Dealing with Cushings in a third world country

[Harley PoMMom]

I totally agree with Marianne, so please stop being so hard on yourself. You are a wonderful Mom to Inu and you are doing the best you can with what is available to you. Hang in there and remember we are here for you both.

Hugs, Lori

[M&Inu]

Hi Marianne,

I am so sorry to be answering so late, but I did read your message and followed your advice: I stopped giving Inu oral serum to not unbalance her electrolytes. But I stopped trilostane all together. I just have these 60 mg capsule samples I got from my vet. He did not answer any of my questions, because he is on vacation. I got word back from Diamondback (thank you for recommending them to me, they would accept a prescription from my vet). I don't know if I should tell my vet he should do it for 3 mg tablets or another low dose, and just tinker with it. It does seem risky to be administering blindly, without a way to measure cortisol levels. I am stumped.

I wanted to ask for recommendations: Leslie directed me to this website (http://franklintnvet.com/cushings-disease-in-dogs/) about herbal remedies (thank you) and I got into contact with the veterinary clinic to see if they would sell me this herbal remedy (Ophiopogon Formula), and they offered me to pay for a consultation per phone with their veterinarian, has anyone visited him or talked to him, by chance?

I really appreciate all your support and help. Here in my country I feel totally lost and alone with this diagnosis and no way to help my dog.

[M&Inu]

I totally agree with Marianne, so please stop being so hard on yourself. You are a wonderful Mom to Inu and you are doing the best you can with what is available to you. Hang in there and remember we are here for you both.

Hugs, Lori

Sorry I had not seen this message Lori, thank you so much. I feel I am using you all as a "paño de lagrimas" a support group that has to see me crying all the time, sorry. But really I feel lost here in my country, zero support or interest in this disease in the veterinarians and no way to help Inu.

Thank you for your message, I do feel better knowing I can come here for support. Hugs.

[molly muffin]

Hello, We're just fine with being a support group, it is what we all are to each other. No matter what the problems.

Your vet will be back now, and so you can have a chat with him and see what he thinks.

So glad to hear that Diamondback will accept your vets prescription. That makes things easier. Now to figure how how best to monitor and test.

[M&Inu]

Hi Sharlene,

Thank you so much for your message. It means a lot to me to have found you all on this forum. Thank you.

[Squirt's Mom]

You are never a problem! We are here to support each other as best we can. Sometimes that is nothing more than being able to offer a shoulder to cry on but that shoulder is always available. I was a complete basket case when my Squirt was first diagnosed and these kind people held me together until I could breath again and start to learn about this disease. We have ALL been scared and lost...even with vet care and medication readily available. It still helps so so much to talk to people who understand, truly understand.

If the vet at Franklin is willing to chat with you I would take them up on it! Listen carefully then ask if they can send you an email so you can go over the conversation again to help you make a decision. It may turn out that what they have to say is the very thing you need hear.

Hugs,
Leslie

[Harley PoMMom]

You and Inu are part of our family and we are here for you both so please feel free to rant, rave, yell, or if you just need to talk, we are great listeners and we will hold your hand through this journey.

Another thought, many of our members and/or their vet have talked to a technical representative at Dechra, the manufacturer of Vetoryl, maybe this could be an option for Inu's vet.

Here is contact info for Dechra's U.S. Office: http://www.dechra-us.com/contact/technical-support or this: http://www.dechra.com/contact-us

As for the Trilostane dosage strengths from Diamondback, if possible I would get 19 mg or 21 mg capsules and some at lower doses, say 2 mg, this way you have options in tweaking the dose.

Lori

[M&Inu]

Hi Leslie and Lori and everyone,

Sorry that I didn't answer sooner. I have been busy and stressed arranging to talk with this vet in Franklin I had told you about. It’s a bit hard for me, since English is not my first language and many things are arranged so differently in the US. But the people in that clinic have been super helpful and nice.

I don't even know any more, if I had told you, that in correspondence with Dr. Bruyette, he told me not to risk giving her Trilostane when I have no way of testing her cortisol levels. He recommended Anipryl, even with the low success rate that medicine has. I have to confess when he told me this, I was again very down. But I am still scared of giving her Trilostane "just like that". And my local veterinarians are really zero help. I think I am more informed about Trilostane now than they are. The super high dose of 120 mg daily was/is a red flag of how out of touch they are with this disease, and the zero interest they have to help even for patients who are willing to buy and pay for all the tests.

So, I took Leslies advice and got in touch with this clinic in Franklin, paid my consultation and had a skype conference with the veterinarian.

I am now a bit more confident in that I will doing something, anything, to help Inu with her Cushings. He is willing to prescribe the Anipryl, since even that medicine, that is not as delicate as Trilostane, is a prescription only medication (why? Are they scared people want to care for dogs with cognitive disfunction?).

But a new problem arises, even with this prescription the pharmacy Drs Foster & Smith cancelled my order, even after contacting this clinic for the prescription, because the address I listed is this P.O.Box service in Doral, Florida that forwards my packages to my country.
Now I am thinking that I will need to have it shipped to the veterinary clinic in Franklin (or any other US address that is not a forwarding system) and ask them to re-ship it to the P.O.Box and I will pay them the second shipping costs.
Also, I won’t be buying at DrsFoster&Smith because I found a better price at PetCareRx, also I hope they are more flexible (?).

We will try for 3 months with:

Anipryl 40mg daily

Ophiopogon Formula, the capsules are on their way already!

HMR Lignans the recommended dose is 1-2 mg of lignan for each pound of body weight, the capsules I bought from Lignans for Life are 40mg, so I was thinking starting her off with 2 capsules = 80mg (she is weighing 89 pounds)

Melatonin 6mg twice daily

Omega oils the recommendation is "Make sure you read the label carefully to ensure that your dog receives 220 mg/kg body weight of a combination of alpha-linolenic acid and the long chain omega-3 fatty acids eicosapentatonoic acid (EPA) and docosahexaenoic acid (DHA)."
I am giving her now 4 softgels of Wholemega that amounts to 4000mg of Wild Alaskan Salmon Oil daily

SAMe 200mg capsules “For large dogs 41 lbs to 80 lbs: give 2 tablets per day”

Milk Thistle 100mg capsules “Recommended dosage for dogs is 2 mg of milk thistle for each pound of dog's weight.” I will start her off with one capsule.

Gingko Biloba daily dose of 40 mg/ 10 kg body weight, I ordered 120mg capsules, and I think I will start her off with one capsule daily

Phosphatidylserine (PS) 100 mg softgel, 1 softgel daily

I feel that everything listed here is in this grey area of, depending who you ask, its “snake oil” and false hope, or maybe it will work. I have been reading up on the research. Sadly, most of the testing, for example of the Lignans has been done in vitro, so really knowing if any of this works to lower her cortisol levels, I don’t know.
But its to start somewhere, and my options are so limited, almost nonexistent.

Also, I am buying PillPockets in bulk for so much medication!

So these have been the news of my battle against Cushing in a situation where I could literally say nobody in the whole country knows or cares how to deal with this.
As always thank you for being here for Inu and me. I hope your days and new Year has been treating you well!

[Harley PoMMom]

I think your plan sounds excellent. 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. The late and great Dr. Jack Oliver at University of Tennessee at Knoxville (UTK) was a premier scientific authority on the subject of Atypical Cushing's and according to a research paper written by Dr. Oliver titled: "STEROID PROFILES IN THE DIAGNOSIS OF CANINE ADRENAL DISORDERS"

Melatonin ~ Results of in vitro cell culture (human H295R adrenocortical carcinoma cells) studies in our lab revealed that both 21-hydroxylase and aromatase enzymes were inhibited by melatonin. Also, in dogs with adrenal disease that are treated with melatonin, and repeat adrenal steroid panels are done, cortisol levels are consistently reduced, and estradiol levels are variably reduced.

The UTK lab does perform adrenal steroid profile testing and the treatment option sheet that is sent out with the test results does list melatonin and lignans as medical therapies (along with Trilostane and Lysodren). From that sheet:

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 either FLAX HULL (SDG) lignan, or HMR lignan.

Although the recommended treatment for atypical cushing's at UTK is very controversial among the veterinarian field I truly feel that trying this with Inu is really a great option. I've had quite a few email discussions with Dr Oliver in the past and he did state that it does take at least 4-6 months to see if any improvement will happen so you may want to give Inu the melatonin and lignans longer than 3 months.

I'm including a link to our Resourse Forum where you will find the information I quoted above, plus more regarding Atypical Cushing's: http://www.k9cushings.com/forum/show...Hyperestrinism

Also included in that thread are links that state what melatonin and lignans are preferred.

You are doing an awesome job!!!

Hugs, Lori

PS ~ I have used Pill Pockets and they worked great, I also hid them capsules in cream cheese or peanut butter too.

[Squirt's Mom]

I think your plan is great! Like Lori said the combination of melatonin and lignans can help a great deal, especially with the intermediate hormones which come into play with Cushing's. The PS is something I used with my Sweet Bebe and it did help her a lot especially with mental acuity as she got older.

On the lignans....you say

HMR Lignans the recommended dose is 1-2 mg of lignan for each pound of body weight, the capsules I bought from Lignans for Life are 40mg, so I was thinking starting her off with 2 capsules = 80mg (she is weighing 89 pounds)

You need to look on the bottle and see the percentage or actual amount of SDG in each capsule. For the Lignans for Life Flaxseed Lignans each capsule contains only 25mg of SDG. SDG is the workhorse in lignans and what helps our cush babies. So while the capsule may contain 80mg of LIGNANS they only contain 25mg of SDG. So check out the back of the bottle under the Supplement Facts and find the amount or percentage of SDG and work from that to determine the dose Inu needs. According to UTK (University of Tennessee in Knoxville where the majority of the research on this has been done) the dose of SDG is - "SDG lignan; one milligram/lb B. Wt./day". So at 89lbs she will need 89mg of SDG (NOT lignans) per day. If the capsule contains 25mg of SDG then she will take 4 capsules a day (89 / 25 = 3.56 capsules, rounded up to 4). Since lignans can cause some digestive upset, I would start with 2 as you planned then go to 3 then up to the recommended dose of 4 capsules a day. I would give her at least a week on each dose to make sure her gut is adjusting well before increasing to an additional capsule.

FYI - this is the Lignans for Life product I am looking at on Amazon. What you have may be different but the math still applies - look for the amount or percentage of SDG and work from there for the dose she needs. Remember, it is the amount SDG not the amount of lignans that matter. https://www.amazon.com/Lignans-Life-.../dp/B007D681K0

Now that I have thoroughly confused you, I am signing off. But feel free to ask and we will work with you to try and get the answers needed.

Hugs,
Leslie