NEWBIE diagnosed Havanese

[hindmak]

My dog Ziggywho is 7.5 years old was diagnosed at the end of March for pit-dep cushings. He started vetoryl 10 mg 1X day and had severe diarrhea. I was having to take him out in the middle of the night. This was being on 10 mg 1 x day for 4 days. This side effect is way worse than his Cushing symptoms which are mild. He does not have pee accidents. The main thing we noticed is that he is food foraging. We are having to keep trash cans etc.. out of his reach. He has slight hair thinning and seems to not have as much energy as he did in the past.
His blood work all looks good with exception of his liver values all were elevate significantly. Blood pressure good, all organs from ultra sound look good with the exception of some adrenal changes (typical for cushing), no bladder infection. After researching more we decided to not start back on vetoryl and taking a more conservative approach with lignans and melotonin and Denamarin for liver support. We started all of those about 3 weeks ago. On Frriday May 5th he was very ill, throwing up and shaking and refusing food. They supect he had an acute case of pancreatitis based on his amylase and lipase. The did not do the specific test for it but based it on sypmtoms and CBC finding. He was given fluid and antiemetic and pain pill and rebounded very quick. He is eating a bland diet I am cooking and back to eating and drinking normal. The good news is after his CBC they could compare to his March CBC and all liver values are improving. So here are my questions.
1. Anyone else have experience with melatonin and lignans?
2. What food do you feed. I am suppose to continue his bland diet a few more days but will start back on appropriate diet just not sure what that looks like? I have read so many things and it seems to contradicting with diet and cushing. I know low fat? Is it high or low fiber and high or low protein? The vet suggested Hills science R/D or I/D. He has been eating grain free so I don't want to do the i/d due to it is not grain free. He weighs 15.3 pounds but was 17 pounds so he needs to gain some weight.
Any insight would be great!

[Harley PoMMom]

Hi and welcome to you and Ziggywho!

What an unique name for your sweet boy! We sure would like to know more about Ziggywho' and his health history as this will enable us to provide you with our best possible feedback and we do this by asking a lot of questions, so here goes some of mine. ;)

Could get copies of all tests that were done on your boy and post any abnormalities that are listed along with the reference ranges and their units of measurement? Also we are very interested in seeing the results from all tests that were done to diagnose the Cushing's and any ACTH stimulation tests. Is Ziggywho taking any medications, herbs, or supplements (besides the melatonin and lignans)? Does he have any other health issues?

Pancreatitis sure can be a bugger to get under control, my Harley had chronic pancreatitis and we could never get his spec cPL number under 300 (RR 0-200). A very low fat diet is required, they should be small and fed throughput the day. Making sure he stays hydrated helps with the healing of the pancreas. The diet should contain a high quality protein along with a moderate amount of fiber. For my Harley I had a diet formulated for him as he had other health issues. Making sure Ziggywho stays at his ideal weight is important because studies have shown in humans that obesity can cause pancreatitis.

I'm at work right now so unfortunately this post will have to be short, I'll try to make it back later but I'm sure others will be by soon to welcome you and to share their thoughts as well.

Hugs, Lori

[molly muffin]

Hello and welcome. hmm, is his name Ziggy or Ziggywho, just out of curiosity. :)

I wonder if the blood work showed any pancrease, (elevation lipase, etc when he was diagnosed with cushings, as this can cause a false positive in cushing results as cortisol will be high) The diarrhea started very early into the cushings medication.

As long as there is pancreatis, I wouldn't treat the cushings. Wait until he feels better and is past this. (that is my thought anyhow)

[hindmak]

ok so here is his test results.
March 24th
ALT 298 range 10-125
ALKP 1212 range 23-212
GGT 22 range 0 -11

This elevated liver enzymes is what started us down the cushing diagnosis. Also the CBC was done bc we were just at his yearly check and I told her that he seemed like he did seem right that his energy was off. We had just moved so I thought a little depressed. Other than that we really had no problems. We left with a 30 day supply of Denamarin and was going to re check in 1 month. Because she mentioned the possibility of testing for cushing I researched it and sure enough he had other symptoms that I would have never thought of unless I read up on it. The main one is foragaing for food and hungry all the time. Nothing to bad... I do not see him drink excess amounts of water but I would say he did have 2 accidents in the house. The other subtle change is his coat. He really isnt losing hair but it is not as full seems thinner.

ok so after reading all about Cush I asked to do the test that same week.So here are those results.
Pre ACTH 5.7 and post 31.6 with anything above 22 being positive

We were referred to an internist who started Vetoryl and 4 days on he had the liquid diarrhea. She told us to stop at we could try when that clears.

He presented to same doc on May 5th for the acute pancreatitis. Sounds like we caught quick bc he responded to a bolus on fluid under his skin and anti emetic and pain pills. In fact his appetite was back later that day and we have been feeding him chicken rice and sweet potatoes. Here is blood work from that day. good news is his liver values are dropping

Alt 189 range 10-125
ALKP 1067 range 23-212
GGT 16 range 0-11

LIPA 4098 range 200-1800
AMYL 2035 range 500-1500

Those values were in normal range in March
LIPA 965 range 200-1800
AMYL 618 range 500-1500
So I really think the meds caused his diarrhea bc he was still eating and acting same just had to go to the bathroom a lot

I know this is long so stay with me here. Meanwhile once we got off vetoryl we started the flaxseed lignans and melotonin. Figured it can not hurt. Both vets said vetoryl is not a cure and only controls cush symptoms which at the time for ziggy is so minimal. Not willing to make him sicker. Down the road if he starts to decline then we would consider again. He was on lowest dose of 10 mg a day unless we want to compound it and the vet did not want to do that in the beginning.

I would like any advice on diet. He has been on a grain free dry dog food but the fat content is 18% Looking for somethin 10 and under. We will continue to cook for him for a couple of days but vet would like to see him back on pet food soon. She said Hills i/d or r/d. Anyone have any other good choices.

[Harley PoMMom]

Glad to hear that Ziggywho is feeling much better after the pancreatitis episode.

I found some very informative information on pancreatitis on the dogaware site, it even lists commercial dogfoods with their fat percentages: http://www.dogaware.com/articles/wdjlowfatdiets.html

It's also good to see that his liver enzymes are coming down, pancreatitis will cause elevations in those levels as does Cushing's. From his ACTH stimulation test the results are indicative for Cushing's but unfortunately there just isn't one test that can accurately diagnose it so a vet will usually perform another diagnostic test such as the LDDS or an abdominal ultrasound. My recommendation, when those symptoms get worse, would be the ultrasound as the LDDS can yield a false positive results when a non-adrenal illness is present, such as pancreatitis, also on the ultrasound if both adrenal glands are visualized this may differentiate between the adrenal or pituitary form of Cushing's.

I agree that since Ziggywho is not presenting with obvious strong Cushing's symptoms that treating can wait as Cushing's is a slow progressing disease.

Regarding the melatonin and lignans; you want to make sure that the melatonin is the plain kind not the fast-acting or slow releasing type. With the lignans what is very important to know is the standardized percentage of SDG or HMR in the product you are giving. SDG is the active component of the lignan.

As an example: As an example: If one 30 mg capsule contains 20% flax lignan extract (standardized).

30 mg capsule = 20% lignans.

20% is 1/5 of 100% (or 100 divided by 20 = 5).

30 mg divided by 5 = 6 mg lignans.

Each 30 mg capsule would contain 6 mg lignans.

The University of Tennessee lab is the pioneer of the lignan and melatonin treatment and their dosage recommendations are: Suggested doses: SDG lignan; one milligram/lb B. Wt./day. HMR lignan; 10-40 mg/day for small to large dogs.


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 extended release products.

This information can be found on their treatment option sheet located here:https://vetmed.tennessee.edu/vmc/dls/Endocrinology/Documents/Treatment%20Considerations.pdf?Mobile=1&Source=%2Fvmc%2Fdls%2FEndocrinology%2F%5Flayouts%2 Fmobile%2Fdispform%2Easpx%3FList%3De7705852%2Da589 %2D4882%2Db46c%2D4b191bb5faae%26View%3D25897ddf%2D d2c4%2D48b2%2Db06b%2D0f69c1425581%26ID%3D5%26Curre ntPage%3D1

Lignans list: https://vetmed.tennessee.edu/vmc/dls/Endocrinology/Documents/LIGNANS%20INFORMATION.pdf

If you have any questions please do not hesitate to ask them. ;)

Lori

[Joan2517]

I think his name is Ziggy...she forgot to put the comma after his name in her first post. Although Ziggywho does sound adorable.

[Harley PoMMom]

I think his name is Ziggy...she forgot to put the comma after his name in her first post. Although Ziggywho does sound adorable.

OMG! Duh! LOL :o:D

[hindmak]

Ha ha I just caught that you were calling him Ziggywho! His name is ziggy. Also he did have an ultrasound and findings were consistent with pit-dep cushings. I am glad I found this group. I struggle with what the right decision is for now with him having such mild symptoms. I was impressed with the study out of Tennessee so that is why I started him on melatonin and lignans and I have 2 local friends of mine who has dogs on this regime and had good results. I am using the lignans for life brand and also their melatonin bc it is the kind you can use on a dog.