Dealing with Cushings in a third world country

[M&Inu]

Hi!
I am reading through all the posts and am getting tons of information I had not found elsewhere. I wanted to say thank you for all the resources and to introduce myself and Inu.
Sadly Inu (13 year old, spayed, 89 pounds, Akita-mix female) is being diagnosed with Cushings. We live in a Latin American third world country and I face several problems:
Here in even better equipped veterinarians can't do more than basic bloodwork and extrapolate from clinical signs. The ACTH tests that could be performed are unreliable, because the standards to which they are compared, in this case the cortisol evaluation is made in labs that are to measure human cortisol, so the results are not very good. But she has signs like: polydipsia, polyphagia, pendulous abdomen, slow hairgrowth, hindleg weakness, panting, hypertension. Her blood work for liver and kidney function is OK and her colesterol is also still in the approved standards.

These symptoms have been ongoing for a while. I have been insisting that it is not "normal" ageing and arthritis. But I have been to three veterinarians and now finally one says, yes she probably has Cushings and the diagnosis wont help you since we don't have the required tests and medication in the country. It has been discouraging and painful. To know that if I lived elsewhere I could provide my dog with the help she needs. And I feel she has been given a death sentence. I have been frantically reading up and trying unsuccessfully to find a US veterinary pharmacy that would sell me Vetoryl with my local veterinarians prescription. I am truly despairing.

Also the medicine that could help her with this disease is available in the USA or in Canada by prescription only (here its not sold at all, I am not trying to buy it cheaper, I am just trying to be able to buy it at all). I would really like to be able to try to help her in her remaining time, and I have read that dogs with proper treatment can have a better life. But here there are simply no options.

When I insisted I want to do something and have been able to bring things from the US with relatives her veterinarian has given me a medical sample of Trilostane (made in India) with 60mg capsules and recommended an initial treatment of 120mg daily (I am now reading through the threads here, and am learning that would be a too high dosage to start from). This "sample" will last me only through 13 days on this dosage. In the meantime I am supposed to see if I can get this medicament send from the US to here which is looking to be really hard.
Also he would be monitoring the success or not of the trilostane through the visual signs of the disease, since the testing is non existing.

Could I start her on 60mg per day (to minimize risk of side effects, that have me scared witless, specially the instant death cases and the adrenal necrosis cases) and hope for the best and watch her clinical signs (polydipsia, polyphagia)?

I am glad to have found this forum to at least be able to vent a bit and not to feel so utterly abandoned. Thank you!

Edit: I added an album with a screenshot of her lab results, if someone wants to look at it. Its very basic blood work.

[Harley PoMMom]

Hi and welcome to you and Inu!

A Cushing's diagnosis is scary enough even when one has the medications and testing available for their dog so I am so very sorry for all the hardship you are dealing with. The 120 mg starting dose of Trilostane is quite high for Inu's weight of 89 pounds as the recommended starting dose is 1 mg per pound so the 60 would be a better option. Are the 120 mg capsules the brand-name Vetoryl which is manufactured by Dechra? If so, are any pharmacies located there that could repackage the 120 mg of Trilostane into lower doses for you? Many of our members use online pharmacies (with a vet prescription) to purchase their dog the medication needed, could that be an option for you?

Since it's Christmas here there is less activity on the forum but hopefully others will be by to offer better advice than me...sorry that I'm not of more help. But please know, you are not alone and we will help in any way we can.

Hugs, Lori

[M&Inu]

Dear Lori,

Thank you so much for replying even on Christmas. Really you have no idea how much it means. This holidays have been one of the most anxious and despairing I have had.

The capsules are 60mg they are sadly Not Vetoryl. They are made in India and the box says “medical sample not for sale” it was all my vet had and he gave it to me so I can start Inu on it and try to get more.

But I didn’t want to start her on 120mg like he said right away, and my gut feeling apparently was right, because I found this forum and the wealth of information, and the recommendations to start with lower doses. (I still am insanely scared of the reported deaths with Tilostane and the adrenal necrosis cases, but I have to accept the risk and try to give her a chance to better last days, weeks, months, years she has left.)

I also didn’t want to start her and not have a supply of more medicine ready. I have bought non prescription medicine and supplements from United States online pharmacies for her. I use a p.o.box delivery system to bring it to my country. I had hopes to buy Vetoryl when I was asked for my vets prescription, but I haven’t found one pharmacy that would accept my vets prescription, because he is not a United States veterinarian. I am truly desperate.

I will start her on one 60mg capsule (of this made in India Trilostane sample) and pray I can get something worked out for buying real Vetoryl and have it brought to me. I know it has legal ramifications for veterinarians to prescribe without seeing a patient, or pharmacies to give it without a us veterinarian prescription, but they could talk with my veterinarian. I am really sad there is so little chance for someone like me to get my dog. He is listed on the us embassy list of veterinarians for my country, they could check he is legitimate.

I am scared, and desperate, but trying to be hopeful, and messages like yours help so much thank you.

Hugs you back and many thank yous and happy Christmas.

[labblab]

Hello, and welcome from me, too! Like Lori, I’m so sorry for all the challenges you are enduring. But at least in terms of the medication, I think I may have a ray of hope for you. I am reposting below a reply that I had written a few months ago to another member who is in a similar situation.


Hello and welcome from me, too! I'm afraid I have only a moment to post right now, but I did want to address your medication question. By any chance, do you have any friends or relatives in the U.S.? The reason why I ask is that one option for you to consider might be a "compounded" version of trilostane instead of brand name Vetoryl. Trilostane is the active ingredient in Vetoryl, and there are compounding pharmacies here in the U.S. that can prepare custom doses of trilostane at a price that is typically much less expensive than the cost of Vetoryl. There have been some studies that have indicated that some compounded versions of trilostane are not as consistent in dosage or as effectively metabolized as is Vetoryl. However, many of our members here have used compounded products with success, and if I did not feel as though I could afford the cost of brand name Vetoryl, I personally would opt for a compounded trilostane rather than not treating at all.

I just now checked with a compounding pharmacy located in Arizona that has an extremely good reputation with our members: Diamondback Drugs. The pharmacist there told me that they could, in fact, honor a prescription faxed from a Mexican veterinarian. However, they cannot send the medication across the border themselves. They could, however, send the medication to a designated recipient in the U.S. It would then be up to you to work out the arrangements for receiving the medication yourself. I don't know whether this helps, but I just wanted to offer this option as a possibility. Here is Diamondback's website if you want more information: http://www.diamondbackdrugs.com/

Once again, welcome, and we look forward to learning more about little Cherry.
Marianne

I encourage you to contact Diamondback to see if they can help you. I know that the cost of the medication is not your primary concern, but being able to obtain a less expensive form of trilostane could be a fringe benefit for you. And as I wrote in my post above, just in terms of service itself, Diamondback has been very helpful to a number of our members throughout the years.

Please do keep us updated!
Marianne

[Joan2517]

Hi and welcome from me too. I wonder if you would be able to have your vet send the blood samples out somewhere where they can be done accurately.

[Squirt's Mom]

Hi M and welcome to you and Inu! :)

If your vet will work with Diamondback I would be happy to help with the shipping. So talk to Diamondback, and your vet, then send me a PM here on the forum and we will work out the shipping details. It is scary enough when we first start on this cush journey when everything needed is readily available....and heartbreaking when difficulties such as you are dealing with compound that fear. Also if you are on Facebook join this group at the link below. You may find other suggestions in addition to Diamondback since members are from all corners of the world (and other information that could be VERY beneficial when it comes to getting medications). One word of caution about the Facebook group tho - they have a very large membership and quite often the info offered is not scientifically based but pure opinion so take comments with a grain of salt, or two. :-) There are a couple of people there you can trust completely - a lady by the name of Glynda Pomerantz and another named Barbara Ashe are always dependable, especially Glynda. She is an Admin here and on the FB group.

https://www.facebook.com/groups/89435412886/

Another option would be herbal support. While there is little science behind herbs for Cushing's there are those Holistic vets who use certain TCM (Traditional Chinese Medicine) formulas with some success. I will be glad to supply the names of some of those formulas if you wish. In the US those things do not require a prescription and would be easy to get.

Regardless, you and Inu are now part of our little family here and we will be with you all the way, helping in any way we can. We are here to listen anytime you need to vent, talk, scream, or cry. Never hesitate to ask or reach out.

Hugs,
Leslie

[labblab]

And here I am, back again with one more thought ;-). In lieu of being able to perform monitoring ACTH testing, here’s an article that describes the possible use of a simple resting cortisol level alone, taken right before the morning dose of trilostane is given. As you’ll see, this is currently an experimental method, but it still may be of some use or interest for your vet to consider. Here’s the link:

http://www.vetpracticesupport.com/monitoring-canine-hyperadrenocorticism-using-pre-pill-cortisol-instead-of-an-acth-stimulation-test/

[M&Inu]

Hi Marianne!

Thank you so much for the information about the pharmacy that could maybe accept my veterinarians prescription. I will get in contact right away.

I have so many questions still:

Could you recommend a starter pack to treat Cushings blind? I know this is a lot to ask, but as I have stated my vet and I would be going about this by clinical signs not tests.
Since I currently only have 60mg capsules. I will start Inu on one capsule daily. If I am successful buying this compounded Trilostane (while holding still the hope to get Vetoryl, since I have heard the dosage and strength of Vetoryl is more reliable) should I buy certain range of MG capsules?
Like maybe 5mg, 10mg, 30mg, 60mg to make combinations and adjustments on the way depending how Inu reacts to the dosages?

Also I wanted to know how much prednisone I have to have at hand for a 89 pound dog, as an emergency help if she displays the side effects? Should I have it as tablets at hand or since vomiting is a side effect, as is injection too? Is the injection subcutaneous or intramuscular?

I have been trying to read all there is. And taking the medication in the morning with food is what I am going to do. But are there any other newbie and "how to treat where there is no doctor" recommendations?

Drug interactions:

Inu currently receives Denamarin one tablet in the early morning on an empty stomach at least 1 hour before her breakfast.

6 drops of CBD oil on treats when we return from a walk.

2 tablets of Traumeel crushed for maximum oral mucosa absorption for he arthritis.

1 tablet of Senilife (Ceva) with her dinner.

On Sunday I gave her Sentry WormerXPlus since with the onset of all the symptoms, she started coprophagia of cats feces. Stray cats come in our garden to defecate and I am not always quick enough to see the feces before she does and eats them.

She is also getting ear drops for a mild ear infection.

What can I keep giving her? What should I stop? Are there better alternatives natives for supporting her brain, liver and joints when on Trilostane?

Also I know this is a long stretch but I was reading sometimes people have been able to correspond with Dr. Bruyett or that he can look at a forum thread when asked? It would mean a lot to me to be able to get a second opinion on my case. Just to go over the very basic blood test results I have and advise on dosage and drug interactions.

Thank you again for letting me know about Diamondback I will contact them immediately. Still if someone else knows how to buy Vetoryl I would appreciate it, thank you.

I just saw your second post, thank you so much. I am forwarding this to my vet, sadly he is out of the clinic until January the second, it would be great if I could do this with Inu, since it would help me not to feel like I am flying blind.

I hope you are having a good holiday.

Thank you!

[M&Inu]

Hi Joan, thank you so much for your message. Sadly sending blood for testing to the US is very difficult, we really are in a third world country. I will ask my vet, just to be sure, but I dont think its feasible. Thank you for your message.

[M&Inu]

Hi Leslie,

My vet would work with any pharmacy that will accept his prescription, I have no fear of that, only now I have the problem I have to wait until he is back at the clinic on January the second. I will see if Diamondback doesn't have a problem with sending to a P.O.Box in Miami, if its not possible, I will contact you for your help with shipping, thank you so much.

I have been in so much fear, I felt the end was right here, but after reading this forum I am getting strength and hope. You have no idea how much reading all the information and discussions are helping me.

I will join the FB group thank you! Thank you also for telling me who I can trust, that is so important.

I have been looking into the herbal support. I would appreciate to know more of what I could give concurrently with Trilostane or instead in the case I can't get Trilostane, or it doesn't work on Inu for whatever reason. I think I need to know all about the possibilities that are open to me. Thank you!

I already feel like in a family, thank you so much for all this welcome and support, it is helping so much. I am oscillating between grief, anger (at most of the vets who told me it is "only normal ageing" and dismissing all the signs for almost one year) and despair, and am not finding anyone here that understands that Inu is much more than "just a dog".

Hugs!

[Harley PoMMom]

I have so many questions still:

Could you recommend a starter pack to treat Cushings blind? I know this is a lot to ask, but as I have stated my vet and I would be going about this by clinical signs not tests.

There really isn't a way to treat a cushdog safely without the proper monitoring ACTH stimulation test but since this is not an option for you, starting Inu out at a much lower dose of Trilostane would be something you could try. The results of one study indicated that larger dogs require smaller doses so it is entirely possible that a low dose would be adequate for Inu. Keen owner observation is one factor that is needed when treating a dog for Cushing's so you would want to watch out for any ill effects from the Trilostane.

Trilostane does have a short half-life and leaves a dog's system rather quickly, so usually just stopping the Trilostane is enough when a dog is displaying symptoms of cortisol dropping too low, but not always.


Since I currently only have 60mg capsules. I will start Inu on one capsule daily. If I am successful buying this compounded Trilostane (while holding still the hope to get Vetoryl, since I have heard the dosage and strength of Vetoryl is more reliable) should I buy certain range of MG capsules?
Like maybe 5mg, 10mg, 30mg, 60mg to make combinations and adjustments on the way depending how Inu reacts to the dosages?

Trilostane cannot be compounded in the same exact dose as Vetoryl capsules so the dose cannot be exactly 5, 10, 30, 60, or 120 mg. However you can have them made into doses of 4 or 6 instead of 5, 9 or 11 instead of 10...etc. Having doses of 4 mg or even lower such as 2 mg, I think, would be better since monitoring with the ACTH stimulation tests can not be performed.


Also I wanted to know how much prednisone I have to have at hand for a 89 pound dog, as an emergency help if she displays the side effects? Should I have it as tablets at hand or since vomiting is a side effect, as is injection too? Is the injection subcutaneous or intramuscular?

The oral rescue dose of Prednisone is .25 mg/kg so to convert Inu's weight of 89 pounds in kg you just divide 89 by 2.2 which = 40.45 then times that by .25 which = 10.1, so the Prednisone recommended is 10 mg. I'm not sure if prednisone can be injected subcutaneous. My vet gave me dexamethasone shots to keep on hand in case my dog needed them. Dexamethasone is a much stronger steroid so the dosage strength needed is a lot lower than prednisone .


I have been trying to read all there is. And taking the medication in the morning with food is what I am going to do. But are there any other newbie and "how to treat where there is no doctor" recommendations?

I don't know of any, maybe someone else will.


She is also getting ear drops for a mild ear infection.

Are any steroids in the drops?


What can I keep giving her? What should I stop? Are there better alternatives natives for supporting her brain, liver and joints when on Trilostane?

I have used Denamarin in the past but did switch over to Milk thistle as it was much cheaper.


Also I know this is a long stretch but I was reading sometimes people have been able to correspond with Dr. Bruyett or that he can look at a forum thread when asked? It would mean a lot to me to be able to get a second opinion on my case. Just to go over the very basic blood test results I have and advise on dosage and drug interactions.


Dr Bruyette's email address is David.Bruyette@vca.com. Another renown endocrine expert is Dr. Mark Peterson and he has a blog that you or the vet could respond to: https://endocrinevet.blogspot.com/2011/02/diagnosing-canine-cushings-disease.html his email address: info@animalendocrine.com

Lori

[M&Inu]

Hi Lori,

So many thanks for answering my questions.

I know I am risking it big with treating Cushing, like this, blind, without test, but I want to do something, just exhaust my possibilities, and I hope that if I am very careful and vigilant on her reactions I could maybe get a right dosage, to at least slow down symptoms like hipertension, panting, polydipsia and polyphagia?

I need to read up more on how compunded medicine works, to even know how to order it in Diamondback. I have already emailed them and they got back to me saying they will ask their compliance department. I am being hopeful they will agree.

Thank you, I have ordered in the human pharmacy prednisone in that dosage, just to have at hand. I will ask my vet about dexamethasone injections.

The ear drops contain: Ivermectina20mg, Prednilosona40mg, Gluconato de Clorhexidina50mg, Ketoconazole200mg and Gentamicina300mg. These drops were prescribed for one week of usage, and her last dose is tonight.

Could you tell me what brand of milk thistle tablets you buy and what dosage you give? Thank you.

I wrote to Dr Bruyettes email but the address is getting rejected. I send it one time to David.Bruyette@vca.com and the second time to david.Bruyette@vca.com (lower case D), both times I got the message of address not found.

Thank you so much for answering and being so supportive.

I hope you are having a nice day.

[Squirt's Mom]

Glad to offer some ideas for TCM approaches. In no particular order as to how well they work -


Men Dong Tang (Ophiopogon Decoction Formula) - http://franklintnvet.com/cushings-disease-in-dogs/

Si Miao San (Four Marvels Powder) - http://www.gfcherbs.com/Images/Four%20Marvel%20Formula%20Monograph.pdf

Long Dan Xie Gan Tang (Gentiana Longdancao Decoction to Drain the Liver) - http://franklintnvet.com/conjunctivitis-in-dogs/



Some general info on treating canine Cushing's Holistically -

http://ivcjournal.com/integrative-approach-cushings-disease/

https://www.tcvm.com/Portals/0/SummerFall2015.pdf


From our archive on some of this info:
http://www.k9cushings.com/forum/showthread.php?8235-Traditional-Chinese-Medicine-and-Cushing


In case you aren't aware, TCM does not approach medical conditions by disease but rather is a "... unique paradigm of medicine (that) grew out of penetrating observation of how everything in our reality functions at the deepest, invisible levels and interacts with the surface or visible physical levels. It’s a medicine of extraordinary relationships. Every TCM principle, theory, and healing practice reflects and harmonizes with the relationships that exist within natural law."** All of which means they do not look at the disease "Cushing's" but rather things like dampness, heat, blood deficiency and so on. And I am NO expert by any means....I use Western Herbal approaches but do trust and respect the very ancient approach to medicine offered by TCM.
** https://www.tcmworld.org/what-is-tcm/


A formula found using both western herbs plus a Chinese herb called Rehmannia from Veterinary Herbal Medicine -

1 part Ginkgo (Ginkgo biloba)
1 part Milk Thistle seed (Silybum marianum)
1 part Dandelion root (Taraxacum officinale)
1 part Rehmannia root (Rehmannia glutinosa)
1 part Astragalus root (Astragalus membranaceus)

"Part" means any measurement. So if you use 1 teaspoon of Ginkgo then you will also use 1 teaspoon for each of the other. If you use 1 tablespoon for Ginkgo, you use 1 tablespoon for the others and so on. There is no set amount - you determine that with the first ingredient in this formula. Buy actual herbs if possible not herbs that come in capsules etc. A good place to get high quality herbs is Mountain Rose Herbs and if you contact them they can tell you if they can ship direct to you where they are. If they can't and you wish to try this, again I can help with shipping if need be. I order from them all the time. ;) The names in italics are the bi-nomial or Latin names which fully differentiate herbs. Often common names, like Dandelion or Milk Thistle, are used to talk about completely different plants depending on area, culture, traditions passed down, etc. so always refer to the bi-nomial/Latin name when researching or ordering herbs.

I hope you find something of benefit in this info!

Hugs,
Leslie

Sources referenced in addition to websites listed above:
Manual of Natural Veterinary Medicine: Science ad Tradition by Dr. Susan G. Wynn and Dr. Steve Marsden
Veterinary Herbal Medicine by Dr. Susan G. Wynne and Dr. Barbara Fougere

[Harley PoMMom]

Just a quick note regarding the ear drops: Prednilosona, I believe, is a steroid, and even though she's only been on it for a week it will cause increased drinking, urinating, and appetite. So I would probably wait for at least a few days before starting the Trilostane, my reasoning behind this is because those symptoms may lessen a bit and since you are needing to watch for changes in her clinical symptoms to judge how the Trilostane is working, it may cause this judgement call harder to make.

[Harley PoMMom]

Hi Lori,

I wrote to Dr Bruyettes email but the address is getting rejected. I send it one time to David.Bruyette@vca.com and the second time to david.Bruyette@vca.com (lower case D), both times I got the message of address not found.



Another one of our members is corresponding with him by email right now so I'm going to ask them for his email address, but in the mean time try this one: david@anivive.com

[labblab]

This is Dr. Bruyette’s new email address: DaveBruyette@veterinarydiagnosticinvestigation.com .

He is no longer at the VCA Hospital, and is a co-founder of this new consulting service.

https://www.veterinarydiagnosticinvestigation.com/

Marianne

[M&Inu]

Hi Leslie!

Thank you so much for all the articles and information about the options of complementing Cushing treatment with Chinese herbs. I am definitely ordering, since I can get that as soon as possible. Only I wanted to keep on asking:

I searched in The Mountain Rose Herbs website, but I would have to buy each individual herb and make my combinations myself.

So I read through the thread in this same forum, you were so kind to link me to, and they said they buy from www.tcvmherbal.com where I could buy the combined formulas cited in this article: (https://www.tcvm.com/Portals/0/SummerFall2015.pdf)
But when I clicked on that website it only says they sell their herbs to veterinarians, you can do a zip code search to see what veterinarian in your area has their products, but I am sure I will encounter yet again the same problem: nobody wants to sell me any Cushing medicine without a prescription, or without seeing the dog themselves.

So I googled the author of the other article you linked me to: http://ivcjournal.com/integrative-approach-cushings-disease/
And I found they have an etsy store where they sell their herbal combinations:
Si Miao San (Four Marvels Powder) https://www.etsy.com/listing/215669250/si-miao-san-four-marvels-powder?ref=shop_home_feat_1
But they dont have the Men Dong Tang (Ophiopogon Decoction Formula) I would have loved to try out.

I wanted to know what you would recommend. Would I be able to cobble together my own formulas buying each individual herb in Mountain Rose Hebrs? It would be so much easier to be able to buy https://store.tcvmherbal.com products, since they are listed by name in the articles and I could use the help finding similar case studies to buy those combinations, for example:

Snowflake was treated with acupuncture once every 2 weeks, was given a cooling diet and daily Chinese herbal medicine with Zhi Bai Di Huang and Four Gentlemen for 2 months initially. 2 weeks later, Snowflake showed significant improvement. She had normal appetite and seemed to be calmer, panting less, and slept better at night. Herbal medicine was switched to Ophiopogon Formula and acupuncture sessions were then tapered to once a month. 4 months after the initiation of TCVM, Snowflake had normal appetite, water intake and urination. Her skin coat was normal and she continued to sleep well at night. Trilostane was successfully weaned off over a 2-month period without any signs of relapse of the disease. Snowflake continued receiving acupuncture every 3 months for maintenance, as well as daily herbal therapy based on pattern diagnosis. (https://www.tcvm.com/Portals/0/SummerFall2015.pdf)

Thank you so much for all the information! Hugs!


Just a quick note regarding the ear drops: Prednilosona, I believe, is a steroid, and even though she's only been on it for a week it will cause increased drinking, urinating, and appetite. So I would probably wait for at least a few days before starting the Trilostane, my reasoning behind this is because those symptoms may lessen a bit and since you are needing to watch for changes in her clinical symptoms to judge how the Trilostane is working, it may cause this judgement call harder to make.
Thank you for your recommendation! And thank you for the other address for Dr Bruyette you gave me.


This is Dr. Bruyette’s new email address: DaveBruyette@veterinarydiagnosticinvestigation.com .

He is no longer at the VCA Hospital, and is a co-founder of this new consulting service.

https://www.veterinarydiagnosticinvestigation.com/

Marianne

Hi Marianne! Thank you very much, I wrote to him on this address you gave me, he already answered back I! I had not expected that, its amazing. Thank you so much.

[Squirt's Mom]

I make most of my own herbal meds using the individual herbs like those from Mt. Rose Herbs and the folk method of preparation. Teas are easy to make but don't last long nor are they as strong as tinctures using alcohol. It's easy to make them (tinctures) using the folk method and I'd be glad to direct you to sites explaining how they are made or explain to you myself. As for the TCM formulas...they are not easy to make and I have never tried because the ingredients that are used are not readily available here. If I were you I would keep searching for the formula(s) you want to try - humans use these same formulas. ;) Use google to find sites where the formula(s) are being sold and see what they require for purchasing. A friend of mine used an animal herbalist in Australia....let me see if I can find that info and I will share it with you. She may have some products already made that may help.

[M&Inu]

Thank you Leslie, sorry I did not answer sooner.

I went ahead and have given her Trilostane three days in a row, each day in the morning 60mg capsule with her food. I felt great yesterday, because she was perking up, drank less and looked better than in weeks. She even got up without problem, really amazing, I was over the moon and we all celebrated yesterday.

Then today she woke up with severe rear end weakness, like she goes into her knees when standing and needs help getting up. I am discontinuing the Trilostane, I bought prednisone, but haven’t given her any, because she is drinking water, eating and going to do her business outside as always, but needs help to not drop her rear end.

I don’t need to tell you all how bad I feel seeing her like this. I now feel guilty for giving her the Trilostane, even if prescribed by a veterinarian. I really have been crying for hours and feel even more helpless than before. I don’t know what to do and if I just made everything worse.
Also since many talk about electrolytes imbalance I have been given her oral serum to drink.

I don’t know what to do. How to really help her. I am simply lost.

[labblab]

I am so sorry for such a worrisome day, after having first enjoyed improvement. However, please do not feel guilty about giving the trilostane, because that may not be causing the problem at all. Especially if Inu was being more active than usual for a couple of days, it may be that she has strained some ligaments or muscles that have been under-used lately. I have a torn cartilage in my own knee, and I’ve learned that I can easily pay the price for “overdoing” on days when my knee has felt better. And that sends it back to hurting again. So I am hoping that perhaps this acute weakness will improve again with a bit more time.

If Inu is otherwise acting normally (for her) in terms of eating, drinking, bowel movements, etc., then I would not worry so much that the trilostane has excessively lowered her cortisol. Also, in the absence of test results or other evidence that her electrolytes are actually “off,” I caution you about giving her a solution to alter her electrolytes. You may unintentionally actually cause an imbalance when there was not one originally.

As hard as it is to see her having trouble standing right now, I’m really hoping this is a temporary setback. If is indeed being caused by pain, perhaps your vet could provide a prescription for medication such as tramadol. This is a type of painkiller that can be effective for animals and humans alike, but it is not in the class of drugs, the NSAIDS, that can be dangerous to give to dogs who suffer from the elevated cortisol levels associated with uncontrolled Cushing’s. Just a thought you might want to discuss with your vet.

Marianne

[Harley PoMMom]

I totally agree with Marianne, so please stop being so hard on yourself. You are a wonderful Mom to Inu and you are doing the best you can with what is available to you. Hang in there and remember we are here for you both.

Hugs, Lori

[M&Inu]

Hi Marianne,

I am so sorry to be answering so late, but I did read your message and followed your advice: I stopped giving Inu oral serum to not unbalance her electrolytes. But I stopped trilostane all together. I just have these 60 mg capsule samples I got from my vet. He did not answer any of my questions, because he is on vacation. I got word back from Diamondback (thank you for recommending them to me, they would accept a prescription from my vet). I don't know if I should tell my vet he should do it for 3 mg tablets or another low dose, and just tinker with it. It does seem risky to be administering blindly, without a way to measure cortisol levels. I am stumped.

I wanted to ask for recommendations: Leslie directed me to this website (http://franklintnvet.com/cushings-disease-in-dogs/) about herbal remedies (thank you) and I got into contact with the veterinary clinic to see if they would sell me this herbal remedy (Ophiopogon Formula), and they offered me to pay for a consultation per phone with their veterinarian, has anyone visited him or talked to him, by chance?

I really appreciate all your support and help. Here in my country I feel totally lost and alone with this diagnosis and no way to help my dog.

[M&Inu]

I totally agree with Marianne, so please stop being so hard on yourself. You are a wonderful Mom to Inu and you are doing the best you can with what is available to you. Hang in there and remember we are here for you both.

Hugs, Lori

Sorry I had not seen this message Lori, thank you so much. I feel I am using you all as a "paño de lagrimas" a support group that has to see me crying all the time, sorry. But really I feel lost here in my country, zero support or interest in this disease in the veterinarians and no way to help Inu.

Thank you for your message, I do feel better knowing I can come here for support. Hugs.

[molly muffin]

Hello, We're just fine with being a support group, it is what we all are to each other. No matter what the problems.

Your vet will be back now, and so you can have a chat with him and see what he thinks.

So glad to hear that Diamondback will accept your vets prescription. That makes things easier. Now to figure how how best to monitor and test.

[M&Inu]

Hi Sharlene,

Thank you so much for your message. It means a lot to me to have found you all on this forum. Thank you.

[Squirt's Mom]

You are never a problem! We are here to support each other as best we can. Sometimes that is nothing more than being able to offer a shoulder to cry on but that shoulder is always available. I was a complete basket case when my Squirt was first diagnosed and these kind people held me together until I could breath again and start to learn about this disease. We have ALL been scared and lost...even with vet care and medication readily available. It still helps so so much to talk to people who understand, truly understand. ;)

If the vet at Franklin is willing to chat with you I would take them up on it! Listen carefully then ask if they can send you an email so you can go over the conversation again to help you make a decision. It may turn out that what they have to say is the very thing you need hear.

Hugs,
Leslie

[Harley PoMMom]

You and Inu are part of our family and we are here for you both so please feel free to rant, rave, yell, or if you just need to talk, we are great listeners and we will hold your hand through this journey.

Another thought, many of our members and/or their vet have talked to a technical representative at Dechra, the manufacturer of Vetoryl, maybe this could be an option for Inu's vet.

Here is contact info for Dechra's U.S. Office: http://www.dechra-us.com/contact/technical-support or this: http://www.dechra.com/contact-us

As for the Trilostane dosage strengths from Diamondback, if possible I would get 19 mg or 21 mg capsules and some at lower doses, say 2 mg, this way you have options in tweaking the dose.

Lori

[M&Inu]

Hi Leslie and Lori and everyone,

Sorry that I didn't answer sooner. I have been busy and stressed arranging to talk with this vet in Franklin I had told you about. It’s a bit hard for me, since English is not my first language and many things are arranged so differently in the US. But the people in that clinic have been super helpful and nice.

I don't even know any more, if I had told you, that in correspondence with Dr. Bruyette, he told me not to risk giving her Trilostane when I have no way of testing her cortisol levels. He recommended Anipryl, even with the low success rate that medicine has. I have to confess when he told me this, I was again very down. But I am still scared of giving her Trilostane "just like that". And my local veterinarians are really zero help. I think I am more informed about Trilostane now than they are. The super high dose of 120 mg daily was/is a red flag of how out of touch they are with this disease, and the zero interest they have to help even for patients who are willing to buy and pay for all the tests.

So, I took Leslies advice and got in touch with this clinic in Franklin, paid my consultation and had a skype conference with the veterinarian.

I am now a bit more confident in that I will doing something, anything, to help Inu with her Cushings. He is willing to prescribe the Anipryl, since even that medicine, that is not as delicate as Trilostane, is a prescription only medication (why? Are they scared people want to care for dogs with cognitive disfunction?).

But a new problem arises, even with this prescription the pharmacy Drs Foster & Smith cancelled my order, even after contacting this clinic for the prescription, because the address I listed is this P.O.Box service in Doral, Florida that forwards my packages to my country.
Now I am thinking that I will need to have it shipped to the veterinary clinic in Franklin (or any other US address that is not a forwarding system) and ask them to re-ship it to the P.O.Box and I will pay them the second shipping costs.
Also, I won’t be buying at DrsFoster&Smith because I found a better price at PetCareRx, also I hope they are more flexible (?).

We will try for 3 months with:

Anipryl 40mg daily

Ophiopogon Formula, the capsules are on their way already! :)

HMR Lignans the recommended dose is 1-2 mg of lignan for each pound of body weight, the capsules I bought from Lignans for Life are 40mg, so I was thinking starting her off with 2 capsules = 80mg (she is weighing 89 pounds)

Melatonin 6mg twice daily

Omega oils the recommendation is "Make sure you read the label carefully to ensure that your dog receives 220 mg/kg body weight of a combination of alpha-linolenic acid and the long chain omega-3 fatty acids eicosapentatonoic acid (EPA) and docosahexaenoic acid (DHA)."
I am giving her now 4 softgels of Wholemega that amounts to 4000mg of Wild Alaskan Salmon Oil daily

SAMe 200mg capsules “For large dogs 41 lbs to 80 lbs: give 2 tablets per day”

Milk Thistle 100mg capsules “Recommended dosage for dogs is 2 mg of milk thistle for each pound of dog's weight.” I will start her off with one capsule.

Gingko Biloba daily dose of 40 mg/ 10 kg body weight, I ordered 120mg capsules, and I think I will start her off with one capsule daily

Phosphatidylserine (PS) 100 mg softgel, 1 softgel daily

I feel that everything listed here is in this grey area of, depending who you ask, its “snake oil” and false hope, or maybe it will work. I have been reading up on the research. Sadly, most of the testing, for example of the Lignans has been done in vitro, so really knowing if any of this works to lower her cortisol levels, I don’t know.
But its to start somewhere, and my options are so limited, almost nonexistent.

Also, I am buying PillPockets in bulk for so much medication! ;)

So these have been the news of my battle against Cushing in a situation where I could literally say nobody in the whole country knows or cares how to deal with this.
As always thank you for being here for Inu and me. I hope your days and new Year has been treating you well!

[Harley PoMMom]

I think your plan sounds excellent. Melatonin and lignans are the treatment for "Atypical Cushing's," this is when one or more of the adrenal hormones are elevated but the cortisol is not. The late and great Dr. Jack Oliver at University of Tennessee at Knoxville (UTK) was a premier scientific authority on the subject of Atypical Cushing's and according to a research paper written by Dr. Oliver titled: "STEROID PROFILES IN THE DIAGNOSIS OF CANINE ADRENAL DISORDERS"
Melatonin ~ Results of in vitro cell culture (human H295R adrenocortical carcinoma cells) studies in our lab revealed that both 21-hydroxylase and aromatase enzymes were inhibited by melatonin. Also, in dogs with adrenal disease that are treated with melatonin, and repeat adrenal steroid panels are done, cortisol levels are consistently reduced, and estradiol levels are variably reduced.

The UTK lab does perform adrenal steroid profile testing and the treatment option sheet that is sent out with the test results does list melatonin and lignans as medical therapies (along with Trilostane and Lysodren). From that sheet:
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.

Although the recommended treatment for atypical cushing's at UTK is very controversial among the veterinarian field I truly feel that trying this with Inu is really a great option. I've had quite a few email discussions with Dr Oliver in the past and he did state that it does take at least 4-6 months to see if any improvement will happen so you may want to give Inu the melatonin and lignans longer than 3 months.

I'm including a link to our Resourse Forum where you will find the information I quoted above, plus more regarding Atypical Cushing's: http://www.k9cushings.com/forum/showthread.php?198-quot-Atypical-Cushing-s-quot-Congenital-adrenal-hyperplasia-like-syndrome-Hyperestrinism

Also included in that thread are links that state what melatonin and lignans are preferred.

You are doing an awesome job!!!

Hugs, Lori

PS ~ I have used Pill Pockets and they worked great, I also hid them capsules in cream cheese or peanut butter too.

[Squirt's Mom]

I think your plan is great! Like Lori said the combination of melatonin and lignans can help a great deal, especially with the intermediate hormones which come into play with Cushing's. The PS is something I used with my Sweet Bebe and it did help her a lot especially with mental acuity as she got older.

On the lignans....you say
HMR Lignans the recommended dose is 1-2 mg of lignan for each pound of body weight, the capsules I bought from Lignans for Life are 40mg, so I was thinking starting her off with 2 capsules = 80mg (she is weighing 89 pounds)

You need to look on the bottle and see the percentage or actual amount of SDG in each capsule. For the Lignans for Life Flaxseed Lignans each capsule contains only 25mg of SDG. SDG is the workhorse in lignans and what helps our cush babies. So while the capsule may contain 80mg of LIGNANS they only contain 25mg of SDG. So check out the back of the bottle under the Supplement Facts and find the amount or percentage of SDG and work from that to determine the dose Inu needs. According to UTK (University of Tennessee in Knoxville where the majority of the research on this has been done) the dose of SDG is - "SDG lignan; one milligram/lb B. Wt./day". So at 89lbs she will need 89mg of SDG (NOT lignans) per day. If the capsule contains 25mg of SDG then she will take 4 capsules a day (89 / 25 = 3.56 capsules, rounded up to 4). Since lignans can cause some digestive upset, I would start with 2 as you planned then go to 3 then up to the recommended dose of 4 capsules a day. I would give her at least a week on each dose to make sure her gut is adjusting well before increasing to an additional capsule.

FYI - this is the Lignans for Life product I am looking at on Amazon. What you have may be different but the math still applies - look for the amount or percentage of SDG and work from there for the dose she needs. Remember, it is the amount SDG not the amount of lignans that matter. https://www.amazon.com/Lignans-Life-Flaxseed-capsules-Pack/dp/B007D681K0

Now that I have thoroughly confused you, I am signing off. :D:D:D But feel free to ask and we will work with you to try and get the answers needed.

Hugs,
Leslie

[M&Inu]

Hi Lori and Leslie,

Thank you so much for your answers. I want to answer more tomorrow. But right now I am having one of my crisis of so much fear.

I have noticed Inu more and more “lethargic”, she sleeps so deeply and only needing to go to the bathroom and food rouses her. I am now fearful she is in the end stages of the disease and all is too late.

I hope I am overreacting, but still I would like to know from you all that have more experience, if this is it? Is the disease too advanced and the crotisol has already done too much, irreparable, damage?

I am sorry not to answer to your important information, I will do it tomorrow when I am in a better state of mind. I just am having an attack of fear and am so worried right now that I have waited too long, listened to the wrong doctors (here in my country) and that we are already in end stages.

Thank you for listening to me.

[Harley PoMMom]

Cushing's is a very slow progressing disease and it can take years for a dog to succumb to the long term effects of high cortisol on their internal organs and immune system. In your initial post you mentioned that Inu's liver enzyme values were within the normal limits, which is a positive sign, because 80-90% of cushdogs generally do have high elevations in the Alkaline Phosphatase (ALP) which is one of the liver enzymes.

The dose for the SDG that Leslie posted is the correct one but since you are giving Inu the HMR type the active ingredient of HMR lignan is different from that of SDG flax hull lignan. The recommended HMR dose is 10-40 mg/day for small to large dogs, and as Leslie stated you need to look for the standardized percentage of HMR on the label. With the melatonin you want to make sure that the melatonin is the plain kind not the fast-acting or slow releasing type. I apologize for all this information that I am throwing at you and I hope it's not too overwhelming or confusing, and if it is please, please let us know, ok? Sending tons of soothing and loving hugs your way.

Lori

[Squirt's Mom]

ah....thanks for that, Lori. I didn't calculate the HRM indeed but rather the SDG. :o

As for Inu's behavior....there are no clear "end stage" signs for Cushing's. There are many things to consider - time of year, ie is the pup able to go outside in the sunshine as much as before, is it colder/hotter, etc.; are there other health issues in play that may be causing Inu to feel poorly; age related changes; has she started any of the supplements you listed and do any of them cause what you are seeing while the pup adjusts. One thing to consider is that as a pup ages they start to lose their senses - smell, sight, hearing - and those can cause a bit of withdrawal as the normal stimulants that surround them fade away. I have a Pug who is around 12 and over the last few months I often have to wake her for meals...and that is NOT a Pug characteristic! They are furry food vacuums naturally! :D She is slowing down and not as interactive as she once was but I am sure it is due to the aging process. She does have some health issues as well, like a seizure disorder, but Cushing's is not one of them. When we have a cush pup we tend to get tunnel vision and credit Cushing's for any and every change we see so keep in mind there could be many other reasons for how Inu is behaving.

You do want to listen to her, tho. You know her best of all and I believe our babies will tell us when they have had enough. But try to relax and consider all that could be in play and see her clearly, not thru the lens' of Cushing's fears - HARD to do at times, I know well. But I also know you are incredibly strong - you have proven that right off the bat with your first post here and by how hard you are fighting to get things to help your baby girl and learn all you can. Inu is very lucky to have you as her mom. :)

Hugs,
Leslie

PS. My offer of a shipping address still stands, just let me know if I can help with the Anipryl or anything else.

[M&Inu]

Hi all!

Really, so many thanks for your support. I think you are helping Inu a lot, since I know, me getting this anxious is not good for her, but I just have so many fears and doubts, and nobody to talk about it here. So I bottle it up, and up, and then I explode in a stress pure post like last night. And I am ashamed to say that so much is anger, I read of successful treatments with Lisodren and Trilostane, with the adequate testing and knowledgeable veterinarians, and I have to confess to feel envy. Because Anipryl really has such a low or non-existent success rate… Then I feel so ashamed of being envious of other people’s troubles…and it’s a vicious cycle. I just would love to be able to give her confidently Trilostane (or Lisodren, since some threads here tell me it’s incredibly successful also), because I think she would feel so much better, so much faster, but I can’t and it’s so frustrating. All these contradictory feelings and you all have to suffer my incoherent panic-babbling. Sorry.

I will begin to answer, finally:


I think your plan sounds excellent. Melatonin and lignans are the treatment for "Atypical Cushing's," this is when one or more of the adrenal hormones are elevated but the cortisol is not. The late and great Dr. Jack Oliver at University of Tennessee at Knoxville (UTK) was a premier scientific authority on the subject of Atypical Cushing's and according to a research paper written by Dr. Oliver titled: "STEROID PROFILES IN THE DIAGNOSIS OF CANINE ADRENAL DISORDERS"
The UTK lab does perform adrenal steroid profile testing and the treatment option sheet that is sent out with the test results does list melatonin and lignans as medical therapies (along with Trilostane and Lysodren). From that sheet:
Although the recommended treatment for atypical cushing's at UTK is very controversial among the veterinarian field I truly feel that trying this with Inu is really a great option. I've had quite a few email discussions with Dr Oliver in the past and he did state that it does take at least 4-6 months to see if any improvement will happen so you may want to give Inu the melatonin and lignans longer than 3 months.
I'm including a link to our Resourse Forum where you will find the information I quoted above, plus more regarding Atypical Cushing's: http://www.k9cushings.com/forum/showthread.php?198-quot-Atypical-Cushing-s-quot-Congenital-adrenal-hyperplasia-like-syndrome-Hyperestrinism
Also included in that thread are links that state what melatonin and lignans are preferred.
You are doing an awesome job!!!
Hugs, Lori
PS ~ I have used Pill Pockets and they worked great, I also hid them capsules in cream cheese or peanut butter too.
Thank you, Lori, and maybe I misused the term “snake oil”, I used it, not because, I think this treatment is not valid, but because all the veterinarians here have an approach to anything not 100% pharmaceutical or surgery is “old wife’s tales”. I went through this in Inu’s childhood and youth, when she had a persistent food allergy, red skin, itching, and the vet of that time wanted to prescribe her steroids (and said, yeah that’s going to be for life). I refused the steroids and went online and researched everything on raw feeding. I changed her diet to raw and home-made cooking only, without rice (she is totally allergic to it, if she gets a bit of rice, because if she finds it she snarfes it down like there is no tomorrow, its 100% sure vomiting session). And I got rid of her itching and red skin, she got a nice coat all her life on that diet. But almost all vets have tried to get me to change her to their brand of kibble, because raw is dangerous.
Also, when she started to present “arthritis” which now I blame on Cushing (hind leg weakness and trembling in hindquarters) all vets prescribed her NSAIDS, Rymadyl and the likes. I was so scared of the side effects, and gave her an herbal desinflamatory, Zyflamend, It helped her a lot for about one year. I have discontinued it right now, because I feel I am giving her way too many pills (?). But then again, I don’t know how much that was helping, because when she was on it, her hind quarters did not tremble as much as now and she did not walk as bowlegged and stiff…
I really hope some of these things have an impact on her. I HAVE to believe it. Thank you for the links I have read them through.


I think your plan is great! Like Lori said the combination of melatonin and lignans can help a great deal, especially with the intermediate hormones which come into play with Cushing's. The PS is something I used with my Sweet Bebe and it did help her a lot especially with mental acuity as she got older.
On the lignans....you say
You need to look on the bottle and see the percentage or actual amount of SDG in each capsule. For the Lignans for Life Flaxseed Lignans each capsule contains only 25mg of SDG. SDG is the workhorse in lignans and what helps our cush babies. So while the capsule may contain 80mg of LIGNANS they only contain 25mg of SDG. So check out the back of the bottle under the Supplement Facts and find the amount or percentage of SDG and work from that to determine the dose Inu needs. According to UTK (University of Tennessee in Knoxville where the majority of the research on this has been done) the dose of SDG is - "SDG lignan; one milligram/lb B. Wt./day". So at 89lbs she will need 89mg of SDG (NOT lignans) per day. If the capsule contains 25mg of SDG then she will take 4 capsules a day (89 / 25 = 3.56 capsules, rounded up to 4). Since lignans can cause some digestive upset, I would start with 2 as you planned then go to 3 then up to the recommended dose of 4 capsules a day. I would give her at least a week on each dose to make sure her gut is adjusting well before increasing to an additional capsule.
FYI - this is the Lignans for Life product I am looking at on Amazon. What you have may be different but the math still applies - look for the amount or percentage of SDG and work from there for the dose she needs. Remember, it is the amount SDG not the amount of lignans that matter. https://www.amazon.com/Lignans-Life-Flaxseed-capsules-Pack/dp/B007D681K0
Now that I have thoroughly confused you, I am signing off. :D:D:D But feel free to ask and we will work with you to try and get the answers needed.
Hugs,
Leslie
Hi Leslie, thank you so much for all the information. You did not confuse me, I appreciate every guidance. I ordered SDG Lignans and HMR Lignans, since I wasn’t sure what would be best, and if there was a side effect or intolerance (or too much fiber in the SDG) that I could switch, without having to wait for a new order (also one large packets are sometimes better in the shipping costs, than many small ones, and I need to save every penny).
The SDG Lignan 35mg (90 capsules) I ordered states on the label: 1 capsule contains 230mg of Flaxseed Hulls and 35mg of SDG Lignans
The HMR Lignan 40mg (90 capsules) I ordered states on the label: 1 capsule contains 40mg HMR Lignans
The franklin vet told me HMR, and that what I was planning on starting with, a daily dose of 1 capsule = 40mg of HMR Lignan. If for some reason I need to, I can switch to the SDG Lignan in a higher dose.
So many thanks for the help with this.


Cushing's is a very slow progressing disease and it can take years for a dog to succumb to the long term effects of high cortisol on their internal organs and immune system. In your initial post you mentioned that Inu's liver enzyme values were within the normal limits, which is a positive sign, because 80-90% of cushdogs generally do have high elevations in the Alkaline Phosphatase (ALP) which is one of the liver enzymes.
The dose for the SDG that Leslie posted is the correct one but since you are giving Inu the HMR type the active ingredient of HMR lignan is different from that of SDG flax hull lignan. The recommended HMR dose is 10-40 mg/day for small to large dogs, and as Leslie stated you need to look for the standardized percentage of HMR on the label. With the melatonin you want to make sure that the melatonin is the plain kind not the fast-acting or slow releasing type. I apologize for all this information that I am throwing at you and I hope it's not too overwhelming or confusing, and if it is please, please let us know, ok? Sending tons of soothing and loving hugs your way.
Lori

Hi Lori, her liver values are 157 U/I (the normal range is supposedly 74-104) I had a freak out when I saw her 53 U/I over “normal” and her vet (the local one) assured me that that is not a worrisome level….Still I have her on Denamarin now, and ordered the SAMe and Milk Thistle from Lignans for Life, because they have good ratings and are cheaper than Denamarin.
I am using Melatonin without any kind of extra addition from GNC, I already had that because my mother took it for a while, but ordered more in Lignans for Life.
This is not at all overwhelming or confusing, I need and want any information, thank you!
I appreciate and also return hugs! Thank you.


ah....thanks for that, Lori. I didn't calculate the HRM indeed but rather the SDG. :o
As for Inu's behavior....there are no clear "end stage" signs for Cushing's. There are many things to consider - time of year, ie is the pup able to go outside in the sunshine as much as before, is it colder/hotter, etc.; are there other health issues in play that may be causing Inu to feel poorly; age related changes; has she started any of the supplements you listed and do any of them cause what you are seeing while the pup adjusts. One thing to consider is that as a pup ages they start to lose their senses - smell, sight, hearing - and those can cause a bit of withdrawal as the normal stimulants that surround them fade away. I have a Pug who is around 12 and over the last few months I often have to wake her for meals...and that is NOT a Pug characteristic! They are furry food vacuums naturally! :D She is slowing down and not as interactive as she once was but I am sure it is due to the aging process. She does have some health issues as well, like a seizure disorder, but Cushing's is not one of them. When we have a cush pup we tend to get tunnel vision and credit Cushing's for any and every change we see so keep in mind there could be many other reasons for how Inu is behaving.
You do want to listen to her, tho. You know her best of all and I believe our babies will tell us when they have had enough. But try to relax and consider all that could be in play and see her clearly, not thru the lens' of Cushing's fears - HARD to do at times, I know well. But I also know you are incredibly strong - you have proven that right off the bat with your first post here and by how hard you are fighting to get things to help your baby girl and learn all you can. Inu is very lucky to have you as her mom. :)
Hugs,
Leslie
PS. My offer of a shipping address still stands, just let me know if I can help with the Anipryl or anything else.
Thank you, Leslie, it’s hard to differentiate, but I had to battle against so many veterinarians that told me that all this is “just normal ageing” that now I maybe on the opposite side. I am just a ball of anger against my local vets… :(
But you made me think about her possible underlying arthritis, what I described above, that I had not thought how it could be affecting her mobility that I have her without her anti-inflammatory medication, because of the fear of giving her too many, so diverse, medications: interactions and possible over-exertion of the liver.
But when I read your answer it got me thinking: She has Cushings and many other things that cortisol is masking, any of those can be acting up, and her hindleg weakness has gotten worse since I stopped Zyflamend….Now I just have to evaluate if I should start her up again.
I also have been reading up on other threads, I think you Leslie have mentioned Adequan. Maybe since its an injection, it doesn’t over-exert her digestive system as much? But I have read, that that is also an NSAID that is hard on the liver, and maybe not so good to use, specially with Cushings dogs? I don’t know anymore… :(
Could the twice daily dose of Melatonin 5mg for a total of 10mg, that I already started her on be an element of the "lethargy"?
I also would appreciate advice on when to give the Anipryl. I am giving her the Denamarin on empty stomach, approximately between 5-6 am, it’s between 1-2 hours before her breakfast.
Should I move Denamarin earlier, like 4 am? So the Anipryl is more “alone” when taken with breakfast?
Trilostane I read has to be given with a meal in the mornings, how is it with Anipryl?
I will let you know Leslie if I need your generous offer for the Anipryl shipping. I haven’t ordered it, because I spend all day yesterday and part of today, because the order was cancelled, as I told you, but the charge on my card was not… :( I finally resolved it, so my bank was aware they pharmacy cancelled my order…but so much extra stress…
I will try again in another online veterinary pharmacy on Monday. For now I could start her tomorrow already, because I got my hands on some human Selegiline (5mg tablets, so I would give her 8 tablets to start her on her 40mg daily).
Also, to prove me wrong, she was a bit more perked up today, so with your answers and her being a bit more awake and willing to go for her walk, I am a bit more stable tonight, thank you.
I uploaded some pictures of Inu in her childhood and youth and current pictures of her and the toll Cushings had on her from a presentation I made for the veterinarian in Franklin to see, if someone has interest to look at that.
Again so many thanks for reading all my babbling and fears. And for comforting me, you are getting us through each day, thank you!

[Harley PoMMom]

Some vets are now using an in-house IDEXX SNAP® Cortisol Test instead of sending the blood sample out to a lab, however the vet does have to purchase the required equipment needed which I image would be expensive. Just in case your vet may be interested, here's a link to the IDEXX web page: http://www.idexx.com.au/smallanimal/inhouse/snap/cortisol.html


Again so many thanks for reading all my babbling and fears.

Ahhh, no thanks needed, we surely understand how scary all of this is and I can't image how distressed I would be in your situation, I was a such mess when my boy was first diagnosed. :eek:

Just took a look at your album and Inu is such a beautiful girl!!

[M&Inu]

Hi Lori, thank you so much for answering and providing this link. I am forwarding it to colleagues that work in labs that analize human samples, maybe they know more about the viability of importing such tests to use on existing machines in existing labs? I would ask my current local vet, but I am frustrated, he hasn’t answered my questions, via email, or phone, I feel ignored, specially when his fees are not cheap...and there is no interest of follow up....I feel so lost here with the veterinarians... :(
So maybe I need to keep on visiting local vets until I hit jackpot, but each one wants to their own blood test and all and I really don’t want to put Inu through so much stress. But maybe I can ask around for a vet that already has the SNAPshot Dx® Analyser o SNAP® Reader BenefitsAccuracy and we only would need to shop for the cortisol kit.

Thank you for saying that of her. The October 2017 picture was already very visible she is suffering from Cushing, you know two vets told me, nah, thats just “normal”. Then the January 2018 is where her harness is already modified to support her hind legs, that was when finally the current vet said, yeah probably it’s Cushing but there is nothing we can do... :(

Again thank you! I hope you have a nice weekend!

[Squirt's Mom]

Never, ever apologize for venting. You may have noticed just under our name at the top of the page these words - "support, educate, encourage, remember". That is why we exist...and "support" is the first word, leading the way for the remainder of our purpose. And truthfully you do not have any thing to apologize for....some of us were a lot worse. :o When Squirt was first diagnosed I found several other groups before I found our family here and by the time I DID find this group of people, I was a total basket case, completely off my rocker! I was terrified, frustrated, angry, and filled with guilt....riding a wild roller coaster of emotions, above all fully believing my Sweet Bebe was dying right in front of my eyes and there was nothing I could do to help her. She was my world and I could not imagine life without her. I was so bad by the time we got here that one of the members, who later became one of my dearest friends, told me I made her think of a woman with her finger stuck in a light socket - hair standing on end! She kindly left out the parts about my bulging eyes and flying slobber. :D I came here the Queen of "incoherent panic-babbling"! I was such a wreck I simply could not understand anything that was being said to me or anything I read. But these kind and loving folk took my hands and held me together until I could start to breath again, think again, hope again....and then they began to teach me what I needed to know to help Squirt have the best life possible. And for 7 years after, we lived a good life in spite of her illness and difficulties. I named myself a "Twitcher" because of the state I was in when I arrived and have always welcomed my brother and sister Twitchers to club...So WELCOME! :D You are not alone in this "exclusive" club by any means. :)

Something to keep in mind with arthritis - cortisol acts as a natural anti-inflammatory and will help with inflammatory conditions like arthritis, allergies, and so on. When the cortisol is lowered in our cush pups those conditions come roaring to the forefront, getting worse while the cush signs get better. So very often we need to play a balancing game - do we let the cortisol run a bit high to help arthritis/allergies/etc or do we lower the cortisol and try to manage the inflammatory condition(s) as they worsen? Which signs/condition(s) make our baby's life more miserable and which improve the quality of their life? Do we deal with the extreme hunger in exchange for less arthritic pain and disability or do we help them return to a more normal relation with food and deal with the pain in another way? But never with NSAIDS as you have already learned. ;)

The hind leg weakness is different from arthritis, tho. That weakness is due to the cortisol destroying the muscle mass. This is also the cause of the pot-belly we see so often in our babies - the abdominal muscles simply lose strength. BOTH can certainly be in play - arthritis and loss of muscle mass...which brings us back to which do we choose to focus on, which causes our baby the most discomfort and loss of quality of life. If the Zyflamend was helping the legs I think I would go back to it as long as there are no contraindications with any of the other supplements/herbs you are using.

As for Anipryl - yes, it does have a low rate of success in controlling cortisol for MOST pups. However, Squirt was on it for over 9 months and it helped her a great deal. For Anipryl to have any effect the pups MUST have the pituitary form of Cushing's and the pituitary tumor MUST be located in the pars intermedia portion of the pituitary gland. 85% of cush pups have the pituitary form and of that 85% only about 25% have the tumor in the right place for Anipryl to work. So that helps explain why the efficacy of this drug is so low. Apparently Squirt's tumor was locate in the pars intermedia for it to work so well on her. So to me Anipryl is always worth a try especially in a situation like yours where the traditional drugs are not available or they are cost prohibitive or the pup cannot handle the tradition treatments for some reason. Inu may be a bit restless at first on the Anipryl but that will improve as she takes the drug longer so don't panic if she seems to be hyper for a little bit when she first starts. It can also cause digestive upset so I would give it with food always and on its own. If you have access to Pepcid AC (NO other form of Pepcid can be used), Zantac, or Tagamet you can give one of these 20-30 minutes before the Anipryl to help with the tummy upsets if needed. The generics of these work just as well as name brand based on my experience. The generics are Famotidine, Cimetidine, and Ranitidine respectively. Scroll about half way down this page to find a chart for the doses used - http://www.walkervalleyvet.com/otc-meds.htm

And yes, you may have hit the nail on the head with the melatonin and lethargy. It may take a bit but that should improve as she adjusts. ;)

We have seen liver values in the 1000's when the high normal is 300 or less. So Inu's liver value is not excessive compared to many we see...another reason you can take a deep breath and put that worry on a back burner. I would continue the home-cooking and raw feeding as long as the fat content is not high. Our cush pups are prone to pancreatitis and we can help fend that off by keeping their diets low in fats.

All in all, you are doing a wonderful job, Mom. So give yourself a big pat on the back and do something for you, just for you for a minute. Something that brings YOU pleasure deep in your Soul....you deserve a minute or three for all the hard work you have done so far. :cool::cool::cool:

Hugs,
Leslie

[molly muffin]

Hello, I just wanted to pop in again and say, what alovely girl Inu is. Love her pictures. Yes there is certainly the signs we general see with cushings showing in her pictures, thinning hair on tail, darker color stomach, muscle loss, but she still looks really good.

As leslie said, being 50, 60 points over is fairly low with what we generally see with cushing dogs so that is a very good thing. It does tend to go, so don't be overly alarmed.

I cannot even imagine the frustration you are going through not having the options that so many others have in regards to treatment and testing. I can tell you that it is frustrating even when you do have the options available trying to get dosage right. Not having it, must make the frustrations 100 times worse, so it's natural to have those crazy days of anger, sorrow, worry.

Melatonin can contribute to lethargy, and it might just be a matter of her adapting to it.

I think you are doing an excellent job advocating for Inu!

[M&Inu]

Hi Leslie, thank you so much for welcoming me into the “Twitcher” club, I really feel like that, but recently I have felt so tired all the time. I am not sleeping well and the stress has me tired all the time. I tried to give myself me time and going to a wedding, but that meant leaving Inu with my mother for one or two nights and I have been so paranoid and clingy. My mother would take excellent care of Inu, but I couldn’t imagine myself enjoying the time without thinking all the time about if Inu is getting up by herself, or if she needs help, if she too passive…IDK it was just too much and I said no. But I already made smaller plans, going out with friends, but just for coffee or lunch in the weekend. I have to start small.

The hind leg weakness has me worried and I am so scared that if I can’t get her cortisol down it will waste away her muscles... I was thinking, has someone done hydrotherapy with your Cushings pups? I was thinking of putting up an inflatable swimming pool about 10 feet in diameter and 2-3 feet in depth and putting her inside to wade a bit. I am worried about her weight (89 pounds) and she being so slow and without interest in moving that the muscle weakness is going to get worse.
Also, right now we are in our “cold season” this means LOW Temperature: 8 degrees Celsius (46 degrees Fahrenheit) and HIGH Temperature 20 degrees Celsius (68 degrees Fahrenheit). So Inu is finally sleeping for some small periods of time on her bed or on her blankets, but still mostly on the cold hard floor, because she is hot all the time. I am dreading the warm season again. Its soooo hard on her. The temperatures rise to 30 degrees Celsius (86 degrees Fahrenheit). Could the pool help for that at least?
Also I was thinking of a wheelchair, so she can walk a bit more again, with most of her weight being supported by the wheelchair? (https://www.k9carts.com/full-wheelchair)
I would be able to build something similar with a friend of mine. I just wanted to know if someone has used it, to help your dogs with the weakness and to rehabilitate the muscle.
We are on day five of Selegiline (human tablets I could get for her to start on, until the Anipryl comes*). I haven’t seen her hyper, I think she has been a little bit more alert, more interested in her environment, her nose is a bit colder and finally a bit more humid, her eyes maybe a bit less red and the polidypsia is maybe not as bad, but the hunger is still so bad, I even maybe feel it’s gotten worse, she wants to eat all the time (I don’t even know anymore what wishful/dreading (positive and negative) thinking is anymore). I feel incapable of objectively assessing if the medicine is having effect.
*The order finally was approved, the prescription was approved all was ready and now they have it on backorder, out of stock, and I have to wait, I don’t even know how long until its shipped…. honestly, I feel everything is a battle.
Again Leslie, so many thanks, really. I think I have to re-learn how to give myself space and time to just breathe. I feel like I have been a year or more (since I was seeing the symptoms all the vets were telling me its “just normal ageing”) I have been on alert and full stress.

Hi Sharlene, Thank you for looking at Inus pictures, I love to show her to everyone, even with her body having suffered under Cushings, she is still beautiful to me. But if I start to compare her pictures in the last two years and see all the signs that veterinarians refused to see I get so angry again. Thank you for your kind words.
With the liver values I so hope Denamarin, or SAMe and Milk Thistle, helps a bit out there. I swing from one extreme to another: wanting to have her blood tested again to see if in the last month-and-a-half something changed for the worse, and wanting to avoid the veterinarian clinic, and not giving her even more stress with so much blood taking.

Again, thank you all for your support. I don’t know with out all of you giving me hope and most importantly, understanding. Thank you!

[Harley PoMMom]

The hydrotherapy sounds like a great way to help with that muscle loss, I believe some members have tried cold laser therapy and acupuncture too. The wheelchair looks like it could help too and that's awesome that you could build it!!

My Harley's body temperature seemed to run hot too and I would spritz his feet with water to try to keep him cooler. Cush dogs do have an insatiable appetite and some members give their dog frozen green beans and carrots to help in satisfying that hunger.

Hugs, Lori

[M&Inu]

The hydrotherapy sounds like a great way to help with that muscle loss, I believe some members have tried cold laser therapy and acupuncture too. The wheelchair looks like it could help too and that's awesome that you could build it!!

My Harley's body temperature seemed to run hot too and I would spritz his feet with water to try to keep him cooler. Cush dogs do have an insatiable appetite and some members give their dog frozen green beans and carrots to help in satisfying that hunger.

Hugs, Lori

Hi Lori, thank you for your reply! I will try the pool idea then, but when its a bit warmer, since I am a big wuss and current "low" temperatures are too cold for me to get into the pool with her.
Ihave bought her cooling mats with some sort of cooling gel in it, that when applied pressure to, it gets cooler than the floor, of course she is like a cat with the shipping box, instead of using her bed, I can buy her ten beds and the floor is stils the best. But thats why she has elbow protectors on, because a year ago she developed a hygroma on her left elbow. Veterinarians wanted to operate, but I got it down and completely healed just with cleaning and olive oil with honey and the elbow pads now on all the time, so that the trauma doesn't repeats itself.
Inu avoids her vegetables but then eats them when nothing else is coming along, thank you, I will give her more, so she fills up with that and can take a break of feeling so hungry all the time.
I hope you are having a good week! Hugs!

[M&Inu]

I also wanted to give an update regarding the online pharmacy PetCareRx, they were very helpful with my order. When I found out it was out of stock and contacted them with my discomfort of how that all was going to make Inu's Anipryl arrive so late, they assured me they would have it as fast as possible and made it an overnight shipment without charge. It has arrived at the "real US address" I provided, and they will be forwarding it to me now! I am very happy.

Also, tomorrow the lignans and the Chinese herbal medicine is arriving here in my country! I look forward to start using them.

[molly muffin]

Oh good, it does seem that you have a system worked out now for receiving medications. I wish there was a solution for easier testing too.

[M&Inu]

Hi Sharlene, hi everybody!

Thank you for your answer Sharlene, sorry that it took me so long to answer.

As they say here: no news, good news.

We are going through each day at a time. I would love to know if the Anipryl is having effect or not. Some days she is panting more than other days, but also these last weeks are getting warmer and warmer over here in the tropics. So I don't know is she just "normal" hot or is it the cortisol coursing through her body?

Polyphagia is still going strong, food is the only thing she cares about! But maybe her eyes are less red. Her hair is somewhat growing? I don't know what is wishful thinking anymore. On MY bad days I see only declining symptoms in her. Its so subjective, without being able to test.




As for Anipryl - yes, it does have a low rate of success in controlling cortisol for MOST pups. However, Squirt was on it for over 9 months and it helped her a great deal.



Leslie could you tell me what symptoms were an indicative with Squirt, that the Anipryl was working?

We are now officially on one month of Anipryl, Selegiline. And aprox three weeks into melatonin with lignans. Also the Ophipogon formula.

I don't know should I up her Anipryl dose to 2mg/kg (she currently is on 1mg/kg=40mg Anipryl)? Is it dangerous to do this? I ask, since it is stated in the insert that you are allowed to up the dosage.

I am trying to get in touch with Dr Castillo in Argentina to try out Cabergoline or 9-Cis Retinoic Acid. Until now no answer from him. I will keep trying.


We are trying to heal a hard to heal sore on her hind leg. Almost any medicated cream has corticosteroids, so I am trying the "natural" way with cleaning it and using honey and stuff, but its going so slow.

I hope everyone here is doing well!

[Squirt's Mom]

Squirt's initial signs that I recall (it has been a decade and my memory ain't what it used to be! :D ) were withdrawing from her family and the activities she used to enjoy; she would do what I called hiding - she would crawl under furniture and stay. She was drinking a bit more and peeing a bit more but her appetite was normal for her, which was always strong to start with. She did have some minor hair loss but nothing major and her hair did regrow after shaving but it was slow to do so. Bear in mind - her cortisol was NORMAL at this point. Once the cortisol began to rise then the voracious appetite and excessive peeing and drinking really kicked in. At that point, we added the Lysodren.

[Harley PoMMom]

We are trying to heal a hard to heal sore on her hind leg. Almost any medicated cream has corticosteroids, so I am trying the "natural" way with cleaning it and using honey and stuff, but its going so slow.


The two skin medications that I've seen on the forum that have worked and contain no steroid ingredient are; Hibiclens and Vetericyn Animal Wound & Skin. I think you can purchase both of these online; Hibiclens in also sold in pharmacies and I see that target has it too and Vetericyn can be bought in a pet store.

Hugs, Lori

[M&Inu]

Hi Leslie and Lori, thank you for answering my post. I have been busy, but good busy. I wanted to let you all know that we are right now doing the 8-hour LDDS test. I will be posting the results when I get them!
Leslie, thank you for your information. I was asking because in other threads you also mentioned Squirt having a spleen tumor that made symptoms like Cushing's and that it was resolved by removing the tumor. I am intrigued because in the ultrasound last year the vet mentioned Inus spleen being small, almost non existing? But he told me not to worry and now I worry. Maybe I will have another ultrasound with another doctor. Also my question was more towards how do I evaluate objectively if the Anipryl is working. I feel her hunger (she still gains more weight, even if I reduce food) and panting and hind leg weakness is the same or bit worse in the hind leg weakness. �� ��
Thanks Lori, I am curing her sore or higroma with a biofilm my current vet advised. It's a membrane made out of honey and it's made for curing deep burn wounds. It's working really well and has cero corticosteroids or antibiotics.

I hope you all are doing well! I will be back with results when I get them.

[Squirt's Mom]

Yes, the tumor causes stress which can cause the cortisol to rise naturally in response to the stressor. Since the tumor had been there for a while apparently her cortisol was elevated long enough to cause cush signs. The elevate cortisol was found during routing lab work for a dental and the tumor found a few months later when we had an ultrasound as part of the testing for Cushing's.

[M&Inu]

Hi!

Thank you Leslie for explaining how Squirts tumor was affecting her cortisol.

I have the LDDS results:

LDDS (Low Dose Dexamethasone Supression)
Cortisol 0 hours: 1.94 ug/dL
Cortisol 4 hours: 0.26 ug/dL
Cortisol 8 hours: 0.83ug/dL

Using this table (https://www.cliniciansbrief.com/sites/default/files/sites/cliniciansbrief.com/files/COC_2.pdf)
4-hour Cortisol 8-hour Cortisol Diagnosis
<1.4 mcg/dL < 50% basal PDH

So now I know its PDH. I still don't know what to do with this now. I am considering using Cabergoline as in the Argentinian study, since Cabergoline I can buy here in my country since its a human medicine.

But I am also at a super low point again, because her liver values just skyrocketed... :(

Triglycerides 245.1mg/dL
TGP/ALAT (alanine aminotransferase) 258.6 U/L
Alkaline phosphatase 1226.7 U/L

I have been giving her SAMe and Milk Thistle every day in the mornings on empty stomach. I had hoped this was protecting her liver. I am so sad right now. Again back to feeling hopeless.

Thanks as always for listening to me. I hope you all are doing well.

[labblab]

Hmmmm...actually, these results are negative for Cushing’s. The very first thing you need to evaluate is the 8-hour result in order to see whether or not the overall diagnosis of Cushing’s is confirmed. You did not include the lab’s normal range, but typically it is 1.4 or 1.5. This means that the dog’s 8-hour result must be higher than that cut-off point in order to be considered positive for Cushing’s. Since your girl’s 8-hour result was only 0.83, I’m confident that was within the normal range. Here’s the explanatory info from that article you cited:


Within 2 to 3 hours after administration of dexamethasone, plasma cortisol levels in dogs with a normal response will decrease to less than 1.4 mcg/dL (reference value dependent on the laboratory) and persist longer than 8 hours...

Eight-hour plasma cortisol levels greater than 1.4 mcg/dL are consistent with a diagnosis of hyperadrenocorticism.

If the 8-hour result is higher than 1.4, it is only then that you go back to further evaluate the 4 and 8-hour results in order to see whether a pituitary tumor is the likely cause. In your case, that further analysis is unnecessary since Cushing’s was not confirmed in the first place. Your results were consistent with those of a normal dog who suppressed her cortisol level throughout the entire testing period (per the top “normal” line of the table in the article).

I hope this explanation makes sense, and I’m not really sure where this leaves you in terms of treatment steps. As the article states, 10-15% of dogs who truly have Cushing’s do not test positive on the LDDS. Typically, though, those few dogs who don’t test positive are in the early stages of the disease. Here in the U.S., in this situation a vet might choose to perform an ACTH stimulation test as an alternative diagnostic option. But, unfortunately, I know the ACTH is not available to you. So right for the moment, I guess we have to assume that something other than Cushing’s is responsible for Inu’s problems.

Marianne

[M&Inu]

Hi Marianne,

Thank you so much for your answer and sorry that I am so slow answering back. Also thank you for clarifying the LDDS interpretation. I am still a bit confused, since now two veterinarians have taken that result as a positive for PDH Cushing result. I am trying to sort things out. I wrote Dr. Bruyette with this info (LDDS test result and high liver values) and Inu's general symptoms and he told me not to worry about the high liver enzyme values and that we are doing ok, and I should stay on the Anipryl, lignans and melatonin for another 3 months.

Two things worry me: her hindleg weakness and the vet thinks she needs some dental extractions. This two things are very detrimental on her life quality. The dental work scares me SO much, since with her symptoms, not even knowing for sure its Cushings, and if it is, its uncontrolled: blood clots, high pressure, liver damage, makes anesthesia so risky, imo. But I always dread the idea how much pain a dog can take, and thinking she is pain because of a tooth makes me want to cry in despair.
And her hindleg weakness, we started acupuncture now, and I hope it helps a bit. But I have been fantasizing more and more of late with the success stories I read on the internet about Adequan. Has anyone used it? Is it too risky also because of her liver? Because "on paper" it sounds like something to try, but I would like to know more. The vet also mentioned Legend by Bayer to use alone or with the Adequan. If someone has had experience with those, I would appreciate your input, thank you!

Also now I am knee deep in a horrible tick infestation! Its horrible. Never had we had this problem, even when we hiked in deeep forrest and now because of stray cats coming into our garden, I am picking up to 5 ticks a day of her.... :(
I am leery of putting even more stuff on her, I already put Advantix II and Advantage and its not working, the vet wants her on Nexgard or Bravecto, but I have hear horror stories about side effects with those. And again her liver...

So I am sprinkling her with neem, Diatomaceous earth, rose geranium oil and ordered Wondercide from the US. I do hope something works.

I am now done again unloading all my anxiety on you, thank you as always for listening to me!

I hope you all had a great week and have a good weekend!

[Squirt's Mom]

If ticks are usually that much of a problem in your area I would her checked out for Lyme, Ehrlichia and other tick-born diseases myself. A condition like those could be the culprit instead of Cushing's. ;) Lyme in particular can cause lameness and a whole host of other issues. In my area of the US ticks, fleas and mosquitoes are a problem and I use a product called Advantage Multi applied to the shoulder area every 40 days or so. This product takes care of the fleas, mosquitoes, and other parasites like worms but it does not have any effect on ticks. So mine also wear a Seresto tick collar. We don't have any problems with bugs NOR do these things show any effect on their labs - they are all in good shape according to wellness screens and CBCs so I don't believe they are causing any harm internally to my dogs. Here are some links on Lyme -

https://www.avma.org/public/PetCare/Pages/lyme-disease.aspx

https://vcahospitals.com/know-your-pet/lyme-disease-in-dogs

https://www.petmd.com/dog/conditions/infectious-parasitic/c_dg_lyme_disease



Also in using Neem oil, use caution. Here is some info on Neem and dogs -

https://www.petmd.com/dog/wellness/neem-oil-pets-it-safe



As for Adequan, I have used it with several of my fosters (all special needs and/or hospice dogs). It can help with joint problems like arthritis and with collapsed tracheas. BUT I would want to rule out Lyme before I assume the lameness Inu is displaying is related to arthritis. I'm not sure using Adequan in the presence of Lyme would be beneficial - treating the Lyme would be most important to me IF that is present.

Good to hear from you again and I hope you find some solutions to the ticks that work soon and that Inu gets to feeling better soon.
Hugs,
Leslie

[labblab]

Did Dr. Bruyette tell you that he interpreted the LDDS result as being positive? If so, I’m really puzzled. Here’s what he has written himself re: that test.


When interpreting LDDS test results, first evaluate the eight-hour post-dexamethasone administration cortisol concentration. If it is above the reference range [typically 1.4 or 1.5 ug/dL], the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

If the eight-hour post-dexamethasone administration cortisol concentration is above the reference range, then evaluate the baseline and four-hour postdexamethasone administration cortisol concentrations to see whether cortisol suppression occurred during the eight hours. If at least 50% cortisol concentration suppression is present at the four- or eight-hour time points, the definitive diagnosis is PDH and additional adrenal function tests are not needed.

http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

So again, in Inu’s case, her 8-hour value was undoubtedly within the reference range and lower than the cut-off number — not higher. So according to Dr. Bruyette’s own article, this result would not confirm a Cushing’s diagnosis although it’s possible she could be in the early stages.

I am guessing he may be recommending the continuation of the melatonin and lignans because it is possible that Inu may have elevations in some adrenal hormones other than cortisol. Elevations in other hormones may cause similar symptoms to high cortisol. So even though Inu is not testing positive for conventional Cushing’s, she may still benefit from this treatment regardless.

Marianne

[kwhit]

Two things worry me: her hindleg weakness and the vet thinks she needs some dental extractions. This two things are very detrimental on her life quality. The dental work scares me SO much, since with her symptoms, not even knowing for sure its Cushings, and if it is, its uncontrolled: blood clots, high pressure, liver damage, makes anesthesia so risky, imo. But I always dread the idea how much pain a dog can take, and thinking she is pain because of a tooth makes me want to cry in despair.

I'm going through the same thing with my Golden, Chance. He's 13.5, diagnosed with Cushing's and my vet says he needs a dental with extractions. I'm very nervous about the procedure, but like you, are worried sick that he's in pain and just not showing it. It's such a difficult decision. I actually am thinking of not treating him for Cushing's because the med he was on made his mobility so much worse. He was falling down all the time and when it happened, he looked so confused. It was awful...

[M&Inu]

If ticks are usually that much of a problem in your area I would her checked out for Lyme, Ehrlichia and other tick-born diseases myself. A condition like those could be the culprit instead of Cushing's. ;) Lyme in particular can cause lameness and a whole host of other issues. In my area of the US ticks, fleas and mosquitoes are a problem and I use a product called Advantage Multi applied to the shoulder area every 40 days or so. This product takes care of the fleas, mosquitoes, and other parasites like worms but it does not have any effect on ticks. So mine also wear a Seresto tick collar. We don't have any problems with bugs NOR do these things show any effect on their labs - they are all in good shape according to wellness screens and CBCs so I don't believe they are causing any harm internally to my dogs.
As for Adequan, I have used it with several of my fosters (all special needs and/or hospice dogs). It can help with joint problems like arthritis and with collapsed tracheas. BUT I would want to rule out Lyme before I assume the lameness Inu is displaying is related to arthritis. I'm not sure using Adequan in the presence of Lyme would be beneficial - treating the Lyme would be most important to me IF that is present.

Hi Leslie! Thank you so much for always answering my messages! And sorry that I am always late in answering. Each time Inu has her bloodwork done, I check for these diseases.
ANAPLASMA PHAGOCYTOPHILUM/ A.PLATYS NEGATIVO
EHRLICHIA CANIS/ E.EWINGII NEGATIVO
DIROFILARIA IMMITIS NEGATIVO
BORRELIA BURGDORFERI NEGATIVO
This time also was everything negative. Also, she doesn’t present anemia in her red cells blood count that is some indicator of Lyme the vets here say. I am always scared she could have it but it is masked and won’t appear on the tests, but the vets tell me that’s unlikely?
I have used Advantage Multi and Seresto on her, and I still get to pick ticks off her, every day. :(
What I meant that I am scared of with her liver values, is the other products, the internal ones, like Bravecto and Nexgard, that the vets here are trying to get me to use.
But another thing I have been reading up is that Anipryl, Selegiline, which she is taking, is very difficult to combine with other things. For example: Amitraz, which is used in tick collars, or medicated baths: should not be used if the pet is taking another MAOI such as Anipryl, Selegiline, or meperidine. Tell your veterinarian if your pet is diabetic or has any other medical conditions.
And now I am scared about everything, did you know its dangerous to be combining SAMe (Denamarin) with Anipryl (Selegiline)? :( Apparently both could lead to Serotonin Syndrome. And I have been giving her both for two months now. I feel so lost without a real guide from the veterinarians.
Also, Tramadol should not be used with Selegiline. I haven’t given Inu any tramadol, but I mention it here, since I read many others use it with their dogs.
I have discontinued the SAMe because now I fear a Serotonin Syndrome and am giving her only milk thistle for her liver.
I really don’t know what I should do. I am just living from one day to another, seeing her weaker in her hind legs and worrying now about her teeth and the potential pain she is because of that.


Did Dr. Bruyette tell you that he interpreted the LDDS result as being positive? If so, I’m really puzzled. Here’s what he has written himself re: that test.
Marianne
Hi Marianne, thank you for your message!
He didn’t say the results indicated a positive. His response was this:
Hi
It sounds like in general things are going well and I would stay with your current treatment. I would not be too worried about the liver enzymes as that is pretty common.
Lets see how things go over the next 2-3 months.
Keep me posted
Dave
Even when I started my email with my question about the LDDS test results, he didn’t reply specifically to those. This was his answer.
Since I love torturing myself I have been reading this thread about Macroadenomas, and I feel there are so many symptoms that Inu has been displaying. I don’t know anymore.
http://www.k9cushings.com/forum/showthread.php?3567-Macroadenomas


I'm going through the same thing with my Golden, Chance. He's 13.5, diagnosed with Cushing's and my vet says he needs a dental with extractions. I'm very nervous about the procedure, but like you, are worried sick that he's in pain and just not showing it. It's such a difficult decision. I actually am thinking of not treating him for Cushing's because the med he was on made his mobility so much worse. He was falling down all the time and when it happened, he looked so confused. It was awful...
Hi Kwhit, I am sorry to hear your Chance is having similar problems and has been diagnosed with this disease. Inu had a dental cleaning and one tooth extraction June last year, I wish I would have it done with another vet, that maybe would have caught this new need of extraction earlier, and she would have gotten all problem teeth extracted in one go. As it is I am truly scared of the anesthesia, Inus liver values are through the roof, and her Cushing or whatever it is that is making her hindlegs weak, makes her pant all the time, is unmanaged, so anesthesia is so scary for me. I don’t know if you read my initial posts, but back then her vet had just handed me a sample of trilostane and told me give her 120mg daily and look where you get more, since in my country you can’t buy it. After reading here some threads, I knew 120mg for Inus weight was way too much, I had not given her anything, but then I decided against my better judgement (no way to test it with an ACTH test, no way of getting more medicine) to give her 60mg daily. On the third day her hind legs just failed her, she could not stand up, collapsed and as you describe it, just looked confused. I immediately stopped giving it to her. Now I am giving her Anipryl, lignans and melatonin, but since it’s so subjective to evaluate, I really can’t tell if its helping or not. Would you let me know what you decide with Chance regarding his teeth? I am so ambivalent.

Generally speaking I am a mess. There are days where her hindleg weakness is so bad, that she had one accident inside the house. She looked so shocked, and helpless and then later when she peed a little bit more in the garden, and I cleaned her and toweled her, she didn’t want to go inside anymore. I cleaned the floor like 5 times before she went inside again. Now I sleep with a video baby monitor on her all the time, to catch her attempts at getting up right away and helping her stand and let her out in the garden.
I just cried, because I don’t know if I am being selfish not making The Decision, when is her quality of life gone? Sometimes I catch myself wishing she could die peacefully in her sleep like a friend’s 15 year old dog. And then I feel 1000x times bad and like the worst kind of coward and worst person at thinking about wishing her death. Because really what I really wish is to make her feel better, and active and happy again, but my possibilities because I live here are so reduced.

Thanks for your messages and for listening to me. I hope you all are having a nice day.

[Squirt's Mom]

Bless your heart. :( The last year of Squirt's life I often felt that way and had that same thought - please just let her pass peacefully in her sleep. I didn't want her to suffer.... and I didn't want to have to make The Decision. She had dementia her last year and I ended up putting the couch cushions on the floor beside my bed, building up a pallet for her beside the cushions and sleeping there most of that year. That way I knew for sure when she was up and roaming plus she could come be beside me when she wanted to be because by that time it wasn't safe for her on the bed - she was apt to step/jump/fall off and her legs were too rickety for a soft surface.

But I promised her that as long as she was able and wanted to fight for each day, I would help her do that in any way I could. I believed and trusted that she would let me know when she couldn't go on - and she did. One day she stopped eating and drinking. I could put food in her mouth and she would just open her jaw and let it fall out; same with water - I would syringe a little water in and it would run out the sides of her mouth. There was a pleading look in her eyes and I knew it was time. She was ready to go be with her Sissy. So I called the vet and faced one of the very worst days of my life....for her sake. I couldn't, wouldn't, watch her starve to death or die of dehydration.

I have missed her every day of my life since and will until my last breath. But I believe one day I will once again be with her and all those I love who have gone ahead.

Listen to Inu and she will tell you when she has had enough, when she is tried of fighting. It may be that she will take the decision out of your hands and simply fly on her own- that is what we all wish for, not only for our babies but for ourselves and our other loved ones as well. But if that gift is not given, I know you will find the strength and courage to do what must be done. I know this because the love you have for your precious baby girl is so very evident...and it is love that allows us to make The Decision.

BUT until that day, you are not alone. Your K9C family is with you every day of Inu's journey. We may not have answers or solutions but we do have soft shoulders to lean on and warm hands to hold yours...and we will fight with you for Inu as long as needed.

Hugs,
Leslie

[M&Inu]

Hi Leslie,

Thank you so much for your answer, it has helped. I have found it so hard and shameful to have those thoughts, and to write them down. Yesterday was another of those "I am the worst human being" thoughts: on our walk I encountered a neighbor that has two huskies, father and son, age 15 years and 4 years. And the 15 year old husky looks just so healthy and normal, and I am like "why my dog, what did I do wrong with mine, and why others get to live a full and issue-free life. It doesn't help that the neighbor kept on and on, on how deteriorated he sees Inu has gotten...

I have tried to make the 5 things she enjoys list someone here mentioned: she always has loved food, walks, car rides, walks in more interesting areas (hiking, etc), hunting squirrels, barking at cats or passing dogs on the street. Now she only is interested in food, nothing else. She stopped barking a year ago. She likes to go out a bit to the park around the corner, and go on car rides, but the enthusiasm is gone. So I really have no idea what she is still getting out of life. I can't say she looks in pain, but she just sleeps and eats, and watches us do things around the house.

Also I think I never mentioned when I did the LDDS test and general bloodwork (where the liver enzymes went so high), I also did a urine analysis: there is no protein loss and the density is 1.03. I have read that is still in range. Also as Marianne has mentioned the LDDS results and maybe the urine analysis indicates that maybe Inu's problems are not exactly Cushings. But the vets here are no help. The explanation is: she is too old. I want to push them towards the 15 year old husky I encountered yesterday and say to them, so yeah so is he and he is fine.

This is so frustrating and I am just a circle of negative thought. Sorry to come and vent, again. Thank you for being here for us.

Hugs back!

[Harley PoMMom]

I wish I have some words of wisdom :( The only thing I can offer are loving hugs and to let you know we are always here for you and your sweet girl.

[M&Inu]

I wish I have some words of wisdom :( The only thing I can offer are loving hugs and to let you know we are always here for you and your sweet girl.

Thank you for the hugs and being here for us all the time. It is much appreciated.

As always I am super late in writing and keeping you all up to date, I just burst in here to vent and disappear. Sorry.

Since last time, we have had good days, and bad days, all in all I haven't seen real worsening of symptoms, maybe in panting and drooling, but its getting really hot here, we are now at the beginning of what promises to be a very dry and hot summer. So I can't know if the panting and drooling and agitation is Cushings fault or the weather.

Her hind legs are weak, but if I help her up, she can walk. We are still managing one or two small walks in the neighborhood. I really need to finally get her started on a bit of easy hydrotherapy. Since there is none in my country, I bought a cheap above ground pool, of the inflatables, 10 feet in diameter, 4 feet high. I think I will finally install it in my garden (I managed to level the ground somewhat).

Her hind leg pressure sores really made me cry sometimes, but I found that spraying propolis and putting a honey membrane on them over night with gauze is making them heal better. It really was difficult to get them to heal. She now has a bit of dandruff and I live in fear of calcinotis cutis making an appearance. I am giving her some baths with water where I soaked oats to soothe her dandruff and camomile tea soaks.

I am still bouncing from one veterinarian to another. I feel they are terribly ignorant. On sleepless night I go through the LDDS test results and ask myself what if not Cushings could it be? Her symptoms are those of Cushings, what else could it be?

I have her still on Anipryl, melatonin and lignans. But have been tempted, since two months ago, where I started writing to the author of the Cabergoline treatment of pituitary Cushings, to start herr on 0.5 mg every 48 hours of Cabergoline. I am a bit scared since I would be going in a bit blind and with zero local veterinarian support, but this is the same for the Anipryl anyways. And as with the Anipryl, there are relatively few side effects.

I hope you all here are well! And as always, thank you so much for being here and listening and being supportive! I wish you all a good rest of the week still! :)

[Harley PoMMom]

As always I am super late in writing and keeping you all up to date, I just burst in here to vent and disappear. Sorry.



No need to apologize, that's what we're here for so whenever you feel the need to vent, talk...etc... please do come here. :)

Hugs, Lori

[M&Inu]

I wanted to give an update: Inu is feeling a bit better right now, but I am already researching the whole euthanasia because I want to be very informed, but for now I am impressed how much better she acts. Her hindlegs are super weak, I need to help her stand up and go potty with a towel under her hind legs. Its hard work, but while she still is eating and wnating to get up, I simply cant take The Decision right now. When she deteriorates I will release her for sure.
I know that it can revert rapidly to bad and worse, but for now I am living one day at a time.
She is taking (for me ironically) prednisone, for three days now and that has perked her up. Her appetite is still as good as always. Water intake is a bit low and therefore her urine is very concentrated. If someone has an idea how to make her drink more water, please let me know.
She also is taking antibiotics, esomeprazol (to avoid a gastric ulcer) and liver support. I would like to give some kidney support but I wouldn’t know what is good for that.
As for her pain she is taking meloxicam. Which I know is hard on liver and kidneys. Any other medicine you know of for pain that is better on the system? I have read about Galliprant, sadly I can’t buy it, in my country its not available and in the United States I need a prescription.

I am nearing the stage where I will have to make The Decision, and I don't blindly trust vets anymore. So I wanted to hear from protocols and the medication used in euthanasia for dogs. Since googling has made me scared that maybe here in my country stuff, that has a bad reputation in euthanasia in other more advanced countries, are no longer used. I want to be as informed and prepared to make Inu passing as peaceful as I can.
I just got scared about things I read, specially about reactions to the pre anesthesia mix injected in the muscle.
https://www.whole-dog-journal.com/issues/20_8/features/Euthanizing-an-Old-Dog_21689-1.html
Thank you for your help!

[Harley PoMMom]

I wanted to give an update: Inu is feeling a bit better right now, but I am already researching the whole euthanasia because I want to be very informed, but for now I am impressed how much better she acts. Her hindlegs are super weak, I need to help her stand up and go potty with a towel under her hind legs. Its hard work, but while she still is eating and wnating to get up, I simply cant take The Decision right now. When she deteriorates I will release her for sure.
I know that it can revert rapidly to bad and worse, but for now I am living one day at a time.

Inu is such a lucky girl to have you as her Mom, you're doing a wonderful job!



She is taking (for me ironically) prednisone, for three days now and that has perked her up. Her appetite is still as good as always. Water intake is a bit low and therefore her urine is very concentrated. If someone has an idea how to make her drink more water, please let me know.

She may like ice cubes, my Harley liked to chomp on them! Also, if she is eating dry dog food you could try putting water or broth (no onions) in it, canned dog food does have a higher moisture count so you could add that to her diet too.


She also is taking antibiotics, esomeprazol (to avoid a gastric ulcer) and liver support. I would like to give some kidney support but I wouldn’t know what is good for that.

Wild salmon oil and CoQ10 are two supplements I recommend for the kidneys.


As for her pain she is taking meloxicam. Which I know is hard on liver and kidneys. Any other medicine you know of for pain that is better on the system? I have read about Galliprant, sadly I can’t buy it, in my country its not available and in the United States I need a prescription.

Has she ever taken Tramadol?

Hugs, Lori