Cocker Spaniel questionable for Cushings

[jlm3552]

I am new to this forum so I apologize in advance for any errors I might make.

I have a female spayed Cocker Spaniel that is almost 13 years old. She is blind due to Glaucoma and can not really hear well (if at all). She had a couple of UTIs that were close together so we did further testing. Cushings was a suspect due to the creatine ratio on a urine analysis. So we did the LDDS test and of course it came back at exactly 1.4 (not less than or greater than). I had an ultrasound of the adrenal glands and showed no tumors there - both were normal size and symmetrical. Did additional bloodwork and her ALKP was at 397 (was 291 in June 2016); thyroid was .8 (was 1.1 in 6/16); blood pressure was somewhat elevated (but they said it was hard for them to get a good reading although they took 3 throughout the day - all elevated slightly). Based on her testing, we can't even say for sure that she had Cushings - maybe pre-Cushings but I can't find a lot of information on treating that. Her symptoms are frequent urination (with accidents in the house), hair loss, panting, and muscle weakness in her hind legs. I have an eye surgery (an ablation since meds won't control the glaucoma pressure) on 3/30 which is going to cost over $500. We thought this might relieve some stress her body is going through. We also thought of putting her on Enalapril (I don't think the doctor meant Anipryl but this was over the phone and they sound similar) which would help the blood pressure and urination. I guess to make a long story even longer, I'm just not sure how much more to put this poor little girl through. She just doesn't seem happy - sleeps a lot or just sits in her cage - food is about the only thing that causes her to show any life. If treatment will alleviate her symptoms then I can do that but with all of the side effects, testing and monitoring I'm not sure if that will just cause her more stress. I've looked into some "natural" treatments for Cushings with Cush Away maybe seeming the best but they all have such mixed reviews and thoughts on their effectiveness (or that they are actually harmful). I'm looking for some "advice" or experiences that anyone has had with a similar situation. I don't want to pull the plug too early but I don't want to selfishly prolong it either. And help would be greatly appreciated.

[Harley PoMMom]

Hi and welcome to you and your Girl!

Was her urine cultured to see exactly what bacteria is present so the appropriate antibiotic can be prescribed? UTI's can be quite painful so if she is getting them on a recurring basis this may cause her to be lethargic. If this were me, I would definitely want to rule out the possibility of an UTI and having an urine sample cultured will help with that.

I'm at work so this post has to be short :( hopefully the others will be able to stop by soon to offer their advice and support. If you have any questions please feel free to ask the. ;)

Hugs, Lori

[jlm3552]

Lori -

Thanks for the response. Katie had a couple of cultures done and we did a couple of rounds of antibiotics based on the cultures. We did one more culture that showed no infection. The UTI has cleared but the urine culture showed a high level of protein in her urine. The next step was a urine test where I took a sample each day for three days. They sent this off to be tested and it came back with a high urine protein:creatinine ratio (not sure what the ratio was). This is why we did additional testing like the LDDS test - due to the urinalysis ratio and some of her symptoms.
Janet

[molly muffin]

Hi Janet and welcome. So it appears that her has some protein loss in her urine. The Enalapril is to help with this and try to get the protein loss down. Are her BUN and creatinine fine?
You can also have an SDMA kidney test done, this is an early detection kidney disease test.
The poor love does have a few things going on it sounds like.

[jlm3552]

Thanks Sharlene. Will the Enalapril help with other Cushing symptoms such as the frequent urination and weakened hind legs? Any experience with the "natural" medications like Cushex and Cush Away?

[labblab]

Hello, and welcome from me, too. I'm afraid the Enalapril will not help with the outward, observable symptoms of Cushing's. It is helpful with the inward, "silent" stuff such as high blood pressure and protein loss in the urine.

As far as the over-the-counter "natural" treatments advertised on the internet, unfortunately we have no scientifically validated way to assess whether they have any effect at all on cortisol levels. Anecdotally, we have had some members tell us they thought they saw some symptom improvement for at least a while. But as far as a firm basis for us to actually recommend any of them, it is just not there.

Given your girl's borderline LDDS result, one other thought does occur to me, though. For several years now, the vet school at the Univ. of Tennessee at Knoxville has been researching a possible condition they label as "Atypical" Cushing's. They associate this condition with elevated adrenal hormones other than cortisol. Many question marks remain re: the existence and/or treatment of this condition, but the bottom line is that they recommend giving a symptomatic dog a pair of over-the-counter supplements, melatonin and lignans, in order to possibly lower levels of other elevated adrenal hormones. Both of these supplements are essentially benign and easy to administer, and they don't require monitoring testing. The downside is that, if they result in any improvement at all, it can take several weeks to begin to see results. But this may be a consideration for you to try. Here are a couple of links to publications by the vet school. The first is to their treatment considerations page -- you'll be looking for the references to melatonin and lignans. The second link gives you sources for purchasing lignans.

https://vetmed.tennessee.edu/vmc/dls/Endocrinology/Documents/Treatment%20Considerations.pdf

https://vetmed.tennessee.edu/vmc/dls/endocrinology/Documents/LIGNANS%20INFORMATION.pdf

If you're interested, we can talk about all this in more detail. But I just wanted to offer it out as a possible treatment alternative.

Marianne

[jlm3552]

Marianne,

You are mentioning a path that I was also thinking of - basically she has symptoms but not a lot of clinical confirmation. I mentioned Cush Away which combines three active ingredients; phosphatidylserine, melatonin and HMR lignans. Their website says these ingredients are recommended by the University of Tennessee College of Veterinary Medicine so I bet they are talking about the study you reference. I'm going to contact my vet today to see if she thinks there is any harm in trying that. Thanks again - Janet

[labblab]

Here's a thread on our Resources forum that talks about the "Atypical" diagnosis in a lot more detail. Also, before ordering the Cushaway, I'd encourage you to review those links I just gave you listing UTK's specific recommendations re: melatonin and lignans dosing and sources. The Cushaway capsules may conform with UTK's specific guidelines, but I'd want to compare them.

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

[jlm3552]

Thanks, Marianne. Looks like 1 capsule of Cush Away has 24mg of HMR lignans and 3.6 mg of Melatonin. Their dosage is 1 capsule for 30#. Seems to be in line with the guidelines on the documents you sent. Thanks for the documents - they had links to other sources for these.

[PennysDad]

Welcome to the right place! There are many people here who are experts, and I am not one of them. Just another dog lover who is 18 months into the adventure that is Cushings disease. Just wanted to pop in to let you know that you are not alone!

[jlm3552]

Thanks, PennysDad - I appreciate that!