Zoe By My Side- Our Journey with Cushings

Hi, my name is Addy and I have two dogs Zoe and Koko. Zoe may have Cushings and I need advice. Here is the long history. I am at work so won't be able to post again for 5 hours. Thank you.

Rescued Zoe, a Lhasa Apso, on 4/17/07 from animal control. She weighed 19 pounds and was 11” high at the shoulder. Probable age 5 years but not sure. Put her on Canidae all stages dog food. Had a bit of a touchy stomach. New food gave her soft stools. Only other problems were reverse sneezing and paw chewing.

August 08 brought home nine month old male dog from animal control. Zoe hurt her paw and had trouble walking, took her to emergency before picking up new dog. Thought it was just strained, rest and pain killers. Saw regular vet, gave her Rimadyl. Had bad reaction to drug. Could hardly stand up. Lots of stress in house with new dog who is sick with kennel cough. Then Zoe ate something in the park, her Canidae formula changed unbeknown to me. Got diarrhea. Vet put her on flaygl and canned Hill’s ID. Told me to pick out new food and transition. Should not be a problem. Was a problem, could never get her off the canned ID. Sometimes even one piece of kibble would cause water stool. Had to supplement canned ID with rice and pumpkin. All blood work normal back then.

April 09 both dogs had vomiting and diarrhea. Put Zoe back on Flaygl but stools never got to be 100%. Went to new vet, blood work again normal. Gave me more Flaygl and Panacur. Two months later went to holistic vet also trained in western medicine and asked for help. She thought Zoe had stress colitis. She did thyroid panel sent to Michigan State. Said Zoe was in the low range, treatment not recommended. However, she wanted to try a glandular thyroid drug called Armour. She put Zoe on a raw commercial diet, Shen Calmer and Armour along with Culturelle probiotic. Zoe went on new diet cold turkey. She said I went too slow trying to transition, and had me journal. We went up and down with water stool but most days she only had one small stool a day. Energy level went up, she lost weight, sore paw was better. She ran into trouble a few months later, put her on Flaygl. Tapered her off it according to new vet, added some Honest Kitchen to her diet and a miracle happened. Zoe was normal again and stayed that way all last winter until we took her to groomers in February. Noticed her coat was very thin after the groom, like she lost her undercoat.

March 10 went back to holistic vet, asked to take Zoe off Armour, I had read drug had been reformulated in Spring of 09 and humans were complaining of hair loss as a new side effect. Thought it was affecting her coat. Thought she may also may a urinary infection as has been licking her potty since last August. She said do urine test for Cushings. Also did panel for thyroid but only checked Free T4 and T3, not full panel. Test came back that Armour really wasn’t affecting her levels, said ok to stop it but that Urine Creatinine test came back positive with very high numbers and she said dogs with that high of numbers always have Cushings, wants to do low dose dex test. She is already picking out what drug to use. I told her I did not even collect urine specimen correctly, no one told me it had to be first urine of the day. Zoe had eaten breakfast, drank water, went for a walk, urinated a few times and then I took the specimen around 10:30am. She is very reactive on walks. She said that did not matter and Zoe had to have Cushings drugs or her hair would all fall out in 2 months. Told vet she would be too stressed all day to stay in c:confused:age at vets and worried it would not be accurate test. Vet said stress would not affect the test.

Everything I read tells me the opposite of what this vet says. HELP! She has no other symptoms except a poor coat. She hasn’t even had a physical exam. If I post her test numbers could anyone give opinion? I feel like I need to start all over with blood work, exam, chemistry panel, etc before testing again for Cushings.

Quote:

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Originally Posted by addy

said ok to stop it but that Urine Creatinine test came back positive with very high numbers and she said dogs with that high of numbers always have Cushings, wants to do low dose dex test. She is already picking out what drug to use. I told her I did not even collect urine specimen correctly, no one told me it had to be first urine of the day. Zoe had eaten breakfast, drank water, went for a walk, urinated a few times and then I took the specimen around 10:30am. She is very reactive on walks. She said that did not matter and Zoe had to have Cushings drugs or her hair would all fall out in 2 months. Told vet she would be too stressed all day to stay in c:confused:age at vets and worried it would not be accurate test. Vet said stress would not affect the test.

Everything I read tells me the opposite of what this vet says. HELP! She has no other symptoms except a poor coat. She hasn’t even had a physical exam. If I post her test numbers could anyone give opinion? I feel like I need to start all over with blood work, exam, chemistry panel, etc before testing again for Cushings.

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Hi and welcome -

Well, here come the questions - pretty standard for new members so bear with us. Can you post the results of the urine cortisol:creatinine ratio test. That test will rule out cushings if it is negative. However, a positive result just means that you need to do more testing to confirm cushings and your vet is suggesting the LDDS (low dose dex test) next, it sounds like. (That might be premature . . . has general bloodwork been done yet?) I suspect you are still a long way from a firm cushings dx. And you are also right . . . more definitive testing is probably in Zoe's future.

Cush dogs will usually have certain elevated enzymes. If bloodwork has been done, then also please post anything that was high or low - out of normal range. (If you didn't have copies of all her test results, start asking for them and keeping a file.) You are also right that stress can skew a dog's cortisol levels on testing. With Zoe having few symptoms, there are other possibilities besides cushings. Hypothyroidism can cause coat issues as can atypical cushings. It could be any number of things. But do give us whatever details you can. Zoe's weight, age, other meds, recent test results, other suspect symptoms - if there are any. Cush pups usually have a voracious appetite and thirst (causing excessive urination), those elev. liver enzymes, are prone to infecctions, weakness in legs, poor coat, muscle wasting, some have skin issues. Not all cush dogs have all the symptoms, and some will only present with a few - but they can mimic the symptoms of several other conditions, which is why it's not always easy to diagnose. Do check out our resource section and start reading as much as you can. You'll get lots of pointers here on what to ask your vet but we do need more info from you. ;);) Sue

I am so sorry that Zoe has been having so many issues, but welcome both of you to our group. I will warn you that we tend to ask a lot of questions of new members but that simply helps us to give you the best advice possible from the group's collective experience. From your post, it's not clear as to which vet is in the rush to test/treat for Cushing's, is it the holistic vet or regular vet? You are correct about the way you collected the urine not being ideal. Was the urine test a urine cortisol:creatinine ratio? If it was simply a urine creatinine, that will tell you nothing about Cushing's. High levels of stress with a vet visit can certainly affect a low dose dex test. A lot of members who have dogs who stress at the vets will take the dog with them during the 4 hours between blood draws, go to the park, go home, whatever you want to do as this will lower the stress levels.

Is the hair loss, poor coat condition the only symptom that Zoe has? Some of the other symptoms can include excess drinking & urination, pot belly, muscle wasting especially in the rear end, & an absolutely voracious appetite. We can most definitely help you understand the labwork that Zoe has had done already. In fact, I'm a medical lab tech with 30+ years experience. If Zoe has had something like a senior wellness panel or super chemistry panel, could you please post only the abnormal results, along with the normal ranges, & reporting units.

When it comes to the low dose dex test (LDDS), this test is considered to be the gold standard to diagnose Cushing's, but it has one big drawback as it can give a false positive result in the presence of non-adrenal illness such as diabetes or thyroid. This is why it's very important to get these other 2 medical issues ruled out. It is also crucial to get a positive LDDS results confirmed by a 2nd test, usually an abdominal ultrasound.

Looking forward to hearing more.

Debbie

PS-I see Sue was posting at the same time, so sorry for any duplication.

Hi Addy,
Just wanted to chime in and welcome you and Zoe. You have been well advised and we are looking forward to the details of testing. Don't let any vet push you into treatment until there has been a proper and thorough diagnosis. Also find out if your vet has had experience treating a cush pup. Sometimes we find that you can get to the bottom of some of these mysteries by consulting with an Internal Medicine Specialist.

i am very new at this, in fact, just found out that my dog probably threw a false positive. he saw an internal med specialist yesterday that said absolutely, stress can make a difference in the test results. my dog had a low dose dex test and was extremely agitated at the vet's that day. he pooped his run; ran around in it and painted the walls. i cried and worried for 5 days that he had an adrenal tumor.
maybe your vet could refer you to a specialist, as well. they could look at the bloodwork, etc. you have already had done and give an informed opinion.

Thanks to all of you for responding. Latest test
Michigan State-4/13/10
Urine Cortisol 422
Urine Creatinine 4.0
Urine Cortsol/Creatinine Ratio 106 H ref range 8-24
Total Thyroxine TT4 27 ref range 15-67
Total Triiodothyronine TT3 1.1 ref range 1.0-2.5
Free Thyroxine Ft4 9 ref range 8-26
Free Triiodothyorine FT3 2.5 L ref range 4.5 -12
Thyroid Stimulating Hormone 7 ref range 0-37

she was taking Armour Thyroid (glandular) 30 mgs 2 times a day for 7 months.

Original thyroid panel 8/21/09

Total Thyroxine TT4 17 ref range 15-67
Total Triiodothyronine TT3 .9 L ref range 1.0-2.5
Free Thyroxine Ft4 13 ref range 8-26
Free Triiodothyorine FT3 1.2 L ref range 4.5 -12
Thyroid Stimulating Hormone 12 ref range 0-37

Zoe is possibly 8 years old, could be older. She currently weighs 18.5 pounds. I measured her water intake, does not even drink average amount, she finishes her food in the same amount of time as my other dog, she begs for food the same as my other dog, they are clicker trained with food, her stomach seems different than younger dog but I don't think it looks like the pictures. She jumps on the bed just fine. I see no other symptoms. She has gained one pound since I weaned her off the Armour. I started that process one month ago and she has been 100% off for 2.5 weeks. I was worried the drug was making her hyperthyroid or causing the hair loss.

here is the thing, she got into a plastic bag with turkey in it and ate some of the plastic and had a bout of diarreha 2 weeks before the test. I gave her Flaygl to stop the inflammation caused by the plastic. That plus not collecting the urine correctly makes me doubt the validity of the urine test and since I feel we have not been taking a detailed approach, I don't trust the validity of the low dose dex test when I know how badly stressed Zoe will be. When she went for her dental they had to put a towel over her head to even get her in the crate.

I have been misdiagnosed by the human medical community, over dosed on drugs I should never have been given. I am cautious of any doctor or vet.

We have only one internist in town that I can find. I don't know how good she is.

I feel I need to start with a chemistry panel, complete blood count, urinalysis and a physical exam. I don't care if I have to pay all over again. I just need to know I am doing right by my Zoe. I do NOT want the holistic vet to do these tests as she already has made up her mind on the diagnosis.

Am I just putting my head in the sand? Am I just afraid to see what is in front of me? My gut is telling me to start over. I do not feel good about this test the holistic vet wants to do. I want to start at the beginning which is what I keep reading to do.

Thank you. Some times my brain is going faster than I can type

First of all, please don't let any vet rush you into treatment. Cushing's is a slowly progressing disease, literally taking years to do its damage to a pup's internal organs. You need to take the time to learn & educate yourself about the disease, including such issues a diagnostic testing medication, & monitoring tests for either medication that is used to treat, trilostane or lysodren. You also need a vet that is willing to work with you as a team for Zoe's best interests. A vet who is willing to listen to your concerns, & answer any & all questions.

Now, the Urine creatinine cortisol ratio (UCCR) does, indeed, point the finger towards Cushing's. I must stress that a positive UCCR test simply indicates that Cushing's is a possibility, but further testing is required. If I were in your shoes, I would be really concerned about letting this vet rush me into treatment. I think it would be in Zoe's best interest to ask for a referral to an internal medicine specialist as a large number of general practice vets, simply do not have the in depth knowledge required to accurately diagnose & treat Cushing's. If you have copies of the general labwork that has already been done on Zoe, as I said earlier, if you will post the abnormal results, I can take a look at them, & see if there is anything else that might point toward Cushing's. Most cushpups have abnormal liver function test results, so I would be especially interested in seeing those results. I don't think it would be necessary to repeat the general labwork. Get that referral to a specialist, & you can take all of Zoe's records with you for their review, letting them decide on how to proceed.

One last thing, a Cushing's savy vet usually will not treat a pup who doesn't have strong symptoms. Monitoring a change in symptoms is one of the primary ways of determining how a pup is responding to the medication.

Debbie

Thank you Debbie. The problem is the blood work is one to two years old and I am afraid may be irrelevant. I could get the 2 year old blood work but last year's test was done by a very stange vet. He was so odd, I really don't want to call there. He claimed to know Zoe and said he treated her as a puppy. I found the whole visit extremely uncomfortable. That is why I moved on to the holistic vet. She was recommended by a friend.

Do I have to have a referral to an internist? One cannot just make an appointment?

Also, is it better to just present Zoe with her hair loss and let the internist start from scratch or tell her about the Cushings link? I have found with human doctors, they seem to dwell on the previous diagnosis and let it influence them.

I am trying to read all I can. I am not retaining alot at the moment, I am too upset, I think. I am afraid of the drugs but I know that seems to be a common reaction. I certainly won't give them to Zoe if I could not even tell if they were working that was one of my concerns. How would I know? I was looking at the melitonan and flax hull treatments, wondering about that.

Could the hair problem be from her diet? Will her hair really fall out in 2 months? Why would the vet want to scare me like that? Are her numbers that bad?

I am like everyone else. Zoe is my life. All I have done for 3 years is try to help this little dog. I leave and breath Zoe 24 hours a day, seven days a week.

Thanks again.
Addy, Zoe and Koko's Mom

Hi All,

I have been in the process of waiting six weeks after the withdrawal of the USP thyroid medication-brand named Armour-natural glandular product. We see the internist tomorrow. Zoe's hair is starting to grow back-so much for her vet saying it would all fall out in 2 months because of her possible Cushings diagnosis. One thing I was not expecting was to see a flare up of her colitis. Has anyone experienced loose stools after withdrawing thyroid meds? Perhaps it is unrelated but I sure had hoped I would not have to focus on her colitis tomorrow with the internist. Zoe was being treated for hypothyroidism because her numbers were on the low side, although Michigan State did not recommend treatment. Her hair started thinning and her tail started looking bad after a groom in February. She then had urine cortisol - ceatinine ratio that showed 104. I did not collect urine correctly and suspected a false positive. She had a colitis flare up going on then as well. I don't think it ever resolved. With so much going on I am worried which way the internist will approach and I want to be thorough. Any suggestions?

Thanks for your help. Hopefully I explained everything. Wasn't sure if you needed by previous post so started a new one. let me know the proper way to do it.

Thanks,
Addy
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Moderator note: Addy, we have merged this post (originally posted in the "How to and Comments" Forum) with your original thread here in the Questions and Discussions Forum. We like to keep all posts about each specific dog in one single topic, so that we can easily look back through the topic to see what was posted about them previously. It's just easier for everyone that way! :)

Hi Addy here,

I first posted probably 3 months ago but had to wait for testing further. I have also cried for 3 months while waiting and today I am falling apart after speaking to internist last night. I need to get it together but it is so hard. What does it mean when they have not just high cortisol but four other hormones high?

Finally have results back so started new post. Original Urine creatine test was 106. History is on first post but thought I should start new one now with all the test results. New tests done through internist.

Does she fit diagnosis? Do I treat the symptoms or the diagnosis? UTK says lysoderm so does internist. I don't know what to do. Lhasa apso maybe 8 yrs old but unknown, has been with us for 3 years, came from Animal Control. on raw commerical diet for 1 year
Blood work does not seem what it should be for Cushing dog, why is Platlet so high?

symptoms: thinning skin on belly, thinning hair, rats tail, exercise intolerance, back legs getting stiff, water intake below normal, food intake- eats as fast as other dog, begs the same, wants to lick EVERYTHING and chew alot on her Kong, does seem hungrier since starting raw diet, not as active, does not do well in heat, only pants when colitis is bothering here and has bad poops, on Shen calmer, was taking armour thyroid natural glandular product and was taken off drug when I noted thinning hair. thyroid tests from Michigan test did not indicate thyroid treatment but she was on the low side so vet tried it. Needs Flagyl frequently for chronic diahrrea and vet wants her on it to maintain stools so has been taking 125mgs 1 time, every other day for 3 weeks. Helps her.

ultra sound- adrena glands larger than normal with one being slightly larger- nothing of signifigance with other organs

cbc, gastro panel from texas state, urinalysis, serum chenistry, full adrenal panel utk, acth test to UTK

SubTest Name Normal Values Results
SP-TY Collection Method Cysto
Hyl None Seen None Seen NORM
Fine None Seen See Notes ABNORM
Coarse None Seen None Seen NORM
Renal Epi Casts None Seen None Seen NORM
WBC None Seen
RBC None Seen
Squam None Seen See Notes ABNORM
Mucus None Seen None Seen NORM
Bacti None Seen None Seen NORM
Urinalysis-Microscopic Thu, 5 /27/2010 11:23 AM
Results/Comments
Fine: Rare/LPF
WBC: Rare/HPF
RBC: Rare/HPF
Squam: Rare/HPF
Vol: <5
Amorphous: None seen
SubTest Name Normal Values Results
Glucose 74 - 145 mg/dL 88 NORM
AST(GOT) 13 - 81 U/L 18 NORM
ALT(GPT) 14 - 151 IU 46 NORM
Alk.P.Tase 13 - 289 IU 325 HIGH
Total Bilirubin .1 - .5 mg/dL 0.1 NORM
Cholesterol 98 - 300 mg/dL 503 HIGH
Total Protein 5 - 8.3 g/dL 6.2 NORM
Albumin 2.6 - 4 g/dl 3.5 NORM
Globulin 2.7 - 4.4 2.7 NORM
Urea N 8 - 30 mg/dL 15 NORM
Creatinine .5 - 2 mg/dL 0.6 NORM
Phosphorous 2.5 - 7.9 mg/dL 3.4 NORM
Calcium 8.7 - 12 mg/dl 9.7 NORM
Sodium 141 - 159 mmol/L 149 NORM
Potassium 3.4 - 5.6 mmol/L 4.4 NORM
Chloride 100 - 118 mmol/L 107 NORM
Bicarbonate 16 - 31 mmol/L 23 NORM
Anion Gap 15 - 25 mmol/L 23 NORM
GGT 3 - 19 U/L 9 NORM
A/G Ratio 1.3
Animal Profile 1 Thu, 5 /27/2010 11:24 AM
Results/Comments
No significant hemolysis or lipemia present.

SubTest Name Normal Values Results
Red Blood Cell Count 4.48 - 8.53 M/ul 7.50 NORM
Hemoglobin 10.5 - 20.1 g/dl 18.0 NORM
Hematocrit 33 - 58.7 40 53.5 NORM
Mean Corpuscular Volume 63 - 78.3 fL 71.3 NORM
Mean Corpuscular Hemoglobin 21 - 27 pg 23.9 NORM
Mean Corpuscular Hgb Conc. 30.8 - 35.9 g/dL 33.6 NORM
Red Cell Distribution Width 11.9 - 18.1 % 15.7 NORM
Platelet Count 140 - 540 K/ul 589 HIGH
White Blood Cell Count 4 - 18.2 x 10^3/ul 5.4 NORM
Seg. Neutrophil Absolute # 2.5 - 15.7 x 10^3/ul 4.05 NORM
Band Neutrophil Absolute # 0 - .2 x 10^3/ul 0.11 NORM
Lymphocyte Absolute # .3 - 3.9 x 10^3/ul 1.08 NORM
Act Lymphocyte Absolute # 0 - .9 x 10^3/ul
Monocyte Absolute # 0 - 1.4 x 10^3/ul 0.16 NORM
Eosinophil Absolute # 0 - 1.3 x 10^3/ul
Basophil Absolute # 0 - .1 x 10^3/ul
Other Absolute # 0 - 0 x 10^3/ul
Blast Absolute # 0 - 0 x 10^3/ul
Promyelocyte Absolute # 0 - 0 x 10^3/ul
Myelocyte Absolute # 0 - 0 x 10^3/ul
Metamyelocyte Absolute # 0 - 0 x 10^3/ul
Hemogram Thu, 5 /27/2010 11:24 AM
SubTest Name Normal Values Results
Segmented Neutrophils % 75
Band Neutrophils % 2
Lymphocytes % 20
Activated Lymphocytes %
Monocytes % 3
Eosinophils %
Basophils %

SubTest Name Normal Values Results
Folate 11.3
Serum Cobalamin (Vit B12) 962
TX AM B12/Folate Thu, 5 /27/2010 11:26 AM
Results/Comments
Normal Ranges:
Folate Fasting: 7.7-24.4 ug/L
Serum Cobalamin: 251-908 ng/L
Printed on: 6/17/10 at 9:09 PM *VL1 3
UT Adrenal Panel Thu, 5 /27/2010 11:27 AM
Results/Comments
Endocrinology Lab Case# EN 10-4088
Test: Result: Normal Range** Result Normal Range**
(post ACTH)
Cortisol ng/ml 47.7 2.1-58.8 304.4* 65.0-174.6
Androstenedione ng/ml 1.05* 0.05-0.57 7.69* 0.27-3.97
Estradiol pg/ml 114.8* 30.8-69.9 102.2* 27.9-69.2
Progesterone ng/ml 0.99 0.3-0.49 5.91* 0.10-1.50
17 OH Progesterone ng/ml 1.18* 0.08-0.77 20.33* 0.40-1.62
Aldosterone pg/ml *** 33.9 11-139.9 357.1 72.9-398.5
* Above or below reference range
** Mean normal range values for spayed female dogs (N=36). QNS = Insufficient sample.
*** Normal range values for male and female dogs (N=72 baseline, N=23 post-ACTH.
These results indicate presence of increased adrenal activity. (SIGNIFICANT)
Comments: Values are increased as indicated.

I have had no sleep so I hope I did this all correctly. Is it too much info?

Thank you all so much.

Moderator's Note: Addy, I have merged your new thread with Zoe's test results into Zoe's original thread. We prefer to keep all posts on a pup in a single thread as it makes it much easier for other members to refer back to the pup's history, if needed.

Debbie

Dear Addy, I am new to this also. My vet /acupuncture/holistic referred me to a specialist in endocrinology. Told me to get these tests.
ACTH Stim Test
Blood pressure
Urinalysis-Antec
Urine Culture MIC
full blood panel.
The senior members can best help you. Also read up on the caine Cushing the resources . Don't just jump into the treatment. Hang in there. Ask questions and get info.
Sonja and my little Apollo.

this is a link to looking up a specialist in your area
http://www.acvim.org/websites/acvim/index.php?p=3

Addy, Usually Dr. Oliver from the Univ of TN writes a report with the dx and the recommendations at the bottom of the report. Can you type that if you have it?

I can answer some of your questions. It is common to have multiple hormones elevated in cush dogs and the lysodren should help that. That is why lysodren is being recommended for treatment. I used it on my dog Haley. She was 12 1/2 when diagnosed and she just passed on 5/22 at the age of 16 1/2 so you can see the drug does work!

Not all dogs have all symptoms. The ones you describe,except the diarrhea, are all signs of cushings.

My concern would be the diarrhea. I would email Dr Oliver (nice guy, he'll read it and respond!) since he is THE GUY regarding this test. Tell him about the diarrhea issues. I wouldn't treat the cushings until I figured out what is causing the diarrhea and try to get her stools normal. (I know you have done alot already)

I also noticed the cholesterol was high. Did he mention this in his report?

Cushings is NOT a death sentence. And it does NOT need to be treated right away. I would continue to focus on the diarrhea. Has anyone ever mentioned Tylan to you? It is a powder antibiotic used to treat poultry I believe. It is not approved by the FDA for use by dogs however many vets recommend it. Just google it and read what many others are saying. You'll see that it is just a powder that you mix with food in very small quantities. I couldn't believe what I read about it. Very positive reviews.

Glad you found us. Keep us posted. Kim

Hi Addy,

I am not an expert, but I just wanted to wish you and Zoe well on this journey. I have just started lysodrene therapy (yesterday) with my Great Pyrenees Sonoma, and I know what it's like -- all the ups and downs and frustrations. I have spent several thousand dollars on tests and medicine and special food, but more importantly, known the fear and frustration, along with subjecting my poor pooch to all these tests, all before a diagnosis was even given.

This therapy procedure is terrifying to me, the icing on top of a very stressful time in my life apart from my pet's issues.

I'll be sure to add anything if I discover any helpful tips during this next week. The posters here are amazing, much better than the myriad of vets I have consulted.

Take care and try to get some rest! Things are always worse on no sleep.

Karin

Right now the chronic loose stools bother Zoe and me more than ehr Cushing symptoms but we have tried to fix this for 2 years. We get better and then in Spring it all gets worse. She always tests out normal for her stool problem. Internist thinks the lysoderm may fix the problem. I read it can make it worse or better depending. Seems like stress colitis, she is afraid of thunder storms and has dietary indiscretion, she eats something in the grass and I can never see what it is, I know she likes crabapples and bunny poop. She was doing better for 3 weeks on the Flagyl and now since I am trying to get her off the Shen Calmer and she ate something in the grass again, she is worse. I hate to up the flyagl again to 2 x a day. Vet suggest Hill's W/D at first but no way do I want to feed that to a Cush dog. Am I being too stubborn? Now vet says don't change food if we are going to treat Cushings as too many changes muddy the waters.

Has anyone had loose stools that got better with lysoderm?

I am at my wits end. I will try to get Dr. Oliver's last page, not sure why vet did not include it but she was working late and nice to call me after hours and talk for an hour.

Also, she said she won't give me prednisone to have on hand. She said she would start on a low dose and it there was a bad reaction, she needs to come in and be seen because if it is that she can't tolerate the drug verses in crisis they need to know as I should not give prednisone if it is drug intolerance it would make it worse. They are emergency center 10 minutes away, open 24/7. Does this sound right?

Addy, Yes, do get the recommendations from Dr Oliver. I repeat, I would email him directly to ask some questions - Assuming that Dr Oliver recommended lysodren therapy I would make sure he is aware of the chronic loose stool symptom. The reason is because diarrhea and vomiting are signs that a dog has too much lysodren. So if you go into this with diarrhea you will not necessarily know if it is from too much lysodren or not.

That is why I suggested focusing on that first. I would be interested in Dr Oliver's take on this.

Regarding the prednisone, alot of vets are not aware that a dog can go seriously low (cortisol) using trilostane. Read Lulusdad's thread (went too low late on a Saturday night and had to go to the ER) and Apollo's thread where we are having the same discussion here:

http://www.k9cushings.com/forum/show...=2220&page=11-

It is easy to say, drive on in but it is much easier to have it on hand. And it can save you an ER bill. Better safe than sorry.

Don't know if you saw my mention re Tylan - I have never used it but I read such incredible testimonies from people who had been struggling with digestive issues for a long period of time and had tried many many kinds of antibiotics, etc. It is worth a few minutes of google research.

Hang in there! Kim

Addy - hi again.

Based on Zoe's test results, it does appear that lysodren would be the best drug. For both the excess cortisol and all of those other hormone(with the possible exception of estradiol) that were out of range on the UTK panel. (Trilostane, on the other hand, can cause some of those secondary hormones to rise over time, and most of Zoe's are already out of range.)

I agree with Kim on the diarrhea and not starting the lysodren until that is sorted out. It is NOT a cushings symptom and will make it harder to tell when Zoe is loaded (as soft stools/diarrhea are some of the signs of too much lysodren.)

However, I did notice that your Zoe's folate/B12 test showed that the latter was elevated. The folate/B12 test is used to diagnose small intestinal bacterial overrgrowth (or SIBO). My Zoe also had that test and her B12 was ok but her folate was out of normal range. And that was what led us to try tylan on her (the drug Kim mentioned.) Not sure but I think usually, both are out of range in SIBO, but I was so desperate to 'fix' the problem that our IMS thought it was worth a try. I had just always figured Zo's intestinal issues were IBD - as an u/s showed that evidence. However, with her there was apparently more going on, higher up in the intestinal tract (the small intestine.) And the tylan did do the trick.

So as Kim said, if you google tylan (or tylosin), you will find that it is used with good success in treating dogs with diarrhea and similar intestinal problems. Zoe's symptoms were soft stools, sometimes diarrhea, and really horrific gas. The drug is a fairly safe and inexpensive antibiotic, especially if you order the powder online and fill empty gel capsules (available at any health food store.) You wouldn't need an rx by doing it that way (as its sold to farmers for use in chicken and bee populations) but you would need your vet to figure out the right dose for Zoe. That just might do the trick for the diarrhea. I'd say it's well worth discussing with your vet before you start the cushings treatment. If your vet is unfamiliar with it, print out the info and take it with you to discuss. I may have saved some of my bookmarked links about tylan so will check and let you know.

The only other thing is the prednisone. I think, especially with lyosdren, having some on hand is important. Dogs can drop too low at all hours of the day, night, week, weekend. I guess having an emergency clinic close by is a plus, but again, taking them there after hours can get real pricey. Sue

Thank you all. I did google tylon and internist mentioned that was an option but since Zoe had been responding to Flaygl and I was used to it she said let's continue with it and it was fine until Friday night. But Friday I tried to again cut back on Shen Calmer and we had thunderstorms and company so maybe she got at something and the 2 combos sent her over the edge. Yesterday she was at the groomers so who knows what happened there and today soft mush stools continue even with Flaygy once a day. So maybe we need to switch and try Tylan. I will call her. I emailed a request to her for Dr. Oliver's last page and will follow up with a phone call tomorrow. Once I have that I will email Dr. Oliver.

Internist said since Zoe responds to antibiotic treatment she felt it was bacterial overgrowth but she thought it might go away once we start treatment. I did read somewhere that it does sometimes happen but I also know lysoderm causes loose stools so I am worried about starting it.

I guess at this point the prednisone is not an issue because I really need stool problem fixed first. I was just trying to get a feel for your thought on how accurate she is. Trying to assess her experience I guess.

I really think some of Zoe's loose stools are from stress as well, but I wanted her off the Shen Calmer in case we tried melitonin and because noone can tell me how Shen Calmer works and the ingredients are in Chinese and holistic vet says, oh no problem but she is not always thorough and I am super parinoid now.

Thanks for letting me ramble and vent. My Zoe is my heart and soul and I feel like I am loosing both. Too much stress, maybe I should use her Shen Calmer. (My attempt at humor while I cry)

Should we change my thread title? We know now it is real diagnosis.

Andy and Zoe , what a sweetheart your little one is. This is tough. Glad to be of support. The senior members can be very helpful. Most importantly you should not be afraid to speak up for Zoe, if you have questions are not sure of what ever do not hesitate to ask your vet.

this website shows the ingredients on the bottom but think in Chinese,
maybe this might help

http://www.euroherbsshop.nl/shen-cal...301300520b5ae6

The input on this site is supportive. There is a lot of knowledge and experience here. I am just starting.

Today I found the courage to email Dr. Oliver and I received an auto reply he is out of the office until July 6th.

Current thinking:

If Zoe needs Shen Calmer for her anxiety could I not replace it with melatonin? I read there is some thought it helps fear of thunderstorms. Would that not also possibly help her coat? If the flax hull lignans are a laxative could they work like pumpkin and pysillium and possible be a fiber that could absorb water in Zoe and possibly help her stools if we find the right doseage?

If the tylon is an antibiotic with anti inflammatory properties and leaves the body through the kidneys, I would not need to worry about Zoe's liver as with the metronidazole which leaves the body through the liver.

Diet- Cushing dogs need high quality protein with low fat and low fiber and should not eat raw? Zoe is on commerical raw turkey with minimum 16% fat and her tablespoon on Embark has flax in it. Will that be too much flax? She only gets 1/8 cup of the Embark per dayand flax is the second ingredient.

Also, if Zoe has "kind of sort of Sibo" is thay why she has such a sensitive stomach and has so much trouble eating new things?

How come all her blood work and urine tests look so normal except for the colestoral which is the same as it was 2 years ago. I mean her alk phos is above normal but with her on going colitis issues, could that not be from her gastro stuff? Am I not reading her tests correctly?

Just throwing all of this out there in case someone may have answers.

Feeling much calmer since I know I have this group to turn to. Thanks guys!!!!!!!

Addy

Addy,

Ironically I mentioned the tylan and within days I had to buy it for my gal Annie who was just diagnosed with bacterial overgrowth. :eek: She doesn't have diarrhea - she won't eat. I've been giving her anti nausea pills and that got her eating. Now I'm giving tylan to give her relief. She must have cramping and internal gas because other than a bit of growling in her tummy for a few days I didn't notice anything.

Anyway - I cannot treat the cushings until this is done either. So I understand your situation. Hang in there - we can lick this thing. :) Kim

Hi Addy,

My boy Harley was scared of thunderstorms until he started taking the melatonin, now he's no longer bothered by them :) According to the Treatment Option Considerations Sheet:

Quote:

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Typically, a dose of 3 mg is given q12hrs (BID) for dogs <30 lbs;

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http://www.vet.utk.edu/diagnostic/en...ings201005.pdf

Harley gets 3mg twice a day (BID). When buying melatonin, you want just the regular melatonin...not the rapid-releasing or fast-acting kind.

Harley takes the flax hulls with lignans also. The lignans that Harley takes are high in fiber and since he has such an elevation in the estradiol hormone I was giving him a little more than what the UTK Treatment Option Sheet recommended. With Zoe having some issues with new food tho, I think I would slowly introduce the flax hull lignans over time.

Her elevated ALP could possibly be from the gastro stuff or it could be from the elevated estradiol and cortisol or the combination of all of them. This only means that her liver is having to work harder, there's no real harm done, ok? Many of us do give our pups some kind of liver supplement like milk thistle or denamarin...ask your IMS about this.

Hope this helps.

Love and hugs,
Lori

Thanks for the input. It seems like July 6th is so far away!!!

I am continuing the metronidazile until I get Zoe off the Shen Calmer so I am able to see what is happening without starting something new. I am keeping her on 125mgs 1 x per day. The weaning off Shen Calmer is taking longer than I expected, we are having storms almost everyday and it seemed like whenever I try to ielliminate the pm dose of Shen Calmer, her poops get bad. So internist said give metronidazole every day or 2 times a day if storms are bad.

Any thoughts about weaning her off Shen Calmer? I tend to be too conservative which will make me go slow but she has been on it since last August at different doseages. I have her down to 1/8 teaspoon 2 x per day and 2 days ago again tried to cut pm dose to 1/16 teaspoons hopefully for 3 days and then get rid of it.

I bought 1 milligram melitonin (regular) yesterday. Maybe I should just make the switch? He current vet IMS doesn't know anything about Shen Calmer. Should I start at 1mg or do the 3mgs right away?

Appreciate any input. Like I said, I start things small and go very slowly, sometimes too conservative.

Lori-where do you purchase your lignans, what brand are they?

Can she be on the melitonan and lignans prior to loading in August? maybe I should wait on the lignans.

I worry all of this will take so long that I won't know if her poops are really better by mid August.

Thanks for letting me ramble again.

Addy

You might try to call a licenced Holistic vet. in your area about withdrawing from Shen Calm and explain what other medications Zoe is on, symptoms, condition. Maybe suggest an alternative which won't interfere with the other medications. Again make sure your IMO knows before making any changes.
Below is a link to find one in your area.
Herbs can be tricky, even in humans.

http://www.ahvma.org/

Quote:

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Originally Posted by addy

I bought 1 milligram melitonin (regular) yesterday. Maybe I should just make the switch? He current vet IMS doesn't know anything about Shen Calmer. Should I start at 1mg or do the 3mgs right away?

Appreciate any input. Like I said, I start things small and go very slowly, sometimes too conservative.

Some pups can get sleepy or a little lethargic on the melatonin so buying the 1mg and trying that first and watching her reaction, I think, is a very good idea. You can always increase her melatonin by 1mg increments, and of course watch for any change in her behavior/poops.

Lori-where do you purchase your lignans, what brand are they?

I buy Harley's flax hulls here: http://www.flaxhulls.com/order.html

Can she be on the melitonan and lignans prior to loading in August? maybe I should wait on the lignans.

Yes she can but like I mentioned before, if it were me, I would add the lignans slowly to her diet.

I worry all of this will take so long that I won't know if her poops are really better by mid August.

Thanks for letting me ramble again.

Addy

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We are here for you Addy, hang in there, ok?

Love and hugs,
Lori

Lori- thanks you so much for the info. I will wait on the flax hulls. I also emailed Honest Kitchen to ask how much flax is in their Embark. I don't want to over due it.

I will try the melatonin 1mg at a time. I think the storms have stopped for the new week.

Sonja-

Thank you for the link. I do have a holstic vet but her advice sometimes concerns me-she will say "just stop doing it" I usually have to rethink whatever she tells me. I will call again tomorrow but so far not liking info I get on the phone from her tech and never can talk to her directly unless I schedule appoitnment.

Her poops were better today on the 1/16 even though we had another storm. Maybe need to go slower. Yikes! Pretty soon I won't have to worry about her poops and loading because it will be winter and she is always better then :)

Thank you all so very, very much.

Addy

Dear Andy
Sounds like you need another vet. on the site I gave you maybe look up another vet and just call see if they will give you an answer about the Shen Calm. If you are not happy with the vet , listen to your gut feeling.

I tend to be slow at doing things also. You are doing the right thing.
Trust your gut feeling. Never be afraid to ask questions.

I called another vet today after dear Sonja prodded me (I need prodding so thank you)

She said I could continue using the Shen Calmer with the melatonin but if I wanted to stop it I don't have to wean her off. Last night I stopped the pm dose. I did have some panting from Zoe last night. This morning I gave her 1/8 teapsoon and again no dose tonite. No panting tonight.

Thursday am will be her last morning dose. I am home for 5 days so I can watch her.

Hope to start her melatonin July 5th, Dr.Oliver gets back July 6th, sounds like a plan to me :)

Oh, Honest Kitchen emailed back right away (they are so nice) Zoe eats 1/8 cup of EMBARK with her raw. They told me that had 14.5 grams of organic flaxseedin it.

How do I figure that into the flax hull equation?

Thanks!
Addy

Glad to hear. you are in my prayers also.
Keep fighting like the rest of us.

Trust your self, listen to your gut feelings. Don't jump into anything without getting the information you need. You have gone through a lot. Don't forget to take care of your self also, to be there for Zoe and your other little fur ball.
Sonja and Apollo.
We'll be praying for you.

Quote:

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Originally Posted by addy

I called another vet today after dear Sonja prodded me (I need prodding so thank you)

She said I could continue using the Shen Calmer with the melatonin but if I wanted to stop it I don't have to wean her off. Last night I stopped the pm dose. I did have some panting from Zoe last night. This morning I gave her 1/8 teapsoon and again no dose tonite. No panting tonight.

Thursday am will be her last morning dose. I am home for 5 days so I can watch her.

Hope to start her melatonin July 5th, Dr.Oliver gets back July 6th, sounds like a plan to me :)

Oh, Honest Kitchen emailed back right away (they are so nice) Zoe eats 1/8 cup of EMBARK with her raw. They told me that had 14.5 grams of organic flaxseedin it.

How do I figure that into the flax hull equation?

Thanks!
Addy

---

Hi Addy,
I just read your thread from start to finish, and wonder if the runny poops issue ever resolved itself? My guess is that it wasn't the plastic, it was the raw diet that caused the problem. Dogs can get salmonella, and all of the other diseases and parasites that humans can from uncooked meats, particularly any kind of fowl or pork. I'm thinking of the "Bones And Raw Food" diet ... not sure if that is what you mean by "RAW" though. the "BARF" diet was a pretty big fad about seven to ten years ago and all research shows that it is not the best choice in diets for dogs. I am sure there are people that will want to fight that statement, and I'm not trying to start any kind of arguments, just hope that you are cooking any meats that you feed your baby. In the wild dogs are lucky if they live to be two years old, and in the wild dogs don't eat turkey, chicken, beef, pork, etc. has always been a point ignored by those who want to stand by feeding their dogs raw meats. Plus in the wild, dogs are catching wild rabbits, rats, etc, and introducing diseases into the domestic dog community like rabies, parvo, distemper., etc.. I think it's great if you want to cook for your dog and their are healthy ways to feed them that way, and raw vegetables and lignans figure into that, but never raw meat. It will make your dog sick if it isn't already, and for a Cushing's dog, it will make being able to tell what is dietary and what is medication complications a nightmare. All of this is just my opiinion, and so feel free to ignore it and proceed as you are, I am not making any judgements, I KNOW you love your dog from your thread, and I know you love her dearly, so I'm sorry if that seemed kind of didactic and definitely don't intend it judgemental - just recommendations that you can take or leave.
I wanted to answer the other dietary issue that you brought up about how to figure in the "organic flaxseed". My guess is that organic flaxseed is not the same as the lignan (which is the hull) of the flax seed, so I don't think it probably adds up to much at all - but I'm totally guessing on that one. The best way to find out would be to ask Dr. Oliver or your Vet, who could calculate it in to what is recommended for your dog if it is indeed the lignan and not just the entire flaxseed which is what it sounds like it is from the way you described it, but on the other hand, doesn't sound like it is from the way it is measured. You might want to call the food company and ask them if it is a the lignan, or if it is the whole flaxseed like it sounds like it is before you ask the vet or Dr. Oliver, that is what I would do.
Welcome to here, from me and Simon, even though here is a place I'm sure none of us wish we had to be, I know that the support and advice that we have received so far has been crucial to getting through all of the confusion and fears and frustrations that come along with a Cushing's diagnosis. If there is any thing that I can do to help, please let me know. Simon's diet needs to be adjusted and is far from ideal too in my opinion, it's just there are so many things to do when you have to manage this disease and your life and your other dogs, and your Cushings dog - I know it is overwhelming, frustrating, scary, and infuriating sometimes. If you ever need someone who can relate to all of that stuff - we are here for you, and you and your sweet Zoe (who has beautiful eyes by the way) are in our prayers.
Love,
Dena, Simon, & pack

Hi Dena,

I agree completely with you on the raw diet and I know she can no longer be on raw with Cushings but the IMS said not to change her food now or we will have too many new things going on and will not know what is causing what. Zoe is on a commerically prepared raw diet called Nature's Menu, we tried it as a last resort. She cannot tolerate kibble and I spent a year trying to get her off the Hills canned prescription food that she was not doing well on. I could never transition to another food without getting watery squirty poops by the 3 day no matter how slowly I went. The raw was the only food we transitioned to without watery squirty poops and we did it cold turkey. She was fine with it all winter until I stopped the thyroid meds, she ate plastic, etc and we have had a major flare up since. Ims originally wanted to put her on Hills W/D and I know in my gut she cannot eat that food.
Since we now have the Cushings diagnosis she said "do not change the food yet, we will look at that down the road" and the IMS is no fan of raw." I have no strong opinions one way or another except I will not feel W/D to Zoe.

The metronidazol is helping her but I don't get consistant firm poops. Since she loves to eat bunny poops, I don't know that I ever will unless I muzzle her ever time she goes outside. I don't have the heart to do it.

Compared to where we were when I first posted, poops are much better. Am still waiting to hear back from Dr. Oliver, I resent email yestderday and did not get a auto reply :)

Thank you for your input. It helps to hear from others. I hate having to go so slow but other than her coat her symptoms are not horrible yet. I worry her numbers were sky high but I really believe that because of the significant colitis flare up and the severe stress, she skewed her numbers. They had to muzzle her at the vets, it was all too much for her.

I did notice she has been anxious again when she is taken from me or if I leave her all alone, like if I take Koko for his walk, she gets very upset. That might be having no Shen Calmer. SHe was like that when I first rescued her.

So many problems in the equation:)

Addy

Hi Addy,

I am not a raw feeding fan by any means but that does not mean it is wrong, even for a cush baby. The only time a raw diet is NOT recommended is when a pup is fighting certain types of cancer. If Zoe does better on the raw diet she has been on, then I wouldn't change it right now. When/if you do decide to change, the best thing is to contact someone who specializes in canine nutrition and have them design a diet specifically for her. They will take into consideration all of her health issues including blood/lab work, environment, lifestyle, activity level, climate, ect. in designing her menu. But for now, I wouldn't change anything. :)

What works for our Atypical babies in the lignans is SDG - which stands for a word a mile long! :p The hulls apparently have a higher concentration of SDG than the seed or oil from flax. The SDG content is usually listed on the bottle and that is what you want to look at. My Squirt weighs about 13 lbs and she takes 3, 40mg capsules of a standardized lignan. The bottle reads, "...flaxseed extract standardized at 20% SDG..." That means that 20% of the 40mg is SDG so she needs 3 caps to meet the amount of SDG Dr. O recommends.

Somewhere on here is a discussion about this topic and I will try to find it for you...my files are on my other computer and my memory is scary :eek: to say the least! :p

I also want to tell you that you are a very special person. We all question "Why?!" when our babies get sick with this condition and seek to find a reason...perhaps even something we have done in our pasts that our babies are asked to pay for. But that's not it. We are given this challenge because we can handle it, because no one else could love and care for them as we will, because the Powers that surround us know they are in the very best of hands. We seek to learn, we blanket them with our love and devotion, giving our all, we hold them up in gratitude for the love they have brought to our lives and show the world what true companionship is meant to be. You are so very special because, you see, you are the only one who can do these things for your precious Zoe. Our babies were sent to us from the beginning because we are the ones they would need at this point in their lives...and you are most worthy of that gift.

Hang in there!
Hugs,
Leslie and the girls - always

aww, squirt's mom

what a meaningful post, thank you so much.
your kind words and support mean alot.

Addy

thought I should clarify something:

On the package of Zoe's raw food from Nature's Menu it states

"if your dog has an auto immune disease, cook this diet"

which is why I agreed with Dena about not wanting to keep her on it long term. I really don't want to cook it. Also, it has 30% organ meat and I am worried about that fat.

although some people continue to feed raw to Cushing pups, I am not comfortable doing it with Zoe and especially this particular diet.

I sure don't relish the thought of switching foods again when we get to that point :(

Have a Happy Fourth of July everyone!!!!

Addy

As far as I know, Cushing's is not an autoimmune disease. An autoimmune disease is when the body actually attacks its own cells. The immune system mistakes some part of the body as a pathogen and attacks it.

http://www.nlm.nih.gov/medlineplus/e...cle/000816.htm

Dear Andy,
I know what you mean, last time I had a blood panel on Apollo, he let out such a shrill scream when they took him in the back. I almost started crying my self. A day after the test he had a bruise almost all the way down his neck. I guess this is another part of cushing(easy bruising). The little guy now has sores and small cuts on his paws(skin thin). I don't like giving medications, because he has such a sensitive stomach. So , yes I am apprehensive about him being on this. For me so far the bops are not bad(can you picture all of us looking down to inspect their bops-what a site that would be) need some humor in all of this. Like I said before I got Apollo off Dog food and have him on a low fat diet now with supplements. Hope you and Zoe are doing okay.
Hugs and licks Sonja and Apollo.

oops, read it wrong it says "cook the diet if your dog has a immune compromised condition:" I then asked her IMS and she said yes, Cushings was just that.

gee, and here i just posted how smart the IMS was since she knew about the hormone cream :(

i still am going to take her off the diet at some point. It was sold recently and I just know the formula will change. They always do after a sale. I was even suspicious tonite, the patties look pinker.

Do I sound parinoid? Yikes!!!

Addy

Quote:

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Originally Posted by addy

oops, read it wrong it says "cook the diet if your dog has a immune compromised condition:" I then asked her IMS and she said yes, Cushings was just that.

gee, and here i just posted how smart the IMS was since she knew about the hormone cream :(

Addy

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"immune compromised condition," yes, our pups immune system can be compromised by the excessive cortisol. So your IMS is right! ;):D