Wow, that's good there is finally a diagnosis for Jett. Glad your vet is willing to listen and learn- that is the sign of a truly good vet. Bet he looks for atypical cushings now!

There are risks associated with over-suppressing the adrenal glands, especially since Jett has normal and not high cortisol levels. Lysodren suppresses all adrenal function, which could make Jett Addisonian (hypoadrenocorticism). You can treat Addison's disease, and some vets actually prefer to make a Cushing's dog Addisonian and then treat that, because it has a better prognosis.

Melatonin suppresses sex hormones, so it should treat all of Jett's symptoms that are attributed to his Cushings. Flax seed competes with estradiol on the receptors, so there is less estradiol effect.

One thing I would still highly recommend is that ultrasound to make sure Jett doesn't have an adrenal tumor. Those should be removed ASAP to prevent them from invading major blood vessels (it's bad).

This is the entire treatment sheet from UT:
Steroid Profiles for Diagnosis of Atypical Cushings Disease: Test Results/Treatment.
Clinical Endocrinology Service (Phone-865-974-5638; Fax-865-974-7147; Web-www.vet.utk.edu)
College of Veterinary Medicine, The University of Tennessee

Where positive test results of increased adrenal activity are present, consider the need for:
1) Ultrasound. To rule out the chance of a primary adrenal tumor (AT) being present.
2) Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a total dose of 3 to 6 mg is given q12h. Use regular melatonin rather than rapid release or extended release products. Melatonin has anti-gonadotropic activity, and it inhibits aromatase (converts androstenedione and testosterone into estradiol) and 21-hydroxylase (lowers cortisol level) enzymes. Monitor treatment effectiveness via improvement in clinical signs or serum biochemistries, or by repeat of steroid profile. Expect positive results in 3 to 4 months.
3) Melatonin Implants (DermatoninTM). Available for dogs. (WWW.MELATEK.NET).
Sizes are 8, 12 and 18 mg for 50 lb dogs, respectively. Effects last 4-6 months.
NOTE: Melatonin and flaxseed oil with lignans are used together when estradiol is increased.
4) LysodrenTM. Lysodren is very effective in lowering cortisol, androstenedione, progesterone or 17-hydroxyprogesterone levels. NOTE: Estradiol is not always suppressed by LysodrenTM, so determining a baseline estradiol level 1-2 months post-Lysodren will determine efficacy.
5) Flaxseed oil with lignans (FSO). The lignans in FSO have phytoestrogenic activity, and may compete with estradiol for tissue estrogen receptors with less biological effect. Lignans also inhibit aromatase (anti-estrogen) and 3-beta HSD (lowers cortisol) enzymes. Sources for animals include health food stores or Internet sites such as WWW.BARLEANS.COM. Give SID, one tsp per 25 lbs on food, or one FSO capsule (1000 mg) with lignans. Lignans without FSO are available, with a suggested dose of 40 mg EOD (30 lbs); see WWW.VITACOST.COM/NSIFLAXSEEDLIGNANS.
6) Ketoconazole. Possibly effective for hyperestrinism when combined with melatonin and lignans.
7) Androgen treatment. For estrogen/androgen imbalance or low androgen levels. (E.g.,
methyltestosterone or anabolic steroids (expensive) such as OxandrinTM). Androgen treatment may have positive effect in reducing estradiol level via negative feedback effect, and may also have replacement value. Monitor liver function when androgen treatment is used.
8) Trilostane. Available in the UK and Europe, but not approved in the U.S. The drug can be used in the U.S. with FDA approval (see PlumbÂs Formulary, 5th Ed., pg 778 & 886). Note: trilostane always increases 17-hydroxyprogesterone, and frequently increases estradiol and androstenedione as well. LysodrenTM may be preferred for Atypical CushingÂs cases. FURTHER NOTE. Care should be used in switching from trilostane to LysodrenTM. Allow adequate time for either drugÂs effects on adrenal tissues to subside before making a change in treatment. (E.g., one month off drug; return of clinical signs of CushingÂs; or post-ACTH stim cortisol levels within normal range).
9) Specific hyperestrinism treatment. ArimidexTM and AromasinTM have particular indication for treatment of hyperestrinism in dogs, but kinetic studies are lacking  they inhibit aromatase enzyme.
10) Ovarian Remnant or Retained Testicle. Ultrasound or exploratory surgery.
11) For clarification, phone Dr. Jack Oliver (865-974-5729) or Dr. Kellie Fecteau (865-974-5833).
In summary, atypical forms of adrenocortical disease (ACD) occur in dogs and cats (i.e., normal or subnormal cortisol response to the usual adrenal function tests). For dogs, it is common to have elevation of progesterone and 17-hydroxyprogesterone (17-OHP). Increase in androstenedione and estradiol occur frequently, but less so than for progesterone and 17-OHP. Testosterone is increased only rarely. Several patterns of hormone increase occur, so running the complete steroid panel will be the most advantageous, in terms of diagnosis of suspected ACD. Also, it is most meaningful to perform an ACTH stimulation test so that comparisons of basal vs. stimulated hormone concentrations can be made. Usually the stimulated values give the most meaningful information. For cats, infrequent samples are received for testing, but recent case reports implicate progesterone as being increased along with adrenal androgens and testosterone. From: J.W. Oliver, Proc. ACVIM Forum, pp. 541-543, 2002, and ACVIM Forum, pp.471-473, 2007.

I am moving on Labor Day weekend to Sanford, NC. I didn't buy a practice yet, though. Banks don't want to lend me money until I have at least 5 years experience, preferably 7. I will try in 5 though. I work at a practice in Fayetteville, NC. It's a very busy practice and since there is not a specialty practice in town, we get to do a LOT of cool stuff. I am learning orthopedic surgery and all kinds of cool things since we basically have to fix everything with what we have (and we do have lots of good toys like ultrasound, in house lab, great surgery equipment, etc). The practice is truly a service to the community as it is very inexpensive, which is needed in Fayetteville- it's not a rich town. So I am very happy there, at least for the next couple of years. Thanks for asking!

Meghan, thank you so much for your opinion on this and for the treatment sheet from UT. Some of it is a bit over my head but your explanation helped a lot. I have started Jett on the melatonin and flax seed oil and it seems he's panting less already. He usually pants a lot at night and last night he rested much better. I checked the price for the melatonin implant and it's reasonable ($55-60). Since the smallest one is for a 25 lb. dog do you think it would be alright for Jett since he's only 16 lbs.?

Good luck with your job. It sounds very interesting. That's a bummer that you can't get your own practice for that long. I think banks are tightening up on everything now. We don't have a specialty here either. I take mine to the newest, most high tech (and most expensive) clinic here and they don't appear to have all the essentials. I am going to check on the ultrasound but since the vet told us Jett probably wouldn't wake up my DH won't even talk about any surgery.