Atypical Cushings - 1) Paw Inflmation & 2) HMR Lignans

[mgalizi]

Good afternoon; new to this site & forums.

I have a 16 year old shih-tzu named Aspen, she has been diagnosed with Atypical Cushings.

I have decided to take the natural route with a montly melatonin injection along with HMR lignan pill...which seemed to be working when Aspen was willing to take the HMR pill, now she refuses and I've tried everything to get her to take the pill and it's just not happening. As a result I see more cushing symptoms. That said, I was wondering if anyone knows if there is a liquid form of HMR I can purchase someplace to get her to take the mediciation? Searched online only pill form shows up.

Also does anyone elses fur kid have inflamation in paw (I assume due to decreased immune system on behlaf of the cushings)..her left paw between her 3rd & 4th toe flares up almost every 3 weeks, it swells to the point she can't put any pressure on foot, then it bursts open a few days later and it takes aproximately 2 weeks to heal closed, so it's never ending constant battle with the paw and her being in pain. I try to soak in epson salt with warm water to reduce swelling, that doesn't work, any other suggestions?

Thank you!

[Harley PoMMom]

Hi and welcome to you and Aspen!

I am assuming that Aspen's atypical cushing's diagnosis was diagnosed with the adrenal steroid profile from the UTK (University of Tennessee) Endocrinology Lab. Could you get a copy of those results and post them here for us?

I'm not sure if the lignans come in a liquid form. When I was giving lignans to my boy Harley they came in a powder form, a consistency sorta like pepper, and in a plastic container. I would just sprinkle his lignans dose on his food and he would eat it that way. If your lignans are in a capsule form I would try opening the capsules and putting it in Aspen's food. On the UTK website they do have a list of suppliers for the lignans, you could get a hold of them and ask if they offer their lignans in a liquid form. Here's a link to that list: LIGNANS (Phytonutrients). (https://vetmed.tennessee.edu/vmc/dls/endocrinology/Documents/LIGNANS%20INFORMATION.pdf)

As far as Aspen's paw goes, I'm don't know what that could be, and what has the vet said about it? If it is oozing I would try an antimicrobial skin cleanser such as Hibiclens and a topical antibiotic such as Vetericyn, one of our Administrators, Glynda, has recommended both of these and she knows her stuff! :D

Could you tell us what symptoms Aspen was displaying that led you or your vet to test for Cushing's? Does Aspen have any other health issues? Besides the medications you listed, is Aspen taking any other herbs/supplements/medications?

I am so glad you found us, and we will help in any way we can.

Hugs, Lori

[lulusmom]

Hi and welcome to you and Aspen.

The paw infections may be due to a compromised immune system but otherwise healthy dogs get these infections between their toes. My friend has a little Chi who had a chronic infection between her toes. The swelling was bad and it was very painful. She too would soak the paw in an epsom salt bath and she used Vetricyn but it never completely went away. She took her to the vet who put her on an antibiotic but it did not resolve the problem either. The vet ultimately had to do a microbial culture to determine which bacteria was present. She had both anaerobic and aerobic bacteria that required two different antibiotics. The last I heard she had not had another episode. You may want to consider having your vet do a microbial culture so that you can get your girl on an effective treatment regimen.

Lori has already asked the questions I had so I won't repeat her. I'll be looking forward to hearing more about your sweet girl.

Glynda

[Squirt's Mom]

Hi and welcome to you and Aspen! :)

When I used the HMR lignans they were in a capsule form not tablet. My pup had become impossible to pill in any shape form or fashion UNLESS I could mix it in her feed - she ate home cooked so it was wet. I would simply open the caps and mix in her feed. You can crush the tablets and try the same. If Aspen is eating kibble, dry feed, try giving her a spoonful of canned feed with the crushed HMR or opened cap of HMR mixed in. Or scrambled egg or chicken / beef broth, tuna or sardine, anything she really likes and might eat with the HMR mixed in. We have to get creative at times! :D

I'm looking forward to more information soon especially the UTK panel results showing Aspen is indeed Atypical. Just to be sure you understand - Atypical is a form of Cushing's in which the cortisol is NORMAL but one or more of five intermediate, or sex, hormones are elevated. If the cortisol is elevated, the pup is not considered Atypical even if some or all of the intermediates are elevated as well. The key deciding factor between Atypical and conventional, or true, Cushing's is the presence or absence of cortisol. So seeing that UTK panel will help us a great deal in helping you and Aspen.

Hugs,
Leslie and the gang

[mgalizi]

Thank you all for your input, I do appreciate it! I have requested copies of her low dose dex tests & ACTH Stim test results and will post shortly.

With respect to the HMR pills, I have tried opening it up and dumping the powder into her wet perscription diet food, even putting the powder into syringe mixed with water to get it down, she's not having it unfortunately. She is simply done with pills being shoved down her throat and I don't blame her. Besides the old slip it in the cheese bit that she has caught on to, I've even tried the old stick it in liver sausage, cheese whiz, bread, peanut butter, etc. I appreciate the links sent, I will def check them out to see if liquid formula exists.

Her paw burst open again last night. Unfortunately the two times prior that, her vet did do another exploritory surgery to clean it out, sent out a small tumor which I'm told was benign, and also had culture sensitivity test done, once again confirming that she has a staph infection and due to age, all prior antibiotic's taken & low immune system due to cushings, she is down to only 2 antiboitics that may treat and mend the infection. The white powder antibiotic to use daily when wound is open, she has been on since her last surgery and the other two times her paw has opened up since...so that's not working. The only other one she can take appears to be the last resort (don't recall name but her vet wouldn't recommend it due to havig severe side effects...something to do with her mind) therefore, I am affraid to try that route.

She went thru cushings testing back in '09 she had symptoms but after all dext, ACTH, Ultrasounds, I was told she didn't have normal cushings. When we moved back to IL a year and half ago we retested AGAIN spending all that $ to find out she in fact had Atypical Cushings all along. Symptoms: constant itching & licking, drinking tons of water & always hungry. Her hair thinning (I can see her skin on all but her paws and ears) not to mention major weight loss recently. The ultrasound also showed tumors but specialist said not to worry about them. Her liver levels and kidney levels were way abnormal so when we started the melatonin & HMR after a few months, her levels were retested and were within normal ranges again. :)

I do appreciate you all taking the time to try help us out, I feel lost and I hurt that she is hurting. Hoping to find something somewhere to help her. Besides the cushings and paw, she is perfectly normal and very healthy for a 16 year old they tell me. Mom's instinct if we can put this paw thing to rest once and for all and get liquid HMR we would be all set :)

[mgalizi]

Good afternoon; I have her lab results (my apologies beforehand if I have provided too much info you don't need to see):

ACTH
Pre-ACTH Cortisol Result 3.3 Ref Range: ug/dL
Post ACTH Cortisol (1) Result 21.3 Ref Range: ug/dL
(1) ACTH Reference Range:
2-6 Pre-ACTH (retesting) cortisol
6-18 Post-ACTH cortisol
18-22 Equivocal post-ACTH cortisol
>22 Post-ACTH cortisol consistent with hyperadrenocorticisim
<2 Post-ACTH cortisol consistent with hypoadrenocorticism
1-5 Desired pre- and post-ACTH cortisol on lysodren therapy
Notes: ACTH response test is only clearly positive (>22) in 30% of dogs with hyperadrenocorticism (HAC); equivocally positive in another 30% of dogs with HAC, and normal in 40% of dogs with HAC.* If the ACTH response test is normal and HAC is still suspected, proceed with a low-dose dexamethasone suppression test. Dogs with iatrogenic Cushing's disease will ahve flatline response test results in the low end or below the normal reference range.

Endogenous ACTH 4.6 L [6.7-25.0] pmol/L L= Low Result

Blood Work / Panels that came back listed as "HIGH":
Platelet Count: 608 (Range 170-400 10^3/mL)
Absolute Neutrophils: 11,400 (Range 2060-10,600/mL)
Alk Phosphatase: 365 (Range 5-131 IU/L)
Triglyceride: 397 (Range 29-291 mg/dL)
Comment: Hemolysis 3+, Lipemia 2+ No significant interference.
Urine Preliminary # 1: No growth on solid media in 24 hrs
Urine Final: No growth on solid media in 48 hrs

Dexamethason Suppression Tests Results:
Cortisol Sample 1 (pre): 1.4000 Range 1.0-5.0mg/dL
Cortisol Sample 2 Dex (post): <0.7 Range 0.0-1.4 mg/dL
Cortisol Sample 3 Dex (post2): <0.7 Range 0.0-1.4 mg/dL
INTERPRETATION OF THE DEXAMETHASONE SUPPRESSION TESTS: *Low-dose dexamethasone suppression test: Normal: Cortisol level less than 1.4 ug/dl 8hrs post-dex. Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl, the following can be used to differentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor. 1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is consistent with PDH. 2. Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistenet with PDH. (Samples taken at 2 or 6hrs are interpreted the same way as a 4hr sample)...if neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor cushings...: Note: Approx. 5% of dogs with PDH have normal results. False positivies may occur with stress/nonadrenal illness. High-dose dexamethasone suppression test: Use this test after hyperadrenocorticism has been diagnosed. PDH or AT: Cortisol level suppressed by less than 50% 8 hrs post-dex. PDH ONLY: Cortisol level suppressed by >50% 8hrs post-dex.

Ultrasound report: (History of elevated ALP)
Liver normal in size & echogenicity. A small to moderate volume of echogenic sediment is noted in the gall bladder lumen. The kidneys are hyperechoic with poor corticomedullary definition. Multiple small cortical cysts are present bilaterally, and a large cyst is associated with the left kidney (2.4 cm diam). A mild amount of mineralized material is noted in the renal diverticulae. Multiple small (1-2mm) hyperechoic shadowing structures are present in the urninary bladder lumen. The right adrenal gland is mildly enlarged (caudal pole 7.6mm thick), and the left is at the upper limits of normal in size to midley enlarged (6.4mm thick). No abnormalities are appreciated in the spleeen, gastrointestinal tract, or pancreas. There is no evidence of lymphadenopathy or peritoneal effusion. IMPRESSIONS: The primary differential for the adrenal gland changes is hyperplasia. The findings in the kidneys are consistent with chronic kidney disease. Multiple small cystic calculi.

Thanks again!
Aspen's Mom

[Harley PoMMom]

We love details!!! Thank you for posting all those test results, I will try to get back later with my thoughts about them, however, I do not see any results from the UTK lab for the Atypical Cushing's diagnosis. The steroid hormones that are involved with Atypical Cushing's: androstenedione, estradiol, 17-hydroxyprogesterone, progesterone and aldosterone, do you have results for these hormones? Also what has the vet said about the ultrasound finding of kidney disease in Aspen?

[mgalizi]

Hi!

I don't have the UTK Atypical diagnosis paperwork. If memory serves me correctly, after seeing specialist for the dex & ACTH, both specialist & primary vet said it was Atypical so we just started treatment from there.

For those additonal results you are looking for...do they have abbreveations, if so please provide so I can look them up on what test results I have on file.

Thanks much!:)

[Squirt's Mom]

Unfortunately, the dex nor regular ACTH can diagnose Atypical because neither of them look at the intermediate hormones. If the dex and regular ACTH were positive for cortisol, then your pup does not have Atypical Cushing's. In Atypical the cortisol is normal. ;) The test done by UTK is a special ACTH that looks at the cortisol as well as intermediate hormones.

[mgalizi]

Appreciate the info, well we must have another report somewhere, I'll continue to dig.

From one of her tests, her cortisol levels were normal. Readings came in @

Cortisol Sample 1 (pre): 1.4000 Range 1.0-5.0mg/dL
Cortisol Sample 2 Dex (post): <0.7 Range 0.0-1.4 mg/dL
Cortisol Sample 3 Dex (post2): <0.7 Range 0.0-1.4 mg/dL

Thanks again I will continue to research and advise if I find out more!