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

In the "Treatment Option Considerations
Steroid Profiles in the Diagnosis of Atypical Cushing’s Disease
Clinical Endocrinology Service/College of Veterinary Medicine/University of Tennessee" (http://www.vet.utk.edu/diagnostic/en...ushing%27s.pdf
)

Quote:

---

NOTE:
Trilostane always increases 17-hydroxyprogesterone (some cross-reactivity with pregnenolones in
assays??), and frequently increases estradiol and androstenedione as well. LysodrenTM may be
preferred for Atypical Cushing’s cases.

---

Trilo reduces cortisol, progesterone and aldosterone but increases 17-hydroxyprogesterone and often increases estradiol and androstenedione as well. This is because of the way it interrupts the synthesis of the adrenal steroids and also might be related to the adrenal hyperplasia that can occur after several months of Trilo treatment particularly when the dog has PDH (which is usually why it is being used).

So it looks from that info that Palmers elevation of progesterone is probably not as a result of the Trilo. The way that Trilo interefers with progesterone production is the biggest reason that Trilo should not be handled by a pregnant woman.

Alison

Susan, see my comments below in lighter blue.

Quote:

---

Originally Posted by Palmer's Mom

Hi Glynda-
You'll see from my summary that Palmer did indeed have 31.9 post on 3/11. I don't have any idea why that one is so high and none of the others are. Also-in addition to the Trilostane we are doing the Melatonin and the lignans. (I've mentioned this before, but thought it might be helpful to mention it again.) It is very strange that Palmer had two stims done, one by your vet and one by UTK and the post numbers were vastly different. The UTK panel would indicate that Palmer is strictly atypical; however, post of 31.9 blew that assumption all to heck. :D

As of today-and we go for a test in one week-Palmer's panting is greatly increased. The thirst is still large. The eating is down in quantity....more times than not. [Today I think feeding him a whole pig would not have satisfied him!] The belly is getting larger....almost to the point where it may be starting to inhibit his ability to move around - just a bit. (Or he may be getting lazy -er and likes being lifted up onto higher surfaces instead of doing it under his own power!;)) Like I said previously, this could be explained by cortisol still not being controlled or the intermediate/sex hormones are creeping up due to the Trilostane. I assume that the test you mention is an acth stim test? If so, the results will help your vet determine why Palmer's symtoms are not improving.

I know nothing about Pomepoo's predisposition to anything.:eek: I didn't go back through your old thread and verify this but I believe that I mentioned that Pomeranians are part of the Nordic Breed family and they have a predisposition to adrenal imbalances. i also mentioned that Poodles are another breed that are greatly over represented. Palmer's utk panel, reflecting elevations of one or more of the intermediate/sex hormones, pretty much confirmed that he is true to his breeding. :) This is only my third dog ever and the first two were mostly without issues. Being a lover of toy breeds, I would have to say that my experience is the opposite. It's more like 2 out of ever three dogs I've ever loved had more medical issues than you could shake a stick at. The first one was a small, mix breed (mutt) and the last one was Pekepoo. We had some eye issues with the Pekepoo, but that was when she was getting pretty old. She lived 17.25 years. :) Wow, 17.25 years is quite a testament to the fabulous mom you really are. Congratulations.

Also-If I remember correctly you have spoken of Lulu's loss of hair. Lulu lost all fur on her body before being diagnosed. She grew a fuzzy coat after being treated with Lysodren but unfortunately, I made the mistake of switching an atypical dog to Trilostane. She lost the fuzzy coat a year into Trilo treatment. We are hoping that at some point, she might sproud some fuzz again but I'm not going to hold my breath. Palmer's hair seems noticeably thinner "suddenly." He usually gets clipped every 4 weeks (because he minds the heat so) and he's due to go in next week, I think, and there's not much there to clip. He's not bald-but the usual thickness is not there. (But then that has been my complaint for myself, as well!!:() I here ya. I've got a fraction of the hair I used to and it really burns me up that what I lost must have been all brown because I find it hard to believe that I lost any gray hair at all.

In addition to all of the above, Palmer seems to need to be with me all of the time. I used to be able to get him to stay by my husband for awhile, but no more. It really slows down productivity! And his arthritis is bothering him a lot. Usually, once he gets moving for a few minutes, he is fine. There have been a few times when we had to cut a walk short due to his limping. If Palmer's cortisol is still too high, I doubt that what you are seeing is arthritis as excess cortisol is a superb anti inflammatory. It is usually not until the Trilostane effectively brings the post stimulated cortisol down to within the acceptable range of 1 to 5, 6 or 7 that arthritis really rears its ugly head . Has your vet manipulated Palmer's joints or xrayed his hips and knees to confirm that arthritis is evident?

I find myself feeling like I'm watching him slip away. He's only 12.25! Susan, I know it is difficult to see our babies feeling so yucky and looking decripit but do not lose hope. I am telling you that once you get the cushing's controlled, Palmer will feel and look a hundred times better. Hang in there and we'll get there together.

Oh-by the way-exactly what are the "intermediates?" Looks like Lori got back to you with this information. Palmer was diagnosed as aytpical because one or more of his intermediates, also known as sex hormones, were elevated. It was also these elevated intermediate hormones that concerned many of us because Trilostane always increases one or more of the intermediate hormones with long term treatment.

Can someone remind me which readings I should pay special attention to? I still get confused on this stuff.:confused: It takes a while to get your arms around the disease, the treatments, the testing and all the big words that make your head feel like it's going to spin off of your neck. :D Just keep reading and trying to absorb everything and the light bulb will come on.

That's it for today, Monday & Tuesday, July 13th and 14th, 2009. Goodnight, or good morning wherever you are!!:):)

-Susan

---

Hi-

Thanks for all the information.....and since we go to the vet next week, I think I now have some specific questions to ask. The usual Vet is away-so it's an associate whom I've not met. It's a guy (not that that matters) and I have no knowledge of his background/experience. It's another perspective anyhow.

Poor Palmer is madly panting today. He also wants to be in my lap. That's very unusual when he feels hot. He'll usually hops up for a few minutes, then he gets down due to my body heat.

Glynda - Yes-the tests other than the UTK one last fall are all ACTH stim tests. That's what we will be getting on Monday.

"Like I said previously" - please do not hesitate to repeat information. I don't mind at all. Originally the volume of new information was so overwhelming. At least now I feel I have a handle on a little portion of it.

"Wow, 17.25 years is quite a testament to the fabulous mom you really are. Congratulations." Thanks for the compliment. She was a real sweetheart....just as Palmer is. He is just a bit more stubborn. :) (Maybe I should say a little bit more of unsuccessful training!)

" I here ya. I've got a fraction of the hair I used to and it really burns me up that what I lost must have been all brown because I find it hard to believe that I lost any gray hair at all. " LOL!! I was coloring mine and I chose to stop. I'm surprised at how much brown I still have.:D Hair tip - in case anyone is interested - Biotin (supplement) helps return some thickness.

" Has your vet manipulated Palmer's joints or xrayed his hips and knees to confirm that arthritis is evident? " Yes-an xray was done. Plus he had both knees operated on (as did I!)....although it seems it's his front left leg that is bothering him the most. I'll double check this with the vet on Monday.

"Susan, I know it is difficult to see our babies feeling so yucky and looking decripit but do not lose hope. I am telling you that once you get the cushing's controlled, Palmer will feel and look a hundred times better. Hang in there and we'll get there together. " While I hate to see him limp and have him panting so much and his tummy so big, I figure there is just a bit more of him there to love. I am thinking about just wetting down his coat to try to help cool him off.

"make your head feel like it's going to spin off of your neck. :D" Isn't that the truth!!!

Your words are very helpful and I truly appreciate all the support. Thank all of you so very much.

Susan

Quote:

---

Originally Posted by AlisonandMia

So it looks from that info that Palmers elevation of progesterone is probably not as a result of the Trilo. The way that Trilo interefers with progesterone production is the biggest reason that Trilo should not be handled by a pregnant woman.

---

I agree with Alison's assessment at this point in time because I don't believe Palmer has been treating with Trilostane long enough to see a marked elevation of progesterone. I honestly believe that my Lulu is the poster girl for what can happen to an atypical cushdog with long term Trilostane treatment. After two years her progesterone level had more than doubled and that was the smallest elevation on the UTK Panel.

Excerpt from Steroid Profiles in the Diagnosis of Canine Adrenal Disorders - Treatment Implications:

Quote:

---

Trilostane. Enzyme inhibition by trilostane occurs for 3-beta hydroxysteroid dehydrogenase, but also for 11-beta hydroxylase.30 Thus, 11-deoxycortisol levels build-up in dogs treated with trilostane. It is also apparent that other intermediate steroid levels increase (androstenedione, 17-hydroxyprogesterone, estradiol and progesterone) in dogs treated with trilostane, which could be due to the 11-beta hydroxylase inhibition, and possibly 21-hydroxylase enzyme inhibition. The reason why only 11-deoxycortisol levels were increased in the above study may be due to the length of trilostane exposure (3-7 weeks), compared to dogs that are exposed to trilostane for extended periods.

---

Thanks Glynda & Allison.

Palmer's doing better today. Stomach is 23". That's pretty big for a 19 lb guy (although that may have changed as well.)

-s

Hi-
Palmer is at the vets being tested. Am I confused or what:confused::confused::o:(
For the stim test.......they told us 4 hours after his Trilostane. Then they keep him and retest. Is there a time span to wait for the retest? I thought it was 4 hours. He's supposed to be "ready" in about one hour.

And I'm still not clear (Sorry)-are there specific readings that I should pay special attention? Obviously the pre and post Cortisol.....but what else should I be looking for? Is it the androstenedione, estradiol and progesterone?......Also the 17-hydroxyprogesterone? Are these readings sometimes listed under other names?

I saw the new associate today. Only saw him-did not have an opportunity to speak to him. He looks to be 13 years old and still has acne :eek::eek::eek: :confused::confused::(:(:( Pardon me for my "pre-judging."

Palmer weighed in at 20.4 lbs. His weight seems to be pretty consistent now. Tummy measures 23" and I think, at its worst, it was 25".

I would guess we'll get the results tomorrow. I'll post them. I'm going to wait to speak to our "regular" vet before we do anything. She should be back next Monday, I'm guessing.

Hi Susan,

The ACTH testing is done 4-6 hours after the trilostane and the test takes 1-2 hours depending on what stimulant they use. What happens is a blood test is done and then a substance/gel is injected and after the 1-2 hour wait then another blood test is taken. So you will get a Pre Cortisol (before the stimulant) and a Post (after) but the other stuff you mention is only done with special testing. Fingers crossed the numbers will be good.

Jenny

Hi Susan,

I have been looking in but have not been posting much as you have many with firsthand experience posting to you.

I am very interested in the treatment and how Palmer responds to it.

Best to you both.

Scott

Susan, are you having a repeat UTK panel done today? The UTK panel is the only thing that will show results on all of the associated hormones, along with the cortisol level.

Debbie

Sigh.......no-not a repeat UTK. After I get these results (tomorrow) and then speak directly with our usual vet, I'll reconsider that. I have to go 2.5 hours away to have it done...........and then there's the expense..........
It's on my mind.........

Thanks Jenny-that's making more sense now.

OK, friends. We have the test results. Palmer was Pre of 5.4; Post of 5.5.

Sounds like good news to me!!:D:D:D

I love those numbers. I had to go back and read your thread to see that there has been a gradual decrease which is just great and a post of 31 to 12 and now 5.5 is just great.:D

Jenny

Hi Susan,

Those numbers are pretty darn nice and they would be perfect if all of Palmers symptoms have resolved. However, just a week ago you mentioned that "the thirst is still large. The eating is down in quantity....more times than not. [Today I think feeding him a whole pig would not have satisfied him!] The belly is getting larger....almost to the point where it may be starting to inhibit his ability to move around".

If Palmer is still symptomatic and is getting once daily dose of Trilostane, then it could be that he may need to go to twice daily dosing. Remember that Trilostane's enzyme blocking abilities starts to diminish after 8 to 12 hours so any time after that, circulating cortisol levels start to rise again. Some dogs, like my Lulu, can make it through the second 12 hours without being symptomatic but some don't and ultimately require the second dose for consistent 24 hour control. A urine cortisol creatinine ratio (UC:CR) can be done by your vet to determine if cortisol levels are too high in the second half of the day. This would involve your collecting a urine specimen, preferably the first pee of the day, before meals and meds.

As I mentioned earlier, if you are not seeing symptoms improve, another possibility could be that the Trilostane has had an impact on the intermediate hormones and one or more could be elevated. Sex hormones can cause the same type of symptoms as typical cushings. As others have mentioned, the only way to determine if this is the issue is to have a full UTK adrenal panel done. The (UC:CR) is relatively inexpensive so that would be where I would start.

I also want to mention that Dechra, the manufacturer of Vetoryl, indicates that a post stim of up to 9 may be acceptable if symptoms have resolved. However, I believe UC Davis' experience with Trilostane dictates that you must get the post stim number below 5 if you want to see complete resolution of all symptoms. I think Palmer is pretty darn close but no banana. So that's my unsolicited two cents worth, again.

By the way, what did your vet have to say about the acth stim results versus Palmer's continuing symptoms?

Glynda

Thanks Glynda and Jenny.

Glynda-thank you for all your input. I spoke with "A" vet, yesterday. She is the fill-in this week while my usual vet is in the west, somewhere. The substitute vet just said that it looked great and to wait and discuss it with my usual vet when she returns. I asked her about that reading of 31 several tests back. I asked if she knew any reason why that one would be so out of whack. Right away she said "No."

I am going to review all this with my vet next week. I'll be sure to ask about the twice a day dosage and about the big belly and thirst.

Question-if I were to get the urine catch to try to determine if the Cortisol is okay in the second half of the day........wouldn't I want the sample to be in the afternoon or evening?:confused:

-Susan

Hi Susan,

I am assuming that you are dosing Palmer in the morning right? If so, you definitely want to catch the urine sample the first thing in the morning before he eats and takes his meds. Cortisol levels will be at it's highest in the am before the next daily dose. There have been a few studies that showed that the drugs effect diminishes at 8 to 9 hours which is not long enough for effective control of cortisol which is why many dogs on once daily dosing never see an improvement in symptoms. These studies actually did an acth stimulation test at 3 to 4 hours after dosing and again at anywhere from 8 to 12 hours. This isn't really an alternative for some of us petowners but the UC:CR is. It is much less expensive and you collect the sample at home so Palmer is as calm as possible. Stress of going to the vet will temporary increase cortisol levels. If the ratio is high, your vet should give twice daily dosing some serious consideration.

Glynda

Hi guys 'n gals-

Palmer had a urine culture test today-results to come tomorrow. Vet said to increase Trilostane with 1/2 pill in PM. She wants to check his blood pressure - but the instrument she wants to use just went out for some repairs. So-maybe BP on Monday or so. The vet said we need to be sure Palmer doesn't have something else going on.

I'll keep you updated.

-Susan

Hi Susan,

Did I miss something, you are increasing Trilo but it looked like the most recent stim was in a very acceptable range.

Scott

Susan, I know that Palmer is still symptomatic, even with the excellent numbers on his last stim. What concerns me is increasing the dose of trilostane, since the 30 mg daily was obviously keeping the cortisol within acceptable range. IMO, it would make more sense to go to twice a day dosing, say 20 mg in the AM, 10 mg. in the PM, to see if you can get better resolution of Palmer's symptoms. I'm just concerned that the increased dose may put Palmer at risk for a low cortisol emergency.

Debbie

Hi Scott-
Yes and no.......she told us to add 1/2 pill in the evening....which would be the increase. Last night I had to get up 3 times to let Palmer out because of diarrhea. He'd also had two bouts of it before bedtime.

I spoke with the vet this AM and she said there is a lot of "something" going around. She has given us an antibiotic to give Palmer. She also said to stop the evening 1/2 pill. In 3 or 4 days, if he seems "well" we'll try the 1/2 pill again. If the same thing happens, we'll know it's the Trilo.

The reason for raising it is mainly because his symptoms are not responding as they did when we first started. She said the results were so good then, she thought adding 1/2 pill would help with the results and might lower his reading another point or two.

He's been very thirsty and panting alot. Of course it's also in the 90's here. I have a room in the house (where the computer is) and we come up here, I crank up the a/c a bit, and he seems to do pretty well. It's not a very active lifestyle.......but at least he's not panting so horribly.

-s

Hi Debbie-

Thanks for your input. I think that's a good idea. Before we start back up, I'll pose that to the vet. That makes more sense to me as well.

-Susan

I spoke with the vet already. She thinks it would be fine to try that, but that the capsule, so far as she and her supplier know, only comes in 30mg capsules. She suggested splitting one capsule-1/2 in AM and 1/2 in PM.

I went online to try to find out if there were any other dosage capsules available anywhere. In so doing, I ran across the following, It is from
the Journal of the American Hospital Association.

Long-Term Efficacy of Trilostane Administered Twice Daily in Dogs With Pituitary-Dependent Hyperadrenocorticism

Dolores Perez Alenza, DVM, PhD, Carolina Arenas, DVM, Mari Luz Lopez, DVM and Carlos Melian, DVM, PhD From the Veterinary Teaching Hospital (Perez Alenza, Arenas), Veterinary School, Complutense University of Madrid, 28040 Madrid, Spain and Clinica Veterinaria Atlantico (Lopez, Melian), Pi y Margall, 42, 35006, Las Palmas de Gran Canaria, Spain.
Address all correspondence to Dr. Arenas.
Trilostane is considered an efficacious and safe medication for canine pituitary-dependent hyperadrenocorticism (PDH). Its recommended frequency of administration is once daily. In this prospective study, the efficacy, toxicity, and long-term outcome of trilostane administered twice daily per os were evaluated in 44 dogs with PDH. Mean initial dose was 3.1 mg/kg q 12 hours, and mean final dose was 3.2 mg/kg q 12 hours. The final total daily dose was lower than previously reported for once-daily administration. The mean survival time for affected dogs was 930 days.

The vet said the advantages of splitting up dosage is a gray area. She said the mfg. suggests that it not be done and that some studies show it's helpful.

She suggested we try splitting up the 30mg pill-half in AM and half in PM. We're going to try that before we retry an increase. We won't be doing that until we are sure he does not have a virus. She wants him totally back to "normal" before we make any changes. That way we can determine if his reaction is truly due to the Trilo.
[IMG]file:///C:/DOCUME%7E1/SUSANS%7E1/LOCALS%7E1/Temp/moz-screenshot.jpg[/IMG]

That's where we stand.

-Susan

Hi Susan,

If you will recall, I suggested that you ask your vet to do a urine cortisol creatinine ratio to determine if Palmer needs twice daily dosing. Is there any reason why your vet didn't opt to do this test before advising you to increase Palmers Trilo dose? He probably does but keep in mind that you opted to treat with a drug that is not recommended for a dog like Palmer, whose intermediate hormones were already elevated. The problem can therefore be that Trilostane is elevating the intermediates to a greater extent and causing the symptoms you are seeing. It is very important that your vet follow proper protocol so that she can make an educated determination as to why Palmer is still symptomatic. Telling you that "something is going around out there" and then instructing you to test the water a second time with a possible overdose doesn't sit well with me at all but then, I'm a little different than most people.

If it is determined that twice daily dosing is necessary, then the proper protocol involves a formula of sorts where you slighty increase the once daily dose and then split into two equal doses in the am and pm. I believe Palmer is on 30mg so you would increase to 40mg and divide into two 20mg doses to be given as close to every 12 hours as possible. I personally would go with this or the 20mg and 10mg Debbie suggested before I would take the risk of making Palmer sick again.

Glynda

P.S. I see that you were typing faster than I can and posted before I hit the send button. I'm at work so it takes me an hour to get one post done in between the interruptions. I am glad to hear that you are splitting the current dose rather than trying the increase again. Whew!

Thanks Glynda. The "something is going around out there" was my cryptic reporting of the conversation. She said something about having seen a lot of dogs with a virus, now.

I have been able to determine that in June the FDA approved 10 mg capsules. I cannot find out if they're available yet. I emailed the mfg support line.

Will someone please tell me what "PU/PD" stands for? Maybe pick up/ put down?? ;););) Ah-I found it! Excess urination/ excess thirst. Why can't they talk in regular folk talk???:confused::confused:

-Susan

It must be Friday:D:D

I just found this online "Cortisol levels are now considered a biological marker of suicide risk."

Does this mean I should have Palmer on a suicide watch?;););)

It just struck me as funny........I know it's serious.

-Susan

Hi Susan,

I'm coming in late here and I'm a little confused and concerned. It sounds like you are using the standard 30mg capsules (Vetoryl I presume) and that the vet is recommending that you split the capsules open? That is very dangerous for both you and Palmer as this exposes you to the Trilostane (which can mess with female hormones) and, if you are sprinkling the powder on his food, could result in some very nasty irritation to his throat and possibly esophagus. It would also be pretty difficult to get a really accurate split dose that way.

I believe a the 10mg Vetoryl capsule may have got FDA approval in June - I'm far from 100% sure of that but if it is right then you should be able to get 10mg caps for tweaking purposes. Even if that isn't the case then you should be able to get the 30mg capsules compounded (by a compounding pharmacy) into smaller doses - this is something quite a few people have had done. That would be a lot safer for both you and Palmer if you need to vary the dose outside 30mg increments and the 10mg caps are not yet available.

Here's what is under the Human Warning's section of Dechra's Vetoryl package insert (bolding is mine):

Quote:

---

HUMAN WARNINGS:
Keep out of reach of children. Not for human use.
Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you.

---

(This is a link to the package insert PDF file: http://www.dechra-us.com/File/prod_vetyrol.pdf)

Now for the confusion: What dose is Palmer on now - is it 30mg capsule (Vetoryl?) once per day? In the past you mentioned "pills" - did you mean capsules or were you using a compounded pill form of Trilostane previously and have gone to Vetoryl capsules now following FDA approval?

Alison

Quote:

---

Originally Posted by Palmer's Mom

It must be Friday:D:D

I just found this online "Cortisol levels are now considered a biological marker of suicide risk."

Does this mean I should have Palmer on a suicide watch?;););)

It just struck me as funny........I know it's serious.

-Susan

---

Susan,

When it comes to canines, I believe the cortisol levels are considered a biological marker of suicide in pet owners. :D:p:D

PU/PD means polyuria (excessive urination) and polydipsia (excess water intake).

As I recall, you have a compounded version of vetoryl in tablet form which Palmer was getting once daily. I seem to remember this because most of us thought you were mistaken because we had never heard of Trilostane tablets. Vetoryl comes in capsules and so do the vast majority of compounded Trilostane. You can get any mg you need compounded in capsule form at any number of compound pharmacies. I used to purchase mine from Diamondback Drugs in Scottsdale, AZ. Many other members use them as well.

www.diamondbackdrugs.com

Glynda

Glynda & Alison, when I saw the increased dose suggested by the vet, I went back & re-read the thread. From what I can determine, Palmer has been on 30 mg. once daily. Now, whether or not Susan is talking about opening the capsules, she will have to clarify that point.

Debbie

How nice to hear from so many!

I think you got it right, Glynda!! - "When it comes to canines, I believe the cortisol levels are considered a biological marker of suicide in pet owners."-
I am sorry to have been confusing. I am giving Palmer capsules. I tend to call everything re: medication a "pill." We have been using the 30 mg Vetoryl. We have been giving one capsule each morning. The one day we added 1/2 capsule in the evening. Palmer had the diarrhea and we have been back on the one capsule - but we are splitting it between AM and PM. The vet mentioned compounding. It sounds like that may be the way for us to go....at least to try. Thank you for the link.


Alison - I am aware of the warnings given with the pill. My child bearing abilities ended twenty years ago. We are very careful to wash our hands thoroughly....but I do think the compounding would be preferable. I had not given thought to the possibility of irritation to Palmer's throat. Obviously I would not want to do that. As the only option for Trilostane presented to me was the 30 mg capsules....I figured I had no choice but to open them and split them.


The 10mg were approved in June. I have been unable to find out if they are on the market yet.

Susan

Susan, if you are wanting to obtain brandname Vetoryl in 10 mg. capsules, I suggest you contact Masters Marketing (a U.K. internet pharmacy): http://www.masters-uk.com/veterinary/home.php

Even though the 10 mg. capsules received FDA approval in June and will soon be available, it appears that they have not yet been distributed to vets for sale to the public (per Dechra's U.S. website). Until they ARE available for purchase through American vets, you may still be able to order them from Masters. I suggest you contact Masters to see what they can tell you about the situation.

Good luck!
Marianne

Susan, don't overlook what was suggested earlier. You can take some of those 30 mg. capsules to a compounding pharmacy & have them reformulated into a smaller dose such as 10 mg.

Debbie

Marianne- thanks for the link. I've gone there and printed out some forms.
Debbie -I did not realize I could take what I have and have them re-mixed. Thank you.

I still have not heard results from the urine culture. There has not been any more diarrhea. I will fax what information I have on Trilostane 10 mg over to the vet's office. I will ask her to call with the culture results (she must not have had them yet. She's really good about that.) and so we can talk about the Trilostane.

I tried to find a place in Canada where I could order the 10mgs. but was unsuccessful. I did find a compounding place that indicated they have Trilostane. They offer it in capsule or tablet form.

Gave Palmer a bath today. I'm not finding his hair anywhere-furniture, etc,.but he sure is getting thinned out.:eek::eek: Right at the base of his tail there is nothing. It's so sad. :( He still reverts to puppyishness after a bath. That's warming.

-Susan

Does anyone find that they shy away from pups predispositioned to Cushings' when getting new family members?

-s

To be perfectly honest, I would think twice before adopting another Pomeranian and I'd probably steer clear of other breeds that I know are over represented in cushing's disease. However, if I had the financial means, it really wouldn't matter to me as caring for cushdogs has become second nature for me.

Glynda

Glynda-do you know where I can find a list of breeds & dispositions? Didn't you say before that Pekingese were also prone to Cushings?

-Susan

Susan, if you will "google" canine cushing's, most any of the common websites should have a list of breeds predisposed. One of the website you might look at is Kate Connick's.

Debbie

Thanks, Debbie. I've seen that site before but at that point I was barely familiar with Cushing's. There is a lot of information there......some of it depressing.......:(

I'm nowhere needing this information, but was curious.

-Susan

:eek::eek::eek: My little doggie is slowly loosing his hair. He's gonna look like one of those hairless whatever they are-s. Oh I'll love him just as much as ever, I just wish it weren't so.

:(:(:(:(

Hi, Susan! It is sad when they get all bald, but it could be worse. Nikki's my first dog with cushings, I think, but maybe if the others had lived longer they would have had it too, who knows.I've also had a dog with diabetes, and for sure cushings is easier to deal with.I really feel for our friends who are dealing with both at the same time. Some even have thyroid disease thrown in. I believe when they get old they will have something unpleasant, just like we all do.I know some do get cushings at a young age, and that is very hard to deal with, I'm sure, but it does seem rare for a dog to go his whole life healthy and happy.But wouldn't it be great!:p I'm sorry I know nothing about trilostane as Nikki is on lysodren, but don't worry too much about the hair loss. I'm sure Palmer will be just as cute! Sharon

Susan, as Glynda & I, along with several other members have mentioned to you when you were both contemplating using trilostane, & also with Palmer's symptoms getting worse, that the trilostane may be the actual problem, here. It is very well documented in the literature that trilostane will raise intermediate hormones, & really isn't an appropriate choice for an Atypical pup. The dose to trilostane that you have been using has obviously controlled Palmer's cortisol, but with the deterioration in his symptoms, IMHO, I really think that trilo is the culprit, here. I would strongly encourage you to e-mail Dr. O, again, make sure you include your original case # from UTK, explain to him that you have tried trilo, give him the the last stim results, but emphasize that Palmer's symptoms are becoming quite worse. I believe that Dr. O's original response to your first e-mail about using trilo included Dr. O stating something to the effect that you could try, but eventually trilo was going to elevate the intermediates, & exacerbate Palmer's symptoms. IMO, I think you have now reached "eventuallly elevate the intermediates".

Debbie