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

[Bailey's Mom]

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

[AlisonandMia]

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

[StarDeb55]

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

[Bailey's Mom]

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

[Bailey's Mom]

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

[lulusmom]

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

[gpgscott]

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

[gpgscott]

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

[lulusmom]

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. 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

[Bailey's Mom]

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