New Member - Just Diagnosed 6 Year Old

[AgilityDog]

Hi everyone. I'm sad that I am posting here because that means my dog has Cushing's, but at the same time, I'm grateful that a supportive forum like this exists.

My almost 6 year old Sheltie was unfortunately just diagnosed with Cushing's Disease... kind of. The vet didn't officially say she had Cushing's, but said she has increased adrenal activity. Here's our story:

My 14 pound 6-year old Shetland Sheepdog Bailey has a history of UTIs. As a puppy, her urine constantly had a low PH (not acidic enough) and at one point around 4 months old, she couldn't even hold her bladder for more than 20 minutes. We managed to control her urine PH with a daily Vitamin C pill and a pinch of D'Mannose powder in her meals. I am proud to say that as an adult, her PH is normal and she has no problem holding it for 8 hours when I am not home.

Because of her past bladder issues, I always run a urinalysis during her annual check ups. Last year, her urine specific gravity came back low. We ran another one a week later and it came back normal, so we left her alone.

Last month, her specific gravity came back low again at 1.014. We repeated it a week later and it was even lower at 1.013. Both tests were from her first urine of the day, before she ate or drank. I'd say about 7 or 8 hours after her last sip of water. Everything else on both urinalysis were normal. Her routine blood work was also normal.

Bailey does drink a lot of water and urinates a lot when I am home. However, she has not had any accidents in the house. At times, she will ask to go out every 2 hours if she drinks a lot of water. She does have OCD tendencies and has always been like this, so her excessive water drinking didn't strike me as odd. Also, over the last few months, her coat has changed. It's not as fluffy as it once was, doesn't grow as fast as it used to and she has dry & flaky skin. I just assumed this was from switching to a natural shampoo and conditioner and maybe because of the dry heat in my house.

Because of Bailey's symptoms, my vet decided to do an abdominal ultra sound and run a ACTH test. The ultra sound revealed that Bailey has small kidneys for her size. They appear to be functioning normal, but are small. She has a little sludge on her gallbladder, but everything else is thankfully normal.

The ACTH test results took a while to come back because they were sent to a lab in Tennessee. This test revealed that Bailey had a little increased adrenal activity. My vet said it was a little increased during the baseline blood test and remained a little increased after. My vet consulted with the lab that ran the bloodwork and they decided to treat her with HMR Lignans 10-40mg and 6 mg of Melatonin.

I already started the Melatonin because that was easy to find in stores. Right now, she is only getting 1/4 of a 3mg tablet. I'm going to increase her to 1/2 tomorrow and then to the whole 3mg by the end of the week. 6mg seems too high to me for her weight.

I had to order the HMR Lignans online and will start that on Monday. I will also start with a lower dose and increase it. I want to make sure she doesn't have any reactions. My vet oddly didn't specify a dosage. Based on my research, I think I will give her 15 or 20mg.

We are going to repeat bloodwork in 3 months and repeat the ACTH test in 6 months.

After her test results, I started wondering if Bailey has any muscle wasting. She trains and competes weekly in agility. She loves it and would be devastated if she couldn't play agility anymore. She seems to have no problem when training, so I hope it has not effected her muscles. A couple of months ago, I did notice that she had a little trouble jumping on and off the couch. It only happened a few times though.

She doesn't have a pot belly and is physically fit. She does act like she's starving and loves food, but she has been like this since day 1 and shelties are known for their love of food. She sleeps a little more than she used to, but this might be due to her age and trust me, she is ready to play with a moment's notice.

Any insights on my dog and her symptoms / test results? Anything else I should do as far as treatment goes? Anything to keep an eye on? Is there a particular diet to support the adrenal glands or any type of food or supplements to avoid?

Sadly, Bailey is not my first Cushing's experience. My childhood Maltese had Cushing's. I remember she had a potbelly, drank an insane amount of water and just seemed to suffer from this disease :(.

Bailey is the first dog I have raised on my own as an adult. I will do anything to prolong Bailey's life and make her as comfortable as possible.

[Harley PoMMom]

Hi and welcome to you and Bailey!

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

It sounds like Bailey had the adrenal steroid profile panel from the UTK (University of Tennessee Knoxville) Endocrinology, which is sent to their Lab to analyze, correct? If so, could you get a copy of those results and post them here...thanks!

The UTK lab always sends a treatment option sheet along with the tests results that they have sent back. If you haven't received one I would ask the vet for a copy, in the meantime I am providing you a link to that treatment option sheet: http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201107.pdf

I am, also, including excerpts from the UTK option sheet:
Melatonin
Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a dose of 6 mg is given q12hrs
(BID) for dogs > 30 lbs. Regular melatonin is usually used rather than rapid release or release products.

Lignan
Lignan has phytoestrogenic activity, and competes with estradiol for tissue estrogen receptors, with less biological effect. Lignan also inhibits aromatase enzyme (lowers estradiol) and 3 - beta HSD enzyme (lowers cortisol). Use either FLAX HULL (SDG) lignan, or HMR lignan. See LIGNAN at our website under TREATMENT for details. DO NOT USE flax seed oil as the lignan content is very low, and the flax oil can increase triglycerides.
SOURCES OF APPROPRIATE PRODUCTS are listed at the website. Lignans are safe, so doses don’t have to be exact. Suggested doses: SDG lignan; one milligram/lb B. Wt./ day. HMR lignan; 10-40 mg/day for small to large dogs.

We really need to see those UTK results, we need to know if her cortisol is high or in the normal range. If her cortisol is not elevated but the other hormones are than Bailey's condition is known as Atypical Cushing's, and again, this is when one or more intermediate sex hormones are elevated but the cortisol is not. We have information regarding Atypical in our Resource thread, here's a handy link: "Atypical Cushing's"/Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism (http://www.k9cushings.com/forum/showthread.php?t=198) The melatonin along with the lignans is the treatment recommended, so you're good there, and this kind of treatment does take a while to see improvements, at least 6 months.

Has a CBC/Chemistry blood panel been done recently? If so, could you post those values that are abnormal with the reference ranges and units of measurement...e.g...ALT 150 U/L (5-50)...thanks!

Regarding her competing in agility, I think that this is fine as long she seems able to do so.

If you have any questions please do not hesitate to ask them, and know we are here to help in any way we can.

Hugs, Lori

[AgilityDog]

Hi Lori, thank you for the quick reply! For some reason, atypical didn't cross my mind. I think I just assumed Bailey had high cortisol. I will call my vet this week and see if I can get Bailey's results.

Bailey had a CBC blood panel and Free t4 done last month during her yearly check up. The vet said it was all normal.

I'll also double check my bill, but there may have been two tests sent to the lab in Tennessee. I know ACTH was one of them. There were also a few different urine tests. A urinalysis, urine culture and something else that I can't recall at the moment. Besides the ATCH tests, the only thing that has come back abnormal is diluted urine.

[judymaggie]

Welcome to you and Bailey! My first Cush pup, Maggie (now have my second, Abbie), was diagnosed via UTenn with atypical Cushing's and initially treated with lignans and a melatonin implant. She later developed "regular" Cushing's as she had elevated cortisol in addition to extremely high estradiol. It will be very interesting to see the full report from UTenn.

You have been a great Mom to Bailey and I hope she can continue to do agility for a long time to come!

[AgilityDog]

Thank you Judy :)

Here are Bailey's ATCH/Adrenal panel test results:

Cortisol ug/dl:
Baseline - 6.88 (normal <1.0-5.9)
Post ATCH - 17.0 (normal 6.5-17.5)

Androstenedione ng/ml:
Baseline - 2.82 (normal 0.05-0.57)
Post ATCH - 6.91 (normal 0.27-3.97)

Estradiol pg/ml:
Baseline - 75.3 (normal 30.8-69.9)
Post ATCH - 79.3 (normal 27.9-69.2)

Progesterone ng/ml:
Baseline - 0.70 (normal <0.20-0.49)
Post ATCH - 1.99 (normal <0.2-1.50)

17 OH Progesterone ng/ml:
Baseline - 0.62 (normal 0.08-0.77)
Post ATCH - 2.5 (normal 0.40-1.62)

Testosterone ng/ml:
Baseline - <15.0 (normal <15-32.0)
Post ATCH - <15 (normal <15.0-45)

Looks like everything except for testosterone is a little high. Cortisol is in the normal range after the ATCH. The test notes say the cortisol baseline may have been high due to stress. I did leave her at the vet for the test and ultrasound while I went to work.

The only thing abnormal on her CBC was Creatine Kinase. It was slightly high at 203. Normal is 10-200.

And the only thing abnormal on her urinalysis was specifc gravity 1.014.

[Harley PoMMom]

According to those UTK adrenal panel results Bailey's cortisol is within their normal ranges, but those intermediate adrenal hormones are elevated. So, the melatonin along with the lignans is what the UTK option sheet does recommend.

Like I mentioned before this type of treatment will take some time to see improvement, so hang in there and try to be patient (yea right, huh!!). ;):)

Hugs, Lori

[AgilityDog]

According to those UTK adrenal panel results Bailey's cortisol is within their normal ranges, but those intermediate adrenal hormones are elevated. So, the melatonin along with the lignans is what the UTK option sheet does recommend.

Like I mentioned before this type of treatment will take some time to see improvement, so hang in there and try to be patient (yea right, huh!!). ;):)

Hugs, Lori

Thanks for your feedback Lori!

I know every dog and every case is different, but what do you think I can expect in the long run from this disease based on Bailey's test results?

[Squirt's Mom]

Welcome to you and Bailey! :)

My Squirt was initially Atypical and was on the lignans and melatonin protocol for about 3 years before her cortisol started to rise and we added a maintenance dose only of Lysodren. She was never loaded with Lyso but went directly to the maintenance dose.

[AgilityDog]

Welcome to you and Bailey! :)

My Squirt was initially Atypical and was on the lignans and melatonin protocol for about 3 years before her cortisol started to rise and we added a maintenance dose only of Lysodren. She was never loaded with Lyso but went directly to the maintenance dose.

Thank you Squirt's Mom. That does make me feel a little better knowing that your dog didn't have to take prescription medicines for 3 years after her diagnosis.

I'm just so angry and frustrated right now. My dog isn't even 6 years old yet. We still have so much to do. I'm not ready for her to decline.

I tried to do everything right. Got her from a reputable breeder, feed her high quality dog food and treats, plenty of mental and physical exercise, yearly check ups, limit vaccines, etc. And despite all that, she is sick. Yet, I know so many dogs that are fed some of the worst quality foods (not on purpose), are overweight, not regularly exercised, never goes for check ups, and live long healthy lives. I don't get it.

It's breaking my heart when I see her drinking so much water. :(

I just received the Lingnans last night, but I will be starting the them on Monday. I am off next week and want to start it when I home all day and can monitor her for side effects.

[Blues people]

Hi ,
With respect to our experienced advisors - i started Blue on HMR lignans right away- he has severe allergies - they helped! The melatonin helped calm his panting and he slept better. We saw no side effects. I did wait on the hard stuff to be there 24/7! And to make sure our vet was available.
We now are doing a loading.after trying maintanence. We were being extra cautious but I think we probably should have done load right away. He is an AB . I bred, raised and did obedience/conformation for 20 yrs.w shelties. Most lived till their late teens and we never dealt w/ cushings, until my last - the most beautiful, smart and social blue Merle - he had thyroid issues first, then as he aged- cushings. He lived until he was 19. We did homeopathic and didn't even realize it Was cushings, until Blues diagnosis prompted me to go through files.

My long winded point- I hope you have the same good fortune w/ your little one. None of us imagine this disease invading our home- and for me I know how you feel, the only thing worse for me than NOT having a dog, is having 1 that is not able to be the best we want for them. Our Blue is a daily challenge to our mental state. We know some days he is hurting, but then he rebounds and we are glad we stuck it out. He has CC very bad and that is so hard to see him with, but he's a trooper. We let him do as he can, rest when he needs - and walks when he is active. He doesn't like to leave home, so we drive a block and he practically runs us home. Trying to keep his wasting muscles from becoming completely weak. Shelties tend to need be active, so I would do what you can to keep it that way. They get depressed when just hanging, esp. If they are used to activity. Also, we use 2 great vitamins from nuvet . The Nuvet plus and the NuJoint DS. My cur and other AB have the softest shiniest coats- AB's hip problems have virtually disappeared, even after intensive running. I do believe the benefit to blue was it kept him alive, despite all the many issues he's had.
Hope some of this helps - when I see how many other people have so many other problems besides the CD & CC , I feel blessed. Mostly that I have good vets and this site w so many knowledgeable and kind people.
Smile, Joan
Ps. Where do you live ? And curious of Bailey's breeding line. Ty

[flynnandian]

i once owned a pedigree shetland sheepdog too, also blue merle.
my current dogs are his children, both bi-blue merle colored.
both do have cushing's disease. they are almost 13 and 14 years old and doing pretty well. still managing long walks.
so don't give up hope!

[AgilityDog]

Hey everyone! I have an update and a quick question about Bailey.

Bailey had follow up CBC bloodwork in June. All bloodwork was normal. In the beginning of September, we did a repeat sonogram. The sonogram revealed that there was a slight deterioration in her kidneys and still a little sludge on the liver. Everything else looked good. Nothing concerning, so we're not treating this. Although, I am now adding a little bit of Dr. Mercola's Kidney & Liver support supplements to her dinner.

We also did a repeat ACTH test in September. The good news is that all her sex hormones are now within the normal range. :D So I am continuing to give her HMR Lignans and Melatonin (2x a day).

However, she still seems to have Cushing's symptoms. Her fur hasn't made much improvement. It's still very ratty and is not growing in the areas where it thinned out. She still drinks and pees often when I'm home (no accidents and holds it for hours when I'm out). Her skin looks a little better, but still flaky in spots. And recently, I noticed black skin patches, especially where they shaved her fur for the bloodwork a few weeks ago. Skin is thin, she had bad razor burn on her belly when they shaved her for the sonogram. It did heal, but took about a month.

Should I bring her back to the vet for any additional tests? Or will it just take a few more months for the melatonin and lignans to help with the fur growth. She has been on these meds since March.

[Harley PoMMom]

What test was performed to check the hormones, and could you post those results?

Skin/hair issues take a while to show improvement, so patience is the key, I know how hard that is as I am the worst at waiting :o

A thyroid not functioning properly causes hair/skin problems has Bailey's levels been checked recently? This is usually noted on the chemistry blood panel and abbreviated with a "T4"

If Bailey's kidneys have lost some function than this will cause an increase in drinking and urinating. Did the vet mention about running other tests to check the condition of the kidneys?

Hugs, Lori

[AgilityDog]

Hi Lori, sorry I should've been more specific.

The ACTH test that was done in September was the same one we did in March. It was the adrenal steroid panel and ACTH Stim test from the UTK. I don't have the results, but when the vet called she said everything was in the normal range.

We ran a full thyroid panel in March, that was also normal.

The only other test the vet mentioned to do for the kidneys was a urinalysis. I have to drop off some urine when I get the chance. My dog isn't drinking or urinating any more often than usual. It just hasn't decreased. Basically, other than the normal lab results, my dog's symptoms hasn't changed.

[SuperCupcake64]

Hi -

I added a few things to my Sammy's diet that really helped his fur (of course, I don't know which one did it, but something made a huge difference): krill oil (great for skin and coat), CoQ10 (good for heart and kidneys), and Denamarin (great liver supplement).

Just a thought since you're already doing the melatonin/lignan thing!

Jen (and Maizie, and Sammy in heaven)

[AgilityDog]

Hey everyone. I have another update on my Atypical Cushing's dog. I am now getting very, very worried. Despite my dog's normal ACTH cortisol & sex hormones results in September, her fur and skin has gotten much worse. And her shaved fur from the bloodwork and abdominal sonogram has not even attempted to grow back.

In August, November & January, she had some sort of neurological episode that caused temporary weakening of the rear legs, stumbling and lethargy. Surprisingly, each episode has actually gotten milder. The one in January only lasted a few minutes and she was back to normal by the morning. In November, we did an MRI of her spine because at the time they thought it was a disc degenerative issue. The MRI came back with normal results. Because I haven't been able to get it on camera, we're not really sure what's going on. Possibly seizures?

We ran a full thyroid panel last month, it came back normal. CBC & chemistry from last week is mostly normal. Only her ALT was a drop high.

Last night, she was shivering and panting on and off for two hours, then urinated on my bed. This has never happened before. Shortly after that she was back to her normal active self. The only thing I did differently was open up a new bottle of Melatonin, but it was the same brand and dosage. I wonder if it could be a bad batch? Or is this a sign that she now has full blown Cushing's.

I feel so clueless and worried right now. Her fur and skin are pretty bad. I am in the process of scheduling a LDDST with my vet and hoping that brings me some answers. I assume if it comes back positive, we will start her on Lysodren because of her past elevated sex hormones. :(

[AgilityDog]

My dog will be getting the LDDST in a few days. Vet says that I should give my dog her normal dose of melatonin & lignans with just a little bit of food the day of the test. Does this sound correct?

[labblab]

Hello again, but I am surely sorry about these new problems. First, as far as the LDDS, I really don't know whether the melatonin would present any kind of issue. Also, some labs request that dogs be fasted prior to a LDDS; others do not. So for both these questions, I have no reason to think you can't rely on your vet's instructions since presumably he has checked them out in advance.

I wish I had some other brilliant thoughts to offer out in explanation of Bailey's issues, but I'm afraid I'm pretty stumped, too :o. As far as the neurological episodes, though, I'm thinking I might try discontinuing the melatonin for a little while, just to see if there's any improvement. Even though melatonin more commonly has a sedating effect, paradoxically it can actually incite nervousness and anxiety in some dogs. Also, I've seen contradictory info re: it being both helpful as an anticonvulsant and also a possible trigger for seizure activity in vulnerable animals. I have a nonCushpup who takes phenobarbital for epilepsy, and at the start of her treatment, I was exploring melatonin as an adjunct therapy. But as I say, I read stuff that ended up making me shy away from it because I didn't want to run the risk of actually triggering more seizures. Since you are concerned about the possibility of neurological abnormalities surfacing as well as increased panting and possible anxiety, I think I'd give her a break from the melatonin to see if at least those specific problems improve.

Here's an article that notes some of the contradictory human findings; whether the same issues pertain to dogs I do not know. But I think it could be food for thought for a dog who is exhibiting possible neurological problems.

http://epilepsytalk.com/2012/11/19/epilepsy-and-melatonin-yes-no-or-maybe-so/

As far as the other issues, I agree that it will be very interesting to see how the LDDS testing turns out. Please keep us updated.

Marianne

[molly muffin]

Definitely not what we normally see, so I guess the question is whether or not she has full out cushings at this point.

There is always with any medication or supplement dogs who will not react well. I don't think it would actually hurt to do as Marianne suggested and stop the melatonin and see if she improves.

Another thought is that since levels can change is to see if the sex hormone levels have changed since September. All her sex hormones where within normal range then?

I'd discuss all those possibilities with your vet.

[AgilityDog]

The thing is the melatonin does help with her behavior. She is a very reactive dog and I have seen big improvements with her barking/lunging on it. She has been on it for over a year now, if she had an issue, would it happen randomly 3 or 4 times? Wouldn't it be more consistent? Instead of stopping cold turkey, I decided to reduce her melatonin from 3mg 2x a day to 1.5mg 2x a day.

I also decided not to feed her or give her any meds/supplements the morning of the LDDST. I don't want anything to possibly cause a false negative or false positive result.

Molly Muffin, yes all her sex hormones returned to normal in September and her cortisol was normal as well. I will ask for the exact numbers when I drop her off for the LDDST. Thyroid was normal last month. Even sent her tests out to a specialist to review and she confirmed that her thyroid is normal.

Her blood work from last month only showed a little high ALT. Her ALT was 233. Normal is below 125. I was recently told that in the past, her cholesterol was occasionally a little high. I'm looking back at her BW from last year when her symptoms were low urine specific gravity and fur/skin issues, her ALP, ALT, AST & cholesterol were all normal. In fact all her liver values were low-normal.

Any other diseases or conditions you suggest I rule out? Her symptoms are:
-Losing Fur
-No regrowth in shaved fur
-very dry/flaky skin (not itchy)
-Thin skin. Blackening skin.
-Occasional rear end weakness
-Low specific gravity on urine test (returned to normal after lignans & melatonin)
-Occasional excessive drinking and urinating (no accidents. holds it for hours when I'm gone. But when I'm home, will ask to go out often)
-Eats like a beast (but has always loved food and acted like she was starving)
-At least 3 neurological episodes (spacey & rear weakness. made full recovery. MRI of spine was normal)

She does not have a weight issue and no pot belly.

[AgilityDog]

My dog just had her LDDST and it came back normal.

Baseline: 2.90 ug/dl (normal <1.0-5.9)
4 Hour - <1.0
6 Hour - <1.0
8 Hour - <1.0
(normal response is <1.0)

Very happy it is normal, but still have no clue what is causing her Cushing's like symptoms. I am going to have to take her to an internal specialist.

[Harley PoMMom]

Hypothyroidism is what screams at me; the fur loss, no regrowth of shaved fur, very dry/flaky skin, thin skin, blackening skin, and even the neurological issue, all of those symptoms can be attributed to a low thyroid level.

I know a thyroid issue has been looked at, however in this situation I do recommend having her levels rechecked at Dr. Jean Dodds lab. An excerpt from her website:

The main reason for sending Dr. Jean Dodds / HEMOPET the serum samples instead of having the testing done locally, is that HEMOPET is the only group routinely offering expert clinical interpretive diagnostic comments that take into account the age, sex, and breed type of the animal. This often means an expected normal reference range for an individual pet that differs from the test lab's generic broad reference range. Practitioners usually are unaware of these differences, which have been established by published research and Dr. Dodds' many years (46 years this year - 2010) of clinical and research experience.

Dr. Dodds is considered an expert in canine thyroid issues and has developed a new diagnostic tool to evaluate thyroid disorders in dogs called the T4:FT4 Ratio.

Here are links about Dr. Dodds: http://www.hemopet.org/education/jean-dodds-veterinarian.html

Thyroid testing (Dr. Dodds): http://www.hemopet.org/hemolife-diagnostics/veterinary-thyroid-testing.html

T4:FT4 Ratio: http://www.hemopet.org/hemolife-diagnostics/thyroid-vet-references/t4-ft4-ratio-thyroid.html

Hugs, Lori

[AgilityDog]

Lori, I absolutely agree with you. And when I had my dog's thyroid panel done a few weeks ago, I sent the results as well as past bloodwork to Dr. Dodds. She said the results were normal and it is not a thyroid issue.

This certainly is a mystery. :confused:

[molly muffin]

What about kidneys? How is the BUN, Creatinine?
I agree an internal medicine specialist is definitely the next step.

[AgilityDog]

BUN and & Creatnine are normal. Only thing on blood chemistry profile that has been high is ALT, but she has had bloodwork where it came back normal, so it's not always high.

[molly muffin]

There are 5% of dogs who will test normal on an LDDS and still have cushings.

My dog is one who has always had normal LDDS tests and she's had several. However, we know her cortisol levels are high (confirmed by ACTH testing) , and when other adverse signs started, like kidney and eye problems, we started her on trilostane.

So while it is possible that she doesn't have cushings and it is something else, there is also that little bitty remote chance that she is one who will not test positive on the LDDS. Just something to keep in mind and can be discussed with an IMS.

[Tinkerbellsmom]

I came across your post when I was searching for others with agility dogs...wonder how they did with it after diagnosis. Anyway, found a fellow sheltie owner!

I wondered if you had considered dermatomyositis? Here is a brief article on it
http://www.illinoissheltierescue.com/dm.html
Also be aware that not all have skin issues as bad as some of the pictures on the website. I may be way off but thought I would throw it out there.

[AgilityDog]

Hi everyone! I have an update on my dog's 3 year journey with Atypical Cushing's Disease. She is still a bit of a mystery. She has shown improvements in some areas, but other symptoms have gotten worse.

Her fur has gotten terribly worse and her skin turned black where she lost fur. If her fur loss continues at this rate, her body will be completely bald in a year or two. Ironically, she does still grow fur on her feet and ears.

Her water consumption and frequent urination has returned to normal! Her skin looks pretty good. Not as dry as it used to be. Yay! And all her kidney tests that were previously abnormal like SDMA and specific gravity are normal for the first time in years. No neurological issues in about year (knock on wood). I am thrilled by this! Her weight, appetite and energy remain normal.

She currently gets: 3mg of Melatonin 3x a day, 20mg HMR Lignans, Dr. Mercola's Liver and Kidney Support, and Dogzymes Ultimate.

Recent Tests:
CBC (Only slight abnormalities):
GGT - 14 (normal 0-13)
Cholesterol - 351 (normal 131-345)
Creatine Kinase - 198 (10-200)

Everything else was in the normal range.

ACTH - Baseline
Cortisol - 5.8 (<1.0-5.9)
Androstenedione - 0.57 (0.05-0.57)
Estradiol - 87.0* (30.8-69.9) HIGH
Progesterone - 0.41 (<0.20-0.49)
17 OH Progesterone - 0.28 (0.0-0.77)

Post ACTH
Cortisol - 17.2 (6.5-17.5)
Androstenedione - 2.70 (0.27-3.97)
Estradiol - 87.1* (27.9-69.2) HIGH
Progesterone - 1.95* (<0.20-1.50) HIGH
17 OH Progesterone - 2.45* (0.40-1.62) HIGH

So being that my dog seems to be doing great, except for her continuing and extreme fur loss, I don't know if I should just let her be or do a skin biopsy. That's about the only test we have not done. We have not tested for dermatomyositis.

Her thyroid is also low-mid normal. So I don't know if I should try thyroid meds. I have emailed Dr. Dodds in the past and she said her symptoms and tests do not indicate a thyroid issue.

Thyroid:
T4 - 1.5 (1.0-4.0)
Free T4 - 1.5 (0.6-3.7)
Free T4 - 19.3 (7.7-47.6)

[labblab]

Welcome back, and thanks so much for this update. Overall, it’s great to know that Bailey is doing so much better in so many significant ways. I do understand why the fur loss remains so puzzling, although if the issue is purely cosmetic, then you may have reached a point where you don’t want to tinker with any more variables.

The only thing I can even think to mention is the possibility of trying a low maintenance dose of Lysodren. I see that her cortisol level is at the upper limit of the normal range, and her levels of estradiol, progesterone and 17 OH Progesterone are all still elevated. Lysodren might not have much effect on the estradiol, but it ought to lower the levels of those other hormones. Whether or not that would help with the fur loss, I do not know. And as I say, you might not want to get involved with Lysodren treatment solely to manage a cosmetic issue. But that’s the one treatment suggestion that comes to mind.

No matter what, continued best wishes to you both and please keep these updates coming!
Marianne

[Squirt's Mom]

Good to hear from you again. I second what Marianne said about the Lysodren. I also want to add that my Squirt started out on the flax (SDG) lignans. When the HRM lignans came out we tried them....and all her intermediates started to elevate again so we went back to the flax lignans and regained control. Something to consider. ;)

[AgilityDog]

Thank you Marianne and Squirt's Mom! My vet also suggested trying Cushing's meds or a skin biopsy to check for DM. But because she is doing so well otherwise, we're going to just continue what we're doing. I understand that since her cortisol is high normal, she will probably be full cushing's at some point, so I will hold off on the Lysodren until we reach that point.

I didn't think to switch from HMR to SDG lignans. It is something I may consider down the line, but I think since she is doing so well besides her fur loss, I will let her be. Thanks all!

[AgilityDog]

Does stress make the Atypical Cushing's symptoms worse? I've noticed that more vets I bring my dog to and the more baths I give her, the more fur she loses. I recently noticed some yellow flaky crust on backside while giving her a bath. Starting to consider a low dose of Cushing's meds. Just of course worried about side effects and if it is worth it for fur loss / crusty skin, which is just a cosmetic issue. I do believe that my dog could be close to completely bald by the end of the year. :(

[Harley PoMMom]

Stress causes cortisol to rise so yes, stress can make Atypical Cushing's symptoms worse. Is the hair/fur the only symptom getting worse?

[AgilityDog]

Stress causes cortisol to rise so yes, stress can make Atypical Cushing's symptoms worse. Is the hair/fur the only symptom getting worse?

Yes, (knock on wood) the symptom that continues to get worse is skin flakes and fur loss.

[Harley PoMMom]

Sometimes dogs with high cortisol can get a skin infliction known as calcinosis cutis (CC). The only way to accurately diagnose CC is with a skin biopsy, skin biopsies can usually be performed under light sedation and local anaesthesia.

Lori