Other medical solutions for Cushings

[Adora5]

Good Morning!

My 10 (almost 11) year old pit bull/American bulldog mix has recently been diagnosed as highly suspicious for Cushing's via a urine cortisol test. We are going to conduct the dexamethasone test but want to wait until her current UTI is cleared up. This really hit me hard as I work in animal welfare and as a certified therapy dog, she has had the opportunity to touch so many lives.

I've been doing some research and I'm really not sure I want to put her on the conventional medications as she has had a slew of medical issues throughout her life (IMHA, allergies, 2 types of cancer, etc.) I've been looking into some more natural solutions for Cushing's and ran across Primalix® CORTI-QUEL. Has anyone ever tried this or any other meds and had success?

Thanks!

[labblab]

Hello and welcome to you and your girl! I absolutely love the photo that is your avatar — with a face and smile like that, it’s easy for me to see why your dog has touched so many lives ;-).

First of all, I agree that, if possible, it seems wise to hold off on further Cushing’s-specific testing until the UTI is resolved. As you probably already know, this is because “false positives” can occur in the presence of other nonadrenal stressors or illnesses. However, uncontrolled Cushpups can remain highly vulnerable to chronic UTIs. So sometimes it becomes necessary to go ahead with further testing even if the UTI remains unresolved. That can be a judgement call for you to discuss further with your vet.

As far as treatment options, we have had a few folks who have reported at least temporary symptom reduction with the use of nonprescription natural/herbal preparations. However, as far as we are aware, none of the companies who market these products have subjected them to controlled studies that demonstrate any actual decline in excessive levels of cortisol. One exception might be the use of melatonin and lignans to lower levels of certain nonadrenal hormones other than cortisol. The University of Tennesse at Knoxville has been researching this treatment combo for some time, and we have had dogs here who have tried this combo for symptom alleviation when they demonstrate a particular abnormal adrenal hormone profile. However, actual results have been mixed. Other over-the-counter products of which we are aware appear to be largely unresearched. I am not familiar with Corti-Quel, as I have not seen any owners reference it here on the forum.

If you have questions about the prescription treatments for Cushing’s, however, we’ll do our best to answer them. Unlike the over-the-counter products, controlled studies related to these medications do demonstrate actual lowering of the cortisol levels that are responsible for Cushing’s symptoms. So even though their use does involve risks, they also confer a genuine treatment benefit as well. If you have specific concerns about their use in relation to your dog, we’ll be happy to share our own experiences.

In the meantime, we’d love to learn more about your girl’s overall health history, as well as the specific symptoms that have prompted the Cushing’s testing. Once again, welcome!

Marianne

[Adora5]

I am the proud dog mom of 2 fuzz-balls. Adora (...because she's Adora-bull), a pit bull/american bulldog mix who is now almost 11yrs and Butterball, a golden retriever who just turned 6yrs. I adopted both dogs at the age of 5 years. Both dogs are certified therapy dogs as I work in the animal welfare industry and do a lot of public education and outreach. As a therapy dog, Adora has opened so many hearts to teach people how wonderful pit bulls can be and she and I have been through so much together. In her almost 6 years with me, she has had an autoimmune disease (IMHA), allergies (shes a white pit bull of course), mast cell cancer, another odd form of cancer and incontinence.

Adora is what I call my "heart dog". I believe that while we love all dogs that we own, certain dogs leave a special place on our hearts. Adora is that dog for me.

So about 6 months ago, I noticed that Adora was drinking slightly more than normal...not a ton, but enough to notice. Then shortly after, I noticed that her coat was really looking rough. Now, we had recently started giving them fish oil capsules instead of the salmon oil from a pump so I thought that might be it so we went back to the salmon oil but it really hasn't made a difference. In addition, about 2 months ago, she knocked her food bin over, spilling food everywhere and almost eating enough to make herself bloat. Something wasn't right, so I made an appointment at the shelter I work at. After an exam and some testing on her urine, it was determined she had a UTI. I didn't think much of it and assumed that was the reason she was drinking so much. So, we put her on amoxi and went on our way. About 2.5 weeks later, on Thanksgiving morning, I got up and went to the gym at 7am. While I was gone for an hour, Adora got into the closet in our bedroom (while by boyfriend was still sleeping) and found a bag of treats in one of my old purses. It had been there for at least 3 years and she never touched it before. This was unlike her, she really doesn't get into trouble. The week following, she peed in the house twice. In the almost 6 years i've had Adora, she has only had 1 accident in the house and it was after she had surgery...so I knew something was wrong. In addition, she was now drinking whole bowls of water at a time. My other dog had to come begging for water because Adora was finishing everything off...even trying to get into the toilet to drink. I knew something wasn't right...this wasn't her at all. I took her back to work with me and they ran a full CBC/Chem/T4 and xxx. We also did chest and abdominal xrays. We then tested her urine again and she still had a raging UTI. This time they also sent urine out for culture (to make sure we were treating the UTI with the proper meds) and also to measure for a urine cortisol level. When we got her urine cortisol levels back, it was at 122. Anything over 34 meant the dog was highly at risk for Hyperadrenocortism.

We are now still treating her UTI with a stronger antibiotic and once that is cleared up, I will need to schedule her for the IDDS test. I'm still trying to accept everything really. She's my girl and I'm really not ready to loose her yet. I want to do what is right for her and I do not want her to suffer but I have to admit, a lot of the medications used to treat cushings have side effects that sound pretty serious. I'm debating on taking her to the holistic vet in the area but I'm still so confused. I don't want to make the wrong choice...

[labblab]

Hi again! You’ll see that I’ve merged the new thread that you just now started into your original thread posted this morning. I’m thinking that perhaps you had trouble finding your original thread once again. However, we like to consolidate all replies related to a dog into one single thread.

Thanks so much for this additional info, however! I wish I had time to write more tonight, but I cannot stay on the forum right now. But I’ll certainly try to return again tomorrow. And hopefully some other folks will also be stopping by, too!

Marianne

[Harley PoMMom]

Hi and welcome to you and Adora from me as well!

AWWW, she sure is a cutie pie!!! And bless you for giving Adora and Butterball their forever homes!

We do have another thread on the forum where different medications are discussed, here's a link to that thread: Cabergoline, Retinoic Acid, and other novel pituitary Cushing's treatments (http://www.k9cushings.com/forum/showthread.php?8551) One particular link in that thread is to an article published by noted endocrinologist, Dr. David Bruyette: Part 3: Current & Investigative Options for Therapy (https://media.wix.co/ugd/38e433_2a59a2806e7c493d81988c1d9fd721cd.pdf)

However, as Marianne has said, those medications have not been widely researched compared to the conventional drugs of Trilostane (Vetroyl) and Mitotane (Lysodren). Vetoryl/Trilostane and Lysodren/Mitotane are strong drugs and both have some pretty scary side effects, however, adverse effects are minimized when the proper treatment protocols are followed. We have many members that are treating their cushdog with either Vetoryl/Trilostane or Lysodren/Mitotane and are experiencing success. Lysodren has been around for many, many years and for decades it has been used, off label, for Cushing's and still is. Trilostane/Vetoryl was FDA approved for the treatment for Canine Cushing's in 2008.

The key to facilitating safe and effective treatment is an experienced vet and an educated pet owner. It is when one or both is missing that dogs get into trouble. So the best advice I can give you is to do your research on Cushing's, the treatment protocols, and how it is diagnosed. I am providing a link to our Resource forum which has a wealth of information regarding Cushing's and also includes articles written by some of the most renown veterinarians that specialize in endocrinology Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10url)

Please know we are here to help in any way we can, and do not hesitate to ask all the questions you want.

Hugs, Lori

[Joan2517]

Hi and welcome from me too. Lori is spot on about an experienced vet and educated pet owner. I knew nothing and trusted my vet who thought he knew everything, but wasn't as up on Cushing's as he thought he was. Educate yourself and then either find a vet who is experienced or educate your own vet. A good vet is willing to learn and won't poo poo the things you will learn here.

[THC]

I was considering those two herbal treatments for my Standard Poodle who has Cushing's. He is presently on 28mg of Trilostane every three days reduced from every day after loss of appetite and energy, and weight. He is eating better and has more energy but has yet to gain back his weight. He has lost 30 pounds! I was conidering the herbal treatments because the Trilostane is causing diarrhea the day after he takes. I have a prescription for Flagyl but don't want him constantly taking that either. Any input will be appreciated.

Administrative Note: For any of our members who wish to reply directly to this post, a new thread can be found here:

http://www.k9cushings.com/forum/showthread.php?8839-Standard-Poodle-Poor-response-to-trilostane

[Adora5]

So, we finished treating the UTI with the stronger antibiotic (Enroflox) for 21 days and upon sending the culture out again, we found out she now has MRSP (think of MRSA in people) in her urine. Well, its uncommon for this to get in the urine, so the vets are thinking that is also what is wrong with her skin. Her skin has gotten progressively worse and last week, she went in for a skin biopsy as well as a LDDS test. We are still waiting on the skin biopsy (but guessing it is also MSRP) but the LDDS test came back. Apparently she is right in the middle between Pituitary and Adrenal. After the vet called the internist at IDEXX to discuss further, she said she would lean more towards the Adrenal but the ongoing UTI's and MRSP could be messing with things and suggest that we do the testing AGAIN once she is cleared of the MRSP. I am so frustrated with all of this. Just when I think we are finally going to have an answer...BLAH. I'm already $2000 in and I don't even have a diagnosis for a disease that is already extremely expensive to treat. On top of that, I don't want my poor girl to feel like crap anymore. :(

Has anyone ever ran into anything like this?

[molly muffin]

Wow, okay that is a lot going on. First thing is did the biopsy result come back and did they check for calicinosis cutis (cc) which is sores that are caused by calcium deposits coming up from through the skin and causing sores. The deposits are caused by high cortisol and can then become infected. So just one thing to rule out.

Do you have the actual results of the LDDS test? There should be a pre, a 4 hour and an 8 hour. If so could you post them? If not, can you get hold of them?

Whether the cause is adrenal or pituitary, they say that she Does have cushings? They just aren't sure which kind at this point?
The only thing different would be that with adrenal they can have surgery and that possibiliy could cure the cushings, if it is solely caused by an adrenal tumor. If not opting for surgery, which always comes with it's own risks, the treatment options would be the same, either trilostane or lysodren. Depending on which your vet and you are most comfortable with. Getting the cortisol lowered might help with getting a handle on the infections. I understand that MRSP can be difficult to get rid of.

However, if they think that the MRSP is affecting the results of whether she actually Has cushings or not, then you probably don't want to start medication unless you are sure. (If the skin biopsy showed cc, that is more likely to be a positive result for cushings)

Hopefully this makes sense to you when you are reading it. If you have questions though, go ahead and ask we'll try to clarify.

[Harley PoMMom]

Since she had so many health issues going on when the LDDS test was performed, unfortunately those results are skewed. That is a drawback with all tests for Cushing's, but especially with the LDDS test, is that any non-adrenal illness, even stress, can yield a false positive result. The vet should of known this so it concerns me that they may not have the experience or knowledge in diagnosing/treating this disease. These tests are expensive so I would ask for a refund for the LDDS test.

[Squirt's Mom]

I agree with Lori - there are simply too many other things going on with Adora for the Cushing's tests to be trustworthy. Cortisol rises NATURALLY in response to any stress like other conditions that have nothing to do with Cushing's. My little Trinket was diagnosed with Cushing's but I always questioned that diagnosis because she had many other things going on that could cause the cortisol to rise. Her vets insisted that because of how high her ACTH results were (>50) there was no doubt. However after she passed I had a necropsy done (necropsy is an autopsy for animals). That showed she did probably not have Cushing's (probably because her brain was not looked at for a pituitary tumor) but she did have some other things going on that had never been diagnosed - like a severe kidney disease and chronic damage from an inguinal hernia, which eventually caused her death. In spite of the fact that I was not convinced she had Cushing's, I treated her with Lysodren just to see if it would help and her cortisol never came down. Why Lysodren? One because I am much more comfortable with that drug than I am Vetoryl (Trilostane) - and yes, I am the oddball on this view. :) Another because I DID question the diagnosis and Lysodren will have no effect if Cushing's is not actually in play so it was truly the safest drug for her with the questionable diagnosis. Her vet wanted me to use Vetoryl but I refused. The ONLY thing in Adora's case that might change my view on starting treatment for her now is if she does have CC (Calcinosis cutis) which is almost always caused by Cushing's. It CAN have other causes but that is very rare. So I would want her to see a Veterinary Dermatologist to test for the CC and go from there.

Hugs,
Leslie