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

Hi! It's Susan, Palmer's Mom. I was so distressed when the other site became unavailable for use.
I need help on how I can load Palmer's picture.
Please everyone update me as to how things are gong for you.
:D:D:D:D:D:D:D:D:D:D:D:D

Hi Susan!!!! :) :) :) :) :)

Be sure and check your emailbox (and spam folder) for a message from us. You need to respond to it to finalize your registration. That way, your posts will show up the board immediately. Until you do that, they will be "held" until a Moderator can approve them for public viewing.

Marianne

YAY Susan!!! I am so glad to see you here. I see that you figured out how to upload a photo as I just came back from looking at Palmer....what a cutie pie. I've missed you both and am looking forward to getting a full update on what's been going on.

Glynda

SUSAN!!!!

You must have been reading my mind yesterday!!! I was wondering how to go about finding you and Palmer. And here you are today!!! :D:D:D:D Wonderful, wonderful, wonderful!!! :D

How are you? How is Palmer? Fill us in on all the details since we last chatted. :)

Welcome home! :D
Hugs,
Leslie and the girls

Welcome back Susan and Palmer.

Your avatar is just like before under the user cp. Your gallery is now referred to as an album (s) and you access it also from the user cp. Let me know if you have trouble with it.

Scott

Hey Susan and Palmer ~

Glad to see you here!! We're the ones who need an update on how things are going with you and Palmer. :D :D Hope all is well.

Louise

Well thank goodness and am I ever glad to see "youse guys!" :D:D

I am very happy to tell you that for now Palmer is doing wonderfully. He has lost two pounds.....makes a big difference in his mobility. He is scheduled for another ACTH stim test in two weeks. I am eager to see the results.

The medications he is taking seem to be working very well. We seem to finally have passed the point of having to fight with him to get his various medicines and vitamins into him daily. I don't know if I ever mentioned but he bit me twice-quite hard- when we started having to give him so many different things. He had never bitten anyone.

His spirits are wonderful. His mobility is wonderful. He lost I think it's two inches around his belly. The drinking of water has decreased and the appetite seems to be really appropriate for him. He has some arthritis which bothers him from time to time but he seems to be able to walk out the stiffness and aches in a few minutes. He is much grayer now, but he did celebrate his 12th birthday in April. I will try to post a current picture soon.

He is being bothered by the warmer weather - but that has always been the case with him with his dark coat. He's good at finding shade and is enjoying being outside after a cold winter and a very slow to arrive spring.

What happened to the former site? I was really distressed when I lost you guys!! :mad::(

Is everyone doing okay?

-Susan

Susan, the success of treatment for Palmer is wonderful. Please continue to post even if it is success only.

We don't know what happened to the other site and much of the posting there has been lost. That will not happen here. This is is managed and owned by a board of persons all commited to the membership.

Scott

Glad you found us! (How did you find us?)

I put your same avatar up (next to your name) last night.

I copied it from the picture in your photo album. :)

I wondered about that Cushy, cause I knew when I posted priviously there was not an avatar.

Scott

Scott-thanks for the explanation, what there is, of what happened.

Cushy-I think I did a search on "Cushings' Forum." Then I just started checking out whatever came up. I have tried many, many times to find a way back to everyone. None of them were successful before. It's so nice to see the names and the pictures.

Anyone....we don't have any "friends." :eek::( I'd love it if any of you would hop back on our page.:D:D Thanks.

Recent picture (like last weekend) of Palmer to come very soon. My son took the pictures....I've not seen them yet. I'll also post one when he looked "not well." Then you can see the progress. The one that is on there now is about 4 years old. It's my favorite picture of him, I think.

-Susan

Susan you may have lost the site for a while but your friends are still here. I'm glad you found us again.
Jenny

Hi guys and gals!
Palmer had his ACTH stim test today (Wed) and I will get the results sometime Thursday. I wanted to speak with the vet today when we took Palmer in, but she was tied up in surgery and while they gave her a message to call me, I never heard back.:(

As I shared earlier, Palmer has done really well on his regimen. In the past 2-3 days, however, there has been increased panting, lots of water consumption, what looks like an increase in the size of his belly, and I can feel those "hip bags." Just 4 days ago I was admiring how well he looked. :eek:

I'll post the test results as soon as I have them in hand. This is one tough disease....and worrying is always lurking around.

Hi Susan,

Don't you just hate seeing these things!?! I do! Even when I am fairly sure the panting, etc. is weather related, that worrying takes over again. I really think Beth's idea of a blood cortisol meter is something that needs to be looked into. :D

Let us know what the results are when you get them and here's hoping they are right where they are supposed to be.

Hugs,
Leslie and the girls

Leslie- Thanks for the positive wishes! What is a blood cortisol meter? I'll look it up when I finish here.

Stim test results are in hand. It appears to be great news!!!:D:D:D:D:D

There are 5 readings which are out of mid-range. They are:

Alk. Phosphatase 701 s/b 10 - 150
ALT (SGPT) 189 s/b 5 - 107
Chloride 104 s/b 105 - 115
B/C ratio 31.4 does not show reference range (??):confused::confused:
Neutrophil SEG 80 s/b 50 - 77

His pre-ACTH cortisol = 4.8
His post = 12.7

She took a urine sample this afternoon and will do an analysis and a culture. I should have those results tomorrow.

She said if they come back normal, we may increase the Lysodren to combat the return of symptoms.

All comments are welcome. The Alk/Phos and SGPT are the only ones that concern me. Also-vet says (as do test papers) a dog on Lysodren "should" have a post-SCTH of 5.....but she's not worried about Palmer's reading.

Yes, the "ideal" post value should be 1-5. You need to keep in mind, though, that you need to treat the pup, & not try to match the textbook numbers as some of these pups have not "read the book".:rolleyes: If you could remind us as to what lyso dose you are presently using, & Palmer's current weight. I quickly reviewed your thread, & I don't see that information. My concern is that a post of 12 is extremely high, & with the return of symptoms, I'm not really sure a simple increase in maintenance dosage is going to do the trick. Also, what was Palmer's last stim result prior to this one, & his lyso dosage at that point, if different than what he is currently on?

I hate to have ask all of these questions, again, but with the loss of the old site, we sometimes need a bit of a refresher as to what has been happening.

Debbie

Hi Susan,

A blood cortisol meter is something Beth dreamed up...it doesn't really exist as far as I know, but wouldn't it be great if it did!

I, too, am a bit concerned with the post reading of 12.7. That sounds like a ug/dl measurement and is a bit higher than is liked for a pup on treatment. Lyso pups usually shoot for a post of 5 and Trilo pups have a bit higher range, up to 9, if I remember correctly. Has Palmer had the UTK panel done again since the first one? With you seeing signs again, the high ALKP, and this post # on the ACTH, it might be worth considering.

Hugs,
Leslie and the girls

Hi-
No problem here with number of questions asked or repeated! :)

First-Palmer is and has been on (for the last 3 months) Trilostane. The 15mg (1/2 pill) is where we started. We're going up from 15mg to 30mg daily. He weighs, at last check, 19 lbs. No we have not done a 2nd UTK-don't feel a reason to do that right now.

His urine tested out perfect so she cancelled doing a culture. :D We are going back in 3 months for another Stim Test. Of course changes in symptoms changes all that. If the increase in Trilo does not help to reduce the symptoms, I'll be back there sooner.

(I can't believe how I sound like I know what I am talking about vs. last October!) :D

I couldn't find a blood cortisol meter. Perhaps all of us could make and patent one? The proceeds could pay for all this testing!;)

The pre and post on the ACTH last time were 3.5 and 31.9. That was when we first started the Trilostane.

I just checked my financial info and I think I must have some test results that are not filed yet. I'll try to get the filing caught up and I'll post any changes to what I've told you. I think I'm going to put all this stuff on an
Excel spreadsheet just to be able to keep track of it. (the numbers)

I am dealing with a nice case of poison ivy which I think was a "gift" from Palmer. How thoughtful of him...... :rolleyes:

Quote:

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She said if they come back normal, we may increase the Lysodren to combat the return of symptoms

---

So, Palmer isn't taking any lyso, now, only trilo? Please correct me if I'm wrong, but it sounds like your vet, now, also, wants to add lyso to the trilo to control the return of symptoms? Did you mean to say Trilo in the above quote, because I'm confused. I'm going to have to flag down some of the trilo parents, but I have never heard of this.

Please remember that we discussed with you the fact that Trilo pretty much always increases the levels of intermediate hormones. In fact, if I remember correctly, you e-mailed Dr. O about using Trilo, & he said you could, but you had to keep in mind that the intermediates would probably increase over time. In light of all of this, I would almost bet that increasing levels of intermediates are what is causing the return of Palmer's symptoms.

Debbie

Hi Susan,

I'm with Debbie here. The Trilo could easily be causing some of the other hormones to increase VS decrease, and an increase in these hormones could cause an increase in the cortisol levels due to the physiological stress of the hyperadrenal activity. Personally, I would want a repeat of the UTK panel asap. Don't forget that these other hormones can cause damages, too. I know you haven't! ;)

Did Palmer have an ultrasound during the diagnostic phase? Was he determined to PDH or ADH? Are you seeing any behaviors that could not be weather related? or any new "oddities"? What form of lignans are you using - oil, capsules or hulls? Dr O wants Squirt switched to the hulls from the purified caps since some of her levels are still elevated. That might be a consideration if he is on the caps or oil. Just a thought.

You have learned a lot since coming on board here! You're getting to be an "old hand" at this stuff! :D Trust me, if my addled old brain can still learn new things, I know yours can!

Hugs,
Leslie and the girls

Only have a second-but, yes, I meant to say Trilostane. Palmer has never been on Lysodren.
My husband is in charge of giving meds, so I'm not sure about the lingans. I think it's oil. I'll look now. The behavioral changes are not weather related as we have just experienced a cool snap. Palmer was determined to by Atypical.....the vet now considers him to be "regular" Cushings.

We had the ultrasound....it showed nothing basically. Just a somewhat enlarged liver....if I remember correctly.

s

Would you be able to post the results from Palmer's original diagnosis - I'm assuming that as he was diagnosed with Atypical Cushing's that there was a UTK panel done?

Using Trilostane is most unusual in a dog with an Atypical diagnosis. I guess with some very specific hormone profiles it couldbe used and bring a benefit but the general thinking is that Trilostane is likely to cause additional problems in most Atypical dogs.

Alison

If I remember, I think Palmer's UTK panel showed that he was Atypical + PDH, but it would help a whole lot if you could post the original panel results as Alison said.

Debbie

Hi gals and guys!

I haven't been ignoring anyone....just needed to get my Palmer papers straightened out, plus I am still having issues with bumps-may not be poison ivy after all.

UTK results =
Cortisol pre 60.6 (2.0 - 56.5); Cortisol post 155.9 (70.6-151.2)
Androst pre 9.9 (0.1 - 3.6) post 26.0 ( 2.4 - 29.0)
Estradiol pre 65.5 (23.1 - 55.1) post 64.7 (23.3 - 69.4)
Progest. pre 0.5 (0.03 - 0.17) Progets post 2.4 (0.22-1.45)
17OH progest 0.41 (0.08 - .022) Post 1.72 (0.25 - 2.63)
Aldost pre 32.3 (11. - 139.9) post 144.9 (72.9 - 395.5)

Evaluation = results signs of both atypical and hyperadrenocorticism.

Recommendations = liver supportive meds; lysodren OR melatonin treatment.

When he was tested 6/18 he had shown a return of panting, thirst and big belly. She increased the Trilostane dosage to a full pill from 1/2 of a pill. The thirst continues, the panting seems to have decreased somewhat and the tummy seems to look a bit smaller.

Current meds = Denamrin (liver supplement) - 225 mg One daily
Melatonin capsules - 3mg Three daily
Flax Seed oil - 1000 mg One daily
Lignans - 40mg One every day
Vitamin E - 400IU One daily
Dasuquin ½ pill daily (joint medication)
Metacam 0.5 mg 15 lb dosage
Vetoryl 30 mg One daily


Did I miss anyone's question?

-susan

No one can offer any comments on Palmer's test results? :confused:

Hi Susan,

I am so sorry that nobody responded to your post. It doesn't happen very often that a thread gets lost when there is a flurry of activity on a given day and I suspect that is what happened here.

I am assuming that the UTK panel was done prior to starting treatment with Trilostane? If so, it was apparent back then that Palmer was atypical and Dr. Oliver's treatment recommendations did not include Trilostane for a reason. I seem to recall that you wrote to Dr. Oliver about using Trilostane and he did say that at some point you would probably see a return of symptoms as Trilostane always elevates one or more of the intermediates. At this point, I am not sure that the continuing symptoms you are seeing are from excess intermediates or the cortisol. The last post stim was quite high so this could easily explain why symptoms have not resolved.

As I explained to you before, my Lulu had elevated intermediates when I started treating her with Trilostane and over the course of two years, she lost the coat she had regained with Lysodren and her intermediates had skyrocketed. I must admit that the Trilostane did a superb job of controlling her cortisol and the voracious appetite, PU/PD and the heavy panting improved tremendously once we got her stabilized on the 30mg once daily. Without fail, her post cortisol was in the 2's and 3's for two years at that dose and aside from losing her coat and her skin getting a lot worse, she did very well.

It is quite possible that once you get Palmer's post cortisol within range, all of his symptoms will resolve and he'll do just fine. However, given that he is atypical, Dr. Oliver's comments will come to fruition and you will see some symptoms return at some point. I also think that you will find that some of the intermediates that were normal on the first UTK panel will be elevated on future UTK panels. I would highly recommend that you keep a very close eye on the intermediates by having a UTK panel done every six months. Had I done that, Lulu would have been off the Trilostane a lot sooner.

I don't have the best memory but even without the benefit of having access to your old thread on cc.net, I'm pretty sure that I just rehashed what I had posted on cc.net.

Glynda

Sorry we did not see it Susan,

I have been gone and am catching up.

I think Palmer is Atypical with slightly elevated cortisol.

If it was me, I would do melatonin and lignans for up to three months and retest.

Palmer has elevated progesterones and these point to a need for Lysodren if the melatonin/lignans do not produce the desired results.

Please continue to keep us posted.

Scott

Susan,

You did not list Trilo as a med.

Sorry I am not connecting.

Please disregard my earlier post.

Based on the results posted I would not be administering Trilo to mine.

Scott

Hi Again,

I located what I think is the last page of your old thread on cc.net which had some useful information for those of us with a really bad memory. :D It looks like your vet did an acth stim test prior to starting treatment and Palmer's post stim number was 31. In contrast, the post stimulated cortisol on the UTK panel shows a post stimulation number of 15.6. As Scott said, this would be a mild elevation. I already asked in my earlier post but can you tell us if the UTK panel was done after starting treatment with Trilostane?

Glynda

Glynda-
The UTK panel was done prior to any medication being given. We get another ACTH stim in 10 days. Depending on results, we'll probably redo the UTK. The Trilostane was started 3/16/09.

Scott-Trilo is being given - I listed it under the brand name-Vetoryl. We are giving 30mg/day. Also, we have been doing the Melatonin and lignans since maybe December.

I'll be back when the next test is run.

Thanks.

Susan

Quote:

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Originally Posted by Palmer's Mom

The UTK panel was done prior to any medication being given.

---

Susan, now I am totally confused because I remembered reading that one of the post stims prior to treatment was 31 ug/dl right? There is a huge difference between that 31 and the UTK post stim of 16, which would be considered normal. Would you show me some mercy and refresh my horrible memory? :D

Glynda

Welcome home.........I know the feeling about being lost....it was a great day for us when we found our way back.

Heather and Zoe Claire :)

Glynda-
Now you have ME confused!! :confused::confused::confused::confused: First - you say post stim..........which post stim are you referring to? Next-you refer to a post stim of 16 in the UTK report and I don't see a "16" anywhere.....not on the original report nor on the figures I recently posted.:confused::confused::confused:

This is a trick, right? You're trying to make me go crazy even sooner!!!;);)

Come back and let me know what I am missing............

Susan

Susan,

I'm sorry to confuse you. I converted the UTK post stim to ug/dl by dividing 155.9 by 10 which equals 15.59, then rounded to 16. In going through the old pages on cc.net, I found a post by me that refers to a post stim of 31 and then you responded with what appears to be your confirmation. Not every page of your old thread is available so perhaps that is why I can't find the post where you actually shared that number with us. Was there another acth stim test done in addition to the UTK panel before Palmer started treating with Trilostane? Here's a copy of the post(s) I am referring to.

Quote:

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03-27-2009, 09:12 PM
LulusMom

Re: Palmer 12 y/o Atypical Cushings

Hi Susan.

Congratulations on a great acth stim test. I am a nervous nelly so unfortunately, I can't leave it at congratulations. Palmer's post stim prior to starting treatment was 31 so if his post is now within the desired range of 1 to 5 after only 10 days, that is a huge drop in cortisol. It is really common to see a continued drop in cortisol in the first 30 days so please keep a very close eye on your boy for any signs that cortisol may be too low. By the way, can you remind me how much Palmer weighs and what dose of Trilo he is getting? Is it once daily or twice daily? Has your vet told you that you need another stim at the 30 day mark? If not, please make sure that you schedule one and make sure that your vet knows to check Palmer's electrolytes whenever she does a stim.

---

Quote:

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03-28-2009, 11:31 PM
Palmer's Mom

Re: Palmer 12 y/o Atypical Cushings

hi Glynda-
Don't mind questions at all.

"Palmer's post stim prior to starting treatment was 31 so if his post is now within the desired range of 1 to 5 after only 10 days, that is a huge drop in cortisol. " That's where it is. I won't have the test results in hand until Monday, but I had a call today also telling me that the urine checked out with everything as "normal."

Palmer weighs 20 lbs or so and is getting 1/2 Trilo pill in the AM only.
We already have the appt for the 30 day mark. I will ask vet to check electrolytes, if she's not already doing that. What are the results "tagged" that will show me that?

In addition, I measured Palmer's tummy today and he has gone down 3"....plus he's lost those "hip bags." He continues to be quite frisky. I'm very grateful.

---

If my pain meds were too much for me that day and I quoted a post stim of 31 that never existed, I need to be supervised more closely. :D So if we throw out that number which has probably confused everybody, then based on a negative LDDS and the UTK panel results, we can assume that Palmer is strictly atypical which begs the question as to why he is on a drug that is known to make that condition worse over time, not to mention much more expensive than the recommended treatment of melatonin and lignans. I believe that Palmer is also a mix of two breeds (Pomeranian and Poodle) that have a predisposition to adrenal imbalances, right?

You mentioned in your post of 6/29; "When Palmer was tested 6/18 he had shown a return of panting, thirst and big belly. She increased the Trilostane dosage to a full pill from 1/2 of a pill. The thirst continues, the panting seems to have decreased somewhat and the tummy seems to look a bit smaller." What testing was done on 6/18and can you share the results with us?

Glynda

Hi Susan,

I've been following your thread and lets see if I got these things straight, ok? This stim test below was done 6/18/09 with the results of 4.8 & 12.7 with Trilostane. Now the UTK results of 16 and the 31.9 were done before starting the Trilostane, is this correct?

Quote:

---

Originally Posted by Palmer's Mom

Stim test results are in hand. It appears to be great news!!!:D:D:D:D:D

There are 5 readings which are out of mid-range. They are:

Alk. Phosphatase 701 s/b 10 - 150
ALT (SGPT) 189 s/b 5 - 107
Chloride 104 s/b 105 - 115
B/C ratio 31.4 does not show reference range (??):confused::confused:
Neutrophil SEG 80 s/b 50 - 77

His pre-ACTH cortisol = 4.8
His post = 12.7

She took a urine sample this afternoon and will do an analysis and a culture. I should have those results tomorrow.

She said if they come back normal...

All comments are welcome. The Alk/Phos and SGPT are the only ones that concern me. Also-vet says (as do test papers) a dog on.. "should" have a post-SCTH of 5.....but she's not worried about Palmer's reading.

---

Quote:

---

Originally Posted by Palmer's Mom

Hi-
No problem here with number of questions asked or repeated! :)

First-Palmer is and has been on (for the last 3 months) Trilostane. The 15mg (1/2 pill) is where we started. We're going up from 15mg to 30mg daily. He weighs, at last check, 19 lbs. No we have not done a 2nd UTK-don't feel a reason to do that right now.

His urine tested out perfect so she cancelled doing a culture. :D We are going back in 3 months for another Stim Test. Of course changes in symptoms changes all that. If the increase in Trilo does not help to reduce the symptoms, I'll be back there sooner.

(I can't believe how I sound like I know what I am talking about vs. last October!) :D

I couldn't find a blood cortisol meter. Perhaps all of us could make and patent one? The proceeds could pay for all this testing!;)

The pre and post on the ACTH last time were 3.5 and 31.9. That was when we first started the Trilostane.
I just checked my financial info and I think I must have some test results that are not filed yet. I'll try to get the filing caught up and I'll post any changes to what I've told you. I think I'm going to put all this stuff on an
Excel spreadsheet just to be able to keep track of it. (the numbers)

I am dealing with a nice case of poison ivy which I think was a "gift" from Palmer. How thoughtful of him...... :rolleyes:

---

Lori

Hi Glynda & Lori -

I think the best way for me to try to clear this up is to post all Cortisol test results by dates.
07/09/08 Before any kind of correct diagnosis or treatment, cortisol = 4.0

9/22/08 started Denamarin (liver supplement)
09/26/08 UTK test results Pre = 6.1 Post = 16

10/07/08 we had the Melatonin implant
2/09 switched to Melatonin pills
3/11/09 Pre = 3.5 Post = 31.9
3/16/09 Dr. Oliver agrees w/vet that Palmer now has "true Cushings"; Started Trilostane
4/10/09 Pre = 2.1 Post = 6.8
6/18/09 Pre = 4.8 Post = 12.7

I think that's the complete set.

Let me know if you have any questions or comments. :)
-Susan

Hi Susan,

Thanks for posting all of the stim test results. That clears up a lot of things and I feel so much better now. Based on these numbers, my comments in my 7/8 post make sense, or at least to me anyway. :D

Glynda

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.)

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!;))

I know nothing about Pomepoo's predisposition to anything.:eek: This is only my third dog ever and the first two were mostly without issues. 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. :)

Also-If I remember correctly you have spoken of Lulu's loss of hair. 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!!:()

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.

I find myself feeling like I'm watching him slip away. He's only 12.25!

Oh-by the way-exactly what are the "intermediates?"

Can someone remind me which readings I should pay special attention to? I still get confused on this stuff.:confused:

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

-Susan

Hi Susan,
The "intermediate hormones."

Quote:

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Originally Posted by Palmer's Mom

UTK results =

Androst pre 9.9 (0.1 - 3.6) post 26.0 ( 2.4 - 29.0)
Estradiol pre 65.5 (23.1 - 55.1) post 64.7 (23.3 - 69.4)
Progest. pre 0.5 (0.03 - 0.17) Progets post 2.4 (0.22-1.45)
17OH progest 0.41 (0.08 - .022) Post 1.72 (0.25 - 2.63)
Aldost pre 32.3 (11. - 139.9) post 144.9 (72.9 - 395.5)

-susan

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Trilostane raises androstenedione, 17-hydroxyprogesterone, estradiol and progesterone in pups according to "STEROID PROFILES IN THE DIAGNOSIS OF CANINE ADRENAL DISORDERS", by Jack W. Oliver, DVM, Ph.D.

Lori

Susan, the post value is always the more important of the 2 results.

Debbie