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!

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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.

Hope this helps!

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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/Original-Voltrex-85g-p647327438)     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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