreciate it! I should mention she's been on 25mg 2x day of proin for years. I also give her a probiotic daily.

[Squirt's Mom]

Hi and welcome to you and Daisy! :)

Because of our recent experiences with Proin, I wanted to share some info and what it has apparently done to my Squirt. She started taking it several months ago and had a seizure 3 weeks ago. A friend called and told me about some of the reports on Proin - many of the things reported were things I had been seeing in my sweet girl but had not connected to Proin. I now believe much of what I have seen happening to her, including the seizure, is a result of the Proin. Your baby has been on it for a while and hopefully is doing just fine with it but I wanted to pass some info on just in case -

http://www.fda.gov/downloads/AnimalV.../UCM296349.pdf



Table 6: Adverse reactions in the 28-day placebo-controlled clinical study
Adverse Reactions
PROIN
-
treated (N=123) (first number)
Placebo (N=61) (second number)

Emesis 20.3% 8.2%
Hypertension (≥ 160 mm Hg) 19.5% 14.7%
Anorexia 16.3% 3.3%
Body weight loss (≥5%) 16.1% 6.8%
Proteinuria 13.0% 8.2%
Anxiety/aggression/behavior change 9.7% 3.2%
Diarrhea 7.3% 9.8%
Polydipsia 6.5% 9.8%
Lethargy 5.7% 1.6%
Musculoskeletal disorder .2% 1.6%
Insomnia/sleep disorder 2.5% 0.0%

http://www.livestrong.com/article/25...ects-of-proin/


Allergic Reaction

Dogs that are allergic to phenylpropanolamine or any of the components of Prion should not be treated with this medication. Improper use of Proin by hypersensitive dogs may induce a severe and potentially life-threatening allergic reaction. Symptoms of a hypersensitive reaction in dogs include weakness, seizures, pale gums, facial swelling and difficulty breathing. Dogs who exhibit any of these side effects after taking a dose of Prion should be transported to an emergency veterinarian clinic immediately.

I am now carrying her outside at least every 2 hours and experimenting with diapers. ;)

Now to your questions - melatonin has the potential to lower cortisol but not by much and not in all dogs. Lignans will do nothing to help the cortisol level. This treatment is used in Cushing's pups who have normal cortisol levels but elevated intermediates hormones - a form called Atypical Cushing's. When the cortisol is elevated the pup needs either Lysodren (Mitotane) or Trilostane (Vetoryl) to lower the cortisol back to normal range. These probably wouldn't hurt her but may not do any good either. But we aren't at the point of choosing which drug to look at first just yet. ;)

Did Daisy have any blood work done recently that shows things like ALP, CHOL, BUN, T4, etc? If so, would you mind posting the abnormal, too low or too high, results along with the normal ranges for each and the little letters that follow each like ug/dl, Mnol/L, etc? There are often things there that can help point toward areas that need to be looked into. Was she tested for an UTI? Have you seen an increase or decrease in appetite or her weight?

Did your vet recommend she see a dermatologist? They can often diagnose Cushing's right off the bat especially with certain skin conditions that are found almost exclusively in cush pups. With the hard lumps you mention I suspect calcinosis cutis, almost 100% certain to mean Cushing's.

There is rarely need to rush into treating Cushing's so we have time to chat a bit with you and help you decide the next steps to take. For today, know that you have found the very best place for knowledge, first-hand experience, and unbeatable support. It can be a scary road at times but you and Daisy will never be alone again. I'm glad you found us and look forward to learning more as time passes.

Hugs,
Leslie and the gang

[Harley PoMMom]

Hi and welcome to you and your sweet girl,

Are the increased urinating and drinking the only symptoms your girl displays? Has your vet ruled out other issues that could cause the increase in drinking/urinating such as diabetes and/or an UTI?

Was a senior wellness blood panel done on your furbaby? If so, could you get copies of that test/s and post any abnormalities that are listed..e.g...ALT 150U/L (5-100)...Thanks! How about an urinalysis, was this done?

If this were me, I would wait to start any type of treatment, including the melatonin/lignans, but I will provide you with a link to our Helpful Resource Thread that has info regarding Atypical Cushing's and treatment, here it is: Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's" (http://www.k9cushings.com/forum/showthread.php?t=198)

The melatonin should be just the regular kind, not the fast-acting, extended release or rapid releasing type.

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[labblab]

Welcome from me, too!

In a situation where a dog has only a few or very mild symptoms of Cushing's, I also usually suggest a waiting period before launching into medical treatment. However, the fact that you've mentioned the hard skin lumps has my antennae waving. Just as Leslie has suggested, it is possible that these lumps are eruptions known as calcinosis cutis. If so, this is pretty much a clear result of elevated cortisol and has the unfortunate potential to get really bad really rapidly. Uncontrolled calcinosis cutis has the potential to totally undercut a dog's quality of life.

Given Daisy's "positive" LDDS test, I would really want to find out something definitive about those bumps via consultation with a dermatologist, again as Leslie has suggested. It usually takes some type of scraping or biopsy to know for certain, although I am guessing that a dermatologist might have a good idea just by viewing the bumps.

Unless your vet has already arrived at an alternative explanation for the bumps, I'd want to talk with him in more detail. Because if they do turn out to be calcinosis cutis, I do think you would want to explore treatment to effectively lower Daisy's cortisol level sooner rather than later. And that would require treatment with something other than the melatonin and lignans.

Marianne

[Budsters Mom]

Hello and welcome from me too!

I am so glad you found us! You have come to the right place! There is a huge arsenal of K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. It looks like you've already made a good start. Hang on tight, It's going to be quite a ride!

So again welcome to you and Daisy,

Kathy and Buddy:)

[Simba's Mom]

hello from Simba and me, welcome to the family of cush parents and their furbabies!!! Settle in, we are here for you!

[daisygirl8]

Wow... thank you for such a warm welcome!

My head is spinning :(

The only testing she had done was the numbers I provided. I'm sorry, I don't know tests name... it tested corisol levels.

Our vet doesn't like to use meds, as he said the side effects are awful. I just don't know what to do.

I was going to try the melatonin and lignans, but now I am thinking maybe not. Do they even work for typical adnernal cushing's???

Do you think my next step should be a dermatologist?

Forgive me... I'm so OCD, and this is driving me crazy... I just want to know what to do next ;) I'm also worried about offending our vet, as we really like him, and he has been great with Daisy!

Thanks, and I apologize in advance, if I drive anyone crazy lol!
Michelle

[daisygirl8]

Sorry, need to add... she was tested twice for UTI, first time placed on antibiotics, then tested again, and felt need to the cushing's test. She seems to be drinking a bit more, and definitely peeing more.

[molly muffin]

Hi from me too :)
Was the second UTI test negative?
The first test you had to diagnose cushings appears to be the LDDS test, with that you are looking for suppression for the full 8 hours. Of course all of these can have false positives if something else is going on in the body, like a UTI, etc.
I'd ask your vet if he thinks the bumps are caliconisis cutis or not. If he isn't sure they can take a scraping and find out if it is or not.
Do you know if a regular blood panel has been done? You want to rule out things like thyroid (T4) and diabetes (glucose).
That is just some options to get you started.
Again welcome. It is all a lot when you first start out trying to find out about cushings, but in no time, through reading up in our Resource section and reading on other members threads, you learn quite a bit.
Cushings Isn't fast progressing, so if this is the case, then you certainly have some time to gain as much knowledge as possible.

Sharlene and Molly Muffin

[Harley PoMMom]

Our vet doesn't like to use meds, as he said the side effects are awful. I just don't know what to do.



Hi Michelle,

Usually the adverse side effects are caused by a vet that does not follow the proper protocols when treating a dog with Cushing's.

Trilostane/Vetoryl and Lysodren/Mitotane are two drugs that are routinely Rx'd for Cushing's. They are strong drugs but are life savers for dogs that do have Cushing's. Please do not be afraid to use either one of those drugs for Daisy. If/when the times comes that Daisy needs treatment we will be with you every step of the way, ok?

Love and hugs,
Lori

[daisygirl8]

This board is amazing, thank you all!!!

The second showed small amounts of bacateria, I think... but, said could have been from catch.

Oh my... yes, I forgot, she did have bloodwork. I don't have results here, but I believe a liver enzyme was slightly off...

I'm feeling relieved to know it's not fast progressing... I didn't know that, I feel like I will wake up tomorrow, and it will be too late.

I know the vet has aspirated both bumps to rule out cancer. She's had one of them for several years. The second one is fairly new, past year. I know my brother's Boxer gets them too.

Thank goodness I found you all!!! <3

[daisygirl8]

Thanks so much Lori, So I guess I just keep a close eye on her? Maybe have the bumps checked out. Do the meds help slow the progression? That would be my only concern, in wanting to get her on something sooner than later. <3 Michelle

[daisygirl8]

Leslie, thanks for the Proin info., I am going to look it over.

[labblab]

Michelle, have you discussed the bumps with your vet yet? If not, I would just tell him that you have been reading more about Cushing's and you are concerned about the possibility that the bumps may be "calcinosis cutis" associated with elevated cortisol. He may already have an entirely different impression as to what the bumps are, and can set your mind at ease. But if not, I'd ask your vet about the possibility of consulting with a dermatologist in order to get a more definitive diagnosis.

Before doing that, though, can you describe the bumps in more detail? How big are they -- are they colored? Where are they located? How long have they been there?

Best of all, can you take a photo and upload it to your album here so that we can take a look at the bumps? It may be obvious just by looking at them that they are unlikely to be calcinosis cutis.

Marianne

[Harley PoMMom]

Elevated cortisol is what Cushing's is. Both of these drugs help with lowering cortisol, but they work differently in doing this.

Many dogs that have Cushing's disease do not get a confirmed diagnosis for many years. Dog's being treated for Cushing's can live out their normal life span and usually with complete resolution of bothersome symptoms.

Bottom line, the goal of treatment is to remedy the symptoms, symptoms that are usually more problematic for the pet owner than the pet. If Daisy's symptoms are not a problem for her or you right now, then, if this were me, I'd wait until they are before revisiting the decision to treat. Although I do agree with Marianne regarding those bumps, that they should be investigated further.

[SoggyDoggy]

Hi Michelle and a big welcome from me too!

As you can already see, there is a wealth of knowledge here on the boards and always someone hanging around to answer any questions, so feel free to post all and as many as you like. It is the best way to learn. If you do decide to go ahead and treat Daisy when you are certain that you are dealing with cushings, then we will all be there to hold your hand through the process. Please don't be afraid of offending your vet - it is his job! Would you go to a doctor who gave you half hearted care because you were afraid of offending them? You are Daisy's advocate, you must be prepared to speak up for her when necessary. And usually we find that when Vet's are challenged on something, they pick their game up pretty quickly. We are all very good customers for vets, as the bugbear of this disease can be the associated costs - which is why the vets love us :D

Anyway, to ask further about these "bumps". You mention that one had been aspirated, which makes me question are they "bumps" or "lumps"? Would you consider them to be surface bumps or are they deep under the skin? Are they movable if you push them around at all? That could be the fastest answer to whether you are dealing with calcinosis cutis or maybe something else. As Marianne suggested, if you could take a photo and upload it to your album (which you can do through your User CP - pictures and Albums) folks here will then be able to have a bit of a look and give you some more opinions and advice.

[daisygirl8]

Ok, going to call Tuft's for a derm. appt. :) $$$, I'm sure, but it will ease my mind. She is my baby! I love her to pieces... We will never have another dog as good as she is, there's no way, I know I am her mom- but, she truly is an amazing dog! She been with me through infertility, then a difficult pregnancy, bed rest... and now is best friends with my 5 year old son. I tried to upload a pic of the bump, I couldn't, she a brindle, so it's hard to see anyway, but I will give it a try again!

[daisygirl8]

I put a pic of bump in an album... hope I did it right. They're hard and moveable... one is the size of a dime, one smaller.

[daisygirl8]

A HUGE Thank You to everyone who has replied tonight :)

[molly muffin]

What was giving you the problem with loading the picture. BTW, love the avatar. Daisy is a pretty girl. Boxers always look so regale don't they.

Okay, sorry, I digress, back to the picture uploading. USER CP, on the left hand side, click on Pictures and Albums, then you'll see Add Album, click that and name an album. Then you'll be able to just upload a picture to your album directly from your computer.

Let us know if you have any problems.

Do you want to speak to your vet first and see if he has any preliminary thoughts on the lump/bump prior to going to the specialist? I'm not saying not too, just checking as your vet might already have some thoughts and he did aspirate one you said?

Sharlene and Molly Muffin

[daisygirl8]

Thank you, she is my pretty girl!

I think I have it posted in an album, the problem was me lol!

Yes, thanks... I am going to give him a call to see his thoughts on it before calling the specialist... my head is spinning!

Thank you!

[SoggyDoggy]

I would definitely speak to your vet first. I am no expert and have no experience with Calcinosis Cutis, but that pic doesn't look like any that I have seen of it, so if you can save yourself the money now, I would. Trust me, if you do end up going down the treatment path, you will need the funds then :p (sorry, but it's not a cheap disease)

I'm sure you will have plenty of other opinions before too long though. :p

[daisygirl8]

Thanks! I am thinking un-related too, as my brother's Boxers have the same type of bumps. $$$, never a dull moment, but we love our fur babies!

[molly muffin]

Hmmm, it is hard to tell. I'll let some of the others that have dealt with CC take a peek.

hugs,
Sharlene and Molly Muffin

[labblab]

Thanks so much for posting the photo, and no, I don't think the growth looks like CC, either. Whew! For what it's worth, if you are interested, here's a page of photos of calcinosis cutis. I will warn you that if you keep scrolling down the page, many are very graphic and sad looking. So I'll leave it to you to decide how much you want to see.

https://www.google.com/search?q=calcinosis+cutis+in+dogs&client=safari&hl=en&source=lnms&tbm=isch&sa=X&ei=9GV2UfLmEvGL0QGz9IHoAw&ved=0CAoQ_AUoAA&biw=1024&bih=672

Based on the photo you've posted, I'd probably forego the derm visit, too. But just keep an eye out for changes, as I'm sure you'd do, anyway. ;)

Marianne

[daisygirl8]

Thanks! The cc in the photos looks more like something that spreads? Daisy's bumps are just that, bumps, moveable. No spreading. The two bumps are not near on another on her body. Thanks so much, I feel better!