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

[lulusmom]

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?

Glynda

[hfurlotte]

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

[Bailey's Mom]

Glynda-
Now you have ME 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.

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

[lulusmom]

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.

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.

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. 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

[Harley PoMMom]

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?

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

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 (??)
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.

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. 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!)

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......

Lori

[Bailey's Mom]

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

[lulusmom]

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.

Glynda

[Bailey's Mom]

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. 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.

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

-Susan

[Harley PoMMom]

Hi Susan,
The "intermediate hormones."

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

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

[StarDeb55]

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

Debbie