Treating Eden’s Cushing’s Disease

Excessive thirst. Increased appetite. Becoming more reactive to people and other animals. Who know all of these small changes would lead us to a Cushing’s Disease diagnosis for our dog, Eden, in August 2023.

Jason and I have keep a log of all of Eden’s tests, treatments, medicines, and diet changes since the diagnosis. This post is designed to help anyone actively battling Cushing’s or who suspects their pet has a positive diagnosis.

February 2024 TL;DR: Eden is doing really well. We’ll have to manage this disease for the rest of her life, but she is happy, energetic, and should have many years ahead of her.

Warning: There are some graphic photos of some of Eden’s wounds in this article.

Meet Eden

Eden is a Female Spayed Hound Mix. We say her birthday is January 1, 2016. She’s a happy 8 year old pup. She currently weights 52.8 lbs (which is over 10 pounds less than she was a year ago).

Our first family dog, Eden came into our life in April 2016 when our kids were 7 and 4 years old.

Eden was officially diagnosed with Cushing’s Disease in September 2023, after I found two half-dollar sized wounds on the back of her head. She would go on to develop a massive case of Calcinosis Cutis (a known secondary effect of unmanaged Cushing’s Disease) until the skin condition was mostly under control in December 2023.

Eden’s Current Medications and Supplements

  • Trilostane (Vetoryl), 30mg twice per day with meals.
  • Kan Essentials Four Marvels Dietary Supplement, 3 tabs twice per day with meals
  • Kan Essentials Subdue Liver Fire, 2 tabs twice per day with meals
  • Visbiome probiotic. 1 capsule twice per day with meals
  • DMSO, occasionally massaged into remaining open sores
  • Silverdine and Silverdine with “yellow”, occasionally massaged into sores
  • Two small pumps of fish (salmon) oil on each meal
Eden's Current Supplements, Medicines, and Topicals

Eden’s Current Diet

  • From September 2023 to January 2024, we had been trying to feed Eden more unprocessed, home cooked foods and treats. She was fed 1/2 cup of Fromm Five Start kibble various flavors and 1/2 cup of a homemade dog food with about 70% animal protein, 15% animal organs, and the rest roots and green veggies.
  • Starting February 2024, we are going all in on homemade, unprocessed food. This includes all her dog treats and no table snacks that are processed.
  • Eden also occasionally gets homemade kefir, raw eggs, and doggy “kimchi” (fermented sauerkraut without spices).

Timeline of Eden’s Cushing’s Disease

June 17, 2023

Eden eats some food off a table at a party. She’s extra beggy despite getting random people food at the party. This is very unusual behavior for her. In hindsight, it’s the first time we remember her being extra hungry.

August 2023

Eden was drinking a lot. By alot, we mean an entire large water bowl 3 to 4 times per day.

She is extra hungry and slightly lethargic.

Kim goes away for a weekend trip, and we assumed the lethargy was potentially related to that. (She gets sad when Kim leaves.) We also know Eden has been eating the cat poop from the litter box (1 cat). Perhaps she caught something. We know we have a well visit at the end of the month and decide to bring it up then.

Both parents went on a business trip August 20-27.

August 27, 2023

We got home from our trip. We noticed sores on her neck/scruff area. It looked like she was maybe in a fight or ran under a barbed wire fence. The people watching Eden said that was unlikely. They didn’t notice the sores.

August 28, 2023

We take Eden to her previously scheduled “well visit” and show the vet the sores. The vet orders in house blood work. Vet techs clean and dress the wounds. 

Blood work shows elevated liver panels. All other panels are within normal range. Stool sample normal.

The vet orders an ultrasound with a Board Certified Ultrasound Doctor at a clinic about an hour from our house.

August 30, 2023

Eden and Kim at the Ultrasound place

Eden gets an ultrasound. They shave her whole belly. Dr. Schelling says most likely diagnosis is Cushing’s Disease but recommends follow up with the LDDST test.

  • Liver: Diffuse hyperechoic hepatomegaly. 
  • Normal gall bladder and biliary ductal system.
  • Spleen: Small in volume, normal relative echogenicity.
  • Gastro-Intestinal Tract: The stomach is normal.
  • The small bowel has thinning and in some areas erosive loss of the villous layer of the superficial mucosa.
  • The colonic mucosa is hyperechoic and in some area thin.
  • Kidneys: Hyperechoic, diffuse cortical stippling.
  • Adrenals: R = 0.83 cm ; L = 0.86 cm diameter. Bilateral adrenal hypertrophy.
  • Pancreas: Normal
  • Peritoneal Cavity: Plethora of omental and falciform fat.
  • Retroperitoneal Cavity: Retroperitoneal fat.
  • Urinary Bladder: Normal.
  • Differential Diagnosis: Vacuolar hepatopathy, adrenal hypertrophy is supportive of pituitary dependent hyperadrenocorticism. Erosive enteritis with villous atrophy and granulomatous colitis. Evaluate for infectious or insufficiency enteropathy.
  • Recommendations: LDDST (Low-Dose Dexamethasone-Suppression Test) – Work-up for infectious or insufficiency enteropathy.

August 31, 2023

Our veterinary performs the LDDST. We drop Eden off at the vet. She is kept there to test her blood over the course of many hours periodically to evaluate her body’s adrenal function.

Eden’s wounds are getting worse. The vet prescribes Cefpodoxime 200mg for bacterial skin infection prevention and treatment.

September 2 to September 7

Eden’s Calcinosis Cutis (a secondary effect of Cushing’s Disease) continues to spread. Kim leaves for a pre-planned 3 week trip traveling in Asia.

Jason is a hero and is home taking care of Eden, our children, our other pets, and our business.

Several times per day, Eden needs her skin cleaned. She takes a bath almost every day. We use a vet-prescribed skin wash, lots of warm water and washcloths. He places the sopping wet washcloths on her skin to soak into the thick wounds. He uses different vet-prescribed creams to keep the wounds covered.

Jason learns that as soon as he can feel the firm spots of calcium start to pool under her skin or erupt, he should shave the area so that he can treat it.

When the calcium breaks through the skin, it gets goopy and solidifies in her hair. Shaving her down on these spots helps him keep the skin from breaking down further.

September 7, 2023

Jason takes Eden to a vet appointment to get the results of the LDDST. The vet confirms the Cushing’s disanosis.

Eden starts Trilostane (Vetoryl), 30mg twice daily with food.

The vet is highly encouraging that we start other holistic measures to reduce Eden’s cortisol naturally. Jason starts feeding Eden 50/50 kibble and homecooked food.

Eden also gets another course of antibiotics (Cefpodoxime 200mg).

September 10 to 13

Eden scratches the sores on her shoulders badly. Jason starts to put her in booties when she cannot be watched (but he is basically constantly watching her). She also has a few shirts that help protect her skin so she can still enjoy some walks.

Jason calls on Kim’s sister and wife to come help. They drop everything and come so that Eden can have an around the clock buddy so she doesn’t keep destroying her skin. Thank you, family!

September 14, 2023

Eden goes to the vet to have sores cleaned, dressed and lasered. Our vet’s physical therapy department person, Marie, is amazing. The laser is basically what humans use for anti-aging and anti-redness. It’s meant to stimulate blood flow and promote healing.

The wounds always look a load better after a laser treatment.

Eden starts Four Marvels (si miao san) 2 tablets per day with each meal.

Dog side of face wound

September 17, 2023

Sores on Eden’s chin and mouth come out. These come “out of nowhere”. Jason was rubbing Eden’s face and didn’t notice them. Then went out for 3 hours. When he came back they were there.

September 21, 2023

Dog with really bad Cushing's disease wounds

Eden goes to the vet for the ACTH Stim Test.

This is another multi-hour test where they inject her with a medication then measure the cortisol level in her blood over time.

A skin sample is taken for biopsy at Eden’s lower back. The goal is to confirm that this really is Calcinosis Cutis and no other conditions on the skin. We are waiting for results.

Baseline cortisol is 2. Through the therapeutic monitoring, cortisol went to 3.3. Recommendation is to stay on the current dosage of Vetoryl 30mg 2 per day.

Vet also recommends Milk Thistle. We purchase this but after first dose, Eden has an extremely runny stool so we stopped it for now until we see another firmer poop.

Dog with healing Cushing's disease wounds

September 22, 2023

Eden goes to the vet to have her sores cleaned, dressed, and lasered. Look how much better they all look after a treatment.

Kim is getting home from her trip on September 25 and can start helping Jason with Eden’s care.

October 2023 to November 2023

Eden is slowing healing. She’s becoming more playful. Her water consumption is returning to normal. Her hair is growing back.

We continue weekly laser treatments. We start using some coconut oil and aloe vera to bring moisture to her skin as it heals. These products also help break up the scabs and calcium deposits. Plus, they are safe for her to lick.

We keep doing 50/50 homemade and kibble. The homemade food smells disgusting (it’s the organ meat!). Our dogs love it.

Eden gets an overgrowth of yeast in her ear—we treat that. We back off on the probiotics and the kefir.

Eden’s hair has nearly fully grown back by the end of November 2023.

December 2023

We get back to a normal routine. Eden enjoys family visits. Kim never leaves her even for an overnight (we are trying to reduce her stress).

The vet isn’t pushing us for another blood test. We are leaving this “as needed” and keeping in touch with anything that comes up.

January 2024

Eden has one persistent wound that just will not heal. We know that it is the calcium based on the scent. She also develops another ear issue, this time an infection.

She seems generally “hungrier”.

We take Eden back to the vet to discuss options. We go over natural treatments we can try. We talk about upping the Vetoryl. We talk about repeating the stim test. Kim and Jason think this is just too stressful for her. We won’t need numbers, we can tell based on her feelings.

Eden loses 1.5 pounds between October and January. Kim’s concerned the homemade food isn’t nutritionally complete.

The vet encourages us to go all-in on homemade, maybe raw, unprocessed dog food.

We add a new supplement to her diet (Subdue Liver Fire). We get a plan to start making all her food (and her sister’s because, that’s only fair).

Today and Beyond

It’s been a journey. We doubted ourselves, we doubted our vet. We scoured the internet for anyone we could pay with experience. We read all the forums. We bought dog food cookbooks.

We’re starting something new this month—doubling down on what we can do that isn’t medical intervention—to try to boost Eden even more.

We’re worried about some travel in March 2024 where we will both be away from Eden (Kim hasn’t been away from Eden at all since she got back in September).

We’ll see what happens next. I’ll keep this post updated for other people to return to.

I’m Here to Help

If you or a friend or family member or someone on the internet is dealing with the early stages of a Cushing’s diagnosis, please send them my way. I can share what we have done, what was helpful. What was unhelpful. What we considered doing. What products worked best. Which were a waste of our time.

Sending all my love and support to anyone out there with a sick fur baby just trying to do right by them.

~ Kim