12-year-old Cairn: Atypical Cushing's?

[drcd279]

Hello all! So glad to have found this forum. In July, I noticed my 12-year-old Cairn terrier, Mandy, drinking excessive amounts of water. My first fear was kidney issues or diabetes. I took her to the vet and they performed a blood panel. She had slightly elevated levels of ALP (226) and ALT (150), as well as a high BUN (41). All other items in the panel were within normal range, including glucose (109, though in January of this year, it was 84).

Her urine sample revealed that it was concentrated, not diluted, so this confused the vet. I then had the LDDS test performed, and my vet called me yesterday to say that Mandy does not have Cushing's. Yet, since my initial noticing of her first symptom of excessive water intake, Mandy has also developed (or, in hindsight actually, I've probably just noticed now that I'm more knowledgeable about Cushing's symptoms) the following symptoms:

• Potbelly and water retention
• Panting
• Excessive hunger (her thirst is better now that she's on a wet dog food, but I suspect that is the only reason why, as it has more moisture content)
• Increase in fatty tumors
• Slight but noticeable symmetical hair loss on her underside

I don't think my vet has much experience in Cushing's - period. She suggested Mandy's panting might be related to allergies. I'm sorry, but I cannot accept that ALL those symptoms are the result of ragweed or something. Then I started reading about atypical Cushing's, wherein other hormone levels are out of whack, but the dogs test negative in traditional Cushing's diagnosis tests.

I read that Cushingnoid pups' bodies are flooded with excess cortisol, which inadvertently helps with chronic issues like allergies and arthritis, because the cortisol calms these problems, though it causes a host of other issues. Mandy has pretty much all the symptoms of Cushing's but I've noticed she is still licking her paws (she has always had atopic dermatitis caused by some allergen that is most active in late summer through fall). So it seems to me that if Mandy had regular Cushing's, her paw licking would likely cease. It continues!

I've been reading everything I can about atypical Cushing's and/or adrenal fatigue or whatever veterinary science is calling it. Most websites recommend trying melatonin and lignans. I gave her her first full dose of melatonin last night and she woke up her usual, perky self as opposed to the somewhat groggy puppy I've seen since her symptoms got worse. I'm trying to not misplace my optimism, but I want to try SOMETHING to help my dog. I can't stand to see her laying next to me on the couch, panting and looking so uncomfortable despite it being a cool 73 degrees in the house.

So I guess my questions for anyone who might be able to offer any insight would be:

• Am I probably correct in assuming this is atypical, based on her symptoms and the negative LDDS test? I am not asking anyone to tell me definitively of course, but I'm wondering if this assumption has any validity. I am currently unemployed (at the worst possible time), otherwise I would not hesitate to get the ultrasound performed immediately.
• Did anyone find that melatonin and lignans worked well? I ordered 20mg HMR lignans from Amazon. I've read varying reports on how much to give. Some say 1mg per 1lb bodyweight. Mandy is around 17 pounds currently (though some of that is water retention). When I initially suspected Cushing's, I tried her on Adrenal Harmony, an herbal blend. This actually seemed to make her worse so I stopped it.
• I read that wet food is better for Cushing's dogs (and is generally agreed to be better for dogs in general, if you can afford the higher costs) so I've put her on Instinct chicken formula. She loves it and it hasn't caused any bowel problems! Anyone found that this helps in atypical cases? I just worry that having been on dry food her whole life up until now, her kidneys may be having a difficult time with all the protein, though it seems to me this is closer to the natural diet of a dog?
• Does anyone know how I would go about getting a full endocrine panel sent to UTK Veterinary College? Would my vet have to agree to do this? I may be able to swing paying for this as opposed to the ultrasound, but I don't know how to get the bloodwork to them.

If you read through all of this, god bless you. I am just so worried about my puppy. I have had her since I was 18 and I'm now 30. If she were 15, I would likely not be investing all this time, energy, and money into researching and resolving, but my baby is 12 and still has a lot of spunk and love of life left in her. Who am I kidding, I would probably do this if she were 15, but what I'm trying to say is that I really do think she could be around for a few more years if I find a way to help her. I just want her to have the best quality of life possible. Any and all thoughts on this would most definitely be appreciated. Thanks for your time. -David

[labblab]

Hello and welcome to you and your sweet Mandy! I have only a moment available to post right now, but wanted you to know that we are very glad you've joined us, and additional info will be provided throughout the day.

I can quickly answer two questions for you, though. First, the blood analysis that UTK provides is based upon an ACTH stimulation test performed by your own vet. The ACTH involves first drawing a baseline blood level (just as was the case with the LDDS). Then a stimulating agent is administered, and one hour later a second blood sample is drawn. Your vet then sends these two tubes of blood to the UTK lab where they will perform a full adrenal panel. This involves measuring the "pre" and "post" levels of other adrenal hormones in addition to cortisol. UTK actually charges a fairly modest amount for the analysis -- the biggest part of the expense is the cost of the ACTH stimulation performed by your vet. We can talk more about this later, though.

Secondly, here's a link to UTK's specific recommendations re: lignans.

https://vetmed.tennessee.edu/vmc/dls...NFORMATION.pdf

Sorry to make this intro so brief, but once again, we're very glad you've found us!

Marianne

[drcd279]

Thanks -- when I brought up the idea of sending the samples off to the UTK college the vet tech reacted as if it were just out of the question. I guess she has never done it before. I told her that UTK is the only place in the country that can offer a full adrenal panel.

I may have to switch vets if she won't accommodate this. I'm terrified that the longer I wait, the worse off my dog will be. I would never forgive myself if she developed SARDS and went blind.

Are there any special shipping methods the vet has to use in order to get it to UTK? I suppose it would be no different than the method they use to ship samples to local testing companies, but it has to go much further.

[Harley PoMMom]

Are there any special shipping methods the vet has to use in order to get it to UTK? I suppose it would be no different than the method they use to ship samples to local testing companies, but it has to go much further.

Yes, the The University of Tennessee lab is very specific about the handling, and here's a handy link where you can find that information: http://www.vet.utk.edu/diagnostic/en...ts_info_07.pdf

What is very important to know is the standardized percentage of SDG or HMR in the product you are giving. SDG is the active component of the lignan. And the recommended starting doses:

Suggested doses: SDG lignan; one milligram/lb B. Wt./day. HMR lignan; 10-40 mg/day for small to large dogs.

This comes from the UTK treatment option sheet: http://www.vet.utk.edu/diagnostic/en...ings201107.pdf

As an example: If one 30 mg capsule contains 20% flax lignan extract (standardized).

30 mg capsule = 20% lignans.

20% is 1/5 of 100% (or 100 divided by 20 = 5).

30 mg divided by 5 = 6 mg lignans.

Each 30 mg capsule would contain 6 mg lignans.

Mandy weighs 17 pounds so she would need around 3 (6mg) capsules which is 18mg and is just a tad above her weight.

Also, the melatonin, it needs to be the regular kind, not the fast-acting or rapid releasing type.

With this type of treatment improvement in symptoms can take up to 6 months to be seen, I know this is not what one wants to hear. Cushing's, whether it is Atypical or Spontaneous, requires a lot of patience.

Regarding the diet; there really isn't a "set" diet, a diet needs to be tailored to that individual dog's needs and health issues. However, dogs with Cushing's do lose muscle mass so their feed should have a high quality protein.

And yes, Mandy could have Atypical Cushing's or it could be that she is in the very early stages of Spontaneous Cushing's. Dog's with Atypical Cushing's generally have the same symptoms of a dog with Spontaneous Cushing's.

We have a good bit of information about Atypical Cushing's in out Helpful Resource Forum so here's a handy link to that info: http://www.k9cushings.com/forum/showthread.php?t=198

If you have any questions please do ask them.

Lori

[labblab]

I'm terrified that the longer I wait, the worse off my dog will be. I would never forgive myself if she developed SARDS and went blind.

Lori has supplied you with a ton of helpful info. I just wanted to pop in to add that SARDS is not a condition that you really have any control over. The causative mechanism is still poorly understood, but it currently seems as though in dogs suffering from SARDS, hormonal elevations and Cushing's-like symptoms accompany the blindness as opposed to being the cause of the blindness. Right now, it is impossible to predict which dogs will suffer from SARDS and there is no way to prevent or cure it. So even though you may feel anxious to proceed with hormonal testing for other reasons, it would not have any bearing on preventing SARDS.

Marianne

[Squirt's Mom]

Hi and welcome to you and Mandy!

I just LOVE Cairns! My Squirt was half Cairn and half Longhaired Chihuahua - she had the spirit of the terrier tho thru and thru!

Squirt started out as Atypical and for several years we treated successfully with the melatonin and lignans, her intermediates coming down. In time, her cortisol did start to elevate bringing into the conventional Cushing's state. Most Atypical pups do eventually become conventional (or spontaneous), requiring the addition of Lysodren, or Vetoryl (Trilostane) in some cases. My next statement is sometimes seen as controversial but I take it as fact - UTK does not recommend Vetoryl for Atypical pups because this drug has been shown to cause elevations in the intermediate hormones so Lyso is their drug of choice if/when the cortisol starts to rise. I actually prefer Lyso so that worked out just fine with me. (You will also find me to be the oddball in preferring Lyso over Vetoryl. ) The controversy comes in because most pups with conventional Cushing's (meaning the cortisol is elevated from the beginning) also have elevated intermediate hormones so many vets simply do not believe in Atypical and some who do accept that form don't think it matters which drug is chosen if the cortisol rises in an Atypical pup. I trust UTK and their research so I stuck with their recommendations and tell those who are dealing with Atypical the same - Lyso over Vetoryl in my book for these pups.

I also want to let you know that Cushing's is one of, if not THE, most difficult canine condition to correctly diagnose so I am never comfortable with making a diagnosis, positive or negative, based solely on one test. The signs in this disease are as important as the test results and the signs you have posted are certainly in keeping with Cushing's - conventional Cushing's. My Squirt did not display the hunger until her cortisol started to rise; in fact, that was the thing that let me know what was happening. So I would consider the ACTH and an abdominal ultrasound. The LDDS is considered the gold standard but just about nothing is 100% in this disease.

Another point is that you may have caught this at an early stage. If that is the case, these signs are going to get stronger and stronger over the next little while and then a repeat LDDS may well come back with a different result.

And....if you could get the actual results of the LDDS and post it here that would be great. It is rare that a vet misinterprets this test but it does happen. Most labs will note on the paperwork if the results are consistent but not always. So you may want to let the gurus here take a look at the results.

Finally, I am glad you are here and want you to know that you and Mandy now have a new family. One who will be with you from here on out, every step of the way. Never hesitate to ask questions - if we don't know we will help you research to see what we can learn. You are no longer alone.

Hugs,
Leslie and the gang

[Allison]

David, hi.

Welcome to the forum! I can't offer a lot of advice. When we adopted our senior dog, his Cushings was already being well-managed and we just had to follow the prescribed treatments. Instead we fought a battle with pancreatisis. If I were to say anything though is I agree with you about having a vet you trust. A disease is hard enough to deal with; you need to know your vet will be of help.

That said, you've come to the perfect place! You and Mandy have a special relationship. There are a lot of experts here who can help as you figure out how to best help Mandy. They'll want to see test results and have lots of questions. But they'll have a lot of sound guidance to offer.

[drcd279]

Thank you guys for replying and your nice words of support. I am working on getting the LDDS results emailed to me from my vet. I can also post her blood work.

I actually took her off the lignans yesterday. She started retaining a lot of water and seemed to be constipated (I was giving her 20mg HMR lignans). After being off of them for 24 hours, she started pooping (and not to be gross, but a LOT of poop), so I think the lignans were causing that. Lori, thank you for explaining the dosage to me.

My question going forward is this: what would be more worthwhile as far as getting this diagnosed goes? I am unemployed but I will begin working in two weeks, but it's just substitute teaching so I have no idea if it will be steady enough. I say this because though money is tight, I think I can swing either 1) the ultrasound or 2) ACHT/stim test and adrenal panel from UTK.

I'm torn about which one to do because although I do think the adrenal panel from UTK might confirm/rule out atypical cushing's, I feel I may end up just doing the ultrasound anyway. On the other hand, if I get the ultrasound and it is inconclusive, at that point I think I would feel compelled to do the UTK panel testing. If I do the ultrasound and the vet notices enlarged adrenal glands, it still might not tell me which "kind" of Cushing's she has. Any advice as to which one I should try first? I really appreciate you guys reading this and offering your thoughts. I am the only one on earth who is going to advocate for my girl and I want her to have the best quality of life for however long I have left with her. It's so stressful trying to help her but also being under a financial strain.

[Squirt's Mom]

If I had to choose between the two I would go with the ACHT/stim test and adrenal panel from UTK. Then when I had saved up enough, the US.

You're doing a good job, mom! Keep your chin up!
Hugs,
Leslie and the gang

[drcd279]

Thanks for the advice, Leslie! I'm actually a dog dad though

I am taking her on Wednesday to get the ACHT stim test and panel sent to UTK. If you or anyone who has done this knows... do I have to pay UTK ahead of time? I've been asking my vet so many questions lately that I don't want to bug her again, but I'm wondering how UTK will accept the panel and perform the analysis if they haven't received payment. Does the vet pay and then charge me in the bill? Just want to make sure there are no hold-ups.