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This question is for Dr. Salkin: Dr., Dusty is showing some

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This question is for Dr. Michael Salkin:Dr. Michael, Dusty is showing some symptoms like cushings. Let me explain what has been going on, but first want to get this new session started.
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Answered in 11 minutes by:
10/18/2016
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 31,810
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Customer reply replied 1 year ago
Reminder of Dusty's situation: He had been on adrenal glandulars since April, showed up with AlkPhos(350) in June, then AlkPhos(950) in September, but had no cushings symptoms. He was also diagnosed with lungworm in September.I weaned him from the adrenal glandulars over two weeks and last dose was given October 10th. We also finished the Panacur for lungworms on the 10th. Vet had given me some 5mg pred tablets in case of cough due to inflammation from worms dying. This past weekend, he had some coughing, so I gave him 3 separate doses of pred, but very very small doses: Friday 1/4 tablet, Saturday 1/4 tablet, Sunday 1/8 tablet. (reminder, Dusty weighs 17 lbs.)By Sunday I noted he could not get enough food. No excess water consumed tho, but his food is very wet already and I give lots of water during the day. He did have somewhat increased urine. During the day he'd had a more cheerful/energetic mood, was over-excited about eating when I went to get food, and seemed a bit unable to relax at bedtime, begging for food into the night until I demanded he go to sleep. Occasionally he will pant for a couple minutes…even tho it is very cool here (this is unusual). His symptoms are exactly the same today. He has not had any pred since Sunday morning.This is such a small amount of pred to cause such symptoms, isn't it? (.25mg twice, then .125 once)Again, I have to ask this: If the AP elevations were due to cushings disease, is it even possible to have AP that high for several weeks and still have no symptoms? What could be going on?

I agree, it's very unlikely that such a dose for such a short period of time would cause cushingoid symptoms such as polyphagia (increased hunger), polydipsia (increased thirst), and polyuria (increased volume of urine). Please note that the degree of elevation in the AP doesn't correlate with the seriousness of the underlying disorder. Let's see if symptoms persist over the next week before deciding whether or not a low dose dexamethasone suppression test for Cushing's makes sense.

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Customer reply replied 1 year ago
Don't cushings symptoms come on gradually usually?

Yes. I also reviewed Dusty's complete blood count (CBC) and found plentiful eosinophils - white blood cells that mostly disappear under the influence of excessive cortisol in Cushing's disease.

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Customer reply replied 1 year ago
I suppose he could be ultra-sensitive to pred now? I used to give him doses like this for many years for his IBD and we never had such symptoms. ???
Customer reply replied 1 year ago
Last year when Dusty had that horrible dermatitis that turned into infection and I was treating with spray on steroid product, he had the same symptoms and even after I stopped, it lasted for about 10 days or more.

Perhaps...or another disease has arisen - diabetes, e.g.

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Customer reply replied 1 year ago
are the symptoms for diabetes the same as cushings? does his bloodwork suggest diabetes? would symptoms come on suddenly like this if diabetes?

Yes, no, and it's possible.

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Customer reply replied 1 year ago
does diabetes cause elevated AP?

Yes, due to fatty liver...

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Customer reply replied 1 year ago
It just seems so suspicious that this happened right after I gave pred. And I wonder what damage we might have caused using those adrenal glandulars?

Let's see what happens now that you stopped giving the pred. That I don't know. Those supplements are unregulated.

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Customer reply replied 1 year ago
OK. Is there anything I can do to help relax him? He is constantly begging me for food. Should I feed him even tho he has had too much already?
Customer reply replied 1 year ago
Dr. Michael, what drugs are available these days for cushings other than Lysodren? Are there ways to treat them without giving that harsh drug?

Give him celery, iceberg lettuce...really low-calorie stuff...

Triostane (Vetoryl) is now the drug of choice for most forms of Cushing's. Nothing that's reliably effective.

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Customer reply replied 1 year ago
Is Trilostane safer than Lysodren?

Yes, but it's not innocuous...

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Customer reply replied 1 year ago
can you tell me what other problems might have been on the labwork if it were diabetes?

the most obvious - an elevated blood sugar

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Time for beddy-bye. I'll talk to you tomorrow.

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Customer reply replied 1 year ago
OK. When you get back, tell me this: with that type of elevated AP, if it were cushings, would you have expected to see symptoms before now?

Yes, certainly

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Customer reply replied 1 year ago
Dr. Michael. Good evening. Just a quick question. Dusty had a good day. I notice he is only showing the cushings-like symptoms in the late evening, where he is extra hungry and a little bit of panting. Does that say anything that it is only in the evening?

No, I don't know of any evening-only disorders except sundowners syndrome which is a form of cognitive dysfunction seen in pets and people. It's conjectured that the dark and quiet of night magnifies the sensory loss in these patients which results in their anxiety and subsequent aimless wandering. Other indications of cognitive dysfunction include disorientation, changes in social and interactive behavior - becoming "needier" or, conversely, more aloof - changes in locomotor and sleep cycle behaviors, and loss of housetraining. Increased hunger, however, isn't expected.

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Customer reply replied 1 year ago
I read once that the "circadium rhythm" or whatever affects the adrenal gland production of cortisol, and it is lowest in the morning. Thought that perhaps cortisol builds up over the day. Anyway, he isn't frantic to eat or panting alot, but he does keep looking at me for food. I am just so worried. Dr. Michael, do most dogs tolerate trilostane well? I just can't understand how we could be talking cushings when just a few months ago my vet thought his labs indicated potential Addisons :(

Cortisol doesn't "build up" but there is a rhythm. Yes, trilostane is generally well-tolerated although initially there might be some GI distress. We shouldn't be talking about Cushing's because he isn't eating you out of house and home and drinking like a fish. He also has too many eosinophils in his blood to think that Cushing's is a significant possibility.

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Customer reply replied 1 year ago
But he is eating more than usual, begging alot, and seeming a bit anxious, unable to relax at night. I notice he is gaining weight, probably from me giving too much to eat. Do cushings symptoms come on slowly like this.

Is he also drinking a lot and producing a lot of urine?

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Customer reply replied 1 year ago
Not drinking alot, not excessive urine either.
Customer reply replied 1 year ago
Just never satisfied with normal amount of food.

Once again, then, he's not cushingoid.

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Customer reply replied 1 year ago
I am relieved a bit now. He does seem to be able to relax in morning and during the day. Just hungrier at night. Maybe his body is just adjusting after stopping all the herbs and adrenal glandular and adrenal support. I took him off most all his supplements last week, so maybe lots going on. The vet put him on LUNG glandular for help with the lungworm, but I am scared to give it. I just don't know what's in that stuff. I think his little system needs a rest for a couple months.

Lung glandular!!!!! What in the world....

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Customer reply replied 1 year ago
All these glandulars are by Standard Process, a whole food company that has been around since 1929. Most all the holistic vets I have had have used their products.
https://www.standardprocess.com/Products/Standard-Process/Pneumotrophin-PMG#.WAex1ekXchQ

The major problem with these products is they're unregulated and don't have a whit of scholarly evidence that they do as they're purported to do. Most are innocuous; some may be dangerous.

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Customer reply replied 1 year ago
I am beginning to think this myself. There is no way to know for sure what they do to the actual organs. I will say, tho, that after taking the adrenal glandular, his electrolytes returned to normal, but the AP elevated. Sigh. Do you agree that stopping all supplements for awhile is ok? Dr. Michael, Dusty's food is so well-cooked that all the nutrients are likely mostly gone. So going without a multi-vitamin for a long time worries me. Thoughts? (I cook his veggies for long time to help his poor digestion). Everythings goes in the food processor, cooked meat, veggies, pumpkin.

Yes. A multivitamin/mineral supplement once weekly is reasonable. I have to leave my computer for a few hours but will reply as soon as I return if need be.

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Customer reply replied 1 year ago
Thank you as always for your expertise and kindness!

It's my pleasure.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 31,810
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Thank you once again.

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Hi,

I'm just following up on our conversation about Dusty. How is everything going?

Dr. Michael Salkin
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Dr. Michael Salkin
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