Atypical Cushing's and Cushing's what's the difference? (Marie and Bruno)

[overfiffty]

Hello everyone;

I haven't been on line for a few days and decided to check the K9 diabetes and Cushings forums. I've posted on both. The meds are on order for the Cushings and I hope to start the Cushings meds on Saturday. I am also doing a curve on Saturday. Dr. Kimmel said if he's still in the 300+ to increase his insulin to 39 units. He was switched last night to 37 units. I certainly hope that with the new medicines for the Cushings that we will see a marked improvement in him. I do not expect him to act like Starr who just turned a year old but I'd like to see him with a better quality of life.

I want to thank whomever was able to move the last e-mail I posted on K9 diabetes to here. I am quite techincally challenged with that sort of thing. I have called Dr. Kimmel's office and requested that they please forward the entire panel result to my home. I hope that they do that because you'd think you are dealing with HIPPA Laws. They are telling us in order to get anything we need from our dogs' file we need to fill out a form. I can see that for a human but not an animal. I'm a legal secretary and even clients can have anything they want from their file they paid for it and technically it's theirs. Anyway happy holiday to one and all.

As soon as I get the entire panel back I'll post it here.

Marie and Bruno

[Harley PoMMom]

Hi Marie,

According to the AVMA:
http://www.avma.org/issues/policy/ethics.asp#VIII

VIII MEDICAL RECORDS

A. Veterinary medical records are an integral part of veterinary care. The records must comply with the standards established by state and federal law.

B. Medical Records are the property of the practice and the practice owner. The original records must be retained by the practice for the period required by statute.

C. Ethically, the information within veterinary medical records is considered privileged and confidential. It must not be released except by court order or consent of the owner of the patient.


D. Veterinarians are obligated to provide copies or summaries of medical records when requested by the client. Veterinarians should secure a written release to document that request.

E. Without the express permission of the practice owner, it is unethical for a veterinarian to remove, copy, or use the medical records or any part of any record.

Love and hugs,
Lori

[overfiffty]

Here's the results: UNIVERSITY OF TENN RESULTS!!!!
TEST
Cortisol ng/ml
RESULT
(baseline) Normal range result post ACTH NORMAL RANGE
56.6* 2.0-56.5 202.3* 70.6-151.2

Androstenedinoe ng/ml
0.27 0.05-0.36 0.63 0.24-2.90

Estradiol pg/ml
143.6 23.1-65.1 141.2* 23.3-69.4

Progesterone ng/ml
0.51* 0.03-0.17 1.6* 0.22=1.45

17OH Progesterone ng/ml
0.2 0.08-0.22 1.54 0.25-2.63

Aldosterone pg/ml ***
79.1 11-139.9 241.7 72.9-398.5

*above or below reference range
** mean normal rnage valuses for neutered mald dogs (N- 37).
QNS = INSUFFICIENT SAMPLE
*** normal range valuses for mal and femal dogs (N=72, baseline, N-23 post-ACTH.)

These results indicate presence of increased adrenal activity (mild-moderate)

COMMENTS; History diabetic enlarged ADs @ US, LDDST + Estradiol elevation is sugnificant and it may be linked to insulin resistance. Various treatment option considerations are attached some veterinarians consider 2-5, 8 depending on the severity of clinical signs.

Obviously they left the sencond page off. I have to call the hospital to get it sent to me. Unfortunately Dr. Kimmel is off this week and Dr. Melhrose is closed at this time so page two will have to follow.

Any thoughts and/or suggestions from ANYONE?????????

[Harley PoMMom]

My boy Harley had his first UTK panel done in April 09, his estradiol was very elevated...a post of 132.2 pg/ml. At that time his cortisol was within the normal ranges so his treatment consisted of just the flax hulls with lignans and melatonin.

In Nov. 09 we ran another UTK panel on my boy and his estradiol dropped to a post of 96.6 pg/ml. Still on the high side but a significant drop for just treating him with the lignans and melatonin.

I really believe you are going to see very good results with your treatment plan. It will take time, that estradiol can be a bugger to get lowered, so just be patient...yeah right! Patience is not one of our virtues, at least it is not one of mine!

Wishing you and Bruno the best of luck and keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[Squirt's Mom]

UTK Treatment Option Sheet:

http://www.vet.utk.edu/diagnostic/en...ushing%27s.pdf

[acushdogsmom]

Hi Marie,

I am copying my reply to you below, that I posted at the k9diabetes forum yesterday.

http://www.k9diabetes.com/forum/show...t=1617&page=16

__________________________________________

Hi Marie,

The UTK treatment options sheet (the page they didn't send you) is actually available as a pdf file on the UTK website.

The most recently updated version there is from January 2010.

http://www.vet.utk.edu/diagnostic/en...ised201001.pdf

Here is a quote from that document regarding treatment options 2-5 and 8:

2) Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs. Regular melatonin is usually used rather than rapid release or extended release products. Melatonin has anti-gonadotropic activity (effective for ferret adrenal disease), and it inhibits aromatase enzyme (decreases androstenedione and testosterone conversion into estradiol) and 21-hydroxylase enzyme (effectively lowers cortisol level). Monitor treatment effectiveness by improvement in clinical signs, biochemistries or by repeat of steroid profile.

3) Melatonin Implants. Available for dogs and ferrets. (WWW.MELATEK.NET). Sizes are 8, 12 and 18 mg for <25, 25-50 and >50 lb dogs, respectively. Effects last 3-4 months. NOTE: Melatonin and flax hull product with lignans are used together when estradiol is increased.

4) 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 lignan from FLAX SEED HULLS (or HMR lignan). DO NOT USE flax seed oil as the lignan content is very low, and the flax oil can exacerbate pancreatitis in dogs (triglyceride levels may increase). Search for standardized products (via Google or health food stores) that allow determination of lignan content. Available products allow for flexible dosing, and the suggested approximate daily dose of lignan is one milligram (mg) per pound of body weight.

5) Maintenance dose of Lysodren. Often useful in combination with melatonin and lignan to help lower sex steroid levels other than estradiol, along with suppressive effect on cortisol level. NOTE: MONITOR CORTISOL LEVELS AS FOR TYPICAL CUSHING’S TREATMENT.

8) Ketoconazole. Alternative Cushing’s disease treatment. Effective for increased cortisol and sex steroid levels. Consider 6 to 12 mg/kg, BID along with melatonin and lignan as above. See write-up at our website (and the recent article on ketoconazole treatment at JAVMA, 233:1896, 2008).

I think that the suggested treatment plan options on the treatment options sheet would include either a maintenance dose of Lysodren OR the ketoconazole. (not both)

And here's another link to a page on the UTK site where they do seem to explain a bit about Ketoconazole and the combination of Melatonin, Lignan, and low-dose ketoconazole. I think that may be the "writeup at their website" to which they refer on the treatment sheet above..

http://www.vet.utk.edu/diagnostic/en.../treatment.php


Hope this helps.

[hfurlotte]

Hi Marie,
I have been away off site for awhile and just starting checking back in with K9 group this weekend. I was quite interested to read the new information that Dr. Oliver has released and I was extremely pleased to see Ketoconizole being used more readly in Atypical cases. As with any medication there are side effects that you want to watch for but this has been a wonderful treatment option for us. We have had our Zoe Claire on Keto for almost two years now and she is doing extremely well with absolutely no signs of "Liver Toxicity"
matter of fact her liver enzymes all are sitting middle of the normal range We have on a couple of times had to increase her keto and a total max she was at was 400mg a day for about 3 weeks then we reduced her when symptoms started to disappear. She is maintaining 200 mg a day with 6mg of Melatonin twice a day. Zoe is 70 lb lab/shep cross. All her hormone levels have decreased so I can only think the Keto and Melatonin are doing their jobs