Almost 8 y.o. recently diagnosed, a few questions

[PaddysPerson]

Hi everyone. I just wanted to post the results of Paddy's last UTK stim test that was done at the beginning of March.

TEST - RESULT (Baseline) / Normal Range (Baseline)** / (Post ACTH) / Normal Range** (Baseline Post-ACTH)
Cortisol (C) ug/dL : 5.9* / <1.0-5.6 / 18.1 / 7.1-15.1
Androstenedione (A) ng/mL : 0.24 / 0.05-0.36 / 1.83 / 0.24-2.90
Estradiol (E) pg/mL : 45.7 / 23.1-65.1 / 42.9 / 23.3-69.4
Progesterone (P) ng/mL : <0.20 / <0.20 / 2.31* / 0.22-1.45
17-OH-Progesterone (17OHP) ng/mL : 0.84* / 0.08-0.22 / 12.46* / 0.25-2.63
Testosterone (T) ng/dL : <15.0 / <15.0-24.0 / <15.0 /<15.0-42.0
* Above or below reference range **Mean normal range values for neutered male dogs

In the notes from UTK, they say to consider a combo of lignans and melatonin and starting on the maintenance dose of lysodren. Our IMS has been waiting to discuss this until after Paddy's oncology appointment, which was last week. I'm not sure what he's going to recommend. A question I have,though, is choosing between the two types og lignans, HMR would be better because of having no fiber...? I'm leaning towards that one, I think.

Paddy has gained a little weight since the beginning of January. He'd been down to 13.2 -ish and is now around 14lbs. I've just been feeding him some rx food along with Dr Harvey's paradigm (his least favorite is the diabetic one - glyco balance - especially when his mouth is bothering him).

The oncology appointment seemed to go well last week. They didn't find any evidence of it spreading. The next day, though, he seemed uncomfortable when it was time for bed (groaning/grunting). He was sedated for xrays so I thought maybe it was from anesthesia or the long day he'd had (also saw a holistic vet on the way home). He started being extra picky about eating and I saw blood in his mouth on the side that did not get extractions. We got antibiotics from our regular vet for that yesterday and an appetite stimulant.Then today, he had blood in his urine . I contacted the oncologist who said to monitor for him having to strain more than usual or not being able to go. She said it could be a UTI or secondary from his prostate... and to have his regular vet or specialist nearby do a urine culture. So, if we can get through tonight, that's something that will happen at the IMS appointment tomorrow (going to have his glucose sensor changed).

[Harley PoMMom]

Oh, poor Paddy and poor you, I am so sorry you both are going through so much right now. On a bright note, I'm glad to read that he's gained some weight!

Regarding the lignans, I'm not sure which I'd suggest, I believe if this were me I'd print out the information sheet that UTK has and take that into the doc office and discuss it with the IMS and see what they recommend. Here's a link to that information sheet: https://vetmed.tennessee.edu/wp-cont...NFORMATION.pdf

Please do let us know how the appointment goes and wishing you both the best of luck.

Hugs to you both, Lori

[Squirt's Mom]

I do hope Paddy is feeling better by now. I, too, am glad he was able to gain a little weight and hope his appetite stays steady.

I used the combo of lignans and melatonin with my Squirt for a while when she was first diagnosed. Her cortisol was normal but more than 2 of her intermediates were elevated so that is the treatment recommended. When we started the only lignans available were the SDG, or flax, lignans. When the HMR, or spruce, lignans came out I thought it was worth a try to switch. When we did we lost control of the hormones so we switched back to the SDG and remained with them for the duration. When her cortisol started to rise we used a maintenance dose of Lysodren and just skipped the loading phase. This worked for her but has not worked for all pups who started out Atypical then developed conventional Cushing's (with elevated cortisol). Many many dogs do very well with the HMR so it is definitely worth a shot to start out with them vs the SDG.

I am a Lyso girl through and through UNLESS the dog has the adrenal form of Cushing's then Vetoryl is best because of the need for steadily increasing doses as time goes by (high doses of Lyso can be very very hard on the digestive system). Otherwise, I will always choose Lysodren over Vetoryl. And yes, I am an oddball.

Looking forward to the next update on our sweet boy!
Hugs,
Leslie

[PaddysPerson]

Paddy's urine was back to "normal" after a few days on the clindamycin (prescribed for his mouth). At IMS appointment, they couldn't do a urine culture or anything because of the antibiotics. So at that time, we held off on re-starting cushing's treatment again (his urine was still kool-aid red then). After he finished 2 weeks of antibiotic, the bloody urine returned, not as red & not consistent (ok so far today). He's been very picky about eating this past week & I've been giving an appetite stimulant - mirtazapine. His teeth are still an issue. I need to go ahead with the rest of his extractions, but...
We saw the IMS the other day & he said Paddy could start lignans and melatonin but waiting on lysodren. I was going to give Paddy HMR because I was worried about him getting too much fiber, however I read that flax lignans have more antioxidants so maybe they might help his other big issue... (also the IMS had dosage of 65mg-250mg for HMR and 15mg for SDG but then I read online 10-40mg HMR for small to large dogs. Have to ask him about that.)
Paddy already gets a probiotic - Visbiome- once a day mixed with a tsp of baby food. I also give him a tsp - tbsp pumpkin with each of 2 meals. Somewhere online I saw that the lignans could be mixed with a little yogurt (to help it absorb better?... ).
Any suggestions on how to give them? TIA

[Harley PoMMom]

So sorry to hear that Paddy's appetite has decreased, believe me I know how worrisome that can be, hopefully it'll pick up.

Regarding the melatonin and lignans; you want to make sure that the melatonin is the plain kind not the fast-acting or slow releasing type. With the lignans what is very important to know is the standardized percentage of SDG or HMR in the product you are giving. I do believe they produce a liquid form of lignans, that may be easier to give. With my Harley I used the powder form of lignans and just stirred it into his wet food.

Hugs, Lori