Labs are good, symptoms persist

[Parris]

Hello all,
I have benefitted from reading your forum, thank you.
This is about APPETITE.
My specific reason for posting is to see if anyone has ideas on appetite suppressants. My 14-yr-old, 25 lb. SF Podengo Médio “Anna” was diagnosed 1.5 year ago when her only symptom was excessive drinking/peeing. Diagnostics ensued and we quickly had her labs stable with 15mg Vetoryl 2 x day. Her excessive thirst & hunger immediately waned but never went away.
To get to the point, she is drinking excessively and is constantly hungry even though her ACTH and labs show she is good. I even asked for the last ACTH before it was due because I was sure her dosage of Vetoryl was too low. So… I’m hoping for help with the desire to eat even when she’s clearly not hungry.

I’ll include her care information but I wanted to get the question out before you stop reading. ��
She is also diagnosed with lung cancer (accidentally, by X-ray) but remains mostly asymptomatic. I mention that only to explain some of her diet/supplements.
Other issues maybe or maybe not related to Cushing’s include sensitivity to being touched unless she initiates it (twitching skin, ducking head, moving away,) mild balance issues; slightly soft, silvery coat over her back/haunches; fecal incontinence (like her mom); appears uncomfortable to lie down, sometimes, lowering slowly; posture slumped in front, “resting” in her shoulder connective tissue, it seems, and occasional knuckling at the pastern.
I’m sure I would recognize other Cushing’s symptoms if they were present (pot belly, weakness, lethargy, thin skin…) because she had an adrenalcarcinoma five years ago (successfully removed) and the months of severe Cushing’s symptoms taught me a lot. At one point she lived muzzled because of eating inedibles!
She still cruises the yard, sniffs for critters and gets on the couch though sometimes she falls out of bed (which is why we’re sleeping on the couch - it’s lower - with dog beds surrounding it.)

I feed 2 x day: 3 meats, 3 veggies and a little fruit… to include canned green tripe, salmon, sardines, tuna &/or mackerel, cooked chicken &/or organic beef; cooked or raw diced broccoli, green beans, raw spinach, carrots, cucumber, romaine hearts, cooked cauliflower, sweet potato &/or hard squash, canned pumpkin; frozen or fresh blueberries, fresh watermelon, apple.
She pesters for and receives ~ 6 snacks a day such as “popsicles” with above ingredients &/or hollow food toys with Red Barn dried beef lung, Nature Gnaws tripe twists, freeze dried liver, Top Chews chicken and apple treats and Health Extension buffalo and white fish kibble.
She maintains a perfect weight, possibly because she enjoys veggies but I wonder if it’s in part because of the cancer. I do avoid carbs because of the cancer.

Vetoryl 15mg 2 x day
Si Miao San
Cosequin
Elk Velvet
Flaxseed oil
Nutra Thrive
K9 Immunity
Turmeric
Ashwaghanda
Mullein

All that may be immaterial to my hunt for an appetite suppressant but there it is. I appreciate any ideas about appetite suppressant in part because I think she’s in danger of an obstruction due to eating something she shouldn’t. Wouldn’t it be stupid after all this to lose her due to an obstruction!!!
Thanks so much, even for just listening.

PS: My username is Parris because “Eve” was taken, but my name is Eve. ❤️

[Squirt's Mom]

Hi Parris,

Welcome to you and Anna!

Appetite is sometimes one of the signs that can be learned and used to train us. I personally am VERY well trained! LOL So that is something to keep in mind....is she truly hungry or is it behavioral? If the cortisol is within optimal range for a dog on Vetoryl the appetite should drop considerably. So with that in mind, would you mind post the results of the latest ACTHs or PVC tests that have been done? Those results may hold the answer to your question.

The drinking could be the result of less than optimal control but it could also be due to something like a UTI or even diabetes insipidus so I would have those looked into. But I think I would start with a very deep dive into all the possible effects of the supplements and herbs you are giving her. For example, where is the deer velvet you are using coming from? In the US we have a disease in the deer called Chronic Wasting Disease and antlers from deer so infected will carry this disease. It seems that this product is considered safe ONLY if it is coming out of New Zealand because there is no CWD in that country. Agitation is one of the side effects of the Nutra Thrive. Ashwagandha can have a negative impact on the thyroid, especially if used for more than a few months at a time. So I would take some time and really look into everything Anna is ingesting to see if there is any possibility that the cause for some of the things you are seeing could be there. You want to look at sites from the medical community (veterinary medical schools, vet clinics, etc.), government studies from places like NIH or WHO and NOT the sites promoting these products. If they sell the products or offer testimonials about the products they are not a reliable source. )

I would also want the diet evaluated by a canine nutritionist to make sure that all the vitamins and minerals she needs are being supplied. I home cook and have never had a recipe that didn't need supplementation. So I would definitely have that checked. Imbalances there can cause all sorts of problems.

But what really concerns me is your comment about the knuckling. And I don't want to think about this much less talk about it with you but we must, sadly. When a dog knuckles it typically indicates a neurological issue, a brain tumor in most cases. Most cush pups, 85% or so, have the pituitary form of Cushing's and the vast majority of these tumors remain microscopic, causing nothing more than the usual cush signs. However, in rare cases that tumor will start to grow into what is called a macroadenoma, or macro for short. These tumors can cause all sorts of unusual behavior that we don't typically associate with a brain disorder. Changes in personality, things like not wanting to be touched, losing control of bodily functions. The only way to know for sure if this is happening is via a MRI or cat scan of the skull. The size of the tumor determines the classification of micro or macro. But it is something I would bring up with her vet. I pray this is not something you have to face on top of everything else you and your sweet girl have already dealt with. She is a trooper for sure....and so is her mom.

I am sure you will hear from Marianne soon with her thoughts but I wanted to welcome you and Anna and share the thoughts that crossed my mind reading your story. I am so glad you found us and look forward to seeing those test results and learning more about you and your precious Anna.

Hugs,
Leslie

[Parris]

Leslie,
Thank you SO much for you very thoughtful reply, clearly based on a LOT of knowledge! I want to take time to address every point you made but I wanted to thank you quickly.
A brain tumor has occurred to me. You have a very kind way of approaching the subject.
I’ll edit my original post which was unclear. My girl’s name is Anna. (The breed, which I’m not surprised anyone is unfamiliar with, is Podengo Médio.)
Thanks and I”ll be back soon!
Eve and Anna

[labblab]

Hello Eve and Anna! Leslie has already done an outstanding job of covering all the bases I could have thought of, and more. Her knowledge about supplementation and nutrition especially far surpasses my own, so I’m very grateful that she’s been able to address those questions in addition to all the others. For the moment, all that is really left for me to do is to welcome you two girls to our family — and that I will do happily! I will anxiously await further info from you, but in the meantime, I’m so glad you’ve found your way to us.

Best wishes,
Marianne

[Parris]

Thank you. Marianne,
Yes, Leslie is certainly a knowledgeable one!!! I’m composing a novel-of-a-reply, waiting on Anna’s last labs from the vet.
Thank you all for maintaining this forum.
❤️

[Parris]

Hi, all,
I have the labs, here. On 8/10/21 Anna’s Cortisol pre- and post-ACTH was 1.3 and 3.9. This is quite a bit lower than the reference range so her symptoms ought to be well controlled.

”is she truly hungry or is it behavioral?”
Truly hungry? I don’t think so. She’ll sometimes continue to ask when she’s clearly full.
Behavioral? You make a very good point about the possibility of her “pestering for food” when she’s not even hungry - as a game of sorts. She definitely knows this game as she has been trained to alert. Yes, she generalizes and uses alert behaviors for her own purposes, lol, but I don’t feel that’s the case, here. If I reject her for too long she finally gives up and goes for poop, and if that’s not available she’s been known to try packing peanuts and cardboard.
(BTW, I also believe this is not obsessive behavior.)
I think it’s a physiological error, that her body is making a mistake and telling her she is hungry when she’s not - just as happens with most Cush dogs. It just isn’t explained by the ACTH stim test results.

"The drinking could be… UTI or even diabetes insipidus…"
Yes. She DID have a UTI last fall and was treated for that. She has tested negative for diabetes. I’ve been harassing my vets for every possible reason for this polydipsia and polyphagia for quite some time. I don’t even like calling it thirst and hunger because her body is clearly not deprived of water or food. She FEELS thirsty and hungry but her body isn’t deficient. Maybe I’m just parsing words.

“… deep dive into all the possible effects of the supplements and herbs…”
Good call. The supplements (with the exception of NutraThrive) were prescribed by Anna’s holistic vet and reviewed by her original vet.
The elk velvet is from Wapiti labs in MN. < wapitilabsinc.com > They have a small, private herd and harvest under the supervision of a veterinarian.
I didn’t know of a relationship between NutraThrive and agitation. It would be worth a NutraThrive vacation to see if it makes a difference.
Anna has been on ashwaghanda for some time so I’ll ask about an ashwaghanda vacation as well.

“… diet evaluated by a canine nutritionist…”
I was thinking the same thing and that’s why I feed ~1/4cup quality kibble and NutraThrive daily but the vets aren’t concerned. I follow the holistic vet’s recommendations. His big thing is green tripe, saltwater fish, root vegetables and hard squashes. I spoke with the western vet again today and she says it looks fine, just stay away from starchy carbs which feed cancer. Honestly, I believe she feels the way I do, that a nutritionally balanced diet isn’t going to save her at this point.

”… When a dog knuckles it typically indicates a neurological issue, a brain tumor in most cases."
I think you may have hit the nail on the head, and the reason I feed what I do is because it makes me feel like I’m doing SOMETHING to give her the right foods for a cancer patient, micro-nutrients notwithstanding.
Another set of medical problems she has dealt with is balance issues including three episodes of vestibular syndrome in the last two years. Oddly, her recovery time shortened from three weeks the first time to two weeks the second and only a week the third time. But I have read that, contrary to cats, dogs generally get this only once and it’s an inner ear problem. Those that get it more than once likely have a problem in the brain which affects the inner ear.
Several months ago she had a different sort of attack which included imbalance and nausea like a vestibular attack but no nystagmus and only very slight circling. Another owner might have not noticed it at all.
My vet had no explanation but said she feared the episodes would increase in frequency and severity and I’d have to start assessing quality of life.
Then, six weeks ago, Anna collapsed on her side, distressed and unable to rise for just a few minutes. It didn’t look like a seizure to me but she spiked a 105* temp and bled a little from the nose. My vet was in surgery and I did NOT want to take her to an emergency vet for euthanasia so I decided to just get the temp down. I used Tylenol and cool packs. I was able to see my vet later in the day and I thought I’d be putting Anna to sleep. But as the temp came down, Anna’s mobility improved and by the time we got to the vet five hours after the incident there was absolutely nothing clinically wrong with her. A seizure is the only reason the vet could come up with for that sudden temp spike but we threw a round of doxycycline at her just in case she had something bacterial. Couldn’t hurt, right?

So, yes, a brain tumor is definitely a possibility. She had the adrenalcarcinoma five years ago, lung cancer was detected and suspected to be advanced a year ago and her sister was PTS riddled with cancers last year. Maybe a brain tumor is causing the polydipsia and polyphagia and it has nothing to do with Cushing’s. ???

All of which takes me back to my search for an appetite suppressant but I’m thinking there isn’t an answer for that. Our bodies are so amazingly complex, so resilient yet so easily thrown off kilter.
She’s very high maintenance right now and sometimes I wish I could temper her persistence but I cherish every day knowing that soon I will be missing the badgering - tapping at my leg, stacking all her dishes in front of me, mashing her nose into my eye, standing on my feet and closing my laptop with her nose.

[Joan2517]

Yes, I miss all those things. The constant looking for food, the drinking, drinking, drinking, the paw licking, the slobbering water all over the floor when he drank, and the tons of dog hair all over the place. I would give anything to have all of that again, so I understand your search for something. I miss my Gable every day.

You're a wonderful mom...

[Parris]

Joan,
Thank you for your understanding and supportive comments.
I’m sad that you are without Gable and the others on your lap or at your feet.
Eve
❤️

[labblab]

Hello again, Eve. I’m sorry it’s taken me so long to get back with you, and I thank you for all the additional info you’ve supplied. I want to “second’ what Joan had written above — you are a wonderful mom, for sure! Handling so many issues with your sweet girl has to be so stressful and demanding, and yet your love and devotion shines through so clearly.

I have to agree that the possibility of a brain tumor does seem quite reasonable. You’ve told us that Anna had an adrenal tumor removed several years ago. Have her current Cushing’s diagnostics pointed towards a new adrenal tumor vs. a pituitary tumor? We’ve actually had a few dogs on the forum who have suffered from both, so it wouldn’t be a first if Anna now has a pituitary tumor. If so, the notion of DI becomes much more likely to me since increasing encroachment on the pituitary gland could definitely be the cause of DI.

I surely wish I had a great suggestion for you in terms of controlling her appetite, but I’m afraid I don’t :-((. I wish I could be more helpful, but you’re personally doing such a great job of covering all the bases that I don’t have many concrete suggestions to offer right now. But you definitely have my concern and my support heading directly your way! Please do keep updating us as things develop or if you have new questions, OK?

Best wishes and healing hugs to both you and Anna,
Marianne

[Parris]

Hi Marianne,
You people are so sweet to extend yourselves to the owners of all the Cush doggies. I certainly appreciate the support and words of encouragement.
My vet and I agreed that additional diagnostics simply to pin down the source of the Cushing’s symptoms (pituitary or adrenal) weren’t valuable. We wouldn’t be able to remove a bad adrenal gland if that were the problem since she already had one removed. And, at Anna’s age, I wouldn’t go crazy with treatments for a pituitary tumor, if that were the problem, especially since she has cancer in her lungs and we have no reason to believe it isn’t in other places as well.
I feel like she probably has a brain tumor. Interestingly, I have discovered that there’s quite a controversy out there as to whether a pituitary tumor is a brain tumor or not. It seems clear to me that they are two different things, although I understand a pituitary issue is usually handled by a brain specialist.
Meanwhile, I’m just enjoying catering to little Anna. She’s such a trooper, as someone said. She can lose her balance and bounce off the walls but still give intense direct attention to something that grabs her interest.
Well, I could go on about her for hours (days. weeks!)

Is DI diabetes insipidus? We did test her for that a couple times since this excessive eating, drinking, peeing and pooping has continued but she shows no signs of it.

Anna has been having more front end ataxic symptoms today, crossing in the front when she moves and her shoulders and elbows seem unstable when she stands still. She doesn’t seem particularly weak, though, and her rear is not affected. She can jump onto furniture. (25 lb dog.)
We had a different, more hectic sort of day, today. Maybe she overextended. Or maybe a tumor is putting more pressure on spinal nerves. But, since it’s clearly not causing pain, I can be patient and wait to see what this new chapter brings. ��
Thank you all!
Eve and Anna ��