7 yr old Husky diagnosed with A-typical cushings

[tashley23]

A-typical cushings.. we have gone through all of the vet crazyness and ended up at Cornell Vet School where Osa was diagnosed with A-typical cushings after 2 negative cushings tests. Osa then had the panel tests done.. here results were: Cortisol-211.6(high), Androstenedione-2.00(normal), Estradiol-619normal), Progesterone-2.28(High), 17 OH Progesterone- 1.16(normal), Aldosterone-553.9(high).. so now I need to make some decisions- I know there is lots of info on this forum, but it is all very overwhelming. I would like to take alternatice route - diet, etc...before puting Osa on lysodren,etc...any help would be greatly appreciated.
Thank you
Todd

[frijole]

Hi Todd. Glad you found us. Diagnosing cushings can be tricky, especially atypical since alot of regular vets aren't familiar with it let alone the tests. Sounds like you found a good source for help though.

We were all overwhelmed at first - and frankly 3 yrs later I still learn more each day. We're just here to help out. :D I suggest you take time to read up on atypical in our resources section.

Regarding diets - my dog has pituitary cushings and most cush dogs have a very low tolerance for fats. So a low fat diet is what my dog has been on. I am not sure if there are any special needs for an atypical cush dog but others will join in no doubt with advice.

Hang in there - tell us more about your dog and your journey thus far.

Welcome!
Kim

[StarDeb55]

Todd, I would also like to welcome both you & your pup to our group! By the way, what is your pup's name? I will warn you up front that we usually play "20 questions" with new members. We ask for all of this information so we can get a better idea of what has been going on with your pup, so here goes. Could you tell us what symptoms you have seen that led you to go to the vet? Was any general bloodwork done such as a senior wellness panel or chemistry panel? Could you tell us specifically what the 2 Cushing's test were that were negative? Can you post the results of those 2 tests? On general labwork, can you post only the abnormal results? Also, when posting any lab results, please include the normal ranges & reporting units. If you don't have copies of your pup's results, your vet should be happy to give them to you. Most of us in the group do keep files on our canine buddies at home as you never know when they will come in handy, especially if you end up at a strange vet. Also, were other medical problems such as diabetes & thyroid ruled out? Is your pup on any other medications or supplements including over the counter products?

It looks like you had the full adrenal panel done at the Univ. of Tenn., Knoxville. There is always a treatment recommendation sheet that is included along with the test results. Could you let us know what that recommendation sheet said?

Sorry for all the questions, but the information just helps us to give you the most appropriate feedback from the group's collective experience.

Looking forward to hearing more.

Debbie

[tashley23]

Hi everyone, thanks for the qiuck responses. Osa is an almost 8 year old siberian husky- i have had her since she was 6 week old and has had some medical problems in the past. When she was 3 or 4 she had stone removed after having urinary track problems.Since then she has been on medicated food on and off for the stones. So Osa started showing some signs of problems last fall. The two big things were a major increase in water consumption, and incontinance. At first the peeing was just small amount here and there and then she had two seperate accidents in her bed- thats when I knew something was really wrong. I took her so several local vets - the first vet said they thought it was thyroid..i took her for a second opinion and the next vet said they thought it sounded like cushings. So i was told that Cornell vet was the best and to go there..so I did - after a few tests at the loal vet it was found that osa had elevatd liver enzymes. We went to Cornel in Jan and her ACTH stimulation test yielded elevated cortisol levels, both in pre- 6.01ug/dl (ref. range is 1.8-4) and post ACTH- 35.1 (ref. range is 6-16 ug/dl). Previous LDDS were equivocal and repeat testing found the same. Osa had been on oral DES for the incontinence which completetly stopped the peeing. but she had to be taken off of DES 2 weeks before testing.
Osa had a pre- Dexamethasone Sodium Phosphate blood sample was drawn, and 0.3 mg of Dex SP was administered. The tested was unremarkable at both 4 and 8 hours. So after the test results came back negative twice the vet thought it was A-typical cushings and wanted to have an Adrenal panel done through the University of Tennessee... The results that cam back abnormal were: Cortisol-211.6 ng/ml, normal range is 65.0-174.6, Progesterone-2.28 ng/ml, normal range is 0.10-1.50, Aldosterone pg/ml-553.9, normal range is 72.9-398.5. These tests results came back in April, and the vet and I agreed that I could take a few months to try and change osa's environment and see what I could find out before puting her on lysodren or any other heavy medication. I have been researching alternative treatment to no avail...Osa has not changed much in the last few months- she is drinking huge amounts of water, but not peeing in the house (mostly b/c I let her out a 100 times a day and night), she is not on DES, she is not losing hair- but where her belly was shaved in the winter has still not growing back. She is starting to shed (its summer-but she hasn't shad at all in almost a year) Its hard to figure her attitude/energy/personality out b/c everything has been different for so long now. but she is not as miserable/depressed as she was when she was peeing in the house..but she is still mopy, tired,etc..and generally doesn't seem herself, another thing- she de.f has a little appetite increase but not too bad the water is and was way worse, but she has stolen a few things off the counter/table-bread, butter, etc.. which she has not done since she was a puppy.. I had lost the tratment option considerations page from Tenn. but I just got another copy...it said:
1-Ultrasouns 2-Melatonin 3-Melatonin Implants 4-Flaxseed oil 5-Maintenance dose of Lysodren 6-Lysodren 7-Trilostane 8-Ketoconazole 9-Selegiline(anipryl) 10-Specific hyperesttrinism treatment 11-Ovarian remnant detection...
So thats a lot of info and 1 time and I def. don't understand it all, but the bottom line is she tested negative for cushings but had the hormone levels listed above off. Any help, suggestions, etc would be greatly appreciated. I would like ot put her on a better diet and maybe even make her food?...thank you so much!

[tashley23]

sorry for all the typos..

[StarDeb55]

Can you tell us if the values you posted from the full adrenal panel are the post values? We would really like to see both the pre & post values from these results.

When it comes to treatment, you can start with the melatonin + FSO with Lignans, but you must allow 3-4 months for this to work. When the treatment sheet mentions flaxseed oil, please double check & see if the sheet isn't specifically talking about lignans, as lignans are the active part that helps block estradiol production, outside of the adrenal gland. Most of us in this group who have Atypical pups use a purified lignan product as you can be certain you are giving a standardized dose. You can find this product at vitacost.com. When it comes to estradiol, the problem with this hormone is that it is produced in several areas of the body outside of the adrenals including fatty tissue.

Unfortunately, there are no natural/alternative treatments that are effective for Cushing's. If there were, all of us would have our pups on them. The 2 main drugs, lysodren & trilostane, are safe, effective drugs when the treating vet uses standard protocols for loading & dosage. Where problems occur is when a vet does not follow these standard protocol, & the pup pays the price. One last thing about these drugs, since Osa is an Atypical pup, trilostane is not an appropriate drug under most circumstances for Atypical babies as the med is known to raise the levels of the intermediate hormones.

Debbie

[tashley23]

Debbie- thanks so much! so the results I am assuming are the post results. The chart titles are: Test/Result(baseline)/Normal Range/Result(post ACTH)/Normal Range...So Yes, I gave you the post results..the baseline results were: Cortisol-24.5(normal-2.1-58.8), Progesterone-0.04(normal-0.03-0.49), Aldosterone-58.7 (normal-11-139.9)...I believe thats what you wanted. 4- Flaxseed Oil with lignans. and it actually gives the site flaxhulls.com and www.vitacost.com/nsiflaxseedlignans.com
Is there a special diet/ a good dog food that I can put osa on?
Thanks
Todd

[StarDeb55]

When it comes to diet, high protein, low fat is preferable as our Cushpups are prone to pancreatitis. The one dry kibble I can recommend that fits the bill is Evo made by Innova which I really like as it also has absolutely no grains. Evo was highly recommended by my 1st Cushpup, Barkley's oncologist while he was being treated for lymphoma, a cancer feeds on fats/carbs. There are a lot of other members who are more "up" on dietary issues than I am, as my Harley who is Atypical +PDH is an extremely picky eater. I just went through one horrible round of him refusing to eat just about anything. Have finally moved him & my other boy to Primal(brand name) raw food diet as that is the only thing I have found in a month that he is eating consistently.

Debbie

PS- Thanks for posting the "pre" values.

[Squirt's Mom]

Hi Todd,

Welcome to you and Osa! :)

On the bottom of your results sheet from UTK there should be recommendations from them as to which treatment(s) to try. Like #'s 1, 2, 4, and 5.... Those numbers at the bottom of the results sheet are what UTK thinks would be best for Osa. Are there any numbers on your sheet?

If I understand correctly, the DES helped with her peeing and drinking? Unless I'm mistaken, this is a treatment for a rarer form of diabetes called Diabetes Insipidus. (Hopefully the pros here will confirm or refute this! :o ) If this is correct, I would be sure to rule this form of diabetes out. It is not uncommon for pups to have several endocrine problems at one time - thyroid issues, diabetes, and Cushing's. So don't get focused on just one issue...be sure all other possibilities are ruled out as either the cause or as joint conditions.

One of the treatments for Atypical is considered "natural" IMHO. While melatonin is considered a drug, N-acetyl-5-methoxytryptamine, apparently an orphan drug by the FDA, the lignans are from plants, the flax plant to be exact. Compared to Lyso or Trilo, these treatments are much milder, on both pup and dad. :p

Here is a link to info on melatonin:
http://www.drugdigest.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3gXDzcPZz8fI0MLLzNjAy NzMzcfCx8zQ5MQE_1wkA6zeAMcwNFA388jPzdVvyA7rxwAsn1k PA!!/dl2/d1/L0lJSklLVUtVSklKSmdrS0NsRUtDbEVBIS9vUHd3QUFBWVFBQU VJSWdsRVU1QUFHTVlJVEVTVnBXcEtOWTFwR0EhLzRCazRSSVhl TjFnOEdqTGszYVJlaUpNbllvLVNaUHhRQ0EhIS82X0RIRkhDTk wyMThKNjMwMjc2Rkw4TDYxNFQ0LzdfREhGSENOTDIxOEo2MzAy NzZGTDhMNjE0VDMvbm9ybWFsL3ZpZXcvSV9fX18xL3NlYXJjaC 9zdGVwL3NlYXJjaER2aA!!/?searchString=melatonin&x=6&y=6&select_category=3#7_DHFHCNL218J630276FL8L614T3

My Squirt has been diagnosed with PDH and as Atypical. She just had her second UTK panel done this Wed. so I will hopefully know if the treatment is working for her. She is not on Lyso...just melatonin and lignans, tho her cortisol was elevated at one point. Melatonin has the ability to lower cortisol, tho not as much as Lyso or Trilo. In theory, it is possible for the adrenal activity involved in Atypical to cause enough physiological stress for the cortisol to elevate as well. Any stress can cause cortisol to go up. However, Osa's cortisol is pretty high so she may well have what is called true Cushing's - cortisol and intermediate/sex hormones elevated, needing combined treatment with the Lyso. FYI, Trilo is not a good option for her as it will cause these other hormones to elevate.

If you are interested in having a home made diet designed for Osa, I can recommend a couple of ladies to do that for you. With a pup who has health issues, especially multiple issues, it is best to have someone qualified design a diet specifically for Osa.

Ok, I'm through ramblin' :o ....for now anyway :p . I am really glad you and Osa found us and I hope to learn more about both of you in the future. Hang in there, you can do this. You are already off to a good start with all the testing you had done, the research you have done and by finding us. We will be with you all the way, you don't have to take this journey alone. Read all you can, ask lots of questions and we will do our best to help you understand.

Hugs,
Leslie and the girls

Some links on Atypical for you:

http://www.k9cushings.com/forum/showthread.php?t=215

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=1

http://www.vetcontact.com/en/art.php?a=132&t=

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

[StarDeb55]

I agree with Leslie about Osa's cortisol. I'm concerned that you are, indeed, dealing with probable PDH + Atypical. By any chance, did any of the vets that have seen Osa do an abdominal ultrasound to take a look at the adrenal glands?

You may have to consider using lysodren as part of Osa's treatment plan. Whether or not you would have to actually do a lyso loading, your vet will have to determine. Lysodren really isn't as scary as it sounds as I have now used it with 2 dogs with very few problems. In fact, my 1st boy was successfully treated with lyso for nearly 8 years, crossing the bridge at 15.

Debbie

[Squirt's Mom]

Hi Todd,

One word of caution about Evo...it is a very good feed, high quality, but it is also high in protein, so be sure that level of protein is ok for Osa before switching. Many, many dogs do well on Evo, tho.

If you are looking for some good commercial feeds, here are some good ones to go along with Evo....Innova, Wellness, Solid Gold, Primal, Fromm...

Here are some links on dog foods you might want to look at:

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down for Dog Food Information)

Research on dog foods
http://www.dogtorj.net/

Also, a link on food ratings:
http://www.petfoodratings.net/

http://www.geocities.com/rottndobie/wholedogjournal.html

[Kiska'smom]

Hello Todd and to your "bear!"

What a great name for a husky! I also have an eight year old husky and a nine year old Malamute. The Malamute has been diagnosed with Atypical Cushing's, and there is some question about our Husky having Cushing's. With our Husky, we are in a wait and watch pattern, as she isn't currently showing any real symptoms. Our Malamute is on a maintenance dose of Lysodren, which she tolerates very well. I have also used DES with our Husky when she went through a phase of peeing indoors. It seemed to work well for her, too. I now give her Proin 50 twice a day. So far, she hasn't needed the DES for about a year.

Both dogs are on a prescription diet that is low in fat, although Sammie (the husky) is becoming a "wide load" again. She is also taking thyroid meds, and probably needs testing again to see if her dosage needs to be increased.

It sounds as though you are doing all of the right things, and have received lots of good information from the pros here. Keep reading and posting. We're all in this together! Again, welcome!

Jeanne, Kiska, and Sammie

[ventilate]

Hi;
Just wanted to note that DES is the meds used for urinary incontenance. Nike has been on it since she was fixed when she was a pup. The meds used for Diabetes Insipidus is DDAVp or desmopressin. With DI the dog will drink a lot and pee a lot, they can not concentrate their urine, even dehydrated it is still very low specific gravity.
Good luck with the treatments.
Sharon

[tashley23]

Squirts mom- I did get numbers back from Tennssee and I listed them on my second post..so all of the treatment option considerations are listed there. DES, as ventilate said, is for incontinence and not diabeties, it only controls urination and not the actual water consumption.. Osa is no longer on DES and has only had 1 or 2 accidents in the laster 3 months.
Im sorry i must have missed something..what is PDH? Thank you again everyone! I will check out the links that you provided. What steps should I take now? I obviously want to do whats best for Osa..I am very hesitant to put her on a major prescription, but if it is best I guess I will have to..should i get the flaxseed oil? Osa has had an ultra sound and nothing was found...thats all for now.
Thank you!

[StarDeb55]

PDH is the abbreviation for pituitary dependent Cushing's. ADH would be the adrenal form.

Debbie

[Squirt's Mom]

Thanks for setting me straight on the DES! :o I feel better about that now! All these initials get confusing even after all this time...:o

Hugs,
me

[tashley23]

Hey everyone.. I have a couple of questions- can someone tell me what melatonin product I should buy for osa and how much I should give her. Second-What Flaxseeed Oil w/lignans should I buy and again what dose should she get... should I put her on these 2 and then have her tested again in a few months before puting her on Lysodren? Also, I forgot to mention, I have Osa on Dasaquin, a joint support supplement..I dont know if that changes anything..thanks for your time!
Todd

[gpgscott]

Hi Todd,

I have not heard of any of the joint supplements conflicting with other meds.

Most of us use purified flax lignans, a good source is vitacost.com and the product is NSI purified lignans in a 40mg capsule. The oils contain varying amounts of the lignans. The melatonin is just plain melatonin not the timed release variety and this can be found just about anywhere that carries vitamins. Make sure you get 3mg as there are a variety of dosage sizes.

It took several months for this treatment to begin to correct Moria's lab results and we did not have elevated cortisol.

Scott

[StarDeb55]

Just to second what Scott has already said, I use a purified lignans capsule with Harley. Most of the time, I buy melatonin at Target, sometimes the grocery store.

Debbie

[tashley23]

Osa is not a good pill eater..should I get the Flax oil? or are the pills better?

[StarDeb55]

Pills are much better as you can insure that you are giving a standardized dose of lignans every time. You can't do that with the FSO + lignans. Have you tried giving pills in a wonderful little product called Pill Pockets? There sort of like a Tootsie Roll or caramel in consistency, being either chicken or beef flavored. There is a hole in middle that you stick the pill, then pinch the hole closed. My dogs love them & they have made handing out oral medication much easier. You could also try hiding pills in a little blob of peanut butter or cream cheese.

Debbie

[Squirt's Mom]

Hi Todd,

You can just open the melatonin capsule and lignan capsule, VS oil or hulls, and put on the food. If you use kibble, dry, then give her a treat with her meals with a couple of spoonfuls of canned food that have the meds mixed in. She will think you are just wonderful! ;)

Hugs,
Leslie and the girls

[StarDeb55]

You can just open the melatonin and lignan capsule

Leslie, the way you wrote this, I'm afraid it can be interpreted to mean that melatonin & lignans are combined in a single capsule. At least, that's the way I read it when I first saw your post. I don't think you mean that, do you?

Debbie

[tashley23]

ok...I spoke with Dr. Jack Oliver from the University of Tennessee today and he told me that Osa should be getting 12mg of Melatonin a day (4 pills- 2 in the morning and 2 at night of 3mg pills).. she weighs close to 70 pounds...so I went to the health food store and bought KAL 3mg Melatonin pills..while I was at the store the women who owns the store thought that it was crazy that I was going to give Osa that much Melatonin and that I was going to be giving it to her at night..obviously she normaly is dealing with humans..but what do you think about this? Also, he said that I could wait to see how she does on this before puting her on Flax Seed Oil...any thoughts? Thanks...

[gpgscott]

Hi Todd,

Please do not rely on information dispensed by persons at healthfood stores.

A dogs metabolism varies from human. To give you an example my wife Vandy takes .075mg thryiod daily and Moria our lab requires .6mg twice daily. In addition you have a nordic, with their particular issues concerning intermediate hormones.

I suggest you stick with the recommendation from Dr. O.

You may want to confirm the dose with your Dr., but I am betting it is appropriate. Thanks for asking about it.

Scott

[tashley23]

thanks scott!

[Harley PoMMom]

Hi Todd,

Concerning the melatonin, here's a link to the treatment option sheet from the UTK. http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing's.pdf

My Harley is on melatonin, he weighs 20.8lb, he gets 3mg BID.
So according to the treatment sheet, a dog weighing >30 lb is given a total dose of 6 mg BID (BID = Twice a day).

I give Harley his first pill in the morning at 5 am and his second pill in the evening at 5 pm, trying to stay 12 hours apart.

I got the "look" too when I purchased the melatonin and told them it was for my dog.:D

Take care,
Lori

[Kiska'smom]

Hi Todd,

Kiska takes 9mg of melatonin twice a day, per Dr. O's recommendation. She's never had any trouble with this large dose. I'm sure that I would be comatose, but she's fine!

Hugs,

Jeanne, Kiska, and Sammie

[tashley23]

Thanks for all of the melatonin info!! I have ben out of town for a few days - thats why I didn't thank you all before... I started Osa on the melatonin on monday..Hopefully there will be some results in the next few weeks. Thanks agian!

[Harley PoMMom]

Hi Todd,

It may take a couple of months before you see any cush-symptoms subside with this type of treatment, Harley is on melatonin and lignans and Dr. Oliver said to give him at least 2-3 months to see results, but all dog are different!.

So don't fret and hang in there, we're here for you and Osa, and let us know how Osa is making out.

Give belly rubs to Osa from Harley and me.
Lori

[tashley23]

Hi Squirts mom - a few weeks back you mentioned that you knew people that designed diets for dogs..it that expensive? I would be very interested...
thanks

[Squirt's Mom]

Hi Todd,

Good to hear from you again! :) How are things going with Osa?

Here are links to those I spoke about who can help you with her diet:

Catherine Lane
http://www.thepossiblecanine.com/

Monica Segal
http://www.monicasegal.com/

Catherine is a Nutritional Consultant, Moncia is a Nutritionist; the difference being Monica's degree is in Veterinary Nutrition, Catherine's is not via veterinary school. Both ladies have years of education and experience behind them and either would do a good job for Osa. They will design a diet that is specific to Osa. Both take a holistic, or whole dog, approach.

The cost varies as does what that cost covers with each lady. Catherine is who I work with and my cost was reduced since I am a student, but I would think the range for both would be something like $200-400. Squirt's plan includes at least two menus she can and will eat, and that keep or improve her current physical state including lab work. The menus include detailed analysis of the food and simple directions for prep and storage. There is much more info provided as well. Cat is open to any and all discussion concerning her diet and health. I am sure Monica will have something similar to offer.

You can contact them and talk to them about what they can do for Osa then decide which way is best for ya'll. There are others out there as well, but these are the two I know and respect. If you look further, be sure to check their credentials.

Good luck!
Hugs,
Leslie and the girls

[Tamarah]

Todd -

I'm a little behind the times, but welcome to you and Osa. How are you and Osa doing this morning? I have just read through all of your posts and one thing that caught my eye was your mention of KAL melatonin from the health food store. I have an atypical cushpup myself and started Crash on KAL melatonin from the health food store - 6 mg twice a day and he's only 34 pounds - and yes the women helping me thought that was way too much also. I worried and Scott told me the same thing as he did you about people at health food stores - it's true - they don't always understand how dog's metabolism is different. Anyway, the reason for my post to you is to have you check the label on your melatonin. As I said earlier I was giving Crash KAL melatonin and about three months into treatment when I was questioning using flax hulls instead of FSO and I took a good look at the melatonin bottle and the label said fast acting. Confused and worried that I did the wrong thing I called my vet and Crash being his first atypical cushings case he put an email into Dr. Oliver to clarify. So, long story short, check the label to see if it says fast acting melatonin. It was all my health food store had and since then I have found regular melatonin at Walgreens.

The Cushings world is quite a journey as you well know by now. This forum is a well of information and support like no other. :) :) Lots of wonderful, knowledgeable people here to help you through. They're amazing and have surely helped me cope with all this!

Best wishes and let us know how you and Osa are doing.

Tammy, Crash, and Darby