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Cushing's In A Dog

by mandercrosby - November 9, 2014 View Case Report

Hi all,

This question is about my own dog, who is a 15kg MN cattle dog mix, 11.5 years old. He was diagnosed with Cushing's about 18months ago, and after trying Four Marvels x 60 days with a homecooked diet, I finally had to start him on Trilostane. I've unfortunately had a devil of a time controlling his Cushing's and am still tweaking his dose of trilostane. Currently he's at 30mg PO BID and planned to move up to 40mg PO in the am and 30mg PO in the pm.

His thirst has improved, he prefers cool surfaces, though this time of year is laying on his bed again. His skin is dry, tongue is lavender without coating and pulses are strong to bounding. There is heat over BL 17-20. His stamina is weaker than it used to be and his coordination is ever so slightly worse than it used to be. He's BAR, still loves his walks, has frequent (4-6x per day) stools, and is highly food motivated. Unfortunately the smell of his homecooked food was just too much for my partner and neighbors, so he's currently eating a grain free turkey and sweet potato kibble with dehydrated carrots for fiber support (stools tend to be loose without the carrots).

I have tried occasional acupuncture on him, though I'm ashamed to say that have not been as good as I should be about treating him regularly.

He's a guy that I would certainly call blood deficient (liver blood deficiency has always been my suspicion with him), has excess damp heat and I'm also suspicious of spleen deficiency. His eyes have lately become somewhat cloudy intermittently (without evidence of cataract).

Given his new lack of coordination, bounding pulses, and poorly controlled Cushing's, are there any herbs aside from Four Marvels you'd recommend? If Cushing's is a triple heater problem, any specific acupuncture points that may be helpful for him?

Thanks so much, as always!!!

Mandy

by naturevet

November 18, 2014

Hi Mandy,

If there was no response to SMS and a home-cooked grain free diet, then this may not be a case of pituitary-dependent hyperadrenocorticism, but rather a single adrenal tumor. Minor Bupleurum is generally our 'go-to' in these cases, and should slowly help lessen reliance on trilostane.

Minor Bupleurum fits the wiry pulse, eye involvement, thirst, preference for cool, incoordination, and lavender tongue. So there seems to be enough there to give it a try. Resolution of the tumor is slow and gradual, but enough symptom improvements may accrue in the next few weeks to justify sustained use.

Steve

Xiao Chai Hu Tang

by mandercrosby

February 15, 2015

Hi Steve,

Noodles developed a very, very tight right tricep about 3 months ago, and on x-ray, no bony lesions or OA is present at all in the limb. He has been shot with buckshot a few times and piece has been lodged in his cranial right elbow since he was 3 months old, but has never been problematic. On ultrasound of the muscle, no tumor is evident, though the right side is much thicker than the left.

He also developed gallbladder inflammation about 2 month ago and had a course of antibiotics and ursidiol which has resolved the problem. He's now on a canned low fat diet (I'd still like to revisit the homemade option).

Given his tricep spasms and pain when walking along with a history of hypothyroidism and failure to regrow hair after clipping (long before Cushing's or hypothyroidism was ever in the picture), I started him on Bu Gan Tang about a week ago. His muscle and coat quality has improved slightly in the last week and he seems to have a desire to walk farther, though on a longer walk he began dragging his right front and scraped a toenail to the point of bleeding.

His Cushing's disease is well-controlled on 40mg trilostane BID, but I just feel that his overall demeanor and stamina have gotten worse since starting trilostane. 6 months ago he could hike 8 miles readily and today I'm pretty excited if he can walk a mile. Something just doesn't seem quite right.

His pulses are still wiry and the left actually feels stronger than the right recently.

I have not yet started the Xiao Chai Hu Tang. On ultrasound about two weeks ago the adrenals are bilaterally enlarged and symmetrical, so there's no overt evidence of an adrenal tumor. Would you still start him on the Xiao Chai Hu Tang? Is it okay to give Bu Gan Tang along with it?

As always, thank you!

by naturevet

February 15, 2015

Hi there,

I've seen Bu Gan Tang have an insulin-sensitizing effect. Why not see what happens

Steve

by naturevet

February 15, 2015

Hi there,

I've seen Bu Gan Tang have an insulin-sensitizing effect. Why not see what happens

Steve

Bu Gan Tang

by naturevet

February 15, 2015

Hi there,

I've seen Bu Gan Tang have an insulin-sensitizing effect. Why not see what happens

Steve

Bu Gan Tang

by naturevet

February 15, 2015

Hi there,

I've seen Bu Gan Tang have an insulin-sensitizing effect. Why not see what happens

Steve

Bu Gan Tang

by mandercrosby

March 20, 2015

Hi Steve,

Thanks so much for all your help with this. An update on my boy:

4 weeks of Bu Gan Tang, and minimal improvement unfortunately. His coat improved slightly in terms of luster, though hair loss at the tip of his tail has progressed and his limp is worse. I feel what could just be a muscle knot or potentially a small tumor in his right superficial pectoral that we're waiting to get ultrasounded. He's also had intermittently softer stools than usual. He also still appears very stiff when he walks, trips more, and tires easily. He's also gotten harder to keep weight on and lost about 2lbs when I was out of town last week.

His tongue is lavender and thin with a thin white coating. Pulses are on the wiry side and symmetrical still. Generally he's still very hot -pants frequently, prefers the floor or thin rugs/mats, likes colder days. Some of the heat over his right shoulder and pec dissipate rapidly when I do acupuncture (specifically TH 14, GB 20, SI 10, LI 11, and LU 1, my attempt at treating local points). And his pulse softened considerably after needling LV 3. After about 15 minutes of treatment, he's now laying on the affected side (which he rarely does) and appears to be much more comfortable.

For now I'm looking at trying a home-cooked diet again and discontinuing the Bu Gan Tang. I'll start the Minor Buplerum and see how that goes. Do you have any other thoughts about what I can do? 6 months ago he was such an active, happy dog, and I hate to see him uncomfortable and so rapidly changed.

Out of curiosity, do you ever have dogs on both Minor bupleurum and four marvels simultaneously?

Thanks!

Mandy

by mandercrosby

March 21, 2015

I can't figure out how to edit my last post, so instead, an addendum!

I should add that it does feel as though his pulse is slightly stronger on the left side than the right and both feel a bit deep to me today. The left definitely still lifts my finger and the right is very full if press a little harder on it. In the past he's had wiry pulses, which I attributed to liver blood deficiency and some liver qi stagnation (he was shot and thrown out of a moving car as a young pup), but I'd say they lost some of the wiriness in the last few weeks (possibly due to Bu Gan Tang and/or last night's acupuncture). So in reflecting, there may have been some benefit to the pulses from Bu Gan Tang, though it didn't manifest much in terms of clinical improvement.

He also in general just looks more deficient than he used to. Since I've rambled somewhat in these posts, here are the issues I'm seeing:

Spleen qi deficiency- soft stools, but no blood is evident and no foul odor, frequently passes undigested bits of carrot or nuts if he eats them. difficulty keeping weight on.

Liver blood deficiency - dry coat, lavender and thin tongue, cloudy eyes, elevated liver enzymes.

Damp heat - Cushinoid, though his PU/PD is resolved on trilostane and he's never been the classic greasy, potbellied, hot mess that many cushing's dogs are. PU/PD, ravenous appetite, and hair loss at the tip of his tail were his presenting problems.

Generalized stiffness and lower energy, particularly sore involving the right front limb.

Thanks, Steve! I really appreciate your help and this forum!

Mandy

by naturevet

March 26, 2015

Hi Mandy,

The formula for tonifying Liver Blood and harmonizing the Liver and Spleen is Xiao Yao San. It's a thought, but it doesn't do much for the gait. Right now, it seems your biggest concerns are the pain.

I'd go ahead and try Xiao Chai Hu Tang. If you decide you need a Blood tonic again, you can use Si Wu Tang alongside XCHT.

As for Si Miao San, I don't believe you saw much of a benefit, so I don't see much point in going back to it, especially if Blood tonics helped a teensy bit

To help boost the pain relieving effects of XCHT, you can add Qin Jiao. Or you can use Benefit Hips and Knees from Kan, which has it in. Just use the doses recommended in my text published by CIVT (www.civtedu.org) rather than those on the product label, so you can be sure you'll use enough.

Most forelimb lameness is due to the neck. I'd be sure to have this dog evaluated by a chiropractor or osteopath. My guess is you'll see some immediate pain relief. The herbs will help if it's a neck issue.

Hopefully that helps your dog out. All the best,

Steve

Xiao Chai Hu Tang

by mandercrosby

September 21, 2015

Hi Steve,

An update and new question on my dog:

About 6 weeks after starting XCHT, my dog's requirement for trilostane dropped precipitously. He was taking 90mg per day (a whopping dose for a guy who weighs 14kg) and then dropped to requiring about 10mg per day (I'm thinking about discontinuing it entirely since he's seemed so well controlled). His forelimb pain, which turned out to be cushing's pseudomyotonia, has improved dramatically with the herbs and with regular chiropractic visits.

He's now showing signs of kidney qi deficiency (PU/PD with a normal to low ACTH stim, low USG, hindlimb weakness, and lumbar tenderness/weakness). He's also become more fearful in certain situations, particularly when strangers approach him. After talking with an animal communicator, he brought up a dull ache in both kidneys along with occasional shooting pains in the right kidney and mentioned that he feels a disconnect in his mid-abdomen around his adrenal glands. His labs certainly support both kidney qi deficiency and a triple burner issue (he's not completely addisonian, but there is heat around BL 22).

On Chinese exam he's got heat over BL 23 x 2, BL 22 x 2, and BL 14 x 2. His right pulses are normal and soft, but his left pulses are slightly deep and weaker. His tongue is normal in size and pink. I'll start treating him to tonify his kidneys, to open the triple burner, and to continue to support stomach and spleen, but I'd like to get him on some herbs to help with kidney qi deficiency. Is there any specific formula you'd recommend given these other case notes?

As always, thank you!

Mandy

by mandercrosby

December 6, 2015

Based on TCVM exam, kidney qi appears to be becoming more significant. I'd like to start him on a kidney tonic (ideally one that would tonify his spleen as well) - is it safe to combine You Gui Wan with XCHT?

Thanks!

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