Corkster - adrenal tumor/3x daily trilostane (Corky has been released)

[littleone1]

Thank you Addy. I hope we get there soon.

He's right next to me, cuddling and snuggling.

I hope you also have a wonderful night.

[frijole]

Good update! I agree that all in all it is positive and what more can we ask for right?! Terri keep up the great work and hug the little monster for me. Kim

[littleone1]

Thank you Kim. I'm really pleased with Corky's blood test results, especially after being on TID with the Trilo.There's been no problems with this dosing. I just gave the little monster a hug from you. He looked at me and went back to sleep. He is so much calmer.

[John II]

Terri,

Such good news about The Corkster! Well done!
Please give him a cuddle for me.

[gpgscott]

Glad to hear that the increase in dosing is moving numbers in the right direction Terri. Corky really does put a point on the fact that treatment can be very different pup to pup.

I am sure the slow go is tough on you.

Hugs to you both. Scott

[mypuppy]

Hello dear friend,
That is amazing with the lower triglycerides--how great for the Cork and you and us.. Wish his cortisol would have been stabilized, but unfortunately as we have been learning, these dose adjustments seem to do the trick for them. Hoping we can talk soon but in the meantime, lots of love and hugs. ILU and Corky much. Jeanette

[labblab]

It's interesting because we've had some recent discussions about using basal cortisol levels to monitor Vetoryl treatment but Corky's results raises some doubts for me. His basal cortisol on the last two stim tests were perfect but as far as I'm concerned, the post cortisol draws were uncomfortably out of range. Have all of Corky's symptoms resolved?

All of Corky's symptoms have not been completely resolved. If they were, his IMS was going to keep him on the 51mg TID, but since they're not quite resolved, she increased his dosage.

If we used the baseline cortisol level with Corky on most of his previous stims, they were low, and that would have led to him being taken off of the Trilo, which would have been a disaster.

Terri, congratulations on the positive bloodwork results!!!! And like everybody else, I'll surely be keeping my fingers crossed for you and Corky as far as this trilo dosing change.

I apologize in advance for hijacking your thread for a moment here, but I just wanted to add a couple of additional thoughts about using baseline cortisol for monitoring purposes. First off, my understanding is that the notion is still very much in the experimental phase with much more research and substantiation needed before it could be a widely acceptable approach. But so as not to throw out the baby with the bathwater, here's how Corky's results might have been viewed using the baseline approach...

According to a recent article by Dr. Audrey Cook (who is the lead researcher in the area), baseline cortisols between 1.3 and 2.9 (or less than 50% of the pretreatment baseline) may represent a "comfort zone" in which it may be possible to assume that cortisol is being adequately controlled as long as a dog is clinically doing well with all symptoms resolved. But if symptoms remain, I believe an ACTH is recommended, regardless of the baseline result. And even if a dog is clinically doing well, if baseline cortisols fall outside of this range, I believe the recommendation is still to follow-up with a stim test to make sure that the dog is not being over-suppressed (post-ACTH less than 1.5) or under-suppressed (post-ACTH over 9.1).

So in Corky's case, I'm guessing that follow-up ACTH's would have been recommended for him, even using the baseline approach. On the face of it, his most recent baseline cortisol was too high and fell outside of the acceptable monitoring range. And his symptoms had not all resolved at the time of the previous testing. And if his earlier baselines were too low for the range, again, I'm assuming that the recommendation would have been to proceed with a stim test rather than just discontinuing his trilostane. I'm really curious, though, to start keeping better track of all our members' ACTH testing. I'm curious to see whether this baseline range between 1.3 and 2.9 (coupled with symptom resolution) really does regularly pan out in conjunction with acceptable post-ACTH results.

Here's a recent "write-up" regarding the research: http://veterinarymedicine.dvm360.com.../detail/698185

Marianne

[littleone1]

Thank you John, Scott, and Jeanette.

It hasn't been an easy journey, but Corky keeps hanging in there and is a real trooper.

I am very pleased with the results of his blood work.

Jeanette, my very dear friend, we will talk soon. Corky and I also love you.

[littleone1]

Hi Marianne,

Thank you, and thank you for your input. If we went by Corky's baseline level, it really would have presented a problem. The last two baselines were in the reference range, but his posts were high. Going back within the last year, his baselines were between 0.9 and 1.3, consistently. I am definitely going to keep having the full ACTH stim test done. Even when Corky's symptoms were under control, his baselines were still very low. I would rather be safe than sorry.

[lulusmom]

I'm curious to see whether this baseline range between 1.3 and 2.9 (coupled with symptom resolution) really does regularly pan out in conjunction with acceptable post-ACTH results.

Me too and that's why I asked Terry about symptoms.