View Question

Cushings Disease In A Dog

by ajerger - December 4, 2024 View Case Report

Hello!
Just inherited this case..Very complex case..
Poseidon is a 16yr old Pomeranian who was recommended to me because the owner wants a holistic approach. Poseidon has the following western diagnoses:

1.Cushings Disease (bilateral adrenomegaly)
2.Stage 3 IRIS Renal dz (non hypertensive and non proteinuric)
3.Hyperphosphatemia
4.Increase ALK > increased ALT
5.Alopecia X
6.Grade II left apical Heart murmur ( new- I ausculted today)
7.Hypothyroidism
8.Partial Collapsing trachea
9.Hepatomegaly
10.GB debris
11.Hx of one episode of pancreatitis after "pup cups" few years ago

PE- Sweet but nervous
1.Truncal/limb alopecia, flakey, hyperpigmentation, epidermal collarettes, (just finished Doxycycline for MRSA infection)
2.HM
3.Resolving ear infection bilaterally
4.Some muscle atrophy
5.MPL
6.Pot belly
7.Halitosis

Tongue- pale pink with lavender center
Pulse- somewhat superficial, toned, resists compression, somewhat wirey

Clinical Signs:
pu/pd
eats but somewhat picky
soft stools
slower to rise from rest, otherwise energy ok
reverse sneezes
snores occasionally
owner says very itchy

Medications:
1. Trillostane 5mg BID
2. Levothyroxine 0.1mg BID
3. aluminum hydroxide
4. Melatonin

Diet- JFFD

TCM diagnosis:
1. Blood Deficiency
2. Damp Heat
3. Shao Yang disharmony
4. Kidney Qi/Yin deficiency
5. Spleen Qi Deficiency

My thoughts for herbs would be
1. Bu Gan Tang- Blood deficiency/alopecia x/Yin tonic
2. Si Miao San- PDH,/insulin sensitizing effects, Alk phosphatase, Damp Heat, spleen Qi deficiency, pendulous abdomen, halitosis

My thought was to begin with SMS, then add BGT?

Also, when managing Cushings disease while on trilostane, how do you know when to start reducing meds, if possible?

thank you so much!

by naturevet

December 5, 2024

Hi there!

I can see all the Chinese diagnoses you're seeing, so I get the confusion! I'm not sure what MPL and HM mean in your notes, but based on everything else, I would guess you would characterize this dog as both Hot (thirst, skin rash) and Cold (polyuria), and fairly Deficient (exam findings).

Hot and Deficient would signal Yin deficiency. Cold and Deficient signals Qi deficiency. Putting those together, I'm wondering about some broad-based Kidney support as your top priority. Rehmannia Eight would support the Kidneys, and perhaps 'light a fire' under the Spleen to improve appetite and digestion. It's also safe to use in a complicated case because it drains Damp and moves Blood, helping to ensure tonification of the deficiencies doesn't aggravate any Excess (e.g., like Damp and Liver Blood stasis).

Tonifying the Kidneys might also help them reconnect with the Heart, reducing the PU/PD tendency. It is also usually eventually needed after long term trilostane use, which tends to deplete dogs after a while.

The only symptom that doesn't cover is the Blood deficiency allowing secondary Wind Heat invasion. If tonifying Kidney Qi using Rehmannia Eight is accepted by the dog, then you could layer in Si Wu Xiao Feng Yin next to address the collarettes, alopecia and itch. If that is well accepted, you could next add in or otherwise move to Xue Fu Zhu Yu Tang to address the collapsing trachea, early heart issues, while further supporting renal blood flow.

Given the absence of proteinuria, I'd use a Rehmannia approach to the kidneys rather than a Shao Yang approach. The above formulas accomplish that.

I would cook the food (if it's not already cooked) since there appears to be a weakened Kidney and Spleen Qi, making the dog less able to handle raw. The fact that the dog is on a real food diet means we don't have to target Damp Heat right away. It's likely not there. The pot belly is potentially as much due to (in Chinese terms) Qi deficiency and/or stagnation as Damp. If it is due to Damp, it is likely not Damp Heat.

That's my best guess on how to proceed. Be patient and make changes gradually. Since the patient is quite worn down, you'll have to do that anyway. Have the owner bring the dog back in if there are any adverse changes, so you can make the most of the new symptoms and get more clear on what the dog wants as its 'starting point', in the event Rehmannia Eight is not it. It seems unlikely to create issues, though, so it seems a safe way to jump in.

Steve

by ajerger

December 5, 2024

So Sorry! MPL(medial patella laxation) and HM (Heart murmur) :) Thank you!
Will keep you updated...

by ajerger

February 13, 2025

Hi there!
This patient is doing much better, the hair regrowth is amazing, I have to upload pics of before and after. Appetite is good, pu/pd is a little better, energy levels are better. I have only added Rehmannia and since he is doing so well, I was planning on waiting here for a bit and see what his body does..
Keep you posted..

by naturevet

February 13, 2025

That's excellent news! Thanks for the feedback. This was a challenging and unusual case!

Steve

You must be logged in to reply

CuredCases.com