New to forum - Cushings diagnosis with liver disease

[mtexas7]

Hello

My name is Mary, and I have an 11 yr old Irish Setter with liver disease. His name is Micah. Less than 2 months ago he was given 2 to 3 days to live due to incredibly high liver values. He is a miracle dog, (even the vet admits this...she sent him home to die) He is on Denamarin now for the liver. The reason I mention this is because today he was diagnosed with Cushings via a urine test of cortisol and creatinine (sorry if I misspelled that) levels. I have suspected Cushings for a long time....he drinks lots, urinates lots, voracious appetite, eats his poop, as well as eating other inappropriate things....in addition, now he has muscle wasting. Finally, the vet agreed to test even though she said he does not "present" like a Cushings dog.
Unfortunately, the vet also says the definitive test for Cushings is the low dex suppression test, not the one she did. She needs to know the levels before treating. The medication she mentioned giving him (I looked it up online...startes with a T or a V) clearly states not to be given to dogs with liver disease. With his liver issue, I am afraid to do dex suppression, or much of anything else right now.

My question is, what are the options of treatment for a dog with liver disease?

I just lost his brother, Star, yesterday. I do not want to loose Micah too. Can anyone help with safe suggestions?

[Squirt's Mom]

Hi and welcome to you and Micah! :)

I am so sorry to hear of the liver diagnosis. Unfortunately, liver disease can present with many of the same signs as Cushing's and cause false positives on the testing so I am not real sure how much value I could place on any cushing's test with liver disease known to be present. The drug your vet is talking about is probably Vetoryl, the generic of which is Trilostane. Lysodren, or Mitotane, is the other option but it wouldn't be any easier on the liver than Trilo would and would probably be harder on the tummy. If there is absolutely no question the liver diagnosis could be wrong, in your shoes I probably would not treat Cushing's even if I could be convinced it was truly present but rather focus on the liver. I would choose to love my baby for as long as possible, making each day a treasure to remember.

I know your heart is already broken from losing Star yesterday. I am so sorry to know you are under such sadness and stress. We are never ready to let go no matter what the circumstances.

Hugs,
Leslie and the gang

[labblab]

Welcome from me, too! Let me ask you a bit more about Micah's liver issues. Has he had a biopsy or any imaging that has identified a specific liver disorder? Has he had a bile acid test that has demonstrated actual liver dysfunction? The reason why I ask is because untreated Cushing's can generate astronomically high liver readings but without causing actual serious liver damage. So the liver elevations may be secondary to the Cushing's and not a primary problem. My own dog was sent to a specialist for a liver biopsy due to elevated liver enzymes, but he came home without the biopsy but with a Cushing's diagnosis instead! In such a case, the liver elevations are not a contraindication to drug treatment for Cushing's, and they may subsequently improve once the cortisol is lowered.

So can you tell us more about the liver diagnosis? Exact numbers for abnormal lab readings will be most helpful.

Marianne

[mtexas7]

Thank you for your replies.
the vet told me Micah's levels, but honestly, I blocked her voice out when I heard 4500, and 3900...I believe that was for ALK P and ALt after being on fluids. The lipase and GGT levels were also very high, which she said supported diagnosis. Yes, the drug she mentioned is Trilostane (Vetoryl) for Cushings
I found the bloodwork, but not the recheck for the ALK p (they had gone higher after fluids were given) Initial values, his Lipase was 5333, GGt 32, ALK P was 3900, and I think the ALt was the one that was 4500. She said she have never heard of a dog surviving those levels....so I am grateful he is still here.

[labblab]

An ALKP of 3900 would not be unheard of in Cushpups. We have seen even higher. And they can also experience mild to moderate elevations in ALT and GGT. Are you certain about the ALT being 4500? If so, that would definitely be incredibly high for any dog. If that were taken out of the equation, I would be wondering about pancreatitis with a lipase above 5,000. In addition to Cushing's, pancreatitis can also elevate ALT. Plus, untreated Cushpups are thought to be more vulnerable to pancreatitis.

You mention Micah having been treated with fluids. What happened at that time that alerted you to the elevated labwork in the first place? Was he overtly ill and that led to him being tested?

Also, does your vet plan to pursue any additional liver diagnostics? If she believes that Micah has serious, even life-threatening liver impairment, I have to agree with Leslie and I am very puzzled as to why she would be advancing Cushing's to the front burner instead of additional liver diagnostics such as an ultrasound or a test of actual liver function. That seems like an odd prioritization of health issues, especially since as Leslie has said, the Cushing's tests can all be skewed by the presence of other nonadrenal illnesses.

I also want you to know, though, how sorry I am about your loss of Star. That has to make your worries and decisions about Micah all the more difficult.

Marianne

[Silliam]

I think you came to the right place, you will get lots of help here.

I am so sorry about star, it makes everything harder when we are trying to look after one while grieving another. I will be thinking of you and your pup

[mtexas7]

Thank you all for the replies. Can I respond to each one individually, or just as I have been doing? I don't see a reply button, except at the bottom of the thread.
For labblab, Micah had a temp of 104, and vomited at 1130 pm. Looked like poop was in the vomit....but he eats poop - Star's, rabbits, deer (Now, he is not allowed out to run in the front anymore after that vet visit, and I pick up his poop the minute he goes). Anyway, I took him to the clinic first thing in the morning after the vomit and temp the night before. Also, after he urinated that morning, the urine smelled awful, so I did a free catch midstream,. He had a horrific uti/bladder infection, and in doing the bloodwork, all the values showed up with the liver. At that time they did an ultrasound, and liver looked OK. they had him on fluids for I think 6 hours, and rechecked liver values and they had gone up, not down. The vet gave him 3 days, and I took him home basically, I thought, to die. She gave me a box of Denamarin...there as been no mention of further liver diagnostics. I was not comfortable with just the Denamarin, and when his urine started to smell "off" again, I had another urinalysis done (negative), and I have wanted a Cushings test for a while, even though they did not think he was a Cushings dog, and so pushed her to do it, and they got the results today.

[molly muffin]

I think with liver disease it would definitely show up as such on an ultrasound, you would see a difference in definitions and possible mass if it were a tumor. It doesn't sound like it is either of those things.
A bile acid test can tell you definitely about that and if there is any blockage.
As Marianne said, undiagnosed prolonged high cortisol Can cause major elevations with the liver enzymes. Denamarin should help, but if it is cortisol, then it needs to come down.
So, is she saying that she did an ACTH test? Do you have that result? there should be a pre and a post level.
Or is she saying she did the LDDS and needs an ACTH before treating? If so for an LDDS there should be 3 numbers, a base, 4 hour and 8 hour.
Could you post those numbers for either test?

Welcome to the forum. I am so sorry you just lost Star. :( So heart breaking to lose even one but to also be faced with serious illness with Micah too, must be even more so.

[mtexas7]

Thank you. It is a very difficult time right now.
The only test for Cushings done so far is the urine test for cortisol and creatinine which came back positive. She wants to retest liver enzymes, then low dex suppression for definitive diagnosis of Cushings and to get levels, then decide regarding treatment, but mentioned Trilostane. After reading you don't give a liver dog Trilostane, I started researching and found this forum today.

[molly muffin]

Urine cortisol can not diagnose cushings, it can only rule out cushings if negative. It can be high cortisol in the urine due to the reasons too. (such as liver)

If you didn't get a copy of the blood tests with the results can you ask your vet for a copy so you can see exactly what is elevated and by how much? I think you will want to start your own file with lab results so you can keep track of what is going on and responses. That is what most of us here do and refer back to them often.

[mtexas7]

Sharlene - do you know if a uti being present could affect the results of the urine cortisol test she did? I asked them to check the urine when I brought it in for the cortisol test. She said a free catch always has some bacteria, and she was not concerned with what she saw...but his urine smells really off - Like fish

[molly muffin]

yes cortisol can and usually does rise when an infection is present in response to the infection.

Is it still smelly? I'd want a full urinalysis and culture done on the urine. You want to know the specific gravity and a culture will often show if there is an infection. If the urine is dilute the infection can be missed.

[mtexas7]

I believe they said specific gravity was 1.011. I will double check that tomorrow. Thank you.

[molly muffin]

Do you know if they cultured the second test to recheck for UTI to verify if the infection was gone? Also, some infections can come back again, even after a check says they are clear. They can just be very hard to get rid of.

[mtexas7]

No, they did not culture the last one. Micah had a uti with e coli and was on different antibiotics for about 3 months....all of those were cultured. Finally, on the recommendation of a chemist friend, I gave him sodium chlorite drops after being so frustrated, and the next test (culture) was clear. That was in July I think. I started him on the drops (oxy E 100) again yesterday.

[labblab]

When you double-check the specific gravity today, can you also reconfirm Micah's ALT level, too? Thanks!

[mtexas7]

Yes, I will confirm. I remember they said they had to dilute the blood to get the values. I do have the first values from my copy of the bloodwork done 9/25... ALT was 3896, and ALk P was 1999. On recheck, after fluids, she said the values had gone up, not down, told me the numbers, and that she believed he had 2-3 days to live... Those values I think were 4500 and 3900. I will check though. Sorry, I think I had those recheck values reversed in my earlier post? I don't have a copy of the recheck Alt and Alk P. The original values I just posted are from a copy of the bloodwork. I just looked at the bloodwork from February, and Micah's ALT was 93, and ALKP was 148.

[mtexas7]

I spoke to the clinic. Specific gravity for the last urinalysis was 1.008 (not cultured), after fluids, the recheck values for ALT was 4821, and ALKP was greater than 2000. She said they diluted, but not a good read on the ALKP, and that is why it just says greater than 2000. I also asked about the cortisol, creatinine results. Ratio was greater than 13.

[Renee]

With such high liver levels, I would have a bile acid test done.

And, get a culture of the urine, just to be absolutely sure. It seems strange that a very dilute urine would still have such a strong smell. Usually, very dilute urine smells like water.

[mtexas7]

His urine has been very dilute, and usually does smell like water, so I think it is odd too. the other time it smelled so bad he had an infection. With the sp at 1.008 I'm not sure the last results were accurate without the culture.
Unless the smell could be his diet this time? He is on Dr. Dodds liver cleansing diet. He eats pacific cod from Alaska, white potatoes, and sweet potatoes. Since his urine smells like fish, I wondered that too.
We have the blood draw coming up to check liver enzymes, then the low dose dex suppression test. Anyone that prays, please say a prayer for Micah.

[Dixie'sMom]

You just answered one of my questions which was, is he on any fish oil supplements or food containing fish oil. I know in humans it sure changes the smell of urine so I imagine that could be the case in dogs too, especially since dilute urine has no odor. The test would be to take him off of anything containing fish oil and see if the urine smell goes back to normal. Of course if he doesn't do well with dietary changes, that may not be an option for you.

I PRAY! And am not ashamed to say so. I will certainly say a prayer for your sweet Micah. Hugs to you also, honey. Hang in there!

[mtexas7]

I am considering doing an abdominal ultrasound rather than putting Micah through a day at the vet and the LDDS test. If there is an adrenal mass, I don't think there is anything to do....isn't that correct? I think it would be best to rule that out first.
Could I get some thoughts and opinions on this decision please?
Thank you Dixie'sMom

[molly muffin]

Well,l an ultrasound gives you a lot for a your money. You could look not only at the adrenal glands but at the liver, gall bladder, pancreas spleen, etc.

If there is an a tumor on the adrenal gland, surgery is usually suggested for cure, but there are those who have treated with medication, just like for a pituitary. It depends on what sort of tumor it is, but really, it is putting the cart before the horse to speculate on whether or not there is a tumor or not.

hugs

[Squirt's Mom]

I can't recommend an abdominal ultrasound strongly enough. The US saved my Squirt's life by finding a tumor on her spleen. Be sure the machine is a high resolution one or ask for a referral to someone who has this type machine.

When Squirt was first diagnosed I prayed for an adrenal tumor because that form offers the ONLY cure - the tumor is removed and the Cushing's goes away for the vast majority of these pups. Those who are not a candidate or cannot have the surgery for other reasons, the adrenal tumor can be medically treated - it is just a bit harder to keep control over. So no, an adrenal tumor does not mean there is nothing that can be done. ;)

You're doing good, Mom! Keep reading and learning and you will be a pro in no time!
Hugs,
Leslie and the gang

[mtexas7]

The vet told me if there was a mass on the adrenal, medical treatment will not help. I don't think Micah is a candidate for surgery...what medical treatment is available otherwise.

[Squirt's Mom]

Your vet is wrong. :o The same meds that treat the pituitary form treat the adrenal form. I'm becoming concerned that your vet doesn't understand this disease nor the treatments for it very well. Which means it is imperative that you educate yourself and quickly. ;) Check out the Helpful Resource section and get going on that learnin'! :D And keep asking questions!

EDITED TO ADD:

As I said before, the adrenal form is a bit more difficult to manage with meds but it is done all the time.

Also, your GP vet is not qualified to determine if your baby is a candidate for an adrenalectomy - you would need to seek a surgeon. They are the ones who know what has to be done and whether it can be or not.

[mtexas7]

I may have misunderstood her then....after researching I see medication is used. I would think she would know....I will get clarification. Thank you

[mtexas7]

Does anyone have any experience treating with Ketoconazole. It is an anti fungal, and it seems (at first blush anyway) to not be as hard on the liver. Also, may target adrenal dependent more effectively?
Any thoughts, opinions, or experience would be appreciated.
I have been researching lots, and I think Micah may be atypical, or adrenal dependent Cushings. I will know more on
Tuesday though.

[Squirt's Mom]

My understanding is that Ketochoazole is very hard on the liver and has little effect on cortisol, the enemy of Cushing's. The only drugs known to have a real effect on cortisol are Mitotane (Lysodren) and Vetoryl (Trilostane).

Atypical Cushing's is a form in which the cortisol is normal but one or more of the intermediate, or sex, hormones are elevated. If the cortisol is elevated the pup is NOT Atypical even if the intermediates are also elevated. Cortisol is the determining factor between the two.

The adrenal based form, or ADH, is true Cushing's, not Atypical. ;) PDH is the pituitary form and it is also true Cushing's. There is another form called Iatrogenic that is caused by steroid use and is usually cured by weaning the dog off the steroids if possible.

[lulusmom]

Leslie has already mentioned that Ketoconazole is really hard on the liver but I wanted to mention that while it does lower cortisol, a good number of dogs, approximately 30% to 35%, do not absorb the drug into the GI tract, making it's efficacy less than desirable. Before FDA approval of Vetoryl here in the states, UC Davis (teaching school) routinely used Ketoconazole to lower cortisol quickly for dogs schedule for adrenalectomies. They now use Vetoryl as it is easier on the liver and it is effective in the vast majority of dogs. On a positive note for the drug, it will not cause Addison's so no acth stimulation tests are necessary. Vetoryl is the treatment of choice for adrenal tumors.

Glynda

[mtexas7]

Thank you. I mentioned it because one of the things I read said it was not as hard on the liver. I read the same thing about it not causing Addison's. The side effects of these drugs sound so horrible. My vet mentioned Trilo might help if it is adrenal...just the side effects have me so concerned. He is 11, and liver issues. It is a very difficult time right now.

[molly muffin]

The key is to start low and go slow when using trilo. No more than 1mg/1lb and university of davis recommends 2mg/1kg which is where we started and it is a lower dose. You do end up probably having to adjust more and tests, but it is normally less risk of bad sad effects like over dosing.

[mtexas7]

Micah's ultrasound was normal! Thank goodness, and his liver enzymes have gone down to 376 and 312 for ALT. But he has lost a lot of weight in 2 months....he is on Dr. Dodds liver cleansing diet. Can Cushings be the cause of losing weight? I am becoming suspicious of diabetes with such weight loss. The vet says his urine does not have sugar, and his glucose level from September was normal. She says he does not have diabetes. the cortisol/creatinine ratio was 58, not 13 like the tech had told me. They want to do low dex suppression next. Dr. Dodds suggested trying melatonin and lignans (university of TN research study) first
Has anyone here used these supplements? Successfully?
Thank you

[labblab]

Dogs with Cushing's typically gain weight rather than losing weight. In the absence of any ultrasound evidence of cancer, I would be more suspicious that his weight loss may be because his new diet is not matching his previous caloric intake. You mentioned that his new diet consists of cod and potatoes (white and sweet). Are there any other ingredients?

So there were no abnormalities whatsoever noted on the ultrasound? How about the adrenal glands -- were they enlarged at all? Although it is not always the case, the majority of dogs with Cushing's will exhibit some degree of abnormality to their adrenal glands.

Melatonin and lignans are suggested by UTK as treatment when elevations are found in adrenal hormones other than cortisol. Their lab is the only one worldwide that tests for these elevations. The procedure involves having your vet perform blood draws in conjunction with ACTH stimulation testing, and then sending the samples to UTK for analysis. The analysis will tell you whether there are elevations in any of the adrenal hormones, including cortisol. Depending on those results, the treatment recommendation will differ. If cortisol is significantly elevated, melatonin and lignans are not an effective treatment. For some dogs with adrenal hormonal elevations other than cortisol, melatonin and lignans have been helpful. However, it can take several months before positive results are seen. For other dogs, the supplements have not proven to be of benefit. For dogs with elevated cortisol, UTK recommends treatment with Lysodren or trilostane.

If you are interested in checking the status of all of Micah's adrenal hormones, the ACTH stimulation test would be the better diagnostic option for Cushing's instead of the LDDS, with the analysis performed by UTK.

Marianne

[mtexas7]

No other ingredients. The liver diet is from Dr. Jean Dodds, the simple version has only cod, white potatoe and sweet potatoes...so that is what he is getting, and he gets about 3 pounds a day divided into 4 meals! Dr. Dodds did not seem concerned with the weight loss, and says the diet will do that, and to hold his weight were it is and just give more food. She was very pleased the liver values had come down so dramatically. Micah's vet is going to work up something to do with BMR, and calorie needs. I am not comfortable with 9 pounds lost in 2 months, but even Micah's vet hesitates in changing much because the liver values have lowered so much. In looking up weight loss with his other symptoms I came up with diabetes....she is pretty adamant he is not diabetic though, based on bloodwork and urine.
US was completely normal. The adrenals were both visualized, normal morphology and size. Both the right and the left were .7 cm. The machine used is one of only 5 in the US (I had asked about high resolution).
I will ask about ACTH vs LDDS, and sending to TN. I don't like to leave him at the clinic for, and she said LDDS takes a day. Is that true of ACTH?

[Squirt's Mom]

Did you get a nutrient breakdown with that diet? ie a list showing exactly how much protein and what kind, fats and what kind, minerals, vitamins, etc? If not, ask Dr. Dodds for that analysis...as detailed as possible. You may find something there that would point to possible weight loss.

[labblab]

In the U.S., the ACTH involves two blood draws and only takes one hour (in Canada it takes two hours because they use a different stimulating agent).

The ACTH is the more specific test for Cushing's; the LDDS is the more sensitive. What this means is that a "positive" on the ACTH is more reliably truly indicative of Cushing's, but it returns a lot of "false negatives" on dogs that indeed have the disease. The LDDS will less frequently miss making the diagnosis in a dog that has Cushing's, but is more likely to return a "false positive" in a dog that actually has some other illness going on instead. So both tests have strengths and weaknesses.

For what it is worth, I think your vet is correct in ruling out diabetes if there is no evidence of elevated glucose in either blood or urine.

Marianne

[mtexas7]

The vet wants to do LDDS first, rather than ACTH. She did agree to me taking him home (I'm only 10 minutes from them) in between draws, which I believe will be at 8, noon, and 4 pm. After being at the clinic for so long last week, he has been really tired, and I just didn't want to leave him for the day. I am happy she agreed. The test is scheduled for Wednesday.
Also, I read somewhere that LDDS can sometimes drive them into diabetes, so I am concerned about that. Has anyone else heard of this??

I started giving him more variety in his diet, and I feel, more balance. Fish, chicken, sweet potato, kale (pulverized with a little ginger and garlic), little oatmeal, eggs, and turmeric. I also give B complex, Vit E, C, pantothenic acid (the vitamins 2 or 3 times during the week), and Vit A once or twice a week. I added small amounts of coconut oil and flax oil too.

[Renee]

I've never heard of an LDDS inducing diabetes. I'd be interested to see if that is founded or just another rumour. I opted to run both an ACTH and LDDS when we were diagnosing cushings. I like having as much information as possible.

As for the diet -- please make sure you are providing calcium in the diet, if he's not getting at least half commercial food. An incomplete homecooked diet can be worse than the crappy commercial food. Calcium is vital for dogs (as with humans), and homecooked diets require calcium supplementation.

[mtexas7]

I can't remember where I read that about diabetes....it may have been the K9 diabetes forum?
Thank you Renee, I will look into calcium.

[Harley PoMMom]

Also, I read somewhere that LDDS can sometimes drive them into diabetes, so I am concerned about that. Has anyone else heard of this??


No I have not read or heard that the LDDS test will cause diabetes. The LDDs test uses dexamethasone which is a man-made (synthetic) steroid that is similar to cortisol. Dogs with untreated Cushing's have high levels of cortisol running through their system. Over a period of time this high level of cortisol may cause the glucose to become elevated (diabetes). Only a small amount of dexamethasone is used to perform the LDDS test, which I believe is not enough to cause such high elevations in glucose that would create diabetes.

Hugs, Lori

[mtexas7]

Micah's LDDS test results came back today. The vet diagnosed him with pituitary dependent Cushings. She said the levels were relatively low, and would not treat with prescription medication. She feels it is "chronic and low grade" She suggested alternatives to the prescription meds, and was interested in learning more about the melatonin and lignans (sent her the info). I am going to start melatonin, but wanted to post his results here and get some comments please.
Cortisol 1 5.3 range 1.0 to 5.0 830 am
Cortisol 2D 1.3 range 0.0 to 1.4 1230 pm
Cortisol 3D 5.1 range 0.0 to 1.4 430 pm

[labblab]

Do you know whether your vet has much experience with testing and treating dogs with Cushing's? I ask this because I am puzzled by her characterization of the LDDS results as being "chronic and low grade" and therefore not cause for prescription meds. First off, in the range of test results that we see here, an 8-hour result of 5.1 is actually quite significantly elevated and definitely fulfills the criteria for a conventional Cushing's diagnosis. Additionally, by definition, Cushing's is a chronic disease. It is chronic and ongoing in every dog who suffers from it unless the cause is an adrenal tumor that can be surgically removed. So that comment seems totally meaningless to me. She is correct about one thing: the results do point towards the pituitary form of the disease -- if your dog truly has Cushing's at all. Remember, we said a weakness of the LDDS is that it is more likely to deliver a "false positive" in the face of other, nonadrenal illnesses. And those temporarily astronomically high ALT values in conjunction with a totally normal ultrasound still leave me scratching my head as to what was/is really going on with your dog. I don't know that I'd start Cushing's treatment yet, either, but it would be because I still don't feel certain that Cushing's is actually the culprit -- not because the LDDS results were "low grade." Now that the liver enzymes are down, what is the current status of Micah's outward symptoms: the thirst, urination, appetite?

You are certainly free to pursue treatment with melatonin and lignans if that is your choice. But it is unlikely to have any significant effect on elevated cortisol as demonstrated by these LDDS results. It simply is not the appropriate treatment if your goal is to lower highly elevated cortisol. What other nonprescription meds does your vet have in mind? Honestly, if it was me, I believe I would still request an ACTH test in order to seek some secondary feedback re: your dog's adrenal function. I don't always think both tests are necessary for diagnostic purposes, but there just seem to be a lot of remaining question marks here.

Marianne

[Squirt's Mom]

Ditto to what Marianne said. The melatonin will do little to nothing to help cortisol....and Micah's IS quite elevated based on the LDDS regardless of what your vet said. :confused: If I were you, I would insist on an abdominal ultrasound on a high resolution machine and an ACTH. And I would ask the vet to explain her thinking on the LDDS since it is most certainly indicative of Cushing's.

Melatonin and lignans MUST be used in combination in Cushing's to have any effect at all. However, I doubt very seriously that this treatment will help Micah. Why? Because it is the treatment for Atypical Cushing's, a form in which cortisol is NORMAL....as these two cannot control cortisol. Their job in Cushing's is to control the intermediate, or sex, hormones. They may help with some of the signs, like hair loss or restlessness, but will not help lower the cortisol, which must be done. ;)

[mtexas7]

Thank you both for your replies. Thirst, urination, appetite remain the same. Lots of drinking, urinating, and voracious appetite. This has been the case for probably 2 years. I have gone to 4 different vets...none thought he "presented" as Cushings, so they would not test. This vet is the first to say OK, and I think it was just to quiet me. She was surprised the ratio came back at 58, and so proceeded with LDDS. His liver values are certainly down, but still not normal for Micah. In February the values were 148 and 43.....now, 371 and 312. She thinks that it was an acute insult of some sort in September that sent them to 4800 and 3800....she is not thinking liver disease. Dr. Dodds diet caused him to lose so much weight, now the focus is on him gaining...and he is - 4 pounds in 6 days after I added some things for more balance, and some supplements. It feels like such a roller coaster. Now I am unsure of what to do. Truth is I was relieved she didn't want to use the prescription meds, and leaned towards alternative....I would rather do that too. I called UTennessee regarding melatonin and lignans before posting here this morning. The technician asked for the test results, and said she would get some answers and call back this afternoon.
Micah has already had an abdominal ultrasound....adrenals were seen, and are normal.....liver normal. The overall result was normal ultrasound.

[labblab]

Micah's two-year history of outward symptoms does correspond with Cushing's. But after that length of time, it seems strange that there is no enlargement whatsoever of the adrenal glands. Not all dogs with pituitary Cushing's have bilaterally enlarged adrenal glands on ultrasound, but I think normal adrenals are more commonly associated with early stages of the disease. Also, there are certain liver changes seen on ultrasound that are often characteristic of Cushing's. The totally normal ultrasound just seems odd to me after a two-year history of strong outward symptoms.

Which alternative med is your vet suggesting?

Marianne

[Squirt's Mom]

Yeah, that report really confused me as well. I would have expected a dog with liver disease to present with something other than a normal liver in addition to the enlargement typically seen with cush pups plus the typically enlarged adrenals. If the US was done 2 years ago, I would want another one now. Something seems to be up with your baby yet nothing seems to really fit what you are being told. So I have become quite confused by the whole picture. :(:confused: Of course, I'm not a vet but there is usually some internal abnormalities seen in a dog with Cushing's and / or liver disease based on the ones I have read here and elsewhere over the years as well as my experiences with my own babies and rescue babies.

[labblab]

Leslie, the ultrasound was just performed a couple of weeks ago. ;)

[Squirt's Mom]

Leslie, the ultrasound was just performed a couple of weeks ago. ;)

Good! Thanks, Marianne!

[mtexas7]

I had the good fortune to speak with one of the vets at the U of Tennessee Endo lab. He agreed with my vet regarding the diagnosis of pituitary dependent Cushing's, and also that the cortisol level was mild. He said the melatonin and lignans can help with pituitary dependent Cushing's. He said sometimes, when the cortisol is not significantly increased, other hormones (I believe he said estradiol, progesterone, aldosterone, and another I don't remember) are more of a factor, and their adrenal panel tests for those....and that melatonin and lignans helps there too. He suggested testing levels again in about 3 months, as it can take that long for the supplements to work....and not every dog responds, but a lot do. I also brought up the liver enzymes, and again he agreed, it was probably an acute insult. He said AlkP can go very high with Cushing's, but he does not think Cushing's was the primary factor there, if it was a factor at all, as the enzymes have come down so dramatically.
He was just great in explaining everthing, and said if my vet wanted to call him with questions, or discuss melatonin and the lignans to please give her his office number.
I am feeling encouraged, and hopeful Micah will be one of the dogs helped by the supplements.
Sorry, I forgot to add....one vet at the clinic did think Micah has liver disease....the older vet does not think so, and she is the one that said acute episode.

[Harley PoMMom]

If a dog's cortisol is high, than generally, the other steriod hormones are elevated also, which are: 17-hydroxyprogesterone, estradiol, androstenedione, progesterone and aldosterone. The UTK lab can test for all these hormones plus the cortisol, it's called the Adrenal Panel and information about this test can be found in our Resource Forum: "Atypical Cushing's"/Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism (http://www.k9cushings.com/forum/showthread.php?t=198[/url)

Link to test info (#3g for an explanation of the ACTH stimulation test plus a full adrenal "panel", which includes cortisol and other adrenal hormones): http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info_07.pdf

With the lignans/melotonin treatment plan it does take some time to see improvements, if this were me, I would not retest until a good 6 months of the lignans/melotonin treatment has progressed.

Hugs, Lori

P.S. You'll find information regarding the lignans/melotonin in that first link I provided. ;)

[labblab]

I remain baffled that both these vets would describe an 8-hour LDDS result of 5.1 as a "mild" response since any result higher than 1.4 is consistent with treatable disease. In order to assess the actual magnitude of the adrenals' capacity to produce cortisol, you would instead need to perform an ACTH stimulation test. The LDDS cannot tell you that. Plus, the LDDS is not useful for monitoring purposes once treatment has begun -- for that, you need to perform an ACTH test in order to assess the impact of treatment upon production of adrenal hormone levels including cortisol. It is for this reason that it can be very helpful to first perform a baseline ACTH at the outset, so that you will know with precision the extent to which the magnitude of cortisol production has been lowered by treatment, if at all. In judging treatment success, there is no way to compare this initial diagnostic LDDS result to a subsequent monitoring ACTH test after treatment has begun.

But having said all that, I wish you good luck with the melatonin and lignans since that is the treatment route with which you feel most comfortable, and we will be very interested to hear whether you end up seeing any improvement either in symptoms or in cortisol level if you proceed with subsequent ACTH testings.

Marianne