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eyelostit
04-23-2008, 09:46 PM
I didn't want to hi jack a post, so created this one, but I am wondering what does melatonin do for a cushings dog? I've read about giving them tablets and the patch but what does help? To Sleep? and also what does the Flax essence do, i give my dogs flaxseed oil on occassion.

thanks

Kiska'smom
04-24-2008, 08:16 AM
Hi there,

I wanted to share some information from Dr. Oliver about your questions. According to him, the melatonin is often used as a first treatment for Atypical Cushing's, especially if alopecia is present. "Melatonin has a anti-gonadotropic activitiy, and it inhibits aromatase (converts androstenedione and testosterone into estradiol) and 21-hydroxylase (lowers cortisol level) enzymes.

The flaxseed oil with lignans or Flax Essence is usually added if estradiol is elevated. The "lignans in FSO have phytoestrogenic activity, and may compete with estradiol for tissue estrogen receptors with less biological effect. Lignans also inhibit aromatase (anti-estrogen) and 3-beta HSD (lowers cortisol) enzymes."

A lot of vet-speak for supplements that have been found to interrupt the effects of certain hormones. When a pup has Atypical Cushing's, one or more of the intermediate sex hormones are elevated. So, melatonin and FSO with lignans have been shown to calm those hormones and allow the endrocrine system to function more normally. The melatonin is used to help promote sleep in people, and it has a calming effect on animals. It just happens to helps with certain hormone levels as well.

If you are giving the FSO, make sure that it is the one with "highest lignans." I used the "Barlean's" brand from Whole Foods before I went to the "Flax Essence" from Vitacost. I believe that the "Flax Essence" is a very purified form of lignans, and I know that it is the one that Dr. Oliver prefers. If I understand correctly, it is the lignans from the FSO that does the job.

Hope that this helps a little!

Jeanne and Kiska

eyelostit
04-24-2008, 10:40 PM
So would it hurt to give my dog some melatonin at a small dose, we never knew where the cushings was coming from the adrenals or pituary, he had the ach test and another test like that, which proved the cushings, I just wondered, I don't want to do him no harm, it would be nice if he could rest without breathing heavy at times. But Chief is getting up there now with the pain meds, would it hurt to give him melatonin? i know it helped me sleep but with a dog it is different.

I wonder why the vet didn't suggest this at the beginning, i can't remember what they had to do to see which gland the cushings was coming from, I don't think it was pursued, I know they talked about an operation that could be fatal and I have his lab results, what do i look for, for the Atypical?

When at first Chief started the heavy panting i thought oh no now he's got diabetes, we go to vet they say he's ok, then we go to McDonalds, I get chief a hamburger, he does his business I look and see the worms, i call vet, have to ride back another hour to get the worm med, that clears up, then the panting continued, then the cushing diag.

Its just me but I swear that tapeworm did something to Chief, I lived in a desert area out west years ago, we did not have to give our dogs frontline or flea med's etc. then I get to PA and he gets a tapeworm, I wonder if a parasite caused something and the weather change? I guess I am just being nuts but it all happened at the same time. Maybe thats why Chief has been around since his diag of cushings in 2005?

I am originally from PA and i remember my other dogs and the tapeworms etc, and the flea dipping before frontline came along.

Just seems to me something went wrong somewhere, it was bad enough with Niki getting diabetes but she had that before the move to PA


thanks

Kiska'smom
04-25-2008, 12:36 PM
Hello again,

Poor Chief. I am really surprised that he is still around, since being diagnosed in 2005! If you can find the papers from the vet, it would help me to know what tests were done, and what the actual results were (the numbers). If he is Atypical, you probably sent a serum sample to the University of Tennessee for analysis. You would have gotten something back listing the hormones and giving you some numbers indicating where there are in relation to "normal." It would have been called a Full Adrenal Panel. I'm thinking that your vet told you that Cushing's disease was caused by either a tumor in the pituitary gland or in the adrenal glands. Either way, it causes the adrenals to pump out too much cortisol. In a Cushing's dog, they lose the ability to control the bodily safeguards that suppress too much cortisol in the system. (It is a normal hormone that is produced by the body. In a normal dog, the body just monitors the release of hormones and regulates them properly.) Therefore, the Cushdoggie has way too much cortisol in his system. It begins to affect the internal organs. Usually you will see high levels of liver and pancreatic enzymes in their blood tests. That is because the cortisol is damaging the liver and other organs. Left untreated, most dogs only last a year and die from heart failure or strokes. So Chief has been very lucky. If he has Atypical Cushings, that is similar, in that another hormone or two (other than cortisol) is racing around the system unchecked, and is also causing damage to the internal organs. The other hormones don't do as much damage or act as quickly as cortisol, but you get all of the same symptoms, and eventually death in bad cases. Melatonin is used in Atypical cases. It has been shown to have an effect on the Intermediate hormones (other than cortisol.) Some dogs have great success with it, but other's don't. If your dog has elevated estradiol, for example, it would need to have Flaxseed Oil with Lignans to target that particular hormone, along with the melatonin.

I'm not a vet, so I can't say for sure that giving Chief melatonin would work for him. I don't think that it would hurt. I give my husky melatonin to help calm her allergies, along with Benadryl. The melatonin should not be the time-released type. You can buy it at any health food store. The dose is 3 mg in the morning, and 3 mg at night (given daily.) However, if Chief has regular Cushings, these over-the-counter supplements will not help. They don't touch cortisol production.

I know what you mean about events triggering Cushing's. I am sure that the Atypical Cushing's triggered Kiska's diabetes. They are such complex critters (as are we) and it just makes sense that when things come on all at once, that there is a primary source.

I hope all of this helps. I need to go right now, but I will check back later. If you want to ask me anything else, I'll be happy to answer!

Jeanne and Kiska

eyelostit
04-26-2008, 12:13 AM
I dug out his test results do you have a fax#

thanks

k9diabetes
04-26-2008, 05:41 PM
Hi Dolly,

Can you post the numbers here?

Otherwise, if you want, you can fax it to me. 916 372 7161

Natalie

Denise
04-26-2008, 09:50 PM
I started giving melatonin to Reba a few weeks ago when I suspected thyroid or Cushings but we didn't know yet. Her symptoms were panting, seeking cool places, hair coat dry and shedding (no balding), PU/PD and increased appetite.

I put her on 3 mg. once a day and then we got the atypical dx so was going to increase to the 3 mg. twice per day as suggested.

We were to start Lysodren tomorrow but the past 3 days she isn't eating like she was. That was a big clue for me because this dog had to be told to get off the couch to eat before and skipped some meals here and there and all of a sudden she was scarfing ehr food and trying to get the others food. She used to turn her nose up at most treats and walk away but started grabbing them AND parts of my fingers!

So, a couple days ago she started leaving food in her bowl and had no desire to see what the others were eating. This morning she didn't eat till an hour later and still left some food and tonight she left food.

I am not starting meds when the most obvious sign I would be watching for was a decrease in appetite since that ahs already happened.

Don't know if melatonin alone can be what's doing this or not but I will be waiting till next weekend to start Lysodren and will be calling ISU and U of Tn. about this. I didn't get a treatment recommendation when her report came back like I did with Bogie, just the list of all possible treatments.

I think I will add flax this week too. Maybe she will be one that can just do the flax and melatonin?? She also isn't PU/PD anymore.

Any thoughts on this???

eyelostit
04-27-2008, 12:02 AM
Hi Dolly,

Can you post the numbers here?

Otherwise, if you want, you can fax it to me. 916 372 7161

Natalie


I will fax now or I never will, hope your fax does not have a ringer oh but hey your on the west coats.

In a few........:)
Hope you got, looking at all that is too confusing for me, thanks

k9diabetes
04-27-2008, 12:09 AM
We're up... fax away.

k9diabetes
04-27-2008, 12:43 AM
Dolly,

Looks like Chief's vet was very thorough... the only thing I can't figure out is whether the DDS was LDDS, low-dose, or HDDS, high-dose - maybe it's obvious to the Cushings folks. It gives the reference range for both but I can't see where it says which dose they gave.

ACTH
Pre 5.5 ug/dL
Post 24.2 ug/dL

Dexamethasone Supression Test
Pre 2.3 ug /dL Ref Range 1.0-6.0 ug/dL
4 hours - 1.6 ug/dL
8 hours - 2.9 ug/dL

Thyroid Free T4 with ED = 1.5 ug/dL Ref Range 0.7-2.5 ug/dL

High Values on Blood Work
ALT = 141, normal 10-100 U/L
ALKP = 280, normal 23-212 U/L

eyelostit
04-27-2008, 12:52 AM
oK, the bill has on it Dexamethasone supression $ 115.00
ACTH stim test $86.00

How can I tell differnece?

eyelostit
04-27-2008, 01:06 AM
So I can tell his thyroid if off, but the other things I can't figure, maybe Kiska can tell.

i wait and see what Kiskas mom says I guess before i give him melatonin, what do you think?

You or Kiska can let me know tommorrow if you are ready to go to bed, thank you for posting the info, i can't tell if its the high or low test, i know i had to leave him there for awhile, then go another day and leave him again for awhile, I think he could have had 2 tests in one day, I would have to call the vet, tho actually i can email them.

if you are still up, send me an email i will stay logged on for awhile

eyelostit
04-27-2008, 01:19 AM
Now I know what "alopecia" means! hair loss, he had this slightly at first, got the 3 raised Little lump bumps cutenous? The one lil lump was on his back, it was on each front leg side above ankle, the one on his back he had hair loss there, i tried a few things I rubbed on it, and finally i think sulfoden took it away and the hair returned, the ones on his legs were itchy to him for awhle, i used the sulfodene again, the itching stopped, he has the 2 small bumps on his legs but they don't bother him anymore. I really can't give sulfodene the credit, at the time i tried alot of differnt things to put on the one on his back from baking soda, vinegar, anti itch, I mixed vaseline with some things, i must of been searching the web at the time, i know i bought alot of those essential oils back then.

Chief does not have hair loss, he is a bit pot bellied, and always hungry, at the last vets visit his heart sounded good, he's normal with the pee's and poos, does not drink water excessivly.

I am now looking at pages for flax essence

k9diabetes
04-27-2008, 11:12 PM
His thyroid looks like it was normal at the time, smack dab in the middle of the normal range.

The ACTH suggests Cushings because the post-stim value is so much higher.

Normal Pre value is 2-6
Normal Post value is 6-18
Possible Cushings Post value is 18-22
Positive for Cushings is a post value in excess of 22.

Look here for some information on the tests: http://www.caninecushings.net/forums/showthread.php?t=6360

Under the LDDS test

In healthy dogs, glucocorticoids exert negative feedback inhibition on ACTH secretion. A low-dose of dexamethasone (0.01-0.015 mg/kg) administered intravenously to healthy dogs causes inhibition of ACTH secretion and reduced plasma cortisol concentrations within 2 to 3 hours lasting up to 8 hours.

In hyperadrenocorticism, the 8-hour cortisol value is not sufficiently suppressed and remains above approximately 30 to 40 nmol/l. The low-dose dexamethasone suppression test is considered an extremely sensitive diagnostic test. In approximately 95% of dogs with PDH (pituitary-dependent Cushings) and up to 100% of dogs with AT (adrenal tumors), cortisol suppression is inadequate. However, some dogs with hyperadrenocorticism have suppressed values at 8 hours and suppressed or elevated (inverse results) values at 3 or 4 hours.

Unfortunately, false-positive test results frequently occur in dogs with non-adrenal disease and the specificity of the test has been reported to be as low as 0.44. In general, the more severe the nonadrenal illness, the more likely that cortisol suppression will not occur. The high negative predictive value of this test means that hyperadrenocorticism is unlikely if cortisol suppression occurs, but in some individual cases this does hold true.

An additional value in performing a low dose dexamethasone suppression test is its ability to distinguish between PDH and AT in up to 60% of cases when circulating cortisol concentrations are measured at 3 or 4 and at 8 hours.


Criteria that indicate a diagnosis of PDH include a decrease of circulating cortisol concentration to less than a laboratory reference value at 3 or 4 hours, less than 50% of the baseline value at 3 or 4 hours, or less than 50% of the baseline value at 8 hours. However, PDH cannot be ruled out if suppression does not occur.



ACTH
Pre 5.5 ug/dL
Post 24.2 ug/dL

Dexamethasone Supression Test
Pre 2.3 ug /dL Ref Range 1.0-6.0 ug/dL
4 hours - 1.6 ug/dL
8 hours - 2.9 ug/dL

Thyroid Free T4 with ED = 1.5 ug/dL Ref Range 0.7-2.5 ug/dL

High Values on Blood Work
ALT = 141, normal 10-100 U/L
ALKP = 280, normal 23-212 U/Lhttp://www.k9diabetes.com/forum/images/misc/progress.gif

I believe the vet would have to tell you from their notes what dose they gave. IDEXX wouldn't know, which is why they are reporting both ranges.

Assuming it's the LDDS, a value of greater than 1.5 at 4 hours is positive for Cushings - Chief's was 1.6.

A value greater than 1.5 at 8 hours is positive for Cushings. I don't have a good enough handle on interpretation of whether it is pituitary.

The best place to check this out would be the Cushings board: http://www.caninecushings.net/forums/forumdisplay.php?f=1

But with my admittedly very limited experience with these results, it looks like the tests were positive for Cushings.

Natalie

Kiska'smom
04-28-2008, 11:27 AM
Hi Dolly,

Sorry that I wasn't back before now to look at your numbers. I do not have a fax, so I am glad that Natalie was able to post your test results. The high values on your blood work are not very far out of whack. (The ALT and ALKP) Usually, with Cushing's, they are 3 to 4 times as high as normal, especially with regard to the ALKP. However, if I am reading your LDDS right (and I'm not completely sure that this is LDDS or HDDS), the results (if LDDS) indicate regular Cushing's. A post 8 hour result above 1.5 would be indicative of Cushing's. The ACTH, I won't comment on, because I'm not sure what the reference range is for that. I think that it would be a good idea to have one of the experts from CanineCushings.net look at your numbers, too! They are far more knowledgeable than I am! However, if your pup has regular Cushing's disease with clinical symptoms, melatonin and FSO with lignans, will not help. These are treatments for Atypical Cushings, where the production of cortisol is not an issue. Regular Cushings is caused by the over-production of cortisol from the adrenal glands, and the body's inability to suppress that production. It can be caused by either a small tumor in the pituitary gland or an adrenal tumor. Both kinds of tumors result in the production of excess cortisol. Two medications are usually used to suppress the adrenal function: Lysodren or Trilostane. I would strongly recommend that you look into the CanineCushings.net site, because they have information pages that can give you much more information about Cushings and its treatment options. Hope that I gave you a little help!

Denise, hi! It sounds like you have already had the Full Adrenal Panel done at the University of Tennessee. If your pup was diagnosed with Atypical Cushing's, then the melatonin might just be helping. You did not say which of the intermediate hormones were out of range on your adrenal panel. That would be good to know, because some of them take different treatments. This is what Dr. Oliver had to say about the melatonin with regard to Kiska:

"Melatonin will definitely lower the post-stim cortisol level significantly, and frequently also has a lowering effect on progesterone levels."

Kiska's progesterone was elevated on her Full Adrenal Panel: 1.96 post stim, with a reference range of .10 to 1.5. Her stimmed cortisol was "high normal" at 171.9, with a reference range of 65.0 to 174.6.

Dr. Oliver said,

"I personally wouldn't do an "induction" with Lysodren for these modest increases in hormone levels."

So, if you are seeing an improvement in clinical signs, then maybe it would be good to monitor Reba for a while longer and see if the melatonin is doing it's work! You could certainly contact Dr. Oliver via email and ask him what he thinks with regard to your personal case. (Just include your Case # in the subject line so that he can look up your information.) Is the appetite the only difference you have seen in her behavior? What about the other symptoms?

Hugs to you both.

Jeanne and Kiska

eyelostit
04-28-2008, 03:54 PM
Thank you for the reply Kiska's mom, I was looking over at the cushings forum I think it is one of the sister boards here, I could not find the values etc, So with no doubt Chief has regular cushings and the melatonin will not help or the flax essence.

I had given him 1 melatonin today thinking he may get a little more rest, but I have not seen that, plus if it isn't going to work in his system, its just not.

I guess I will take the Melatonin. ;)

Take care

gpgscott
04-28-2008, 05:34 PM
Thank you for the reply Kiska's mom, I was looking over at the cushings forum I think it is one of the sister boards here, I could not find the values etc, So with no doubt Chief has regular cushings and the melatonin will not help or the flax essence.


Hi Dolly,

Jeanne asked me to look in, I have been really busy lately and I am sorry I missed these goings on with Chief.

I know Cushy is also looking in on this board and I hope we hear from her as well.

These numbers look borderline Cushing's to me, I would get the extended panel to see where all the hormones are.

Is Chief well regualated in terms of diabetes?

Best to you and Chief. Scott

eyelostit
04-28-2008, 05:49 PM
Chief is not a diabetic, he's had cushings for 2 yrs now, he was 12 at diag. I decided not to go with the treatment because of his age and the cost's involved, but he has not lost hair etc, he does alot of panting, he was at the vet for nail trim and the vet could not get over he was still going on, she told me he would die within a year without the treatment. So............who do you believe the vets? I really don't have faith in vets when it comes to the diabetes, I am not that up to date on cushings, Chief is a happy dog, he is not throwing up, his bm's are fine, his last exam was fine, he does not drink excessive water, he's getting some warts, one by his eye, his hips are starting to go he's on meloxicam for that, my older dog who passed had gotten those warts too, they just seem to get this when they get older.

With his age at 12 at the time of diag. and reading up on Lysodren etc, I did try the Ketoconzole which had him zonked, I just did not want to put him thru this, with being 12 yrs old I felt that was kinda old for Lysodren, if he had been 7-8 that would have been different. Chief is 14 now.

My other dog Niki is the diabetic.

Take care:)

gpgscott
04-28-2008, 06:55 PM
Hi Dolly,

Ok, Iv'e got it now. There is no good reason to not try the combination of melatonin and lignans that I can see. The rate recommended for the rest of us was 3mg melatonin twice daily and 1000mg flaxseedoil (Barleans is best) or 40mg purified lignans once daily.

Your cortisol is in the near normal range and this treatment could bring that down a bit. The treatment does not have an immediate effect in most dogs, it can take up to three months for response.

In order to tell if this treatment can have an effect you need to commit to a routine for at least three months and then retest.

Hope this post is of some use.

Best to you, Chief, and Niki. Scott

Denise
04-28-2008, 07:43 PM
I posted Reba's numbers on the Everything Else board since she isn't diabetic and I didn't want to hijack this thread.

Kiska'smom
05-01-2008, 10:01 PM
Hi Dolly,

I hope that the melatonin gave YOU some rest! Well, I see that Scott gave you some good advice! I'm glad that he was able to look at your posted numbers. I don't think that the Atypical treatment could hurt Chief. There seem to be more and more dogs with a combination of Cushing's and Atypical Cushing's diagnoses. If Chief is showing very few clinical symptoms of regular Cushings, then perhaps a little control of the intermediate hormones would add a little relief. You just never know, and again, I don't think that the melatonin and Flax Essence would do any harm. They are both inexpensive, too! I wish that I knew more; but you have both sites to help you along!

I'll be thinking about you and hoping that things are going well for both Chief and Nike!

Hugs,

Jeanne and Kiska

eyelostit
05-07-2008, 01:10 AM
Thanks for the replys, I held off giving him 2 melatonins, and stopped, but if you guys think its ok to give him melatonin i will try and get the flaxseed, is it ok to do the melatonin till i get the flax essence?

Kiska'smom
05-07-2008, 10:52 AM
Hi Dolly,

Yes, it is okay to give the melatonin by itself! It helps with hair loss (although it hasn't helped Kiska's rat-tail) and also inhibits aromatase and 21-hydroxylase enzymes. There will be limited control of cortisol. The Flaxseed oil with lignans or Flax Essence both help inhibit aromatase and 3-beta HSD enzymes. They also help to lower cortisol. I don't remember what intermediate hormones were high in Chief's case. The Flaxseed oil also helps with liver function, and I give it to my dogs even though they don't need it for the Cushing's.

I hope that things are going well for you and your pups!

Hugs,

Jeanne and Kiska