New to forum. Introducing Cookie.

[tkksa]

My name is Kathy. My dog, Cookie, was diagnosed with A-typical Cushings last year. Her 17-hydroxyprogesterone is high. She is a bichon frise that we got from a rescue, and she is about 10. In addition to A-typical Cushings, she is also believed to have Irritable Bowel Syndrome, but we aren't getting her officially diagnosed because that is just too much for her. As long as we can control it with diet, we're fine, since she can't have the hormone based meds that are used to help IBS anyway. We had her on Trilostane, but it made her really lethargic, so we switched to Lysodren (on a small maintenance level dose), but then the IBS started, so right now, she isn't on any med, since they want her V&D free for 3 months before trying Cushings meds again.

From the time we got her 5 years ago, she always had frequent urinary tract infections with high crystals. However, other Cushings symptoms didn't present until last year. Over urinating, over drinking, almost constant panting, even at rest in a room with cool temperatures, and laying down on the cool floor. Her blood work came back with cholesterol that was very high. Tested for Cushings, came back negative, even though her symptoms were text book Cushings, so we took her to an internal specialist, who sent out her blood and found the 17-hydroxyprogesterone for the A-Typical Cushings.

Curious right now though, she has stopped with her A-Typical Cushings symptoms. Working with vet. She is drinking very little and urinating little, and her UA came back negative for UTI. I'm putting water in her food to supplement. No V&D, but I wonder if there is something else going on that would stop the overdrinking, over urinating, and panting symptoms.

[Harley PoMMom]

Hi Kathy,

Welcome to you and Cookie! So sorry for the reasons that brought you here but glad you found us.

I am assuming V&D stands for vomiting and diarrhea? Could you get your hands on copies of all tests that were done on Cookie and post any abnormalities that are listed along with the reference ranges and units of measurement...i.e...ALT 150U/L (5-50), also could you post the results from the adrenal panel, it might look like this:
Pre: Estradiol pg/ml 75.8 normal 30.8-69.9 Post 80.5 Normal Range: 30.8-69.9
Is Cookie taking any other herbs/supplements/medications? How much does she weigh? Besides the IBS, does she have any other health issues?

Atypical Cushing's is when the cortisol is not elevated but one or more of the intermediate/sex hormones are. The usual treatment for Atypical Cushing's are lignans along with melatonin and sometimes a low dose of Lysodren is given too. Was it the lignans and/or melatonin that agitated her IBS?

I am sorry for all these questions but the more we know about sweet Cookie the better our feedback can be, ok?

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

Here is a link to our Resource Thread with info regarding Atypical: Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's" (http://www.k9cushings.com/forum/showthread.php?t=198)

Love and hugs, Lori

[Squirt's Mom]

Hi and welcome to you and Cookie! :)

Boy, talk about off to a rocky start. :eek: Trilostane should never ever be given to a pup without elevated cortisol, never. That is point one. Point two is that Trilostane is not recommended for Atypical period because it causes elevations in the intermediate hormones, which are what is in play with Atypical.

Atypical is treated via melatonin and lignans, either flax or spruce lignans. UTK is quite specific about this treatment so I'm not sure why the IMS decided to shun it other than that some vets don't believe in Atypical. If the melatonin and lignans don't lower the intermediates on their own then Lysoden is added as a maintenance dose only (given 2-4 times a week), no loading at all with Atypical. So if she is showing signs, I would start her on the lignans and melatonin asap. It takes up to four months for this protocol to work so we have to be patient with Atypical treatment. You can find the info from UTK here -

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

I'm sure others will along soon to share with you as well. I'm glad you found us and look forward to learning more soon.
Hugs,
Leslie and the gang

[tkksa]

Hi Lori and Leslie,

Thanks for your quick replies. Her regular vet says that she is a very complicated case. Interesting about the Trilostane. Perhaps that's why it just wasn't working for her. Her IMS, although she believes in A-typical Cushings, found in her experience that the melatonin and lignans didn't really work except to help with the fur loss. Cookie hasn't lost fur, but according to her groomer, it has changed to a finer and thinner consistency. She was put on the Lysodren at a small maintenance dose, consistent to what Leslie posted. But since we're in a holding pattern on any med while we look for the prolonged stabilization on the vomiting and diarrhea (which we are on our way to now, finally), she isn't being treated for it at all, and hasn't been since the late winter/ early spring. I'll have to get the test results, but it may take time. The IMS sent those to her vet. I just know that the 17-hydroxyprogesterone was the culprit. I also know that her cortisol was normal. She has bad teeth. When we first got her, she had hepatitis caused by 3 abscessed teeth that were removed. After that, she had resorbtion of two teeth, which were also removed. She has crystals in her bladder and kidney, which we were attempting to keep at a low level with a prescription do food, but when the IBS flared up this year, that food caused V&D, so we had to move to an intestinal health food, which she later also rejected, and now we are on a simple protein potato and rabbit dog food, which is being tolerated, and Royal Canin says should be nice to the urinary tract as well. Frequent urinary infections where present before the A-typical Cushings, and are believed to be separate from it, but exasperated by it. Twice this week, she urinated in our bed and slept in it. First time that ever happened. She usually jumps off the bed and asks to go out. No other incontinence that we can see. But the urinary analysis came back negative for infection and diabetes. I just find it odd that after a year plus, all of a sudden, the over drinking and over urinating have stopped, and so has the constant panting, which are what prompted me to have her looked at, and started us on the path to the A-typical cushings diagnosis. In fact, I haven't seen evidence of her drinking at all. The only water she is getting is what I put in her food, but that isn't what she is supposed to get in a day. She is urinating, probably at somewhat normal frequency, or just under normal. So, I've started asking questions at what additional ailment might counteract those symptoms, since I don't believe that her hormones are suddenly where they need to be. I'm honestly afraid of what there's left to find.

[Harley PoMMom]

The inflammation of her liver, caused by the bad teeth, could be the culprit for the increased drinking/urination, and now the liver has calmed down allowing Cookie to be able to drink/urinate normally.

[LtlBtyRam]

Welcome to the forums. I'm pretty new around here too, and by the way the folks around here are PAWSOME!
Angela

[lulusmom]

Hi and a belated welcome to you and Cookie.

I do believe that Cookie is a complicated case, including the fact that she may never have had atypical cushing's and the elevated progesterone had nothing to do with her symptoms. It is quite possible that whatever was causing the symptoms your vet attributed to atypical cushings has simply resolved. That happens more than you know. I'm a rescuer and I've had multiple dogs with more than a few abnormal values on blood work and despite no meds, new blood chemistry done two to four weeks later showed no abnormalities. Lori's explanation is what I'm talking about and it's completely plausible that this is what happened to Cookie. Hopefully her symptoms will stay gone but if Cookie were mine and I felt like I was waiting for the other shoe to drop, I'd talk to the specialist and ask him/her if there is something I should be worried about.

Atypical cushing's has always been controversial in the veterinary community and any treatment prescribed, including Trilostane, is a big crapshoot. Despite UTK's belief that Trilostane is not the best treatment of choice, many specialists and experienced gp vet do prescribe it. From what I've read, the efficacy is no less or no more effective than Lysodren, which means it's efficacy is also a crapshoot. I've included a url to a paper written by Dr. Ellen Behrend entitled, "Atypical Cushing’s Syndrome in Dogs: Arguments For
and Against", which I think will give you a really good idea as to why this syndrome is so controversial.

www.2ndchance.info/cushingsbehrend2010.pdf

I'm a show me and a science based person so with no explanation as to why my cushdog displayed no symptoms despite having sky high sex hormones and with little to no scientific evidence validating atypical cushing's as a legitimate syndrome, I'll just have to continue scratching my head until somebody figures it out. :D

Glynda

[tkksa]

Hi everyone,

Thank you. I'm definately feeling the puppy love. The issue with the teeth and hepatitis was years apart from the onset of the Cushing's symptoms. But it would be such a good thing if she didn't have it since she also has the frequent UTI's and IBS. And, they won't clean her teeth (and see if anything else needs to come out) because they don't consider her A-typical Cushings stabilized. And, if we didn't have to worry about steroids, we might be able to treat the IBS, if diet alone won't solve it (and mind you, we've only ever had her on prescription dog food from the start, because of her urinary issues, so she never had table food from us).

Along with what Glynda said, our GP vet said that there are many vets who don't medicate for A-typical Cushings because they don't believe that the dog needs to be medicated for the increase in those hormones. I think we'll look for some other things with xray and ultrasound - to make sure there isn't another shoe to drop. Then, if her Cushingnoid symptoms stay away for a while, I'll take her back to the Internal Specialist and have her retested for the hormone. She had those symptoms for a year (a little more), but I guess we may never know what increased the 17-hydroxyprogesterone, and how it resolved, but I'm getting a little ahead of myself here. She's only been symptom free for less than a week. Definately have a more hopeful outlook for her though. She'll still have the UTI's and IBS, but maybe not the A-Typical Cushings. I never knew there was a lot of misdiagnosis there, but for right now, until we know more, we'll keep the status-quo. I'm going to read this article though. I'm science based too.

Thank you,
Kathy