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

[Bailey's Mom]

Hi!
Palmer just had his latest stim test. His eating, drinking, tummy symptoms had returned the last time he was tested and his Pre #s were the highest we've had and his post #s were the second lowest we have had. If you look back at the 6/09 numbers they were very good. The bad numbers showed up 10/09. We had a stim test in Oct and his pre/post were 1.8 and 3.6. The only difference in what we were doing is that we shifted over to compounded drugs after 6/09. After 10/09 we went back to Vetoryl. Now all of his numbers are well within their ranges except for Alk. Phosphatase....that has always been high. Does anyone know if that is something to be concerned about?
The weather here has been bad all winter. Either too cold or too wet. We've had three "hundred year" floods. I got him a remote control car to play to give him some exercise.The funny thing is he is more interested in the little wire on the remote control! He acts as he would if a bug were flying around his head. It's soooo funny.

Other than that the tummy goes up and it goes back down. He seems to be feeling very well and will turn 13 next month. I just wanted to share the good news.

-Susan

[Harley PoMMom]

Hi Susan!

It is good to hear from you, we have missed you and hearing about Palmer.

Re; the Alk. Phosphatase (ALP), is his ALT within normal range? If it is, then I wouldn't be too concerned with the ALP being elevated...out of curiosity just how high is Palmer's ALP? The ALT is more specific to the liver than the ALP.

We had a stim test in Oct and his pre/post were 1.8 and 3.6.

If his pre was 1.8 and his post was 3.6...these to me look like pretty good numbers, tho his post could go higher, say to 5.4 according to Dechra. How are Palmer's symptoms now? If his symptoms are still present then most likely his intermediate/sex hormones are elevated, especially if his cortisol is being controlled.

I bet Palmer is having a blast with his new toy! My cat would love to get his paws on that car too!

Please keep us updated, and it was so nice hearing from you.

Love and hugs,
Lori

[StarDeb55]

Susan, Lori brings up a very good point. If you are definitely seeing a "rebound" in some of Palmer's symptoms with the cortisol under control, it's very likely that elevated intermediate hormones may be the culprit/s.

Debbie

[Squirt's Mom]

Hi Susan,

So good to hear from you! And with good news to boot! It sounds as if our Palmer is handling his meds ok and feeling quite good. As long as he is acting good and the numbers stay good, then your goal has been met.

It sounds as if the compounded drug didn't work well for Palmer. Interesting..... I wonder why? Someone else had trouble with compounded meds...it gave the pup diarrhea. Turned out the culprit was one of the mixers used by that pharmacy; a colored additive, if memory serves. Just goes to show that these babies are individuals and what one can handle, another cannot. You are such a smart mom to go back to the brand name! I'm glad that did the trick for Palmer!

I would love to see him chasing the "bug" on wheels! That sounds hilarious! And what a great idea for exercise! I wish that would work with Crys, but she would have to "kill" the remote vehicle and eat it.

Keep in touch and let me know how Palmer is doing...and you! I hope you both continue to flourish.

Hugs,
Leslie and the girls - always

[Bailey's Mom]

Hi gang!

Lori-Palmer's ALT is 89 which is within the range. The only other time we got an ALT test result was back at the beginning and it was 200 (9/08).

Debbie-I never have understood what "elevated intermediate hormones" refers to. I asked the vet if she knew what they were (way back) and she said "no." Can you help me understand that?

Leslie and the girls- Palmer's remote control car is way too big for him to get it into his mouth. It's about 12" long, I think. I had to make sure he would not be able to try to swallow it. It seems there is nothing between the tiny ones and ones like this, size wise....unless you want to pay big bucks. It's made by Tyco and is call Stunt Psycho. It goes forward, back and around in circles. It will flip over and then you can get it to right itself. As I recently had foot surgery and am having more knee surgery on Monday, I had to have something that would take care of itself. I won't be able to be chasing something around to put it right side up. When you turn it on, it has headlights that light up. It doesn't make much noise. You can turn it to the left and turn it to the right. It will even do wheelies! It's simple enough that I can operate it. Now that the weather seems to be getting nicer, we may take it outside and play with it on the lawn. I'll try to get a picture of Palmer and his new toy this weekend. It really is a hoot!!
Thanks for responding....it's so nice hearing from you all. I will try to get back here more frequently.

-Susan

[labblab]

Hi Susan,

It wasn't clear from your earlier post whether or not Palmer is still suffering from an increase in Cushing's symptoms, or whether he's OK now that you've switched back to the brandname Vetoryl. Also, what were the actual results of the stim test that you just had done?

Those two pieces of information will help us know whether or not there may be an issue with Palmer's intermediate hormones (and I'm afraid I've got to run before explaining in more detail what they are -- but I know that somebody else will do so!)

Marianne

[Harley PoMMom]

Hi Susan,

Trilostane always increases 17-hydroxyprogesterone (some cross-reactivity with pregnenolones in assays??), and frequently increases estradiol and androstenedione as well.

This is from the UTK treatment option sheet.
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Treatment%20Info,%20Atypical%20Cushing's,%20revise d,%20Oct.,%202009.pdf

The 5 intermediate/sex hormones: (Estradiol, Androstenedione, 17-
Hydroxyprogesterone, Progesterone and Aldosterone) all are made from the adrenal glands, now the estradiol is made from the adrenal gland and other places.

Since Trilostane increases some of these hormone levels, a pup's clinical signs can come back even when the cortisol is being controlled.

Hope this helps.

Love and hugs,
Lori

[Bailey's Mom]

Gosh-I thought for sure I had posted the stim test numbers. His pre was 3.6 and his post was 10.4, His symptoms have decreased - his tummy looks good, his thirst has calmed down and his eating is way down. He's been kind of "punk-ish" the past two days, but he seems to be fine.

With regard to the intermediate hormones, I still don't understand what it means if they are elevated. How does that affect them? In looking back, I see we have had those results only once and that was with the original UTK testing. I don't know why the testing that is being done is not including those readings.

He turns 13 on the 20th. I know he's looking forward to that.

Thanks for getting back to me!

-Susan

[Harley PoMMom]

Hi Susan,

Only the lab of the University of Tennesse run by Dr Jack Oliver, can do the full adrenal panel which tests the 5 intermediate/sex hormones.

The intermediate/sex hormones if elevated can make their clinical signs come back even if their cortisol is controlled. By clinical signs, I mean a pups symptoms would emerge again.

If Palmer's symptoms haven't returned, then I wouldn't worry about this. If his symptoms do return and his cortisol is being controlled then I would concern myself with this.

Hope this explains it better.

Love and hugs,
Lori

[labblab]

Gosh-I thought for sure I had posted the stim test numbers. His pre was 3.6 and his post was 10.4, His symptoms have decreased - his tummy looks good, his thirst has calmed down and his eating is way down. He's been kind of "punk-ish" the past two days, but he seems to be fine.

-Susan

Hi Susan,

That's great that Palmer's symptoms have improved and that he is generally doing well (hope he's no longer feeling "punkish" by the time your read this reply!). However, with a "post" result of 10.4, if you DO start seeing a rebound in his symptoms, I think you'll first want to increase his trilostane dose before worrying about the possible effect of any elevated intermediate hormones. His stim result was higher than the level that is recommended by Dechra (the manufacturers of Vetoryl). As you'll see on their Treatment and Monitoring Flowchart, the ideal "post" result is between 1.45 and 5.4 ug/dl. However, as long as symptoms are controlled, they're OK with a result as high as 9.1. But Palmer is now even higher than that. So if you do see a return in his symptoms, his cortisol level is the primary issue that needs to be addressed. Here's a link to that Flowchart:

http://www.dechra-us.com/File/vetory..._Flowchart.pdf

And all best wishes in advance for Palmer's Happy 13th Birthday on the 20th!!

Marianne