Cushing's Disease

My dog is about to turn 15. She was recently diagnosed with Cushing’s and her vet put her on 20 mg of Vetoryl. She is currently about 13-14 pounds and it ended up being too high of a dosage. She got extremely ill and I took her off of it and she bounced back. The vet and I agreed to not put her back on it and I would like to try a holistic approach, but he doesn’t practice that approach so couldn’t give me advice.

She has IBS, an enlarged heart, a heart murmur, sludge in her gallbladder, and recently had fluid in her lungs. She takes Vetmedin, Lasix, Ursodiol, and Benazepril. 

She’s an extremely picky eater and I make her homemade meals of things such as canned salmon, brown rice, cauliflower, green beans, eggs, and chickpeas for the most part.

Based on this information, I’m wondering what I can do for her holistically and safely to help with the  Cushing’s. I have searched this group and #dogcushings and watched your video. I’m familiar with a lot of the options, but due to her ailments and medications want to make sure I am doing the right thing. Thank you so much!

Dr. Steve's Advice - Given the history of congestive heart failure, IBS, and gall bladder sludge, the first thing I would still try is a low carb meat-and-vegetable diet with Four Marvels added. Based on her response, we can modify as needed, but that is how I would start. Note that the diet change is VERY important. It sounds like there is a lot of starch in your homemade diet, which is problematic for dogs. At the most, all plant material should probably make up about 1/6 of what is in the dish, with the rest being meat. You could even just reformulate her diet first, and then let me know what the lingering problems or symptoms are after making that change.

If her starch consumption is already scanty, and you're still nervous, let me know all the symptoms your dog is experiencing and when exactly they happen (and when they started), so I can see if there is anything more appropriate than Four Marvels. Alternatively, start with the dose on the label of the product (which is very low), ensure there are no issues, and if not, move up to giving the amount in the table at https://nphc.ca/using/dosage twice a day

Hope that helps

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This is my sweet Roxa. She is 14 years old and she had a tough few months. She was recently diagnosed with cushing's disease and it is not confirmed which one it is (the test was inconclusive and no ultrasound was done). Due to the severity of her symptoms itis believed that she has an adrenal tumor. 

She has started 10mg of vetoryl at the end of November and increased to 10mg twice a day for two weeks now. Her symptoms have not improved and I am mostly going by the excessive drinking and the potbelly. She is 41lbs and I don't believe the dosage is high enough to make a difference. 

Roxa also had a seizure about a months ago. This was the first one she ever had and I started her on CBD oil right away. She had no more seizures and it sure seems like the CBD is helping her feel better overall.

A couple of weeks ago I also noticed that her back is all covered in a crust along her spine. She is loosing hair and it has gotten quite a bit worse in the last week. I believe it is a side effect of the steroids and calcium built up. 

She had obe treatment of light therapy for it and is also on some anti-inflamatories (minocycline). I am just keeping her wounds clean and using a calendula cream on her. Do you suggest any other treatments for her?

I am also waiting for a tincture for her made out of gingko, milk thistle, dandelion, rehmannia, astragalus. 

Do you recommend anything else for her on her back and in general for the cushing's?

Thank you so much for looking at this.

Dr. Steve's Advice - it's my belief that most cases of Cushing's can be pretty easily and quickly cured. You can read about other cases, watch a presentation, and view my thoughts on the disease at #dogcushings. 

You'll see that the first thing I recommend is the feeding of a real food diet that is focused on meat and vegetables. No large quantities of carbs like rice. No big quantities of fat. No kibble or canned food. Without making that change, nothing works particularly well, so the change is 'non negotiable'. 

The cost of feeding that way may be significant, but probably pales in comparison to what you've spend on vet bills. I always tell people: "You're going to spend the money somewhere, either on food or at the vet. It's much cheaper and better overall to spend it on the food".

Once you've got the dietary foundation for improvement in place, the next step is usually to introduce Four Marvels Combination. Kan Essentials makes a version which you can often find online in the US if your vet won't supply it. Alternatively, if you're in the US, you can contact Diana Hermann through the instructions she provides above, under Featured posts. 

Those two steps - real food and Four Marvels - are enough to get most cases improving quickly. The first case I ever treated this way also had seizures, which resolved at the same time as the Cushing's. I would also expect your dog's skin complaints to improve at the same time and pace, which is usually quite rapid. 

A few other comments. Severity of symptoms are unrelated to where the tumor is actually located - pituitary vs. adrenal. Most affected dogs don't actually have a tumor. I explain what the problem really is for most of them in that video at dogcushings.

Hopefully this helps you out!

Click here to read the whole thread.

Hello Dr Steve, my Cushing’s dog now has stage 2 Kidney failure. I’m stopping the Vetoryl / Trilostane since an increase she has these labs. Her hind limbs were trembling and very week a few days ago but her rear has been lagging for a few weeks now. She hasn’t had a solid stool in a long while more recently watery spell back to mush. Green mucus from vag. Always wants it wiped gets happy when I get a tissue or wipe. She’s Mobile just slower. More insecure. most Rehmannia based formulas increase her indigestion and diarrhea. There maybe a heart thing too? Waiting on report. She is back to eating. She hasn’t vomited in days. It was just that morning /24 Hour and that was the day before these labs were taken. Basically I’d be very interested in an herb formula that can help her kidneys and her Cushing’s without causing diarrhea. I have no idea if that’s possible.  dampness is her enemy. Everything gets worse when she takes in humid air if wind coming from the n/east, and there’s a slight chill. Wind /damp /cold (refusal to be outside) and switches but hot is no good either as a Frenchie never is. Getting ultrasound and sterile urinalysis Wednesday. Home cooked been that for most her life making adjustments for the kidney stuff and I have phos binder on board.(tumor egg size 9/22 right adrenal) I’d guess she has hypertension or close. PU PD and PP all up. Going through way more In house potty pads.

Dr. Steve's Advice - the weakening on Trilostane suggests Qi or Yang deficiency, which weakens the Spleen, aggravating Damp formation. The worsening on Rehmannia likewise suggests Damp.

Given the above, the GI signs, the possible protein-losing enteropathy that is going on, the azotemia, the liver enzyme elevation and the Cushing's, one formula I'd suggest is Wei Ling Tang. I use the Nat Path version, but Kan Essentials sells it in liquid and tablet form as Spleen Support Formula. I've seen it help all of the above. 

Hopefully that helps

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I’ve been struggling since September 2020 with my dog Steele’s health. He’s a 10 year old male neutered German Shepherd Siberian Husky cross. 

Noticed a big decrease of energy in him in September 2020 and it’s been a steady decline ever since. We’ve been in and out of the vet with blood work done and normal. He just had a slightly elevated liver enzyme’s but they weren’t concerned. It was suspected hypothyroidism. His coat became very corse, he drinks bowls and bowls of water and urinates like a horse multiple times when we go out for washroom breaks. 

He’s started to loose fur a lot and has been having issues with his skin over the last few months. We were just in for a big mass under one of his pressure sores that had filled with fluid and ruptured. The vet which wasn’t my regular said he was text book Cushing disease. Wondering your thoughts on him and I will probably move forward testing him for cushings to see if that’s the case.

Dr. Steve's Advice - that certainly does sound like Cushing's. If ALP was significantly elevated on his bloodwork, that would further corroborate it.

You can absolutely do further testing, but dogs can be highly symptomatic, yet test negative for years, before the condition is finally proven to be present. Vets can't really prescribe the drugs for Cushing's until that positive test, since they are quite toxic to a normal dog. Fortunately, you don't need to wait!

The main cause of Cushing's in at least 2/3 of cases appears to be a processed diet. Switching to a lower starch meat-and-vegetable diet often precipitates an immediate improvement, within just a couple of weeks. We also pair that with Four Marvels Combination, a formula available through your veterinarian from Natural Path (if they are interested in helping you) but also from Kan Essentials if they are not, via sites like Amazon in the US. The herbs and diet work together to normalize adrenal gland activity and eliminate excess secretion of cortisol, which is often not due to a pituitary tumor, but apparently to the consumption of high glycemic index diets. 

Note, however, that even if it was a pituitary tumor, ample research shows Four Marvels can help, since it doesn't just act on body metabolism, but also on the adrenal glands

You can read about a recent case treated successfully this way in #dogcushings

Hope this helps!

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I have read through so many posts in #dogcushings but I haven’t found a similar case to mine.
My 12 year old Frenchie Cocoa was diagnosed with Cushings with the ACTH test and ultrasound showing a pituitary dependent. He has developed calcinosis cutis and lethargic most of the day , his eyes are constantly goopy and mucus is coming out of his nose as well. He seems to open his mouth to grasp for air when he’s inhaling. Some times he will be trembling too. He urinates frequently and drinks a large amount of water by putting his mouth into the bowl instead of lapping it up before. The bottom of his chin is dripping wet every time from dipping his muzzle into the water to drink the water which he didn’t do before.
He does not have any pot belly appearance nor increased appetite. He has become a very picky eater. Only eating cooked chicken breast. He has been losing weight consistently the last few months.
He started with vetoryl 20mg/ day for only a few days then decreased down to 10mg because he was having trouble opening his mouth , wasn’t eating and his saliva would be brown. After having 10mg/day for a week while only eating chicken. He became very lethargic again. We decided to stop the vetoryl.
For a couple months now he only pooped 2-3x in this long of a span , then recently he had a few days of pooping only green mucus constantly through the day, every couple hours. The green mucus has stopped now but I haven’t seen him poop still.
After the doctor recommended to put him to sleep because the vetoryl wasn’t working. I found these wonderful supportive groups here including you and hoping we can find another way to improve his daily life.
I have started him on the adrenal gold therapy, four marvels and melatonin. I will be stopping the melatonin since I found a few posts saying that it does not help.
For the calcinosis, I have been using duox3 shampoo 1x weekly and daily foam. The dermatologist said I’ve been doing fine and said there was nothing we could do about healing it until the cushings was controlled.
I would like to start him on a raw diet but he’s too picky at his current stage. Uninterested in many foods I attempted to give him. He had been eating royal canin Hydrolozed protein for all of his life for allergies until his loss of appetite. Since then he only eats chicken breast.
Could you share your insight on which medicines I should add on to help with the symptoms I mentioned. Such as the lethargy, loss of appetite, and calcinosis.
Thank you so much for your consistent willingness to help and support us with our fur babies.

Dr. Steve's Advice - I think you're on the right track, but I would do two things. Four Marvels might be a bit strong for your dog right now and might suppress appetite further. I would switch to Spleen Support by Kan Essentials, which I have used to counter Cushing's in smaller, chillier, weaker dogs. It should help actively resolve that inflammation causing the mucous in the stools, help promote GI motility and stimulate appetite. There is a version called Dispel Damp and Nourish the Skin, also by Kan, that might make a start with that calcinosis cutis, especially if it is secondarily infected. Both of those formulas are often found on Amazon in the US

As for food, raw is not necessary. Just real, unprocessed food is enough. Diets don't have to be balanced for several weeks, since your dog will have stored ample levels of vitamins and minerals over the past few years. Chicken is fine for now, or whatever else might entice him. Try other things, too. Liver? Maybe some bacon? Few seem to be able to resist that last one!

I would also get thyroid supplementation going. Some of that lassitude is undoubtedly due to hypothyroidism. It may improve as the above herbs kick in, but why not treat it in the interim so he feels better and gets more of an appetite.

Hopefully these ideas help you out!

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I have a 9 year old terrier, cocker spaniel and dachshund  mix male dog. About 3 years ago we noticed some itching and scratching with a lot of paw licking. He had a pretty bad rash all over his body. We took him to our vet and he was prescribed Apoquel 16 mg 2x day. 

Two days after giving him this his symptoms multiplied. We took him back to the vet. They took him off of it. Since then he’s been visiting the vet often with symptoms such as bloating, itching, rashes all over his stomach, extreme dry nose, excessive panting, patches of hair missing with sores, multiple skin infections and no energy. I pushed for them to test him for cushings but his labs came back inconclusive. 

HIs lab work has showed issues with his liver and they put him on milk thistle. He’s had several labs over the past 3 years. Always it’s high liver levels. Nothing else.

The latest is a large rash all over his stomach (Leto/chlorohex shampoo given and GenOne Topical Spray). Extreme stuffed and dry nose (animax ointment). An ear infection that’s damaged his eardrum (motazol given) and as of this week his eyes are draining a terrible liquid that’s mucus and I’m wiping alit with warm towel. He’s struggling to breathe and is just miserable. We are regulars at the vet but I’m frustrated. He’s dropped a lot of weight these past few weeks. 

His dog food is purina pro plan for sensitive skin and stomach. I do share things like apples with him daily. 

Anything you can think of that might help me help him I’d greatly appreciate. 

He’s the middle dog. Rascal.

Dr. Steve's Advice - job one is to (at least for a couple of weeks) give him food that does not come from a factory. There is a recipe pinned to the top of this page you can use if you want to cook your own, or you can go to a boutique pet supply store and grab a commercial raw diet, a freeze dried diet, or a 'home cooked' refrigerated diet. These diets are the first things anybody should do if their dog is Cushingoid, whether or not the blood tests identify it, since development of the condition to the point that lab tests can pick it up takes a while.

Usually within even just a couple of weeks, the improvements are clear and comprehensive. You might not need to do anything more than that, but if you want, you can also add in Four Marvels from Kan Essentials. It's the go-to for Cushings. Either that, or if the only real lingering symptoms are nasal congestion and eye goop, you can use Three Seeds Combination instead from the same company. You can find these online usually at Amazon if your vet is unwilling to stock them for you.

The other possibility is Cessorex (https://goldstandardherbs.com/products...) from Gold Standard Herbs. It's not quite as commonly the answer for Cushing's, but is needed for some cases. What brings it to mind for me is the worsening of skin symptoms on antibiotics. That can happen if they disrupted the microbiome, causing a leaky gut to worsen that, in turn, flares up any allergies, so keep Cessorex in mind. Particularly if the above diet change does NOT help your dog, Cessorex is likely to be your baby.

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Hello,

Im attaching to google drive all results photos + the full story of all vets and results which visited Document , Please read it direcly if you have time

https://drive.google.com/.../1UwiTEL3jPlEXpwpSk...

I tried to make short Version:

I have Male Pomeranian Dog which Today is 3 Years Old , and current weight is 5.8KG
He is Unneutered ,
for the past 11 Months I have visited 8 different Vets to identify which disease he has Thyorid/Cushing or other .

This is the main symptoms he has :
-Increasing Hair loss in stomach , and both sides of body
-Increasing Potty belly (bloated stomach )
-Excessive hunger
-small Skin problems

Tests have done:
ACTH, LDDST , X5 ULTRASOUNDS IN DIFFERENT RADILOGISTS , FT4 , T4 ,TSH , UPC , Urinalysis , UCCR etc..
Have Done x4 Ultrasounds

Short Story:

Currently he got treated with : Ursolite 100mg (1/2 per day) for his gallbladder , Wepatic (for liver)

After all the vets visited has came to conclusion with 3 Vets:

IMS Number 1:
Tested with him : FT4,T4,TSH,LDDST,ACTH, X2 ULTRASOUNDS
We haven’t confirmed 100% he has Cushing cause of “Fasle Positive results”
at the end he decided or we do LDDST again , or start treating with Trilostane 7.5mg twice a day. ( I didn’t understand if he meant 15mg total a day , or 7.5 total a day)

Expert VETernian in my country:
After checking Previous results of lddst , acth ,
and did another Blood test told me he has “ AT CUSHING” (Iatrogenic Cushing's with secondary pathology of the liver)

-Gave me treatment of Ursolite 100mg (half tablet a day) , and wepatic for liver support

AT first wanted to treat with ketoconazole , and recent visit gave me to treat with “Trailstone”tablets 10mg , twice a day ( 5mg morning , 5mg evening)

IMS 2:
-Suspected its thyroid issue , treated my dog with thyroxine 0,1mg for 1 month ,
after FT4 test and more ultrasound , conclusion Cushing in adrenal,

and some gallbladder problems

Along with this, an adrenal tumor in such a young dog is unusual (but not impossible) and you need to make sure that the finding is indeed significant. It may be necessary to consider surgical removal of the enlarged gland and/or drug treatment for the excessive secretion of cortisol (which will not affect the tumor itself but will help the clinical signs caused by cortisol secretion).

1. Continue the treatment with thyroxine 0.1mg for another 1 month
2. Continue Wepatic and Ursolite treatment without change.

3. Adding Metronidazole (Metrogil) 250 mg, a quarter of a pill twice a day for a month.

4. In a month, Come for another vist and repeat abdominal ultrasound to assess the rate of adrenal growth, repeat the ACTH test to assess the level of cortisol secretion and a decision on future treatment: surgical or conservative.

Final thoughts :

-Currently finished 30 days Wepatic tablets for liver + 30 days Ursolite 100mg for gallbladder which vet B gave him.
-still TAKING thyroxine 0.1mg for one month and a half ( which IMS2) GAVE HIM even after out ruling thyorid problem he told me to continue taking it until our next visit in 2 weeks.

1. Vet B: want me continue give him Wepatic for more 60 days + start treatment of trilostane 5mgxtwice a day = 10mg per day.

2. IMS2 : said don’t need to give Wepaitc , only continue with Thyorid pills + Metronidazole (Metrogil) 250 mg, a quarter of a pill twice a day for a month.
AND Then come for another ultrasound , and then decide on continued treatment

3. IMS1 : 7.5MG Trailstone twice a day ( I didn’t understand if he meant 15mg totally a day or not).

Anyway each vet gives different opinion those are the only 3 which figured out my dog has cushing and not other disease,. And ive visited over 8 vets im losing my mind please help me out to sort out situation. And with which solution I can go.

if I go with VET B , is 10mg per day is a lot of 5.8kg dog?

Im attaching to google drive all results photos + the full story of all vets and results which visited Document if have time to read.

Dr. Steve's Advice -   I'm not seeing results of the low dose dexamethasone suppression tests or ACTH stimulation tests. Those are what we use to diagnose Cushing's. I would say, however, that with the ALP as low as it is, and the adrenal glands basically a normal shape and size, that Cushing's is unlikely. The symptoms are suggestive of Cushing's, but if it's not showing on the labwork, then Trilostane doesn't seem advisable, especially in the absence of compelling laboratory evidence of Cushing's

Has your dog started to grow hair back on trilostane? If so, then maybe it's Cushing's after all. The dose for a whole day is about 10 to 15 mg. It looks like one vet wants to split the dose and the other just wants to give it once. Either is okay, but I wouldn't particularly expect great results given the rest of the findings.

As for having low thyroid, that much is clear. But it appears to be 'euthyroid sick syndrome' where your dog is lowering it's own thyroid deliberately because something else is wrong.

If this were my dog, I would go ahead and move him onto a real food meat-and-vegetable diet immediately, and probably start him on Four Marvels Combination (Si Miao San) if you can find it. If not, change the diet for now. Cushing's like symptoms often start to improve within just a week or two of a switch from kibble and canned to real food

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My boy is a boxer in 2020 he got imha was on lots of meds and 3 blood transfusions, this year he was diagnosed with hypothyroidism and Cushings. His fur has become thick. He seems to stay hot. He use to sleep with us but now would rather sleep on the cold hard floor. Is there a cooling bed that you recommend? He will be 9yo in Feb. 

Dr. Steve's Advice -  

your dog will cool off once the underlying disease tendencies are addressed. The history of IMHA, become heated and Cushing's makes me wonder if your dog has a Shao Yang disharmony. A skilled veterinary acupuncturist could tell you. Meanwhile, a real food diet and Halscion (https://goldstandardherbs.com/products...) by Gold Standard Herbs may help a lot. I use it to prevent IMHA relapse and normalize adrenal output. It helps dog sleep better and cool down at night

Hope that helps!

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Is Happy wander an ok replacement for lignens and melatonin for a dog with atypical Cushing starring in their blood work or should those be used as well and if so does Khan have those? I have looked and can only find them in the product that may affect the liver. 

Dr. Steve's Advice -  they can all be used together if you like. I don't think Kan makes them, though, if you're looking for another vendor. I don't use them much myself, so I can't really help you there. Both should be pretty easy to find in stores or by Googling.

If you decide to forego them, I would expect the Happy Wanderer to work pretty well on its own

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Hi Dr Steve, My pup tested + for Cushing’s /5cm large adrenal tumor , 

last Dec nyc cooler weather and I had her on Si Miao San she had an episode stopped walking  /peeing /eating and pooing. ER suspect IVDD got gabapentin and Acup and Physical therapy + Double p 2 but that never felt right hot paws, her bones were steaming I was changing her to Liu wei di huang wan but I listened to vet not myself. She Will not walk in rain (potty pad trained) wind has her dizzy and cold w/ wind or cold damp not good. last few months wasting more pronounced drinking too much peeing and more than just Frenchie hunger. 2020 and now uti w stones they passed the other day and Fly-biters (bad) (3 years no episodes but after fasted (acid bike when not fed) work up and long car ride windows open fall wind phlegm ? They returned worse than ever) her skin was very bad when adopted that’s mostly normal. Have her on Ophiopogon Formula/ mai men dong san and wei qi booster has paste like stool long straining 1 x day. Always on home cooked low fat 75%meat 25%carbs mostly greens but recently more sweet potato for stool.(that’s cut now) stool is just the same as it’s fed in color. She was never much a farter but is now. Wasted , eye goop, yin def, 2 weeks ago ago pulses - rapid, right sided stringy, pot belly, grunty /sighing, worst gas, tired. I’m thinking Jue Yin syndrome ? Idk now has cold paws. Worried winter will take her …any thoughts. ZHi bai di huang wan? With something else .  Processing fats have always been her weakness. Night time & night sight issues. We have not been out after dark since 2016 when I learned she’d rather hunt rats than pee. When hot on walk will reach for weeds if we stop to rest will lick the sidewalk or asphalt - Was on yi guan jian for a bit and back in the day long Dan xie gan tang for ears. More fearful like last fall. Still wants to eat . Cool seeking calm when not too warm. TYIA for any input.

Dr. Steve's Advice -  it's hard for me to read your shorthand, and there is no dating on the lab work or ultrasound. I'm also not clear if your dog can walk or not after that disc disease incident. All that being said, the first thing that springs to mind for me is a combination of Bu Zhong Yi Qi Tang and Xiao Chai Hu Tang. You sound like you have someone who will dispense herbs to you, or maybe you can get them yourself. If so, I would use that duo.

BZYQT will help address the pasty stools and your sense of Jue Yin excess. It will also help raise the Spleen Qi and Blood to where it can be dispersed by the upper burner to the exterior body, to protect against invading Wind pathogens. Lastly, it will tonify the Spleen Qi to help reverse the wasting you're seeing. XCHT will support BZYQT in its work, but will also help harmonize the flow of Yang Qi in the body, to get rid of the PU/PD and polyphagia.

Biomedically speaking, when Cushing's occurs on a raw food diet, we have to treat the adrenal like it is an actual tumor, which it sounds like it is. XCHT is an anti-cancer formula so it can help with that. As well, if there is still time to get the adrenal removed (because the ultrasound is recent), I'd explore that if the herbs don't work.

Hopefully this helps you out!

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Hi Dr. Steve!

This is my sweet Roxa. She is 14 years old and she had a tough few months. She was recently diagnosed with cushing's disease and it is not confirmed which one it is (the test was inconclusive and no ultrasound was done). Due to the severity of her symptoms itis believed that she has an adrenal tumor. 

She has started 10mg of vetoryl at the end of November and increased to 10mg twice a day for two weeks now. Her symptoms have not improved and I am mostly going by the excessive drinking and the potbelly. She is 41lbs and I don't believe the dosage is high enough to make a difference. 

Roxa also had a seizure about a months ago. This was the first one she ever had and I started her on CBD oil right away. She had no more seizures and it sure seems like the CBD is helping her feel better overall.

A couple of weeks ago I also noticed that her back is all covered in a crust along her spine. She is loosing hair and it has gotten quite a bit worse in the last week. I believe it is a side effect of the steroids and calcium built up. 

She had obe treatment of light therapy for it and is also on some anti-inflamatories (minocycline). I am just keeping her wounds clean and using a calendula cream on her. Do you suggest any other treatments for her?

I am also waiting for a tincture for her made out of gingko, milk thistle, dandelion, rehmannia, astragalus. 

Do you recommend anything else for her on her back and in general for the cushing's?

Thank you so much for looking at this.

Dr. Steve's Advice -  it's my belief that most cases of Cushing's can be pretty easily and quickly cured. You can read about other cases, watch a presentation, and view my thoughts on the disease at #dogcushings.

You'll see that the first thing I recommend is the feeding of a real food diet that is focused on meat and vegetables. No large quantities of carbs like rice. No big quantities of fat. No kibble or canned food. Without making that change, nothing works particularly well, so the change is 'non negotiable'.

The cost of feeding that way may be significant, but probably pales in comparison to what you've spend on vet bills. I always tell people: "You're going to spend the money somewhere, either on food or at the vet. It's much cheaper and better overall to spend it on the food".

Once you've got the dietary foundation for improvement in place, the next step is usually to introduce Four Marvels Combination. Kan Essentials makes a version which you can often find online in the US if your vet won't supply it. Alternatively, if you're in the US, you can contact Diana Hermann through the instructions she provides above, under Featured posts.

Those two steps - real food and Four Marvels - are enough to get most cases improving quickly. The first case I ever treated this way also had seizures, which resolved at the same time as the Cushing's. I would also expect your dog's skin complaints to improve at the same time and pace, which is usually quite rapid.

A few other comments. Severity of symptoms are unrelated to where the tumor is actually located - pituitary vs. adrenal. Most affected dogs don't actually have a tumor. I explain what the problem really is for most of them in that video at #dogcushings.

Hopefully this helps you out

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Good evening Dr Steve. I have a question About my 12.5 year old Jack russle cross who just had a ultrasound done Wednesday and they have found a lump 6cm big on the left side of her liver. The vet and the specialist who did the ultrasound suggested I get it removed. My question is... is she to old for surgery? The vet said there is a 0.5% chance a dog can not make it at this age. I know a very slight chance but I am still terrified. They said if its left then it could rupture in side her if it gets bigger and she will bleed internally. She also has pirituary cushings disease which she has had for two years and is on 5mg trilistand for that twice daily. I have attached her ultrasound scans here. Any advice would be much appreciated  

Dr. Steve's Advice -   if your dog is otherwise strong (with no brain, heart or kidney complaints), and if the liver enzymes aren't too high, then there doesn't appear to be any contraindication to careful general anesthesia. Age itself is not a reason to not do a procedure. It's when the aging process produces a bunch of damage that you can then have problems. If your vet has thoroughly examined your dog and feels confident, and you trust him/her, then that's all you can really ask for in the way of assurances 

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 Hi Dr. Steve! Buckle up, this is a long one! My 13.5 Frenchie, Frank, was recently hospitalized for pneumonia. He had no noticeable symptoms except he stopped eating a drinking.  He was treated in hospital for 3 days and released with antibiotics and anti-nausea meds. About a month prior to the pneumonia, he had an idiopathic vestibular event, which he’s mostly recovered from except for the head tilt and getting dizzy going down stairs. Approximately a year ago, he was diagnosed with Cushings; it’s well controlled with meds. While in hospital, he had extensive blood panels and ultrasound of major organs. Nothing was out of the ordinary or unexpected.  The biggest issue we’ve been having is weight loss and muscle wasting. In his prime, he was typically 35-38lbs always trying to lose weight. Now, he’s 26lbs. With all of these factors, my team of vets believe there is something more going on in his brain, like a tumor or lesion. We’ve declined the ct scan, as he’s too old for surgery/chemo/radiation. We want him to have a very happy and comfortable end of life. 

So, the question is what are the best supplements and supports to prolong the good he has left? We’ve heard about turkey tail, pepcid, Benadryl, and vitamin c. Another tricky piece is, he has become an exceedingly picky eater and is crafty with pills.  So any creative suggestions for getting meds in would be greatly appreciated.  These things no longer work: peanut butter, pill pockets, cheese, deli meat, pizza crust. 

Here is a picture of Frank from today after he came home from the hospital.

Dr. Steve's Advice -  I guess the first thing that needs to be considered is that the drugs for his Cushing's might be too much for him. The main sign that they need to be scaled back is loss of appetite and weakness. Even if ACTH stim tests show the adrenals are "right where the vets want them", this can be the case. I don't think there would be a hazard to abruptly discontinuing the drugs for a few days to a week. If you saw your dog's appetite and energy rally, you'd have your diagnosis. Most Cushing's cases can be cured without drugs, just by changing to a real food diet and adding in some herbs.

If you don't have an appetite for making that change without your veterinarian's say-so, a way to prove this might be the issue is to give Frank what Chinese medicine considers a Qi tonic, namely Liu Jun Zi Tang (aka Six Gentlemen and sold by Kan Veterinary Essentials as Six Gentlepets). If you don't have holistic vets on your team that can order from Natural Path, then you can probably find it online (https://tcvmpet.com/.../six-gentle-pets-liu-jun-zi-tang...). Dose according to the schedule at nphc.ca->using herbs->dosages. If you see an improvement in him, then we will know for sure the drugs are too much and that you should tackle the Cushing's another way.

That's what I would recommend for now. I personally feel the above is much more likely than a brain tumor. This may be a straightforward fix. Please let us know how it goes.

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 Hello Dr Steve. Me again !   My dog has Cushing’s Disease.   I had been using PranaPets (pretty much all of them ).  Last vet appt his liver values increased even more.  I have been trying different foods for him.  Home made, then used Littke Hunter which is too expensive for such a small bag.  Then Honest Kitchen dehydrated , then to Maeve which is totally frozen raw.  I also feed my Chihuahua the same, but I believe he may have gotten pancreatitis from it? Not sure too sure, but now back to honest kitchen fish & oats.    I then added Denamarin.    I will go to vets to check his liver values again in a month or so.    With the pranapets (now - CBD , lignans & melatonin) and Denamarin, I saw this below.   Can this also be given?   I don’t want to overdue it with supplements if it may be too much 

Thank you

Dr. Steve's Advice -  there would be no problem using Halscion (https://goldstandardherbs.com/products/Halscion-p450909521) in your dog with Cushing's. It's a first choice for those that haven't responded to diet change, which appears to be the case for your dog. It may help bring down those liver enzymes, too. It's definitely worth a try and compatible with the other supplements you specified. 

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Hi Dr. Steve! Can a Cushing's dog be given Lumbrex? She is a 10 year old boxer with pituitary Cushing's (with a macroadenoma) and had SRT done over 2 years ago. She also has very bad arthritis and has been whimpering more recently. We have been giving gabapentin 100mg 2x a day and know we can increase that but I'd prefer to give less drugs, not more. Her Cushing's is controlled with vetoryl but we only give 10mg every few days. We also give CBD 10:1 with THC as needed for pain. I was on the Gold Standard website ordering Cessorex and saw the Lumbrex and thought it might help. Any recommendations are appreciated! I hope you have a fabulous 2023! 

Dr. Steve's Advice -  If your dog has actual arthritis in the hips or knees, I'd wonder about Gold Standard Herbs' Voltrex (https://goldstandardherbs.com/products...) as a better fit. If the joints are severely puffy and swollen at all, such as in polyarthritis, then I'd wonder about a Kan Essentials product called Free the Sinews. If you meant the arthritis was in her back, not her legs, then Lumbrex is a good fit if both legs are somewhat equally affected and she is primarily weak and not so much lame. If the response to Gabapentin has been dramatic, that is another reason to try Lumbrex.

Some people just use Voltrex and Lumbrex together to hedge their bets! Hope that helps!

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My Buster was just diagnosed, on May 22nd, for Cushings.
He's in the early stage, I think!
Because, although he drinks alot of water, he's not running out to pee  countless times a day.
He's fed 1c of food, freeze dried raw, 1/2-3/4 in the am n the rest b4 bed.
He does have that hanging belly n pants a lot.
But he's restless!
He moves all over the house at night.
He'll go from the bathroom, the floor is cool, to his box in the dining area, to any of his 3 other pillows.
His Dr Vet put him on Vetroyl, which I bought, but I'd rather not start him on that.

Looking for natural helps, Thank you

Dr. Steve's Advice -  get a hold of some Four Marvels from Kan Essentials. It is often available online at Amazon in the US. You can read or watch a video of how it works at #dogcushings. Dose according to the guidelines at https://nphc.ca/using/dosage. In tandem with a real food diet, it will produce benefits within a couple of weeks in most dogs. Note that a real food diet is superior to freeze dried. You can make your own, or feed a commercially cooked or raw diet from the store. Improvements will then be even more rapid

Hope that helps

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 Hi Dr Steve!
Our dog, Ginger, is suspected of Cushings due to an ultrasound done yesterday to check her belly to see why her liver #’s are elevated. The vet said no tumors but likely Cushings. She us drinking a lot of water and just started panting whenever we’re outside. It is warm spring weather, but this is new. She is about 11 y/o. I watched ur video and I have inquired with Nejolla Korris about what food Peanut was on. She advised Instinct Raw and vitamins. I will be switching from Instinct kibble to raw. I would like to start her on Four Marvels too. Can u suggest vitamins I can add to her raw diet going forward?
Thank u!

Dr. Steve's Advice - it may not be necessary to add vitamins to the raw food. Instinct has veterinary nutritionists on their board, so it should be adequate.

The Four Marvels and real food diet are a potent combination. Here's hoping you see the same improvements as Peanut!

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Oakley 12 yo retriever  mix with diagnosed cushings.Has muscle loss. Food is honest kitchen dehydrated food started about 20 days ago. Was giving 4 marvels switched to Halscion and Lumbrex from gold standard herbs. Diagnosed with abcess tooth( needs surgery) this is why the blood work. Was diagnosed with gastroenteritis 5 days   before abcess tooth. Is there anything  I can do for his high level of liver enzymes and his low t4 or anything else you can see that could be helpful. Vet wants to do ultrasound before surgery to make sure nothing else is going on with gall bladder or liver. 

Dr. Steve's Advice -  Four Marvels may still be a good idea if you only just got around to changing the diet. You may have switched off it, thinking it wasn't working, but if you don't change the diet in a Cushing's animal, Four Marvels may not resolve the symptoms satisfactorily. In fact, even Honest Kitchen may be too processed to see results. A raw or real food diet (whether commercially cooked or one you make yourself) will likely yield faster results. We have to assume the ALP and GGT elevations stem from the Cushing's, so hopefully your current diet change will be enough to help them head back downwards.

As for the thyroid, please get a TSH test done. If it's high, then your dog is hypothyroid and should be treated with thyroxine or a glandular extract that has not had its thyroid hormone content removed. If it's not high, then your dog is deliberately slowing down its thyroid hormone production to slow the disease process down, and we should probably respect that, by focusing on curing the Cushing's instead

Let us know what the ultrasound shows, but a real food diet and potentially a return to Four Marvels might be enough to get the job done

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