Another Newbie trying to figure out what to do

[ValleyGail]

My dog, Lucy, is a Maltese mix. I've had her since January, 2012 and her estimated age at that time was 3 years, so her estimated age is about 14. A few months ago I took her in for routine blood work and the vet said her results suggested Cushings. Her symptoms at that time were thinning hair and somewhat increased appetite and thirst. However, she's always been a picky eater and by "increased" appetite that meant she was usually finishing her food rather than sniffing and walking away. The vet that I trust the most said that they can only treat symptoms and since she didn't really have any and considering her age, she didn't see cause for the "next" test. I agreed--mainly because she gets so very stressed with each vet visit, I hated to put her through extensive testing.

In the past couple of months her symptoms have increased. She's gaining weight, she's hungry ALL THE TIME. I mean it's all she thinks about when she's awake. I've been giving her melatonin with lignans and milk thistle for about a month. No idea if it's helping. She's drinking a lot and peeing in the house fairly frequently which she very rarely used to do.. She's also extremely restless in the evening. We were giving her way too many treats which we are trying to quit doing. So she begs and when that doesn't work she paces around the house sniffing for fallen crumbs. 😥
At this point I'm not sure what to do. She gets so stressed at the vet (panting, pacing) that I honestly feel like she's going to hyperventilate. I'm considering getting her records and having a mobile vet come in. My current vet is very popular and very busy.
Sorry to make this so long. I guess I'm looking for advice as to how to deal with this ravenous hunger, whether anyone else has luck with the melatonin/lignans supplement, and details on what the testing for cushings entails.
Thanks for any information anybody can share.

[Harley PoMMom]

Hi and welcome to you and Lucy!

When my boy Harley had Cushing's he had that ravenous appetite too, that sweet boy acted like he was starving all the time and it broke my heart to see him like that. You could try giving Lucy carrots or frozen green beans to help deal with that hearty appetite. As far as the testing for Cushing's, the LDDS is the "gold standard" test, however since Lucy gets extremely stressed at the vets, which could cause a false positive result on the LDDS test, I would recommend the ACTH test instead. I also suggest, if feasible, having an ultrasound performed as this would get a "look" at the internal organs and especially those adrenal glands.

Did Lucy have any blood work done such as a CBC/Chemistry panel? If so could you post any abnormalities that are marked with the reference ranges and units of measurement; as an example: ALT 100U/L (5-50)...thanks!

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. I do want you to be aware that the recommended treatment for atypical cushing's is very controversial among the veterinarian field. Regarding the melatonin, it is recommended that one use the regular kind not the fast acting or slow releasing type. I'm including a link to our Resourse Forum where you will find the information 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.

Please know we will help in any way we can and do not hesitate to ask all the questions you want!

Hugs, Lori

[Squirt's Mom]

Hi Gail(?) and welcome to you and Lucy!

From the description I would say Cushing's is a definite possibility and I agree with Lori on the testing preferred for a dog who's stressed just going to the clinic. The ultrasound can go a long way toward determining which form is in play - adrenal or pituitary. The vast majority of cush pups have the pituitary form and it is the easiest to treat with the best prognosis. The US can also find other issues that may be causing the changes in behavior and any abnormal lab results...such as a tumor, or liver damage, etc. So the US can be invaluable. I credit that test with saving my Squirt's life...it found a tumor on her spleen.

If the mobile vet has the ability to do the testing required I would try that route. But another option is to ask the vet to allow you to keep her outside between the draw times. The ACTH will take about an hour...she will have a blood draw followed by an injection. Then about an hour later she will have another blood draw. Some folk have been able to have the vet come out to their car to do the draws and injections...but not all vets are as understanding. It can help a great deal tho if she can leave the clinic when they aren't work with her so I would insist this be allowed to lower the risk of a false positive. For the US they can lightly sedate her so she won't be as upset. It is a non-invasive test but the pup needs to be still so many are sedated for this test.

And a bit of information in case she does test positive...the starting dose of Vetoryl/Trilostane for a dog her size is 1mg/lb. So if she weighs 10 lbs the starting dose should be a maximum of 10mg per day.

I'm sure you're overwhelmed by now so this is a good place to stop. If you have any concerns or questions please let us know. We have all walked in your shoes and understand what others might see as "helicoptering". :D I was a twitcher...getting anxious if a hair got out of place! LOL

Glad to have you and Lucy in the family here at K9C!
Hugs,
Leslie