Question Details
Cushing Case
by Pamela77 - November 18, 2009
Cushings case

“Lily “ Nannestad, 14 yr old FS 12/5 # poodle

Diagnosed years ago with cushings and having difficulty regulation on trilostane. She can do 4 mg for a while and then she gradually gets very crazy, ravenously hungry and loses hair. On higher doses she gradually, over several weeks, gets listless and anorexic and her ACTH stim goes flat

Other history includes front leg lameness probably due to cervical disc disease – it is helped by chiro

She won’t tolerate acup

Her pulses are very thin, her tongue is usually pale pink with no coat.

She has sebaceous cytic skin disease and some low grade yeast dermatitis that is controlled with Malaseb although she is still itchy.

She has severe crepitus all along her back and hind leg weakness.

She has tummy gurgles, metallic breath and presumed gastric reflux. A real food diet helped with this but it is still a problem. She has a “sensitive “ GI tract and easily gets tummy upsets.

I tried si miao san at 1/8 tsp SID. Over 4 days she became anorexic, was lip smacking a lot, (her sign of regurg) and decreased energy. When the herbs were stopped she improved.

Other than trying homeopathic s.m.s., what other herbs would you recommend. We would like to try to keep the trilostane at 4 & ½ mg and do the rest with herbs, or eventually be able to stop the trilostane.
Replies
by naturevet
November 19, 2009
Hi Pamela,

Do you have a sense of where the Cushing's is coming from? Adrenals? Pituitary? If it's adrenal origin, I find these animals often present as Yin deficient, at least in part. In that case, SMS can be too drying.

The pulse (thin) suggests the dog needs tonification. When treated with trilostane to excess, she appears to suffer Qi deficiency. When the trilostane dose is too low, we could make a case for Yin deficiency. Given her age and somewhat decrepit back end, I'd be interested to see what she did with a basic tonic. I don't have a rationale for that from a western medical perspective, except that we've seen atypical Cushings respond to a Blood tonification strategy (Xiao Yao San). Maybe there's an in-between sort of Cushing's that would still respond to such an approach, despite being more overtly symptomatic.

If I were to take this approach, I'd want the formula to contain Ginseng and other 'adaptogens', since they often have a moderating influence on ACTH secretion and cortisol secretion, when it's occurring to excess. The research on Ginseng to this effect is particularly prevalent. You could try the small formula called Sheng Mai San (Generate the Pulse), which includes Ginseng and Schizandra. Or you could use something you might already have on your shelf, like Tian Wang Bu Xin Dan. That's probably my top pick here. If we're right in our thinking, you'll be rewarded with some improvement.

Good luck and keep us posted,

Steve
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