Susan, as Glynda & I, along with several other members have mentioned to you when you were both contemplating using trilostane, & also with Palmer's symptoms getting worse, that the trilostane may be the actual problem, here. It is very well documented in the literature that trilostane will raise intermediate hormones, & really isn't an appropriate choice for an Atypical pup. The dose to trilostane that you have been using has obviously controlled Palmer's cortisol, but with the deterioration in his symptoms, IMHO, I really think that trilo is the culprit, here. I would strongly encourage you to e-mail Dr. O, again, make sure you include your original case # from UTK, explain to him that you have tried trilo, give him the the last stim results, but emphasize that Palmer's symptoms are becoming quite worse. I believe that Dr. O's original response to your first e-mail about using trilo included Dr. O stating something to the effect that you could try, but eventually trilo was going to elevate the intermediates, & exacerbate Palmer's symptoms. IMO, I think you have now reached "eventuallly elevate the intermediates".

Debbie