Have I finally found my friends? (Palmer has crossed over the Bridge)

Hi Susan,

I'm glad you got the response from Dr. O with all that great info and that you have an appointment with Palmer's vet on Monday for a discussion. This info will certainly help your vet in determining a course of action/treatment for Palmer that will relieve those symptoms he has been experiencing.

Hope you have a productive appointment on Monday and that Palmer's bp readings are good. Take care and will be watching for your update.

Louise

Hi Susan,

Thanks for posting the response from Dr O. Isn't he great? It would be so easy for him to just blow us off as pests, but he always responds and is always so kind.

I hope you have a great session with your vet Monday and that Palmer can get to feeling better soon!

Hugs,
Leslie and the girls

Hi-
I only have a moment. When the vet's office called to set up the appointment the vet (Jennifer) passed along answers to my 4 questions.
#1 Would it be advisable to run a UC:CR test?
Answer-she can do it, but doesn't feel it is necessary.

#2. Discontinue flax seed oil.
Answer-agreed.

#3 Is she able to run an adrenal panel?
She thinks so-she has to check.

#4 I want to try Lysodren.
Answer-make an appointment for Monday, we'll discuss treatment options then. She thinks it may be premature.

She is consulting with an Internist and another vet person over the weekend.

Okay-back to just me. I don't know why she is resisting the Lysodren. At the very beginning it was mentioned as an option.

I would really appreciate (I know I've been told before) getting some "ammo" to support my case on Monday. Any comments anyone can offer will be greatly appreciated. (Especially UC:CR)

Thanks.

Susan

PS-yes Dr. O IS great. :D:D:D I'd like to meet him. He's thorough and prompt and talks so I can understand him.:):)

(I love these little icons!!)

-s

Hi Susan,

I have only a moment to post right now, but I did want to give you some thoughts regarding a couple of your questions. First, as to the advisability of performing the UC:CR test: It is a simple test to run, and the results might give you a more complete picture as to whether or not Palmer's once-daily trilostane dosing is keeping his cortisol level well controlled throughout a 24-hour time period. If you do decide to run this test, however, it has been suggested to us that the most accurate approach is to collect and pool urine specimens on three successive mornings:

Quote:

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Originally Posted by David Bruyette

Many studies have shown that the only way to accurately gauge urine cortisol levels is to obtain the first morning voided urine sample on 3 consecutive days and then pooling the urine to run a UCCR. When done in this fashion it is likely an accurate test. Otherwise there is likely too much day to day variation to make a single random cortisol very helpful.

Dave Bruyette DVM DACVIM

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Dr. Bruyette is a member of our forums, and has further elaborated that if you do choose to collect and pool urine samples, they should be refrigerated until you take them to your vet for analysis.

From what Dr. Oliver has written, however, I think the broader issue is whether or not trilostane is currently a good treatment option for Palmer at all. If it is not, then the question of once vs. twice daily dosing for optimal cortisol control really becomes a moot point. And in that vein, should you choose to perform another full adrenal panel, your vet really needs to coordinate the testing with Dr. Oliver. I see that in his reply to you, Dr. Oliver's suggestion is to stop the trilostane altogether for two to three weeks prior to performing the test. Otherwise, it is impossible to separate out the dog's naturally occuring adrenal hormone profile from the elevations caused by the trilostane itself. You do not want to go to the effort and expense of performing the test until the results will be meaningful.

Having said all this, I have to agree with the other folks here who are encouraging you to consider shifting to Lysodren and discontinuing the trilostane altogether. So I hope that is an option that you will be able to discuss more thoroughly with your vet on Monday.

Good luck!
Marianne

Hi Susan,

The biggest argument in favor of switching to Lyso is Dr Oliver himself. Dr O is the premier researcher in the area of Atypical Cushing's and therefore is the one source to be relied on. If he says, and he has, that Trilo will always cause these other hormones to increase, then you can bank on it. "The sex steroids are almost always (I’d say always) increased when a dog is on trilostane. "

This one statement is all I would need to hear in order to make the decision to stop the Trilo immediately and make the switch to Lyso after the UTK panel is run - no debate necessary.

Your vet can make the blood draws for the UTK panel but cannot run the test itself - unless something has changed very recently, the Uni. of TN in Knoxville (UTK) is the only lab in the country, perhaps the world, that currently does this testing. I know it will be difficult to let that month pass with Palmer receiving no treatment, but you are already dealing with cush signs so it won't be such a change. The wash-out period is crucial, tho. Especially since he has been on the Trilo for so long. His adrenals need time to return to their untreated state for the test to be accurate so that wash-out is very important.

I think you are making the right move, Susan, and Palmer will be much better for it.

Hang in there!
Hugs,
Leslie and the girls

Hi Susan, boy have you been a busy camper this week. ;) Good job and know that we all needed coaching on this stuff in the beginning....


#3 Is she able to run an adrenal panel?

Leslie is correct - she only has to submit the sample. Make sure she submits it directly to the Univ of TN and doesn't send it to her regular lab as they will just mark the price up and send it to the univ of tn!!

#4 I want to try Lysodren.

I would print out some of our posts where we have pointed out that trilo can cause problems within atypical cushings dogs do you have it handy. Tell her you know that the Univ of Tenn is the only lab that does the testing for atypical and that you made direct contact with the Dr. there that advises vets on what to do. Print out his email and read it to her. She cannot argue with this world expert.

I think she is unfamiliar with lysodren or had a bad experience. Please make sure that she does not give you any lysodren yet. This is important. There needs to be a washout period between trilo and lysodren. So first get the test done and see what Dr. Oliver writes out on the results sheet for your vet. Then, assuming he will recommend lysodren... go with the dosage amount that HE recommends and the timeframe HE recommends. This way HE is telling your vet what to do. This is a win/win for your vet as she will have her hand held by an expert. You get peace of mind that he knows what he is doing!

Good luck and great job. Kim

Y'all are sooooo nice :cool::cool::cool:
Thanks very much for the encouragement. I will get my notes ready. I may be back before Monday with a question or two.

=Susan

Ask away, honey! We are all here for you and Palmer!

Hugs,
Leslie and the girls

Hi-
I sent "Jack" (that's how he is signing his emails now) the question about my vet being able to "do" the panel. He says she can-(get the samples) and sent me a link to detailed instructions on how to do it.
(He even responds quickly on weekends!):D:D:D:D:D