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Integrative Approach to Cushing’s Disease

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As Cushing’s becomes more prevalent in veterinary practice, more clients are requesting holistic treatments over merely conventional approaches. Building health from a young age can also lessen the risk of this disease.

Cushing’s disease is caused by an overactive adrenal gland that’s producing too much adrenal hormone. This is most frequently due to a benign pituitary tumor, which signals the adrenal to produce more hormone than it needs. Occasionally, it is caused by an adrenal tumor in the actual gland.

With an adrenal tumor, removal is usually recommended. With pituitary tumors, however, removal is too difficult, so the treatment of choice is to use a drug such as Trilostane, which stops the production of adrenal hormone by blocking its release. This can be risky because if too much hormone is blocked, the animal can become seriously ill, or develop the more serious Addison’s disease.

The main symptoms of Cushing’s disease are a potbellied appearance, excess hunger, increased water consumption and symmetrical hair loss. Cushing’s disease can also cause weakness and panting. These dogs have a weakened immune system and are prone to infections and cancers. People will often report increased agitation and some dogs will have issues with sleeping through the night. Many dogs have a tragic look to them.

THE CUSHING’S/DIABETES LINK

The thinking these days is that Cushing’s disease appears to be closely related to type II diabetes. Some believe that both diseases are the same syndrome, but are just manifesting differently. When brain scans were done of cats with insulin resistant type II diabetes, pituitary tumors characteristic of Cushing’s disease were found.* Wow!

Both diseases seem to be induced by an overload of nutrients of the carbohydrate variety. Animals with Cushing’s disease and diabetes develop what is called metabolic syndrome. Their body cannot handle the amount of carbohydrates and high glycemic index ingredients in many processed diets. These high glycemic index diets cause high levels of inflammation in their bodies, which lead to problems in the endocrine system. This can lead to insulin resistance, development of pituitary tumors, and other inflammatory diseases.

DIET IS A FACTOR

No one knows for sure why there has been such an increase of Cushing’s disease in dogs, but dietary issues are definitely a big factor.  Inflammation seems to play a large role as well, whether it arises from poor diet, or other factors such as overvaccination, overuse of pesticides, or the overall increase of chemicals in our environment.

Over years of practicing holistic medicine, I have gone from thinking I could help control the side effects of Cushing’s disease in dogs on drugs, to having dogs in my care that are completely controlled with diet, herbs and acupuncture. My preference is always to begin treating dogs early in the disease and before they are put on drugs. I sometimes even have success with dogs who have been chronically ill.

My first goal is to change the patient’s diet. I pull all grains and most carbohydrates out of the diet, feeding the dog the least processed diet he can tolerate. This may take major coaching so the client will see how easy and inexpensive feeding fresh can be. Raw, high protein diets are best. If raw is not possible, then feeding a grain-free, potato-free, high protein, high quality homemade or purchased cooked food is second best. Canned food with these qualities can also be an acceptable option.  Do not feed these dogs dry food! I have found that changing the diet alone can make a huge difference in these dogs, so if you can only work with diet you can still help these animals.

HERBAL TREATMENT

Secondly, I treat the dampness and inflammation through herbal treatments. This is the best way to get the endocrine system back to normal regulation.

  • In most dogs, the best Chinese herbal formula for this is Si Miao San. It helps to decrease inflammation in the body, regulates insulin, and improves digestion. I sometimes add corn silk to this formula to help with insulin resistance. Not surprisingly, this is also one of the main formulas I use for diabetes. Si Miao San works best for the hot, panting, overweight Cushing’s dog.
  • For thin, weak, deficient dogs, especially if there is emaciation, I often start with a formula called Eight Treasures which treats qi and blood deficiency and helps with digestion and absorption.
  • I also will sometimes work with the kidney-tonifying formula Liu Wei Di Huang Wan if the emaciation is not so severe and there are issues with empty heat and panting.
  • I put almost all my patients with Cushing’s disease on ginkgo biloba. Ginkgo slows the release of adrenal hormone and can help control some of the symptoms of this disease. I almost always use it in a formula with hawthorn (leaf, flower and berry). This combination of herbs helps quite a bit with the sundowner’s nighttime anxiety. Sometimes this formula makes the difference between good and mediocre control of the disease. It’s also great for helping with dementia, high blood pressure, and protecting against heart disease and stroke. Because of this I often recommend it in my older animals even when they don’t have Cushing’s disease.

ACUPUNCTURE ALSO ASSISTS

Most of my practice centers around acupuncture. I love to needle dogs with Cushing’s because they have such a great response. Acupuncture helps regulate the endocrine system and reduce inflammation in the body. I have found that many dogs will only need acupuncture about every two months once we get them stable, unless we are treating other health issues as well. 

I practice Traditional Veterinary Acupuncture and some of the points I have found to be helpful for Cushing’s are fei shu (BL13), gan shu (BL17 or BL18 depending on your style of acupuncture), pi shu (BL20), ming men (GV4) and hou san li (ST36). I also always needle tien men (GV17) and bai hui to open up the body to receiving.

I always caution my clients to be aware that natural treatments can change the amount of Trilosten and other drugs needed to control Cushing’s. If a dog stops eating, becomes lethargic, or has sleep disturbances or vomiting and diarrhea, this could be a sign of overdose.

While I have not been able to get all my Cushing’s patients controlled without Western drugs, I am usually at least able to significantly reduce clinical signs and/or the dose of drugs needed to regulate the illness. In a disease without many good, safe options for treatment, I love having effective natural options to offer my patients.

Case Studies

Clancy – A few years back, I treated a cute, spunky little Cairn terrier named Clancy. We were able to catch his Cushing’s disease very early, just after he was diagnosed. His main symptoms were an increase in weight, panting, excessive jumpiness when touched, and easy startling. He also drank a lot of water and was always hungry.

With acupuncture, herbs and diet, we have been able to keep Clancy happy and symptom-free for about two years. Occasionally, he would have a little fl are-up of symptoms, but we were able to treat them with acupuncture and some herbal and dietary changes. Clancy received acupuncture about every eight weeks; I needled tien men, fei shu, pi shu and ming men.  He was on Si Miao San with corn silk and after a year I also started him on ginkgo.

Patty was a lovely 11-year-old golden retriever diagnosed with pituitary Cushing’s. She presented with excessive drinking, urinating, a ravenous appetite and panting.  She had bilateral hair loss with complete baldness on both sides. She also had arthritic hips and a lot of hind end weakness.

She originally came to me for just a couple of acupuncture treatments while her regular holistic vet was away, and was already on ginkgo and mai men dong tang. I switched her over to Eight Treasures with added corydalis for hip pain, and cang zhu, yi yi ren and huai niu xi to treat her dampness. I started acupuncture treatments, needling tien men, fei shu, gan shu, pi shu, ming men, bai hui, hou san li and ba shan. 

Within a month, Patty’s hair started growing back and her hips improved. She had a small stroke a couple months after I started treating her and her Western vet started her on Trilostane. At that point, Si Miao San and bai ji li were added to the acupuncture, ginkgo, and her original formula.  Over the next year, she had three Trilostane toxicity events (vomiting and diarrhea) as we regulated her Cushing’s with acupuncture and herbs. We reduced her dosage each time until she was completely off the drug and controlled just through acupuncture and herbs. 

Sunshine was an energetic 13-year-old Lab mix who presented with pu/pd, a potbellied appearance, excess heat and restlessness.  She was also prone to digestive issues, which included gas and sometimes vomiting.  She received acupuncture – tien men, fei shu, gan shu, pi shu, shen shu, bai hui, hou san li and ba shan – and was started on Si Miao San. Her person already made her an excellent grain-free homemade diet so I made no changes there.

After a few months, Sunshine’s symptoms had improved but the restlessness and night anxiety were still present, so I added in Chai Hu Jia Long Mu Li Tang with added Dang Gui and devil’s club, and a little later a mixture of hawthorn berry, flower and leaf with ginkgo and ashwagandha. Through her final years, Sunshine received monthly acupuncture and her Cushing’s remained stable without drugs. We shifted treatments slightly as new old age issues emerged. She lived to 16 years of age, when she tragically died of bloat one evening.


*Elliott DA1, Feldman EC, Koblik PD, Samii VF, Nelson RW. Prevalence of pituitary tumors among diabetic cats with insulin resistance. Am Vet Med Assoc. 2000 Jun 1;216(11):1765-8.