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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 30288
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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My Havanese is 10 yrs old. Has been diagnosed or reasonably

Customer Question

My Havanese is 10 yrs old. Has been diagnosed or reasonably certain she has Cushings. I don't know what to do. She had an ultrasound $400. And is scheduled for blood work all day Monday. After listening to a vet on You Tube I am not sure this is necessary. I am 70, disabled and living on SS only. The Dr. On You Tube suggested just doing a first in am urine test. She does not approve of the toxic meds given for Cushings. Suggested first Melatonin. Also some herbal things I have not written down. The ultrasound shows her adrenal gland to be at high end of normal size for her size dog. Also thickened wall of kidneys. Also valve problem in heart ( causing the sounds of slight arythemia-sorry cannot spell). Her belly is frighteningly large. X-Rays had shown her liver was 2x normal. She has been urinating in house for first time since infant. Just completed antibiotics for urinary t infection. I am going to be moving to Davis next month to live with my daughter & family. She just completed her masters and beginning PhD. Needs my help with her 2 children. I am wondering if I should wait and take her to Davis Clinic? Will that be too long a wait? Also do you know how Davis treats Cushings? Any advice would be helpful.
Submitted: 2 years ago.
Category: Dog Veterinary
Customer: replied 2 years ago.
I already know everything you answered to the person asking about Cushings. My questions are very different and perhaps need an endocrinologist to properly answer.
Expert:  Dr. Michael Salkin replied 2 years ago.
Aloha! You're speaking to Dr. Michael Salkin
I'm sorry to hear of this with Sophia. It's important to note that Cushing's shouldn't be a consideration unless Sophia is eating you out of house and home and drinking like a fish and then forming large volumes of urine. Is this the case, please?
A distended abdomen due to muscular weakness seen in cushingoid dogs is common but a liver 2X normal size isn't consistent with Cushing's. We expect some enlargement but not to that degree should Cushing's be present. Urinary tract infection is common with Cushing's.
Should she be cushingoid, treatment is reserved for those dogs in which the symptoms of Cushing's disease prevent a normal quality of life. I might not treat a 10 year who is minimally affected. To answer you directly, please dismiss the ineffective melatonin and herbal remedies which will fail when addressing this disease. Yes, cushingoid dogs don't require immediate treatment and so waiting for UC Davis to take a look at Sophia is reasonable. That's where I trained and my major professor found the initial treatment of Lysodren (mitotane)for canine Cushing's disease. Lysodren has been largely replaced with trilostane. There are no specific diets recommended for cushingoid dogs but it's reasonable to limit fat and increase fiber as we would do with any obese dogs.
Please respond with further questions or concerns if you wish. I'm not sure which posts of mine you've read so don't hesitate to clarify your primary concerns.
Customer: replied 2 years ago.
I am questioning your response regarding water and overeating. The answer to both is 'No'. However many places I have researched tell me there are many symptoms connected with Cushings. Not all dogs have all symptoms. If she has 2 of the listed symptoms she has Cushings (I have read many times). I failed to tell you that her Cholesterol level was high but of greatest concern was the ? Think it was something similar to Alkaline Phosphate level was super elevated - in the 800's. If that does not indicate Cushings what would you suspect? Sorry I don't think all dogs drink and eat too much necessarily to be diagnosed with Cushings.
I just lost my larger dog June 1st. His name was Skyler. He had MD (muscular degeneration). It was very much like the disease that took my husbands life in 1993. He had ALS. Skyler had very gradually lost his back legs. I had to lift him to standing position. Then he could walk even tho back legs were very weak. NOW I am talking about Skyler because he had the issue with water. Could not get enough. I had to refill bowl twice a day. Then just before I finished making his wheelchair from PVC pipe, he had two strokes and died.
Customer: replied 2 years ago.
I wanted alternative treatments for Cushings. Not the meds you mentioned as they are very toxic. Many vets no longer give. I believe there must be herbal - Chinese concoctions that would help. Do you have an endocrinologist to consult? Has been long time since you graduated and perhaps you are just not familiar with the options available today?
Customer: replied 2 years ago.
I believe many are using acupuncture as well.
Customer: replied 2 years ago.
What explanation would you give for a belly that looks like she swallowed a melon?
Customer: replied 2 years ago.
Also what could cause 'liver disease'? To explain size of her liver? She is not diabetic.
Expert:  Dr. Michael Salkin replied 2 years ago.
Thank you. It's the rare dog indeed who is cushingoid but not polydipsic (increased thirst), polyuric (increased volume of urine), and polyphagic (increased hunger). I've never pursued the diagnosis of Cushing's if my patient didn't demonstrate those symptoms.
Cholesterol can elevate in cushingoid dogs but an elevated cholesterol is also consistent with hyperlipidemia (elevated fat level in the blood), hypothyroidism, hepatic insufficiency, and protein losing enteropathy. An elevated AP is consistent with Cushing's but it's a nonspecific enzyme often elevated in older dogs. It usually indicates biliary stasis (sludging of bile) and isn't pathognomonic (specifically indicative) of Cushing's.
Consider having the urine protein:cortisol ratio performed. It's a good screening test for normalcy. In other words, if the ratio is normal it's very unlikely that Sophia is cushingoid. If the ratio is elevated, it doesn't diagnose Cushing's because non-adrenal disease can elevate the ratio too but it does indicate further testing with a low dose dexamethasone suppression (LDDS) blood test.
For alternative approaches to Cushing's, please relist your question but amend it to say, "I'm looking for a naturopathic vet..."
I'll opt out which will allow such a vet to enter our conversation. Please don't leave a rating or respond to me - either of which will dissuade other vets from responding to you.
Customer: replied 2 years ago.
She acts perfectly happy and normal. Loves her walks! Goes nuts when sees my friend, Kathy. Also loves kids! Anytime we pass a child or stop to talk she is in heaven. On one walk a family of three were arriving home - getting out of car with their 3 yr old daughter. Dad is a fireman. We talked while she played with daughter. Following day as we passed their house no one was home. However she stopped and just sat down in driveway. Waiting patiently for her friend to return. Smart cookie she is....
Thank you so much for the info you just gave me. A bit frightening however! Appreciate your time. Did not know you had a homeopathic Vet to request!
Customer: replied 2 years ago.
Very appreciative.