Hopefully doing that will also show if there is anything else going on with Diabetes? I don't know if anything in the blood test he did pre-dental would show up if Diabetes was an issue?
I'm guessing that Hannah's blood glucose level was part of the pre-dental labwork, and that it was normal. If that value had been elevated, your vet would have suspected diabetes. But you can double-check with him as to what Hannah's glucose level was on that test.
Where do I find the milk thistle? I think I ready other information about people trying supplements with some success and I would be open to that as well.
As Kim said above, you can buy milk thistle in health food stores. SAM-e is another supplement that is often recommended for liver support. Here's a link that gives more info about both these supplements:
http://www.k9cushings.com/forum/showthread.php?t=192
I would not waste my money on other supplements advertised on the internet as specifically "curing" or controlling Cushing's. There is no scientific evidence that they help.
-Should I move forward with a dental? He said they can still do one when we are ready. I know Cushing's dogs can be more prone to infection, but I also don't want to spend tons of money not knowing what other treatment, procedures she may need. She doesn't have great teeth, but has had many pulled, and has had yearly dentals as long as I have had her (the past 8 years).
As has already been said, you don't want infections to get out of control in Cushpups. The one reservation that I would have about a dental is the fact that most anesthetics can be hard on the liver, and we know from her lab results that Hannah does have some liver involvement going on. So in my mind, performing the dental would involve the judgement call as to whether her teeth are currently in a state where it is worth burdening her liver with the anesthetic. Again, something to discuss further with your vet.
-Does it make sense that she is eating more and losing weight? She is 10.8 lbs. now and was 12.3 in June. (I am wondering if this could be due to muscle loss).
While it is true that most Cushpups gain weight rather than lose it, my own boy also lost weight prior to diagnosis even though we even switched to a higher-caloric food in order to try to "beef him up." So I do know that weight loss is possible. He definitely did lose muscle mass during the pretreatment period.
-Do Cushing's dogs lick/itch a lot, even without any visible skin conditions? This seems to be worse this winter (when her allergies have normally subsided in winter). And is the random, but somewhat incessant barking and pawing at us when we have no idea what she wants, something that could be part of Cushings?
Again, while it's true that steroids can aid in controlling the manifestation of allergies in many dogs, my Cushpup was also a "weirdo" in this regard and licked his front paws incessantly for a long, long time prior to diagnosis at a time when his cortisol level was very high. As soon as his cortisol level was controlled with trilostane, the licking magically ceased. I have no explanation for what was going on, but it was a clear and definite change for him.
-Do you think the LDDS test with the 4 and 8 hour checks does clearly indicate the pituitary form of the disease?
The pattern of Hannah's LDDS test is consistent with pituitary Cushing's (suppression at the 4-hour mark with "escape" at the 8-hour mark). In terms of the numbers themselves, she is right at the borderline, because vets are generally looking for either a 4 or 8-hour result that is less than 50% of the baseline cortisol level. So with a baseline of 3.7 and a four-hour level of 1.9, she is hovering right there at the 50% mark that would be diagnostic of PDH. Here is a link to a thread that will give you more info about interpreting LDDS tests:
http://veterinarymedicine.dvm360.com.../detail/580093
-Would the abdominal ultrasound show anything other than enlarged adrenal glands to show more evidence? Or were you thinking it might show a tumor there, which would mean it is not a pituitary issue?
Yes, exactly right, the appearance of the adrenals could give further support for either the pituitary or adrenal form of the disease. But in the absence of overt Cushing's symptoms in Hannah, I was also thinking as much along the lines of making sure that there is nothing strikingly abnormal about her liver (other than the changes that are typical of Cushing's) or other internal organs that might account for her test elevations.
-Is there any "typical" progression with this disease? Like how long it might be before Hannah shows worse symptoms? I realize all pets are different, but my vet said it is typically slow, and my only experience is my parents' dog, which was VERY quick.
I agree with your vet's assessment that Cushing's is generally a slowly progressing disease in the absence of aggressive tumors, which are the exception rather than the rule.