Question from client!!
Brief history before the question…
My dog Annie had bloodwork done before a minor surgery last year to remove a skin tag from her eyelid. Her ALT was elevated, maybe around 200? After an ultrasound, the vet saw that her gallbladder was severely enlarged. After consulting with a local specialist, we decided the gall bladder should be removed. Surgery was very successful, and they also removed a noncancerous nodule from her spleen. They did a tiny liver biopsy at the time to check things out and the biopsy turned out ok! They did, however, see something (too technical for me to explain) that indicated that cushing’s was a possiblity. We had noticed for a while that her abdomen was a little big, although she has always sort of carried weight there. Also, she sometimes seems thirstier than my other dogs.
So, after the surgery, and giving her liver some time to recover, we tested again. We tested twice over this past year and her values not too long after the surgery were around 500 (alt) but last month were down to around 300 (alt). The ALT is the only liver enzyme that is elevated.
First, we did the urine cortisol ratio test to try and rule out cushings. It didn’t rule it out. So we did the ACTH stim test. Her score was 177. My doctor said the usual cutoff to indicate cushing’s is 173. So she is just over the line.
She suggested we not treat yet but test her again in six months. We will do bloodwork sooner than that to see if her ALT is rising.
I’m looking for alternative treatments. I am worried about the trilostane, which is my vet’s treatment of choice.
Can you tell me more about melatonin and lignans? Daphne
Tips on Alternative Cushing’s Treatments in Dogs
My recommendations are based strictly on the above scenario.
1. Consider a Low dose Dex. test. This test may definitively support a true diagnosis.
2. Repeat the imaging and compare the adrenal glands in order to appreciate a size difference or the presence of a tumor.
If a diagnosis of Cushings is confirmed, then Vetoryl is the current treatment of choice in Western Medicine. I have used this drug and most owners are happy with the results. The most common side effects not to mention cost, follow ups, and compliance are the following: poor appetite, GI disturbance, and weakness.
Many owners opt for alternative cushings treatments in dogs. If owners decline the use of Vetoryl for true Cushings, I use Eastern herbal medicines and diet changes depending on the condition of the dog. These treatments offer owners a less expensive option with virtually no side effects. Some dogs respond well and some don’t. It pretty much depends on the dog. If the Cushings is atypical, I use melatonin and lignans. You can find more info here.
Remember, if the screening tests for Cushings are negative and the liver enzymes are slightly high coupled with signs of Cushings, then your dog may have atypical Cushings.