From the Desk of Dr. Marc Smith…
Note: One of the goals of Natchez Trace Veterinary Services and Dr. Marc Smith is to provide ultimate transparency. The following question and answer session was pulled from Dr. Smith’s iPhone email archives and used, unaltered, in this article.
A Question for the Doctor:
Hi, I am exploring holistic options for treating my dog with Cushing’s Disease. She has just been diagnosed as “borderline” cushingoid. She has some symptoms but they are not severe. My vet thinks we should forego any treatment for now and watch and wait, recheck in a few months. She is on denamarin for her liver, and it is helping. Any advice? There are products online I am considering, but I am a very careful researcher and pet owner. -Daphne
Dr. Smith’s Reply:
Eastern herbals and dietary therapy is The way I treat pretty much all Cushing’s. The typical Western treatment with vetoryl I pretty much reserved for the most aggressive forms of Cushing’s.
Other treatment you might be interested in for atypical Cushing’s include melatonin and lignin therapy. Thank you and I hope this helps.
Do you have any experience with the Cushex drops? Most traditionalists say they are snake oil (and they may be) but I’ve looked at and researched the individual ingredients and they seem like they could be potentially helpful:
Dandelion (leaf & root), Burdock (root), Astragalus (root), Arsenicum album (30C), Hepar sulphuris calcareum (30C), Mercuris solubilis (30C), Sulphur (30C)
I would bring my dog in if I was in Nashville, but I am in Knoxville, TN. So, if there’s any more direction you can give me, I would greatly appreciate it. My vet has recommended just not treating currently because she is just over the zone into cushingoid diagnosis. But, if I can get a jump on helping her now, I would like to. Vetoryl is my vet’s treatment of choice.
What kind of dietary changes do you recommend? I am already transitioning her to homemade food and I can tell it helps with the thirst.
Also cushex drops I don’t recommend.
Do you think they would harm my dog (the cushex drops)? is the ACTH test what you use?
No, but they are a waste of money. I would use melatonin and lignins.
There are a variety of tests to diagnose Cushing’s. Your case sounds suspicious.
Why suspicious? The first test was the urine cortisol: creatinine ratio (UC: Cr) test that my doctor said could be used to rule out Cushing’s. But, unfortunately, that test indicated that we should do further diagnostics. So then she did the ACTH stimulation test. And her results indicated that she does have Cushing’s. I’d like to know what is suspicious so I talk to my vet.
From what I have read, that is a standard test for diagnostics. She also mentioned lignans and melatonin (from research she had read about from the University of TN vet school) but said she didn’t know very much about that treatment. And I also read that sometimes those are only good for atypical Cushing’s? Is that what you use for Cushing’s when it’s caused by a pituitary tumor? we know she does not have an adrenal tumor because she had an extensive ultrasound done before her gallbladder was removed. Do you see improvements with lignans and melatonin?
Appreciate your comments.
What I meant by suspicious is that since I have not seen and examined your dog, it is hard for me to tell whether or not your dog does have Cushing based on the information that you gave me. I did not know that you had an abdominal ultrasound performed.
Nonetheless, I think you have to make a decision. I have used melatonin and lignins in all types of Cushing’s whether it be atypical, pituitary-dependent or adrenal dependent it does not matter. I have had what I consider to be a good success using this protocol. Usually, I have used it after the people have declined Betoryl as vetoryl can have some potentially significant side effects.
I hope this answers your question. If you want more information go to our website at www.FranklinTNvet.com and type in under the search bar the subject for which you are looking. I would prefer to answer these questions through the website so other readers can benefit from our discussion. I will gladly help you and thank you for your interest and I hope I have answered your questions.
I certainly will do that tomorrow. I’ll send a question with her tests and diagnosis and questions on treatment. Appreciate your help.
A 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 doc saw that her gallbladder was severely enlarged. After consulting with a local specialist, we decided it should be removed. That 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 and it was ok but they did see something (too technical for me to explain) that indicated that Cushing’s was a possibility. We had noticed for a while that her abdomen was a little big, although she has always sort of carried weight there. And she sometimes seemed thirstier than my other dogs.
So, after the surgery, and giving her liver some time to recover, we tested again. she had also been on denamarin since the surgery. we tested twice over this past year and her values at once a time not too long after the surgery was around 500 (alt) but last month were down to around 300 (alt). That is the only one that is elevated.
We did the urine cortisol test to try and rule out Cushing’s. 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. but we will do bloodwork sooner than that to see if her alt is getting better.
I’m looking for alternative treatments. I am worried about the trilostane, which is my vet’s treatment of choice, and also less harsh than lysodren from what I can tell.
Can you tell me more about melatonin and lignans?
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