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

Quote:

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Originally Posted by Palmer's Mom

: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.

:(:(:(:(

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Susan,

Losing hair is not normal.

I also think that given the labs you have posted that the Trilostane could be causing the loss of hair.

Scott

Hi! I have been following along and I have to chime in and join the others that have mentioned that the trilostane could very well be hurting Palmer. I hate to put it so bluntly but after 3 years of reading here we see a whole lot of cases. We have seen what you are going thru happen before. And it can be prevented possibly by testing to see if in fact your dog has atypical cushings.

It is easily overlooked as a lot of vets just don't know about it. The good news is that if it is atypical - you might not need any harsh drugs but rather flaxseed and melatonin which are lots cheaper too.

The hair loss occurs when cushings is not under control or there is another reason for it. This is not normal. Sorry, but I am feeling sorry for Palmer and it seems like you are frustrated... it could be as simple as looking into this. Is there a reason you don't want to go there? Just trying to understand, I know this is complicated. Just trying to help. Kim

I went back further and read ... I apologise... I didn't realise you had already determined that Palmer is atypical. I am pretty sure you could end the problems by going off of the trilo. I understand if you want to hear it from a vet... since you are concerned about yours, why not email Dr. Oliver with all of the symptoms you have mentioned to us? It doesn't cost a dime and he is the expert. He is also a great person. A thought?

Kim

Thanks to all of you for your input. I have just sent an email off to Dr. O. :D:D I gave him the history, the stim test results and list of medications.

I know a number of you (many) think the Trilostane is not the answer. I appreciate the fact that you continue to give me your input. I do listen and consider all you have to say.

Thanks.

Susan

Hi Susan,

We listen to you as well and have learned a few things from your journey with Palmer.

I hope you understand that our concern is that the Trilo may be getting the cortisol under control without question. But it may also be causing the other hormones to elevate as it lowers the cortisol which kinda puts Palmer in a catch-22 situation. The damage from elevated cortisol for him may not be as big a concern on the Trilo, but the damage due to elevation of the other hormones may be increased.

Looking forward to Dr O's reply...the last one was eye-opening for me! :);)

Hugs,
Leslie and the girls

Susan,

Thanks for the update! I am sure you will feel better getting feedback from Doctor O... as he truly is the best. Glad you decided to do it. He is very approachable. Nicest vet EVER. Good luck! Kim

Okay folks...I have my responses. His responses are in red, where I could get this program to do that. For some reason a color change would not "take" on all of them.

I gave Dr. O. a list of all of Palmer's medications and asked him to review them. His response-
Flax Seed oil - 1000 mg One daily
>>May not help much with the lignan, since lignan content is only about 2%. The flax oil can also raise triglyceride levels, which can sometimes cause pancreas issues.
Lignans - 40mg One every other day
>>I’m suggesting lignans given at approximately 1 mg per lb now. If this is a product that has 20% content of lignan per 40 mg of product, then the lignan content is only about 8 mg (20% of 40). If so, I’d give it every day.

Regarding Trilostane -
I don’t know that much about trilostane at this point, except that it usually increases both androstenedione and estradiol levels. This doesn’t always cause the dog any problems, but in some, clinical signs of Cushing’s will re-occur at some time point; presumably due to the increase in these sex steroids.

Regarding stim test numbers -
These are good numbers for the cortisol, but this is expected with the trilostane. If estradiol and androstenedione were determined, I can almost guarantee you that they would have been increased.

My next observation/question - I told her –okay-but his symptoms have returned. He has distended stomach, much increased water consumption, lots of panting and now I can tell he is losing his coat. We usually have him clipped every 4 weeks because the heat bothers him so. I had to cancel the last appointment because there wasn’t enough there to clip. That was 2 weeks ago. Today, he could use some “neatening up” but on his body there really isn’t enough there to justify a clipping.
>>I would say that the sex steroids have increased a considerable amount, like they almost always do with trilostane.



I asked the vet if we might be headed for Lysodren and she said she did not think so.
This sometimes has to be done, when the sex steroids increase to the point that clinical signs return, when the dog is on trilostane.


Do you think he is still Atypical?
It would look that way if you did our adrenal panel while on trilostane. The sex steroids are almost always (I’d say always) increased when a dog is on trilostane. Many dogs tolerate this for long periods; others come back with clinical signs of Cushing’s, and a switch to Lysodren may be indicated at that time.
and....finally -

If you do our canine adrenal panel (sex steroid panel) at some point, I’d suggest going off the trilostane for 2 or 3 weeks. Otherwise, you won’t be able to tell if it’s increased adrenal disease, or more likely, sex steroid build-up due to the effect of trilostane

I'm waiting for my vet call today. They did tell me that the urine culture came back good. I'll let you know about my conversation with the vet whenever that happens.

When the panel was done, Palmer was not yet on Trilostane.

-Susan

Susan,

I have to tell you straight.

There is no reason to fear Lysodren. It is clear to me that your Dr. does not favor Lysodren and I really cannot understand why.

It is clear that Trilostane increases the hormones which contribute to the symptoms you are reporting.

The good thing is that Palmer is largely Atypical and would most likely not require a loading of Lysodren, which is the most difficult phase.

If this was me, I would suspend the Trilo, do a new UTK panel and then start the Atypical treatment of lignans/melatonin and then consider adding a maint dose of Lysodren after a period of time.

Best. Scott

Susan, I tinkered with your post to put Dr. O's comments in red including the ones you had difficulty with, in the process some of the >>> were lost but I think I have Dr. O's all in red, please let me know if I didn't get it right.

Susan, 3 yrs ago when my dog was diagnosed I was clueless and scared. I had to fire my first vet and move on to a 2nd one. By then I had read about both trilostane and lysodren and I was really preferring trilo. Problem is the vet had never used it and I wanted his experience.

So I went the lysodren route. I was scared but it is really not a big deal. It is dangerous when a vet doesn't follow the protocol and communicate clearly with the pet owner. If both take it seriously (which should be done with any chemo drug) there is no reason to fear.

After reading here for 3 yrs I am not relieved that I went with lysodren because I have seen many dogs like yours that go on trilo thinking it is a cure but learn later that they must switch. Plain and simple I lucked out.

Do not fear - we will help you thru this should decide to switch. I am glad that you heard back so quickly from Dr O. Hang in there! Kim

Heard back from the very busy vet - we are going in on Monday for a blood pressure check and to discuss what's ahead.