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

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