Harley's visit to the Univ. of Penn.

[Harley PoMMom]

Hi everyone!! Glad to see alot of you have made it here, I was so worried that I had lost you's just when Harley and I found such loving and supporting friends.:):) So, Harley's U/S showed and Confirmed: Gallbladder wall hyperplasia, right adrenal nodule (7.3 mm at caudal pole), left adrenal gland normal in size ( high end of normal range), small splenic nodule, and an enlarged liver. Also confirmed: Hyperadrenocorticism ( suspect pituitary-dependent). His blood pressure was elevated at 180 mmHg. They collected a sterile sample of urine to test for a urinary tract infection. They performed an endogenous ACTH level to see if this will help to determine which type of Cushings he has and I also requested they run a full adrenal panel through the Tennessee lab. Someone will call me with the results (endogenous ACTH, UTI, full adrenal panel) next week, then finally we can start Harley on meds. Dr. O'Neill (Univ. of Penn. woman IMS) is leaning towards trilostane for treatment and I am just not sure, what do you all think? His NEW vet back here in York, which I had a consult with on Monday said he's not real keen on treating Cush pups with trilo, but he would do whatever I wanted to do and he really was interested to hear what Univ. of Penn. diagnosed and what they wanted to treat Harley with. Dr. O'Neill did tell me to take Harley off the raw food diet, so now I'm feeding him Innova senior.

Lori and Harley

[Lulusmom]

Hi Lori.

I am glad to see that you made your way here too.

Can you tell us why your vet suspects that Harley has pituitary dependent cushing's. Just asking because from everything I've seen, the ultrasound findings don't clearly indicate PDH. My memory is bad and without the benefit of your thread on cc.net, I can't remember if perhaps Harley had an LDDS test that was consistent with PDH. In any event, the endogenous acth should give your vet a good indication as what you are dealing with.

I'm glad to hear that you are going to request a UTK adrenal panel. This is so important for anyone that is contemplating treating their dog with Trilostane. This test takes quite a bit longer to get results so I wouldn't expect them for about 10 days.

I think you need to get a confirmed diagnosis before you decide on an appropriate treatment. Surgery is usually the first option for an adrenal tumor; however, if treatment is chosen over surgery, then Lysodren would be a better choice of treatment. Trilostane is very effective in reducing cortisol; however, it is known to always elevate one or more of the intermediate sex hormones with long term use. This is particularly problematic for dog that already has sex hormone elevation(s). This is the reason why the UTK adrenal panel is so important before making your final decision.

My dogs are thriving and healthier than ever since switching them to a commercially prepared raw diet so I am curious as to why Dr. O'Neill had you change Harley's diet??

Glynda

[Harley PoMMom]

Hi Glynda,
Harley's LDDS test results, taken 3/30/2009, were:
Suppression, 4samples
vet cortisol......................5.9................. ..............1-6...(resting)..uG/DL
Time 1:...........................10AM

vet cortisol......................9.5................. ..............uG/DL
.............................................Canin e...
.......................................POST DEX:..<1.0
.......................................POST ACTH:.5.0-18.0
Time 2:...........................2PM

vet cortisol.......................11.4............... ..............uG/DL
Time 3:............................4PM

vet cortisol.......................12.1............... ...............uG/DL
Time 4.............................6PM

I thought these numbers were pointing to adrenal cushings, but since the U/S did not differentiate between pituitary or adrenal, they are running the adrenal panel thru UTK lab. I was considering a CT scan on Harley's brain to see if we could find a pituitary tumor, do you know if anyone has had any luck with that? I asked down at Univ. of Penn. they didn't seem too hopeful that they would find a tumor.

As far as the raw food diet, I was making Harley's food at home, not getting the commercially prepared raw diet, like BARF, what do you feed your furbabies? If you don't mind me asking?

Thanks alot for replying back to me.....Harley and Lori

[Lulusmom]

Hi Lori,

Thanks for posting those LDDS results again. I now remember looking at them and thinking "adrenal tumor". The ultrasound results are more indicative of an adrenal tumor as well. The UTK panel does not differentiate between PDH and an adrenal tumor but the endogenous acth does so I'm glad that your vet will be doing one.

My dogs eat Primal organic, hormone and antibiotic free chicken. I buy the frozen nougats. You thaw out what you need in the refrigerator and serve it up.

Glynda

[Squirt's Mom]

Hi Lori,

So glad you to see you and Harley made it here!

I'm not well versed on the LDDS, but from the ultrasound does sound more like ADH to me. Usually with PDH, both adrenal are enlarged and relatively close in size. The one adrenal being so much larger in Harley's U/S, makes me wonder if he doesn't have an adrenal tumor. That could be good news, tho! Adrenal tumors are the only form that offers a cure, in the US currently anyway. Will be looking forward to the andogenous ACTH results along with you and everyone else!

Sounds like the folks and U Penn are some fine docs! I'm glad you have a source like that so close!

Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Lori,

FWIW - I feed my cushpup Primal chicken also. I used to give him kibble and after reading an article on Raw Green Tripe, I added some of it in his diet. I've been trying for years to get Wylie's coat softer - it's always been dry. I tried supplementing with olive oil, Foster's & Smith 3V caps, fish oil...nothing worked. After a couple weeks of supplementing with some tripe, his coat started to get softer. He then was diagnosed with Cushing's and now has an IMS vet. In December I decided to get rid of the kibble and switch him to raw. The IMS did not like that idea and sent me several articles, basically being worried about bacteria with a dog having a compromised immune system. I was torn because she has a valid point, but I had seen for myself what a little raw can do (improved coat in Wylie's case) and what I've read of kibble also worried me. In the end, I decided to go with the raw.

Alison (Alison & Mia) had posted an article or link to an article about somone going to a veterinarian conference and commented on the "bacteria hysteria" that was present. For me, it helped put things in perspective.

-Susy

[Harley PoMMom]

Hi Susy,
"The IMS did not like that idea and sent me several articles, basically being worried about bacteria with a dog having a compromised immune system." That's what the IMS said to me too, so you know me, all worried, have to switch food for Harley so he doesn't get sicker. UGH. This so hard sometimes, trying to do the right thing for your furbaby. Harley loved the home-cooked meals, so I compromised and give him alittle cooked lean meat and some raw vegs w/ his innova, he wolfs it down in seconds. Do you think that is ok?

Harley and Lori

[Wylie's Mom]

A raw (uncooked) diet is different from a cooked meal. A properly handled & cooked meal shouldn't raise as much of a bacterial concern to your vet, IMO. I primarily give my pup Primal or Nature's Variety (Raw), about 70%; and some cooked Chicken & rice, about 20%; the rest is a mix of commercial treats and frozen veggies/fruit and a little kibble for his toy. I think it's apparent that my Wylie likes the cooked Chicken & rice the best, the way he violently eats it. Sorry, I can't really give you an opinion - I don't think I know enough about dog diets - plus, I don't really know how I feel about kibble anymore. I gave Wylie kibble for about nine years - I only give him a little now because I can't put raw or cooked food in his buster cube!

-Susy

[Buffaloe]

Hi Lori,

I think I mentioned before, Harley sure is a cool looking dog. If Shiloh ever ran into him, I know she would just love him...she'd flirt with him like a school-girl.

Shiloh had a very large adrenal tumor, a very successful adrenalectomy in 2006 and is doing great today at 14. Most certainly, if Harley has an adrenal tumor it is very much on the small side. At 7.3 millimeters, that is about 1/8 the size of Shiloh's tumor and much smaller than most we have seen here. That is very good news! The results of the LDDS test indicate that it could be an adrenal tumor. What the chances are based on the LDDS test, I don't have a clue. Hopefully, the endog. ACTH test will give you more certainty. The adrenal panel is also a great idea. Most dogs with adrenal tumors secrete an excess of one or more of the intermediate hormones. If Harley has any elevated intermediate hormones, I think Lysodren would be a better choice than Trilostane.

I'm sure no expert on diet but I discuss it with my vet quite a bit and Shiloh is an awfully healthy dog at 14 1/2. For her kibble, I've always fed her Solid Gold Hundenflocken. I just buy the very best canned food I can find and give her about 1/4 can/day. I buy those cooked chickens at Costco and give her the white meat along with some organic brown rice and some brocolli, green beans, carrots, etc. I feel real good about giving her the chicken, organic rice and veggies and she loves it. Her only supplements are glucosomine and fish oil, every day.

You sure are going the extra mile with all of Harley's testing. I hope and pray it all pays off beautifully. All the best to you and Harley and Shi sends your cool boy kisses.

Ken

[barney's mom]

Hi Lori,
I just wanted to say hello and welcome!
I see that we are neighbors! I just moved to York, PA six months ago. I have a border collie who has pituitary cushing's and is on Lysodren. I moved from MD and we were seeing an IMS there, but have just been seeing a regular vet here. It is nice to know that U of Penn is an option if needed.
Nice to see someone so close!

Cheryl

[Harley PoMMom]

Hi Cheryl,
It is comforting to know that you and your border collie (would his/her name be Barney?) live so close to Harley and I. What vet are you seeing down here? The Univ. of Penn.that Harley went to was in Philly (Matthew J. Ryan Veterinary Hospital), although I was told there is a Univ. of Penn. located in MD.

Hi Ken,
Harley's head is getting so big from all the compliments!!:>) We thank you and Shi for them. I think I will look into buying those cooked chickens at Costco, thanks for the info.
I also hope and pray something soon sheds some light onto what type of cushings Harley has, the IMS and his NEW vet did tell me that he is in the early stages of cushings (how they really figure the stages, I don't know), maybe b/c he hasn't lost any of his hair????
I really appreciate that you told me the story about Shiloh and explained to me about the size of the adrenal tumors, I have been trying to look that info up and could not find much. When I get Harley's test results back I will post them and hopefully you will chime in then too.

Bless all of you, Harley and I are so happy and lucky to have found such supportive and loving friends.......Harley and Lori

[barney's mom]

Hi Cheryl,
It is comforting to know that you and your border collie (would his/her name be Barney?) live so close to Harley and I. What vet are you seeing down here? The Univ. of Penn.that Harley went to was in Philly (Matthew J. Ryan Veterinary Hospital), although I was told there is a Univ. of Penn. located in MD.



Yes, he is Barney :)
I live in west York and we were in the process of looking for a vet up here in York when my other dog Beth got in a scrap with my sister in law's dog and ripped her eyelid. We took her to Dover animal hospital and she was stitched up by "Dr. Rick" (that's what we call him, and his last name escapes me at the moment) He has been absolutely awesome and I was very lucky to find him.
Barney has been seeing him ever since he developed a corneal ulcer that is very slow in healing. He is coming due for a stim test, and if all is well and stable, I would like to have Dr. Rick continue to treat him for cushings as well.
He did have a stim test there a few months ago but the Dr and I don't see eye to eye on his treatment (his stim has been slowly trending upward and the other doc didn't want to tweak his meds or miniload him again since technically he was within normal limits, I will be astounded if he is still normal and not high, although he remains asymptomatic. but lol that's a whole other story)

What vet do you see here?
I am glad that Harley saw a specialist for diagnosis. The vet my dog used to see originally diagnosed Barney with adrenal cushings due to a poor quality ultrasound and was going to treat him with much higher doses of Lysodren to supress the adrenal tumor. All his other tests were positive for cushings but inconclusive for the type of cushings. The IMS found he had pituitary cushings and I shudder to think of what would have happened had we begun therapy on high doses. (he loaded on a bird dose)

Cheryl

[Harley PoMMom]

Hi Cheryl,
I live in Strinestown, it's a little town about 10 miles north of York.
How is Beth doing with her eyelid? What breed is Beth? When I was searching for a new vet for Harley (long story about his old vet :mad:), Dover Area Animal Hospital is one I called also, they told me Dr. Anne Parker was their vet that was up on Cush dogs and I was going to go there but the Sunday before we were to go to Univ. of Penn., (which was on Tuesday 14), I noticed Harley was overdue for his rabies shot, so Monday morning I got up early and starting calling vets that I talked to before and asked them if they could get Harley in for his shot and the only one that would schedule me in on that day was Shiloh Vet. Hospital in Manchester, boy were they a life saver:eek: I believe I am going to call John Ingold Vet. hospital, located at 2200 west market street b/c he has a 24 hour emergency service of his own, in which HE is on call for, just to have him for a back-up for Harley.

Let me know how you make out with Barney, and I will pray his limits will be normal. How did your IMS find out Barney had pituitary cushings? Harley's diagnosis is still up in the air as to adrenal or pituitary :eek::confused: The IMS at U of Penn thinks pituitary, but I'm not so sure.

Take care........Harley and Lori

[barney's mom]

Beth's eye has completely healed. Dr. Rick did an amazing job at stitching her up. Her eye was ripped back at the outer corner completely through. I can't even see the spot if I look for it. Beth is a pound puppy whose pappers say she is a german shepherd mutt. The vet doesn't think she is a shepherd. I've looked online at dog pics of black and tan kelpies that could be her twin. So who knows ;)

I have heard wonderful things about Anne Parker at Dover.

Barney was hard to diagnose. One ultrasound showed that one of his adrenal glands were enlarged. His stim as well as his endogenous ACTH came back inconclusive. He had a horrible painful episode in which we didn't know where the pain was coming from at the time (it turned out to be a herniated disc) and during his work up they did two more ultrasounds as well as an MRI that got much clearer images of the adrenal glands. Bilateral enlargement indicated pituitary cushings.

I like the idea of having a vet on call that you are familiar with. My best friend takes her dog to Dr. Ingold! She loves him but snuggles doesn't have any health problems, so I guess she hasn't really seen him in action.
(what a small world eh?)

I was looking at Harleys ultrasound and it does show both glands enlarged. Doesn't one gland usually atrophy in the case of an adrenal tumor? (its been awhile since Barney's diagnosis, forgotten alot of the specifics)

[Harley PoMMom]

Hi all,
Dr. O'neill (Univ. of Penn.) called me on Sunday to tell me that Harley's adrenal panel bloodwork, somehow, got messed up, so today Harley is at his vet getting the panel redone again to be sent to UTK. Dr. Oneill did say that he does not have UTI (good news), but his Endogenous ACTH results are not back yet.
So, if you all would please keep fingers, paws crossed that Harley's bloodwork panel gets done right today and we receive the results soon (I know around 2 weeks), I'd appreciate it!!
Harley and Lori

[Kwiggles]

Hello Lori,

I wanted to stop by and say hi to you and your handsome Harley. My dog Joe is in a similar boat as your Harley- he is positive for Cushings but despite extensive testing we haven't been able to definitively distinguish if it is adrenal or pituitary.

An abdominal ultrasound done on Joe at Cornell Vet Hospital about 4 weeks ago was able to clearly visualize the left adrenal and it appeared normal but slightly enlarged. The right adrenal could not be fully visualized or measured because it was obscured by a loop of bowel.

Not sure what your vet will recommend for Harley, but my vet's advice was to go ahead and put Joe on Lysodren to give him some relief from his symptoms, and at the same time continue to try to get a good visualization of the adrenals, by CAT scan, MRI or re-check ultrasound. So we just completed Lysodren loading on Sunday and I'm awaiting results of his ACTH stim test done yesterday AM.

I wanted also to tell you that I asked the ultrasonographer (her name was Dr Yaeger) about the guideline that 'when there is a tumor on one adrenal gland, the opposite adrenal is atrophied.' She responded that she has found that to be often not the case- that even with a tumor on one adrenal, the other may be normal size or even enlarged. Just thought I'd pass that along for what its worth.

Wishing you success in pinning down Harley's diagnosis and hoping you will get good results on his bloodwork.
Karen & Joe

[Harley PoMMom]

Hi Karen and Joe,
'when there is a tumor on one adrenal gland, the opposite adrenal is atrophied.' She responded that she has found that to be often not the case- that even with a tumor on one adrenal, the other may be normal size or even enlarged. Just thought I'd pass that along for what its worth.
Hey thanks for the info, will keep that in mind, all info. is welcomed.
This waiting and wondering is awful :confused::eek:but what are you going to do:confused: When I picked Harley up at the vets office he was all smiles, he shows his teeth when he is happy, so I know they are good to him. They said they were just finishing the test (Spinning ??, freezing ??) and were getting the info. to send to UTK. Glad they know what they're doing :) as I sure don't feel like I do :confused: They took his blood out of his neck this time b/c they read in the info. pack that I gave to them from the UTK that if the blood samples are grossly hemolyzed they have to be repeated in a week, they said sometimes it's better to take the blood from the dogs neck than the leg, they did say why and I should have written it down, I will when I see them next week.
Poor Harley:eek: he has his neck, belly, right front leg and right rear leg all shaven, he doesn't know what to make of this bare skin :confused::eek:
We'll be watching for Joe's test results and crossing all of fingers and paws for good luck and believe me w/ 2 dogs and 2 cats that's alot of paws crossed!!:)
Talk to you soon, Take care,
Harley and Lori

[Harley PoMMom]

A Doctor from Univ of Penn. called me yesterday with Harley's Endogenous ACTH results, he said the number's were high and indictive to pituitary cushing.:(:confused::eek:
I also heard from Harley's vet that they sent his adrenal panel out to UTK along with all his results/records related to his cushings. Now the waiting game :eek::eek::eek: I will post the details when I receive them for sure, b/c I know that I am going to need ALOT of advice.:eek::confused::(

Harley and Lori

[barney's mom]

Dontcha just hate the waiting game?????????
It seems all my test results are due Friday and are never on time, so I am stuck the entire weekend wondering. Hopefully it goes quick for you!
ps...I passed the Shiloh Veterinary Hospital today and thought of you, haha!
Ironically, me and Barney were coming home from the vets.

Cheryl

[Harley PoMMom]

Can anyone tell me what these endogenous results mean?

..............4/15/2009 11:09:00.........Reference Range.......Units
Endogenous ACTH.............41.1 (H).......(6.7-25.6)..........pmol/L
Aldosterone, Baseline.........197..............(14-957)...........pmol/L
Aldosterone 1h post ACTH...443.............(197-2103)........pmol/L

Any info would be appreciated,
Thanks,Harley and Lori

[barney's mom]

Hi Lori,
Unfortunately, about the only one I can decipher is the endogenous ACTH, which you already know is high and would indicate PDH.
I am sure some of our members more experienced with a full adrenal panel can help you with your other numbers will be along this evening.

Cheryl

[Harley PoMMom]

These other numbers were with the endogenous results, I haven't got the adrenal panel results back yet, still anxiously waiting :eek::confused: I was just wondering if these results should be emailed to Dr. Oliver (UTK).

Harley and Lori

[Buffaloe]

Hi Lori,

I personally think the endogenous ACTH test is probably the best of the blood tests to differentiate between pituitary/adrenal cushing's. We never had that one done on Shiloh and I don't know how to interperet the numbers. But, they said it indicated PDH. I would think that is a positive because pituitary tumors are much easier to treat with medication than adrenal.

I also think it is really good that Harley's aldosterone is within the normal range. Shiloh's aldosterone was significantly elevated and she had the big adrenal tumor. All of her other intermediate hormones were within the normal range. I'm just saying, Harley having normal levels of aldosterone is a heck of a lot better than if they were elevated.

It sounds like your vet treats Harley very well. I know my vet and his assistants treat Shi really well because she gives my vet kisses...and Shi is pretty darn stingy with her kisses.

Lori, we were typing at the same time...if it were me I'd wait until I had all of the results from Tennessee before contacting Dr. Oliver. Hopefully in just a few more days.

Ken

[Harley PoMMom]

Ken and Cheryl, you are both right, from what I am reading the high number for the endogenous ACTH test does indicate pituitary cushings for Harley :( I'm on pins and needles until the full adrenal panel results from Dr. Oliver gets back.:eek: Then I don't know what will be worse-- this waiting game-- or the treatment phase-- will I do it right:confused::confused::eek::eek:I'll be a mess:eek::eek: Hopefully, you'll all be here to help me thru it:p

Harley and Lori

[barney's mom]

The waiting game is WAY worse than the treatments. ;) I still hate the waiting game. (waiting on stim test results now, lol)
We are right here with you! Hoping you get your panel back soon.
It's been over a year since Barney's diagnosis, and every single test he had came back consistent with cushings' but we couldn't differentiate the kind of cushings until his ultrasounds.
Sounds to me like Harley is PDH, and you are awaiting information to rule out that he is atypical also?

If this is solely PDH, have you given any thought to treatment?

Ps.....it was chilly today :)

[Harley PoMMom]

Cheryl, Yes I am waiting to make sure Harley is not atypical also.

As far as treatment, I was hoping Dr Oliver would suggest something, if not, then I'll probably go with Lysodren, or what Harley's vet and I feel most comfortable giving to him. I really like Harley's new vet, and Harley does too.
When I get the adrenal panel results back, I will post them and hopefully I will get advice here as well. I DO NOT WANT TO MAKE THE WRONG CHOICE for Harley, so I am asking everyone and anyone to help me when this time arrives. It seems Harley's LDDS test was indictive to adrenal cushings and now his endogenous test points to pituitary, so WHAT DO YOU DO???:confused::eek: Harley's U/S really showed nothing but a small nodule on one of his adrenal glands and enlarged liver, so this tells me nothing.:eek::confused:
I've read trilo. is for both adrenal and pituitary cushings, but one can only treat a cushpup w/trilo as long as the cushpup is not atypical.
So, if I never really can pinpoint Harley's cushings, how can I really treat him properly? :confused::(

Harley and Lori

[Harley PoMMom]

Here's Harley's results from the UTK.

.......................................result..... ..Normal.....RESULT(post.....Normal
....................................(baseline).... RANGE**.....ACTH)...........Range**
CORTISOL ng/ml.................61.6*....2.0-56.5.........129.8..........70.6-151.2
ANDROSTENEDIONE ng/ml.....0.43*...0.05-0.36.......1.67............0.24-2.90
ESTRADIOL pg/ml...............129.4*..23.1-65.1.......132.2*.........23.3-69.4
PROGESTERONE ng/ml.........0.66*....0.03-0.17.......1.15............0.22-1.45
17 OH PROGESTERONE ng/ml.0.30*...0.08-0.22........0.91...........0.25-2.63
ALDOSTERONE pg/ml ***......32.5.....11-139.9.........81.9...........72.9-398.5

(*Above or below reference range.)
(**Mean normal range values for neutered male dogs (N=37)),
(*** Normal range values for male and female dogs (N=72, baseline, N=23 post-ACTH).)

These results indicate presence of increased adrenal activity.(Mild)
Comments: Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens.:confused::eek: For elevated estadiol, some veternarians consider items 2 or 3 and 4 of attached sheet. Various treatment option considerations are attached. More estradiol information is on our website under Treatment Considerations.

I understand giving Harley Melatonin (regular, NOT rapid release) but for the flaxseed oil with lignans, the website they direct you to is confusing me-www.FLAXHULLS.COM, THIS WEBSITE is now selling pressed flaxhulls that they say are just for Atypical canine cushing's and the dosage is the same. I'm not so sure, does anyone know about this????

Any comments, advice, anything is appreciated on Harley's results, treatment, just talk to me please:eek::confused:

Harley and Lori

[AlisonandMia]

I understand giving Harley Melatonin (regular, NOT rapid release) but for the flaxseed oil with lignans, the website they direct you to is confusing me-www.FLAXHULLS.COM, THIS WEBSITE is now selling pressed flaxhulls that they say are just for Atypical canine cushing's and the dosage is the same. I'm not so sure, does anyone know about this????


I personally don't know a lot about this (the whole flaxseed oil/hulls etc issue) - but don't worry others do! On the old board (cc.net) there was a lot of discussion about this so there is a quite a bit of knowledge here on the subject. Someone should be along with some useful input for you soon.:)

Alison

[Buffaloe]

Hi Lori,

I can't help you with the flaxseed, etc. at all, we never dealt with atypical cushing's.

I've heard that Dr. Oliver may be on vacation but should return in a few days. Alison has all of his contact information, particularly his e-mail address. In my opinion, when you communicate with him, you should ask him if the U.T. test results give any indication that Harley may have an adrenal tumor. We had similar testing done and after going back and forth with Dr. O a couple of times, he eventually told me he thought Shiloh had a primary adrenal tumor....based on the test results. I'm just saying, I think it would be worth asking him about it in light of Harley's LDDST results and his ultrasound. Harley's post ACTH cortisol level was in the normal range which is often seen with adrenal tumors. That may also be common with atypical cushing's, I don't know. I'm strictly a layman but Dr. Oliver is THE expert. I think you should pick his brain a little when you get the chance...get all the information from him that you can. He is the best!

I think someone will be by soon to help you with the atypical treatment. I hope I didn't confuse you or worry you needlessly. I think after you converse with Dr. O everything (diagnosis, treatment) will be crystal clear.

Ken

[Squirt's Mom]

Hi Lori,

I know how hard it is to relax when the diagnostic phase seems to go on and on, but I was like you and wanted to know all I could about Squirt's hormone functions that could effect treatment choices.

The most important thing on her results and treatment options was the suggestion from Dr O to have an ultrasound done. She had already had one four months earlier but I took his advise and had a second one. This is when I was told about a tumor on her spleen. To make a long story short, once the surgery was over and she had completely recovered, her cortisol level came back the lowest its been since 3/08 when she was diagnosed. Her signs are gone, she is doing very well tho she has not been tested again. Without his suggestion, that tumor would probably have ruptured, which is life-threatening. When I saw the comment about the nodule on Harley's adrenal, my antennae went up. Did the docs make any comment about that? I can't help but wonder if it could be the source of the hyper-adrenal activity. :confused:

I have included a portion of the treatment sheet from UTK showing the numbers Dr O listed and put the dosing info in bold. Many have not seen this sheet so don't really know what we are talking about when we mention it. :o

Anyway....the FSO (Flax Seed Oil) w/ Lignans was the standard approach at 1000 mg until the purified lignans in a capsule came on the scene. The purified lignans have a consistent dose of 40 mg/cap. Many dogs cannot handle the amount of oil in the FSO's so the caps helped them. Now, there are the crushed hulls. They serve the same purpose as the FSO w/lignans and the capsules. I use the purified lignans so I can't offer any first hand experience with the hulls, but it seems like Glynda was looking into it for her little ones. And on the old site, one, or more perhaps, of our members had opted to use them with apparent good results. It's is my opinion that if Dr O approves, then they have to be alright. ;)

The post numbers all look good to me except for the estradiol, which makes me wonder about that nodule again. I'm not sure what the pre numbers indicate but there are those here who do! :D

What Dr O is saying here, "Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens." is that the hormone estradiol can be produced (synthesized) in areas of the body other than the adrenal glands (where the other intermediate/sex hormones are produced) such as fat (Adipose cells/tissue). This is why Lysodren may not be effective on estradiol; Lyso works on the adrenal cortex only so since estradiol may be coming from fat tissue, the combination of melatonin and lignans are used as they will be effective outside the adrenal glands. Estradiol is one of the more difficult hormones to get control of because of this, but the bright side is that treatment for Atypical is much easier than for true Cushing's. ;)

You will do just fine with all this, Lori, I know you will. And we will be here with you all the way.

Hugs,
Leslie and the girls

Treatment Option Considerations Steroid Profiles in the Diagnosis of Atypical Cushing’s Disease Clinical Endocrinology Service/College of Veterinary Medicine/University of Tennessee

"2) Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a total dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a total dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs. Regular melatonin is usually used rather than rapid release or extended release products. Melatonin has anti-gonadotropic activity (effective for ferret adrenal disease), and it inhibits aromatase enzyme (decreases androstenedione and testosterone conversion into estradiol) and 21-hydroxylase enzyme (effectively lowers cortisol level). Monitor treatment effectiveness by improvement in clinical signs, biochemistries or by repeat of steroid profile.

3) Melatonin Implants. Available for dogs and ferrets. (WWW.MELATEK.NET). Sizes are 8, 12 and 18 mg for <25, 25-50 and >50 lb dogs, respectively. Effects last 3-4 months.

NOTE: Melatonin and flaxseed oil with lignans are used together when estradiol is increased.

4) Flaxseed oil (FSO) with lignans. The lignans in FSO have phytoestrogenic activity, and may compete with estradiol for tissue estrogen receptors with less biological effect. Lignans also inhibit aromatase enzyme (lowers estradiol) and 3-beta HSD enzyme (lowers cortisol). The oil may have low level of lignan, so a flax hull product may be preferable. E.g., WWW.FLAXHULLS.COM (standardized product with high content of lignan). Give SID on food: 1/2 tsp for dogs <30 lbs; 1 tsp for dogs >30 lbs. Also, WWW.VITACOST.COM/NSIFLAXSEEDLIGNANS. Standardized, lower concentration lignan product (40 mg capsules). Give SID: 1 capsule for dogs <30 lbs; 2 capsules for dogs > 30 lbs."

[Harley PoMMom]

Oh Darn,:( just when I thought we might be on the road to treatment.
I pulled out Harley's papers from the Univ. of Penn. and there in my face is:

Confirmed: Right adrenal nodule(7.3mm at caudal pole), could be consistent with hyperplasia or an EARLY ADRENAL TUMOR.

Confirmed: Small splenic nodule.
Univ. of Penn. says to do another U/S in 6 months to see if the nodules have grown.

I called Harley's vet and left a message to see if we should have another U/S done now.

OMG, I never gave those nodules a thought bc when I asked Dr O'Neill(Univ. of Penn) about the nodule on Harley's adrenal gland, she said it was so small it PROBABLY had no effect on his cortisol levels.:mad:, so, thank you, thank you so much for bringing this to my attention Leslie and Ken. I really don't know what I would do without all your help and support.

Leslie, special thank you for deciphering for me about the elevated estradiol and peripheral tissues :) Was all jibberish to me :eek::confused: until you put into cushpup mom terms :D

Well, the ole boy nudgin me to go out, so I'll check back later.
Again, Thank you so much for the information.

Harley and Lori

[barney's mom]

Not sure what to make of that Lori.
Honestly I don't think they do either. It is small that they aren't sure if it is a tumor, or hyperplasia, which is an overgrowth in the number of cells in that area.
I am still in the camp of I don't know what to think with Harley.

Also, if it is an adrenal tumor, they sometimes still treat with meds before surgery. So I guess a whole lot will be learned from your doc looking at the whole clinical picture, the lab results in conjunction with the US findings.

OMGosh, you have got to be going nuts at this point!

Cheryl

ETA:
Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens.

My knowledge here is strictly in humans, estradiol is an estrogen, the most prevalent form of estrogen in the human body. Fatty tissue can synthesize estrogen. That's why obesity is a risk factor or breast cancer, the increased amount of circulating estrogen.

Cheryl

[Harley PoMMom]

I have, probably, a stupid question :o

"When using Melatonin, Typically, a total dose of 3 mg is given (BID) for dogs < 30 lbs."

Total dose, does that mean 3 mg twice a day or does it mean 1.5 mg twice a day??:confused::confused:

I should be getting this, yous are probably reading this and thinking "did this girl fall down and hit her head and can't think straight." :):confused::eek:
Well, I didn't fall down, but I sure can't seem to think straight right now.

Harley and Lori

[Squirt's Mom]

Hey Lori, :D

No such thing as stupid questions!

BID means twice a day, every 12 hours, so that means you give 3mg 2X/day for a pup under 30 lbs.

I tried that fell-down-and-hurt-my-head thing once, no one believed me. :p

Hugs,
Leslie and the girls

[Harley PoMMom]

Bless you Leslie,

I tried that fell-down-and-hurt-my-head thing once, no one believed me.


You know just what to say to make a person laugh when they feel like just screaming, bawling, tearing their hair out, etc... you get the picture~that's me right now!!:p :eek::confused::p

Harley and Lori

[Truffa's Mom]

Hi Lori and Harley, I've seen you've been following us successfully to here.

My Truffa is an atypical cushings pup. I am not as versed on the tests and all about atypical, you would think, but no. I always ask for help here, is like mi mind doesn't want to understand. When we received the diagnosis we were sent home with the Melatonin prescription and the medicine for the high blood pressure. My vets never recommended the lignans or all the other options that Dr. Oliver suggests for atypicals.

So I asked on this forum, and after a lot of research on my part I decided to use The Mega Omega Organic Sprouted Flax High Lignans (http://www.health4allproducts.com/faq.htm), in part because Leslie bought all the inventory of the Flax Oil capsules that they were using on CC.net (kidding but true ;)) and because after reviewing several options I thought that this product was very interesting. Both my dogs take it now and they love it. I am buying it at http://www.tandjnaturals.com/ and I am very happy with it. We will have to do another UTK panel and for sure another Ultrasound and blood pressure to really be sure. But without knowing the numbers, I would say that she is doing better.

I know that raw food is the best, but I took a "middle option", in part because I am not sure if cancer is present so I am avoiding grains and things that can put a strain on her immune system. Ahhh and she lost her teeth, so I am giving her Thrive (dehydrated food that I mix with low sodium chicken broth and water) and also Core from Wellness (grain free kibble) mixed with the chicken broth. So far We all love the food here. I don't think most vets are aware of all the good diets that are listed beyond their commercial shelves.

Please say hello to adorable Harley and keep smiling.

Marcela & the Choco Labs

[Harley PoMMom]

Hi Marcela & the Choco Labs,

Marcela and Truffa, what very unique and beatiful names. Thanks for the info and the links, I did check them out and found them very interesting.

When are you having the next UTK panel done? I am very anxious, as you are too, to see them numbers and I am glad to hear she is doing better.

Harley's vet said that she can do the Melatonin implant in Harley, if I choose to have it done, I'm not sure, do you know of anyone that has a furbaby with one? I didn't talk to her about the implant at all, so I don't anything about it and she is on vacation this week.

I love your avatar, Truffa sure is a sweatheart, I once owned a black lab named Blue. He loved to catch his frisbee.

Harley thanks you for keeping his Mom sane, well nearly :D

Take care, Harley and Lori

[LuvMyMunchie]

Harley's vet said that she can do the Melatonin implant in Harley, if I choose to have it done, I'm not sure, do you know of anyone that has a furbaby with one? I didn't talk to her about the implant at all, so I don't anything about it and she is on vacation this week.


Scott's (gpgscott) Moria and also Steph's (corgipallie) Pallie have both had the melatonin implant.

Louise

[Harley PoMMom]

Thanks Louise,

Do you know if they have had any luck with it?

Harley and Lori

[LuvMyMunchie]

I know that Pallie has had more than one implant and I do believe the melatonin is doing its job. I'm not sure at this point if Moria currently has the implant or is taking the melatonin orally but as far as I know, Moria is doing well also.

Louise

[Harley PoMMom]

Oh Louise, that's great news to hear, cushpups doing well.

From the little bit I've been reading or should I say comprehending:confused:, they have to replace the implants every so often, like every 4 months.

Just don't know if I would want Harley to go through that stress all the time, or maybe it's not that bad.:confused: Have to find out more :eek::rolleyes::)

Harley and Lori

[stardeb55]

Lori, Scott was using an implant on Moria, but he has said in the past that there is no definite way to determine when the life of the implant is running out. Mostly because of that, he has switched Moria to oral melatonin. He has also said that the implant did have a tendency to leave a pretty nasty looking scab. My Harley who is both Pit & Atypical has been using oral melatonin since diagnosis, along with the Flax Essence capsules.

Debbie

[Harley PoMMom]

Debbie,

Do you get your Melatonin online or from where? How does one tell if you are getting the "pure" thing? I purchased Harley's at the 'Vitamin Shoppe' here in York, Pa. and am hoping they are of the right quality.

Harley and Lori

[stardeb55]

I just buy it at Target or wherever, making sure that I don't get the extended release version.

Debbie

[Harley PoMMom]

Hello to all,

Just wanted to wish everyone a "HAPPY MOTHER'S DAY."

[Squirt's Mom]

Thank you, Lori,

Happy Mother's Day to you as well.

Hugs,
Leslie and the girls

[LuvMyMunchie]

Hello to all,

Just wanted to wish everyone a "HAPPY MOTHER'S DAY."

.....and a very "Happy Mother's Day" to you and all the other Moms from me also!!

Louise

[gpgscott]

Hi Lori,

So you have a complicated diagnosis going on and you may or may not have an adrenal tumor.

Concerning the melatonin implant, Stephanie (corgipalliesmom) still does it, I do not.

As has been mentioned there is no concensus concerning the effective life of the implant, and the needle is large and can cause bleeding and scabbing.

I like the oral. It is cheap, you see it go down, and in our case combined with the lignans and other support (purified lignans, lecithen, milk thistle) it is effective.

I have not studied your entire thread and so some of these comments might not apply to your case.

I can't see a downside to trying the oral melatonin first.

As has been mentioned the most commonly prescribed dose we see is 3mg twice daily and you do not use the timed release product.

Best to you and Harley.

Scott

[Harley PoMMom]

Hi Scott,

Thanks so much for posting to me, your opinion on the implant was very much appreciated and helpful. :)

the needle is large and can cause bleeding and scabbing.
:eek: Harley does not like needles, so this was valuable information, and I don't want to put him thru undue stress if I don't have to.

So, the oral Melatonin and the pressed flax hulls will be what he is on.:D

Thank you again Scott,

[Harley PoMMom]

Hi To All,

I sent DR. Oliver a e-mail concerning Harley and his diagnosis and treatment, I would like to share it with you all and get your opinions/advice/whatever:)


The cortisol levels are fairly normal, although baseline is slightly
high. So, this would be called Atypical Cushing's syndrome (cortisol
essentially normal, but sex hormones are increased).
>>>The Estradiol levels are very elevated and probably causing rhe most
problems. Other intermediate hormone levels are also increased at
baseline. by DR. Oliver of Harley's Full Adrenal Panel.

But does Harley have pituitary cushings as well as Atypical? So will I
be treating Harley with something more powerful later? (Pituitary
cushings noted below by his endogenous test)


The hormone levels above support what is called Atypical Cushing's, and
it is due to a pituitary-dependent condition based on the endogenous ACTH
test result. Atypical Cushing's can be caused by eithe pituitary-dependent
disease or adrenal-dependent disease; in this case, pituitary-dependent. answer by Dr. Oliver



I'm sorry for all the questions, and I hope you can answer them for
me. Should I be running more test? Another ultra-sound? His Ultra-
sound did show a 7.3 mm nodule on his right adrenal gland, (U/S done
4/14/2009 @ University of Pennsylvania Vet. Hospital).

The nodule is probably not an issue at this point. The endogenous ACTH
level indicates the problem is with the pituitary (probably a small tumor
in the anterior lobe of the pituitary) that is releasing excess ACTH, and
this is stimulating the adrenals to produce excessive adrenal steroids.

>>>Treatment in this case can be melatonin and the flax hull product, and a
maintenance dose of Lysodren can also be added to give greater coverage
(treatment effect). I can discuss this with your veterinarian if it would
be helpful.

>>>Hope that helps. Regards, Jack.

[stardeb55]

Lori, Dr. O isn't saying that Harley has Pit Cushing's, too. What he is saying is that the source of the Atypical is coming from a lesion in the Pit gland which is causing the adrenals to pump out the excess intermediate hormones. To have Pit Cushing's, the cortisol must elevated. Harley's cortisol is basically normal. (You always look at the post value which is the most important). Atypical can be either adrenal or pit-based, just like regular Cushing's.

What do the vets say about monitoring the nodule on the adrenal gland? Have they said to do a US after a certain period of time to see if there are any changes in that nodule? If they haven't said anything, I would ask.

Debbie

[Harley PoMMom]

Debbie,
Thanks for your post.

Harley's vet want to do another U/S in 6 months to see if the nodule has grown.