Have I finally found my friends? (Palmer has crossed over the Bridge) [Archive] - Canine Cushing's Information and Support Forums

Bailey's Mom

06-01-2009, 12:54 AM

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

gpgscott

06-01-2009, 10:55 AM

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

acushdogsmom

06-01-2009, 03:19 PM

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. :)

gpgscott

06-01-2009, 03:42 PM

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

Scott

Bailey's Mom

06-02-2009, 01:57 AM

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

BestBuddy

06-02-2009, 04:59 AM

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

Bailey's Mom

06-18-2009, 01:33 AM

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.

Squirt's Mom

06-18-2009, 12:30 PM

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

Bailey's Mom

06-18-2009, 06:55 PM

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.

StarDeb55

06-18-2009, 07:02 PM

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

Squirt's Mom

06-18-2009, 07:16 PM

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

Bailey's Mom

06-19-2009, 06:38 PM

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:

StarDeb55

06-19-2009, 06:58 PM

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

Squirt's Mom

06-19-2009, 07:25 PM

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

Bailey's Mom

06-19-2009, 08:33 PM

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

06-19-2009, 08:43 PM

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

06-19-2009, 09:51 PM

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

06-29-2009, 04:07 AM

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

07-08-2009, 11:03 PM

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

lulusmom

07-09-2009, 12:06 AM

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

07-09-2009, 04:24 PM

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

07-09-2009, 04:59 PM

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

07-09-2009, 05:00 PM

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

Bailey's Mom

07-11-2009, 01:53 AM

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

lulusmom

07-11-2009, 03:09 AM

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

hfurlotte

07-11-2009, 03:57 PM

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

07-12-2009, 09:01 AM

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

lulusmom

07-12-2009, 11:00 AM

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. :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

Harley PoMMom

07-12-2009, 11:46 AM

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!!!: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.

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

Bailey's Mom

07-14-2009, 12:30 AM

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

07-14-2009, 01:04 AM

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

Bailey's Mom

07-14-2009, 01:04 AM

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

Harley PoMMom

07-14-2009, 09:20 PM

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

07-14-2009, 09:24 PM

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

Debbie

AlisonandMia

07-14-2009, 09:45 PM

In the "Treatment Option Considerations
Steroid Profiles in the Diagnosis of Atypical Cushing’s Disease
Clinical Endocrinology Service/College of Veterinary Medicine/University of Tennessee" (http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing%27s.pdf
)

NOTE:
Trilostane always increases 17-hydroxyprogesterone (some cross-reactivity with pregnenolones in
assays??), and frequently increases estradiol and androstenedione as well. LysodrenTM may be
preferred for Atypical Cushing’s cases.

Trilo reduces cortisol, progesterone and aldosterone but increases 17-hydroxyprogesterone and often increases estradiol and androstenedione as well. This is because of the way it interrupts the synthesis of the adrenal steroids and also might be related to the adrenal hyperplasia that can occur after several months of Trilo treatment particularly when the dog has PDH (which is usually why it is being used).

So it looks from that info that Palmers elevation of progesterone is probably not as a result of the Trilo. The way that Trilo interefers with progesterone production is the biggest reason that Trilo should not be handled by a pregnant woman.

Alison

lulusmom

07-14-2009, 10:15 PM

Susan, see my comments below in lighter blue.

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.) It is very strange that Palmer had two stims done, one by your vet and one by UTK and the post numbers were vastly different. The UTK panel would indicate that Palmer is strictly atypical; however, post of 31.9 blew that assumption all to heck. :D

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!;)) Like I said previously, this could be explained by cortisol still not being controlled or the intermediate/sex hormones are creeping up due to the Trilostane. I assume that the test you mention is an acth stim test? If so, the results will help your vet determine why Palmer's symtoms are not improving.

I know nothing about Pomepoo's predisposition to anything.:eek: I didn't go back through your old thread and verify this but I believe that I mentioned that Pomeranians are part of the Nordic Breed family and they have a predisposition to adrenal imbalances. i also mentioned that Poodles are another breed that are greatly over represented. Palmer's utk panel, reflecting elevations of one or more of the intermediate/sex hormones, pretty much confirmed that he is true to his breeding. :) This is only my third dog ever and the first two were mostly without issues. Being a lover of toy breeds, I would have to say that my experience is the opposite. It's more like 2 out of ever three dogs I've ever loved had more medical issues than you could shake a stick at. 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. :) Wow, 17.25 years is quite a testament to the fabulous mom you really are. Congratulations.

Also-If I remember correctly you have spoken of Lulu's loss of hair. Lulu lost all fur on her body before being diagnosed. She grew a fuzzy coat after being treated with Lysodren but unfortunately, I made the mistake of switching an atypical dog to Trilostane. She lost the fuzzy coat a year into Trilo treatment. We are hoping that at some point, she might sproud some fuzz again but I'm not going to hold my breath. 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!!:() I here ya. I've got a fraction of the hair I used to and it really burns me up that what I lost must have been all brown because I find it hard to believe that I lost any gray hair at all.

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. If Palmer's cortisol is still too high, I doubt that what you are seeing is arthritis as excess cortisol is a superb anti inflammatory. It is usually not until the Trilostane effectively brings the post stimulated cortisol down to within the acceptable range of 1 to 5, 6 or 7 that arthritis really rears its ugly head . Has your vet manipulated Palmer's joints or xrayed his hips and knees to confirm that arthritis is evident?

I find myself feeling like I'm watching him slip away. He's only 12.25! Susan, I know it is difficult to see our babies feeling so yucky and looking decripit but do not lose hope. I am telling you that once you get the cushing's controlled, Palmer will feel and look a hundred times better. Hang in there and we'll get there together.

Oh-by the way-exactly what are the "intermediates?" Looks like Lori got back to you with this information. Palmer was diagnosed as aytpical because one or more of his intermediates, also known as sex hormones, were elevated. It was also these elevated intermediate hormones that concerned many of us because Trilostane always increases one or more of the intermediate hormones with long term treatment.

Can someone remind me which readings I should pay special attention to? I still get confused on this stuff.:confused: It takes a while to get your arms around the disease, the treatments, the testing and all the big words that make your head feel like it's going to spin off of your neck. :D Just keep reading and trying to absorb everything and the light bulb will come on.

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

-Susan

Bailey's Mom

07-15-2009, 05:02 PM

Hi-

Thanks for all the information.....and since we go to the vet next week, I think I now have some specific questions to ask. The usual Vet is away-so it's an associate whom I've not met. It's a guy (not that that matters) and I have no knowledge of his background/experience. It's another perspective anyhow.

Poor Palmer is madly panting today. He also wants to be in my lap. That's very unusual when he feels hot. He'll usually hops up for a few minutes, then he gets down due to my body heat.

Glynda - Yes-the tests other than the UTK one last fall are all ACTH stim tests. That's what we will be getting on Monday.

"Like I said previously" - please do not hesitate to repeat information. I don't mind at all. Originally the volume of new information was so overwhelming. At least now I feel I have a handle on a little portion of it.

"Wow, 17.25 years is quite a testament to the fabulous mom you really are. Congratulations." Thanks for the compliment. She was a real sweetheart....just as Palmer is. He is just a bit more stubborn. :) (Maybe I should say a little bit more of unsuccessful training!)

" I here ya. I've got a fraction of the hair I used to and it really burns me up that what I lost must have been all brown because I find it hard to believe that I lost any gray hair at all. " LOL!! I was coloring mine and I chose to stop. I'm surprised at how much brown I still have.:D Hair tip - in case anyone is interested - Biotin (supplement) helps return some thickness.

" Has your vet manipulated Palmer's joints or xrayed his hips and knees to confirm that arthritis is evident? " Yes-an xray was done. Plus he had both knees operated on (as did I!)....although it seems it's his front left leg that is bothering him the most. I'll double check this with the vet on Monday.

"Susan, I know it is difficult to see our babies feeling so yucky and looking decripit but do not lose hope. I am telling you that once you get the cushing's controlled, Palmer will feel and look a hundred times better. Hang in there and we'll get there together. " While I hate to see him limp and have him panting so much and his tummy so big, I figure there is just a bit more of him there to love. I am thinking about just wetting down his coat to try to help cool him off.

"make your head feel like it's going to spin off of your neck. :D" Isn't that the truth!!!

Your words are very helpful and I truly appreciate all the support. Thank all of you so very much.

Susan

lulusmom

07-15-2009, 07:14 PM

So it looks from that info that Palmers elevation of progesterone is probably not as a result of the Trilo. The way that Trilo interefers with progesterone production is the biggest reason that Trilo should not be handled by a pregnant woman.

I agree with Alison's assessment at this point in time because I don't believe Palmer has been treating with Trilostane long enough to see a marked elevation of progesterone. I honestly believe that my Lulu is the poster girl for what can happen to an atypical cushdog with long term Trilostane treatment. After two years her progesterone level had more than doubled and that was the smallest elevation on the UTK Panel.

Excerpt from Steroid Profiles in the Diagnosis of Canine Adrenal Disorders - Treatment Implications:

Trilostane. Enzyme inhibition by trilostane occurs for 3-beta hydroxysteroid dehydrogenase, but also for 11-beta hydroxylase.30 Thus, 11-deoxycortisol levels build-up in dogs treated with trilostane. It is also apparent that other intermediate steroid levels increase (androstenedione, 17-hydroxyprogesterone, estradiol and progesterone) in dogs treated with trilostane, which could be due to the 11-beta hydroxylase inhibition, and possibly 21-hydroxylase enzyme inhibition. The reason why only 11-deoxycortisol levels were increased in the above study may be due to the length of trilostane exposure (3-7 weeks), compared to dogs that are exposed to trilostane for extended periods.

Bailey's Mom

07-16-2009, 05:44 PM

Thanks Glynda & Allison.

Palmer's doing better today. Stomach is 23". That's pretty big for a 19 lb guy (although that may have changed as well.)

-s

Bailey's Mom

07-20-2009, 03:42 PM

Hi-
Palmer is at the vets being tested. Am I confused or what:confused::confused::o:(
For the stim test.......they told us 4 hours after his Trilostane. Then they keep him and retest. Is there a time span to wait for the retest? I thought it was 4 hours. He's supposed to be "ready" in about one hour.

And I'm still not clear (Sorry)-are there specific readings that I should pay special attention? Obviously the pre and post Cortisol.....but what else should I be looking for? Is it the androstenedione, estradiol and progesterone?......Also the 17-hydroxyprogesterone? Are these readings sometimes listed under other names?

I saw the new associate today. Only saw him-did not have an opportunity to speak to him. He looks to be 13 years old and still has acne :eek::eek::eek: :confused::confused::(:(:( Pardon me for my "pre-judging."

Palmer weighed in at 20.4 lbs. His weight seems to be pretty consistent now. Tummy measures 23" and I think, at its worst, it was 25".

I would guess we'll get the results tomorrow. I'll post them. I'm going to wait to speak to our "regular" vet before we do anything. She should be back next Monday, I'm guessing.

BestBuddy

07-20-2009, 04:45 PM

Hi Susan,

The ACTH testing is done 4-6 hours after the trilostane and the test takes 1-2 hours depending on what stimulant they use. What happens is a blood test is done and then a substance/gel is injected and after the 1-2 hour wait then another blood test is taken. So you will get a Pre Cortisol (before the stimulant) and a Post (after) but the other stuff you mention is only done with special testing. Fingers crossed the numbers will be good.

Jenny

gpgscott

07-20-2009, 06:24 PM

Hi Susan,

I have been looking in but have not been posting much as you have many with firsthand experience posting to you.

I am very interested in the treatment and how Palmer responds to it.

Best to you both.

Scott

StarDeb55

07-20-2009, 06:57 PM

Susan, are you having a repeat UTK panel done today? The UTK panel is the only thing that will show results on all of the associated hormones, along with the cortisol level.

Debbie

Bailey's Mom

07-20-2009, 09:06 PM

Sigh.......no-not a repeat UTK. After I get these results (tomorrow) and then speak directly with our usual vet, I'll reconsider that. I have to go 2.5 hours away to have it done...........and then there's the expense..........
It's on my mind.........

Bailey's Mom

07-20-2009, 09:07 PM

Thanks Jenny-that's making more sense now.

Bailey's Mom

07-21-2009, 07:00 PM

OK, friends. We have the test results. Palmer was Pre of 5.4; Post of 5.5.

Sounds like good news to me!!:D:D:D

BestBuddy

07-21-2009, 07:07 PM

I love those numbers. I had to go back and read your thread to see that there has been a gradual decrease which is just great and a post of 31 to 12 and now 5.5 is just great.:D

Jenny

lulusmom

07-21-2009, 07:55 PM

Hi Susan,

Those numbers are pretty darn nice and they would be perfect if all of Palmers symptoms have resolved. However, just a week ago you mentioned that "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".

If Palmer is still symptomatic and is getting once daily dose of Trilostane, then it could be that he may need to go to twice daily dosing. Remember that Trilostane's enzyme blocking abilities starts to diminish after 8 to 12 hours so any time after that, circulating cortisol levels start to rise again. Some dogs, like my Lulu, can make it through the second 12 hours without being symptomatic but some don't and ultimately require the second dose for consistent 24 hour control. A urine cortisol creatinine ratio (UC:CR) can be done by your vet to determine if cortisol levels are too high in the second half of the day. This would involve your collecting a urine specimen, preferably the first pee of the day, before meals and meds.

As I mentioned earlier, if you are not seeing symptoms improve, another possibility could be that the Trilostane has had an impact on the intermediate hormones and one or more could be elevated. Sex hormones can cause the same type of symptoms as typical cushings. As others have mentioned, the only way to determine if this is the issue is to have a full UTK adrenal panel done. The (UC:CR) is relatively inexpensive so that would be where I would start.

I also want to mention that Dechra, the manufacturer of Vetoryl, indicates that a post stim of up to 9 may be acceptable if symptoms have resolved. However, I believe UC Davis' experience with Trilostane dictates that you must get the post stim number below 5 if you want to see complete resolution of all symptoms. I think Palmer is pretty darn close but no banana. So that's my unsolicited two cents worth, again.

By the way, what did your vet have to say about the acth stim results versus Palmer's continuing symptoms?

Glynda

Bailey's Mom

07-23-2009, 01:21 AM

Thanks Glynda and Jenny.

Glynda-thank you for all your input. I spoke with "A" vet, yesterday. She is the fill-in this week while my usual vet is in the west, somewhere. The substitute vet just said that it looked great and to wait and discuss it with my usual vet when she returns. I asked her about that reading of 31 several tests back. I asked if she knew any reason why that one would be so out of whack. Right away she said "No."

I am going to review all this with my vet next week. I'll be sure to ask about the twice a day dosage and about the big belly and thirst.

Question-if I were to get the urine catch to try to determine if the Cortisol is okay in the second half of the day........wouldn't I want the sample to be in the afternoon or evening?:confused:

-Susan

lulusmom

07-23-2009, 10:31 AM

Hi Susan,

I am assuming that you are dosing Palmer in the morning right? If so, you definitely want to catch the urine sample the first thing in the morning before he eats and takes his meds. Cortisol levels will be at it's highest in the am before the next daily dose. There have been a few studies that showed that the drugs effect diminishes at 8 to 9 hours which is not long enough for effective control of cortisol which is why many dogs on once daily dosing never see an improvement in symptoms. These studies actually did an acth stimulation test at 3 to 4 hours after dosing and again at anywhere from 8 to 12 hours. This isn't really an alternative for some of us petowners but the UC:CR is. It is much less expensive and you collect the sample at home so Palmer is as calm as possible. Stress of going to the vet will temporary increase cortisol levels. If the ratio is high, your vet should give twice daily dosing some serious consideration.

Glynda

Bailey's Mom

07-30-2009, 12:52 AM

Hi guys 'n gals-

Palmer had a urine culture test today-results to come tomorrow. Vet said to increase Trilostane with 1/2 pill in PM. She wants to check his blood pressure - but the instrument she wants to use just went out for some repairs. So-maybe BP on Monday or so. The vet said we need to be sure Palmer doesn't have something else going on.

I'll keep you updated.

-Susan

gpgscott

07-30-2009, 04:27 PM

Hi Susan,

Did I miss something, you are increasing Trilo but it looked like the most recent stim was in a very acceptable range.

Scott

StarDeb55

07-30-2009, 05:16 PM

Susan, I know that Palmer is still symptomatic, even with the excellent numbers on his last stim. What concerns me is increasing the dose of trilostane, since the 30 mg daily was obviously keeping the cortisol within acceptable range. IMO, it would make more sense to go to twice a day dosing, say 20 mg in the AM, 10 mg. in the PM, to see if you can get better resolution of Palmer's symptoms. I'm just concerned that the increased dose may put Palmer at risk for a low cortisol emergency.

Debbie

Bailey's Mom

07-31-2009, 04:27 PM

Hi Scott-
Yes and no.......she told us to add 1/2 pill in the evening....which would be the increase. Last night I had to get up 3 times to let Palmer out because of diarrhea. He'd also had two bouts of it before bedtime.

I spoke with the vet this AM and she said there is a lot of "something" going around. She has given us an antibiotic to give Palmer. She also said to stop the evening 1/2 pill. In 3 or 4 days, if he seems "well" we'll try the 1/2 pill again. If the same thing happens, we'll know it's the Trilo.

The reason for raising it is mainly because his symptoms are not responding as they did when we first started. She said the results were so good then, she thought adding 1/2 pill would help with the results and might lower his reading another point or two.

He's been very thirsty and panting alot. Of course it's also in the 90's here. I have a room in the house (where the computer is) and we come up here, I crank up the a/c a bit, and he seems to do pretty well. It's not a very active lifestyle.......but at least he's not panting so horribly.

-s

Bailey's Mom

07-31-2009, 04:28 PM

Hi Debbie-

Thanks for your input. I think that's a good idea. Before we start back up, I'll pose that to the vet. That makes more sense to me as well.

-Susan

Bailey's Mom

07-31-2009, 05:10 PM

I spoke with the vet already. She thinks it would be fine to try that, but that the capsule, so far as she and her supplier know, only comes in 30mg capsules. She suggested splitting one capsule-1/2 in AM and 1/2 in PM.

I went online to try to find out if there were any other dosage capsules available anywhere. In so doing, I ran across the following, It is from
the Journal of the American Hospital Association.

Long-Term Efficacy of Trilostane Administered Twice Daily in Dogs With Pituitary-Dependent Hyperadrenocorticism

Dolores Perez Alenza, DVM, PhD, Carolina Arenas, DVM, Mari Luz Lopez, DVM and Carlos Melian, DVM, PhD From the Veterinary Teaching Hospital (Perez Alenza, Arenas), Veterinary School, Complutense University of Madrid, 28040 Madrid, Spain and Clinica Veterinaria Atlantico (Lopez, Melian), Pi y Margall, 42, 35006, Las Palmas de Gran Canaria, Spain.
Address all correspondence to Dr. Arenas.
Trilostane is considered an efficacious and safe medication for canine pituitary-dependent hyperadrenocorticism (PDH). Its recommended frequency of administration is once daily. In this prospective study, the efficacy, toxicity, and long-term outcome of trilostane administered twice daily per os were evaluated in 44 dogs with PDH. Mean initial dose was 3.1 mg/kg q 12 hours, and mean final dose was 3.2 mg/kg q 12 hours. The final total daily dose was lower than previously reported for once-daily administration. The mean survival time for affected dogs was 930 days.

The vet said the advantages of splitting up dosage is a gray area. She said the mfg. suggests that it not be done and that some studies show it's helpful.

She suggested we try splitting up the 30mg pill-half in AM and half in PM. We're going to try that before we retry an increase. We won't be doing that until we are sure he does not have a virus. She wants him totally back to "normal" before we make any changes. That way we can determine if his reaction is truly due to the Trilo.
file:///C:/DOCUME%7E1/SUSANS%7E1/LOCALS%7E1/Temp/moz-screenshot.jpg

That's where we stand.

-Susan

lulusmom

07-31-2009, 05:26 PM

Hi Susan,

If you will recall, I suggested that you ask your vet to do a urine cortisol creatinine ratio to determine if Palmer needs twice daily dosing. Is there any reason why your vet didn't opt to do this test before advising you to increase Palmers Trilo dose? He probably does but keep in mind that you opted to treat with a drug that is not recommended for a dog like Palmer, whose intermediate hormones were already elevated. The problem can therefore be that Trilostane is elevating the intermediates to a greater extent and causing the symptoms you are seeing. It is very important that your vet follow proper protocol so that she can make an educated determination as to why Palmer is still symptomatic. Telling you that "something is going around out there" and then instructing you to test the water a second time with a possible overdose doesn't sit well with me at all but then, I'm a little different than most people.

If it is determined that twice daily dosing is necessary, then the proper protocol involves a formula of sorts where you slighty increase the once daily dose and then split into two equal doses in the am and pm. I believe Palmer is on 30mg so you would increase to 40mg and divide into two 20mg doses to be given as close to every 12 hours as possible. I personally would go with this or the 20mg and 10mg Debbie suggested before I would take the risk of making Palmer sick again.

Glynda

P.S. I see that you were typing faster than I can and posted before I hit the send button. I'm at work so it takes me an hour to get one post done in between the interruptions. I am glad to hear that you are splitting the current dose rather than trying the increase again. Whew!

Bailey's Mom

07-31-2009, 06:03 PM

Thanks Glynda. The "something is going around out there" was my cryptic reporting of the conversation. She said something about having seen a lot of dogs with a virus, now.

I have been able to determine that in June the FDA approved 10 mg capsules. I cannot find out if they're available yet. I emailed the mfg support line.

Will someone please tell me what "PU/PD" stands for? Maybe pick up/ put down?? ;););) Ah-I found it! Excess urination/ excess thirst. Why can't they talk in regular folk talk???:confused::confused:

-Susan

Bailey's Mom

07-31-2009, 06:12 PM

AlisonandMia

08-01-2009, 08:41 PM

Hi Susan,

I'm coming in late here and I'm a little confused and concerned. It sounds like you are using the standard 30mg capsules (Vetoryl I presume) and that the vet is recommending that you split the capsules open? That is very dangerous for both you and Palmer as this exposes you to the Trilostane (which can mess with female hormones) and, if you are sprinkling the powder on his food, could result in some very nasty irritation to his throat and possibly esophagus. It would also be pretty difficult to get a really accurate split dose that way.

I believe a the 10mg Vetoryl capsule may have got FDA approval in June - I'm far from 100% sure of that but if it is right then you should be able to get 10mg caps for tweaking purposes. Even if that isn't the case then you should be able to get the 30mg capsules compounded (by a compounding pharmacy) into smaller doses - this is something quite a few people have had done. That would be a lot safer for both you and Palmer if you need to vary the dose outside 30mg increments and the 10mg caps are not yet available.

Here's what is under the Human Warning's section of Dechra's Vetoryl package insert (bolding is mine):

HUMAN WARNINGS:
Keep out of reach of children. Not for human use.
Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you.

(This is a link to the package insert PDF file: http://www.dechra-us.com/File/prod_vetyrol.pdf)

Now for the confusion: What dose is Palmer on now - is it 30mg capsule (Vetoryl?) once per day? In the past you mentioned "pills" - did you mean capsules or were you using a compounded pill form of Trilostane previously and have gone to Vetoryl capsules now following FDA approval?

Alison

lulusmom

08-01-2009, 08:52 PM

It must be Friday:D:D

I just found this online "Cortisol levels are now considered a biological marker of suicide risk."

Does this mean I should have Palmer on a suicide watch?;););)

It just struck me as funny........I know it's serious.

-Susan

Susan,

When it comes to canines, I believe the cortisol levels are considered a biological marker of suicide in pet owners. :D:p:D

PU/PD means polyuria (excessive urination) and polydipsia (excess water intake).

As I recall, you have a compounded version of vetoryl in tablet form which Palmer was getting once daily. I seem to remember this because most of us thought you were mistaken because we had never heard of Trilostane tablets. Vetoryl comes in capsules and so do the vast majority of compounded Trilostane. You can get any mg you need compounded in capsule form at any number of compound pharmacies. I used to purchase mine from Diamondback Drugs in Scottsdale, AZ. Many other members use them as well.

www.diamondbackdrugs.com

Glynda

StarDeb55

08-01-2009, 09:23 PM

Glynda & Alison, when I saw the increased dose suggested by the vet, I went back & re-read the thread. From what I can determine, Palmer has been on 30 mg. once daily. Now, whether or not Susan is talking about opening the capsules, she will have to clarify that point.

Debbie

Bailey's Mom

08-03-2009, 12:13 AM

How nice to hear from so many!

I think you got it right, Glynda!! - "When it comes to canines, I believe the cortisol levels are considered a biological marker of suicide in pet owners."-
I am sorry to have been confusing. I am giving Palmer capsules. I tend to call everything re: medication a "pill." We have been using the 30 mg Vetoryl. We have been giving one capsule each morning. The one day we added 1/2 capsule in the evening. Palmer had the diarrhea and we have been back on the one capsule - but we are splitting it between AM and PM. The vet mentioned compounding. It sounds like that may be the way for us to go....at least to try. Thank you for the link.

Alison - I am aware of the warnings given with the pill. My child bearing abilities ended twenty years ago. We are very careful to wash our hands thoroughly....but I do think the compounding would be preferable. I had not given thought to the possibility of irritation to Palmer's throat. Obviously I would not want to do that. As the only option for Trilostane presented to me was the 30 mg capsules....I figured I had no choice but to open them and split them.

The 10mg were approved in June. I have been unable to find out if they are on the market yet.

Susan

labblab

08-03-2009, 12:36 AM

Susan, if you are wanting to obtain brandname Vetoryl in 10 mg. capsules, I suggest you contact Masters Marketing (a U.K. internet pharmacy): http://www.masters-uk.com/veterinary/home.php

Even though the 10 mg. capsules received FDA approval in June and will soon be available, it appears that they have not yet been distributed to vets for sale to the public (per Dechra's U.S. website). Until they ARE available for purchase through American vets, you may still be able to order them from Masters. I suggest you contact Masters to see what they can tell you about the situation.

Good luck!
Marianne

StarDeb55

08-03-2009, 10:50 AM

Susan, don't overlook what was suggested earlier. You can take some of those 30 mg. capsules to a compounding pharmacy & have them reformulated into a smaller dose such as 10 mg.

Debbie

Bailey's Mom

08-03-2009, 10:15 PM

Marianne- thanks for the link. I've gone there and printed out some forms.
Debbie -I did not realize I could take what I have and have them re-mixed. Thank you.

I still have not heard results from the urine culture. There has not been any more diarrhea. I will fax what information I have on Trilostane 10 mg over to the vet's office. I will ask her to call with the culture results (she must not have had them yet. She's really good about that.) and so we can talk about the Trilostane.

I tried to find a place in Canada where I could order the 10mgs. but was unsuccessful. I did find a compounding place that indicated they have Trilostane. They offer it in capsule or tablet form.

Gave Palmer a bath today. I'm not finding his hair anywhere-furniture, etc,.but he sure is getting thinned out.:eek::eek: Right at the base of his tail there is nothing. It's so sad. :( He still reverts to puppyishness after a bath. That's warming.

-Susan

Bailey's Mom

08-03-2009, 10:20 PM

Does anyone find that they shy away from pups predispositioned to Cushings' when getting new family members?

-s

lulusmom

08-04-2009, 04:15 PM

To be perfectly honest, I would think twice before adopting another Pomeranian and I'd probably steer clear of other breeds that I know are over represented in cushing's disease. However, if I had the financial means, it really wouldn't matter to me as caring for cushdogs has become second nature for me.

Glynda

Bailey's Mom

08-04-2009, 06:49 PM

Glynda-do you know where I can find a list of breeds & dispositions? Didn't you say before that Pekingese were also prone to Cushings?

-Susan

StarDeb55

08-04-2009, 07:16 PM

Susan, if you will "google" canine cushing's, most any of the common websites should have a list of breeds predisposed. One of the website you might look at is Kate Connick's.

Debbie

Bailey's Mom

08-04-2009, 11:29 PM

Thanks, Debbie. I've seen that site before but at that point I was barely familiar with Cushing's. There is a lot of information there......some of it depressing.......:(

I'm nowhere needing this information, but was curious.

-Susan

Bailey's Mom

08-05-2009, 05:05 PM

nikkismom

08-05-2009, 05:28 PM

Hi, Susan! It is sad when they get all bald, but it could be worse. Nikki's my first dog with cushings, I think, but maybe if the others had lived longer they would have had it too, who knows.I've also had a dog with diabetes, and for sure cushings is easier to deal with.I really feel for our friends who are dealing with both at the same time. Some even have thyroid disease thrown in. I believe when they get old they will have something unpleasant, just like we all do.I know some do get cushings at a young age, and that is very hard to deal with, I'm sure, but it does seem rare for a dog to go his whole life healthy and happy.But wouldn't it be great!:p I'm sorry I know nothing about trilostane as Nikki is on lysodren, but don't worry too much about the hair loss. I'm sure Palmer will be just as cute! Sharon

StarDeb55

08-05-2009, 08:44 PM

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

gpgscott

08-05-2009, 09:44 PM

:eek::eek::eek: My little doggie is slowly loosing his hair. He's gonna look like one of those hairless whatever they are-s. Oh I'll love him just as much as ever, I just wish it weren't so.

:(:(:(:(

Susan,

Losing hair is not normal.

I also think that given the labs you have posted that the Trilostane could be causing the loss of hair.

Scott

frijole

08-05-2009, 09:54 PM

Hi! I have been following along and I have to chime in and join the others that have mentioned that the trilostane could very well be hurting Palmer. I hate to put it so bluntly but after 3 years of reading here we see a whole lot of cases. We have seen what you are going thru happen before. And it can be prevented possibly by testing to see if in fact your dog has atypical cushings.

It is easily overlooked as a lot of vets just don't know about it. The good news is that if it is atypical - you might not need any harsh drugs but rather flaxseed and melatonin which are lots cheaper too.

The hair loss occurs when cushings is not under control or there is another reason for it. This is not normal. Sorry, but I am feeling sorry for Palmer and it seems like you are frustrated... it could be as simple as looking into this. Is there a reason you don't want to go there? Just trying to understand, I know this is complicated. Just trying to help. Kim

frijole

08-05-2009, 11:12 PM

I went back further and read ... I apologise... I didn't realise you had already determined that Palmer is atypical. I am pretty sure you could end the problems by going off of the trilo. I understand if you want to hear it from a vet... since you are concerned about yours, why not email Dr. Oliver with all of the symptoms you have mentioned to us? It doesn't cost a dime and he is the expert. He is also a great person. A thought?

Kim

Bailey's Mom

08-06-2009, 02:34 AM

Thanks to all of you for your input. I have just sent an email off to Dr. O. :D:D I gave him the history, the stim test results and list of medications.

I know a number of you (many) think the Trilostane is not the answer. I appreciate the fact that you continue to give me your input. I do listen and consider all you have to say.

Thanks.

Susan

Squirt's Mom

08-06-2009, 11:24 AM

Hi Susan,

We listen to you as well and have learned a few things from your journey with Palmer.

I hope you understand that our concern is that the Trilo may be getting the cortisol under control without question. But it may also be causing the other hormones to elevate as it lowers the cortisol which kinda puts Palmer in a catch-22 situation. The damage from elevated cortisol for him may not be as big a concern on the Trilo, but the damage due to elevation of the other hormones may be increased.

Looking forward to Dr O's reply...the last one was eye-opening for me! :);)

Hugs,
Leslie and the girls

frijole

08-06-2009, 04:19 PM

Susan,

Thanks for the update! I am sure you will feel better getting feedback from Doctor O... as he truly is the best. Glad you decided to do it. He is very approachable. Nicest vet EVER. Good luck! Kim

Bailey's Mom

08-06-2009, 06:23 PM

Okay folks...I have my responses. His responses are in red, where I could get this program to do that. For some reason a color change would not "take" on all of them.

I gave Dr. O. a list of all of Palmer's medications and asked him to review them. His response-
Flax Seed oil - 1000 mg One daily
>>May not help much with the lignan, since lignan content is only about 2%. The flax oil can also raise triglyceride levels, which can sometimes cause pancreas issues.
Lignans - 40mg One every other day
>>I’m suggesting lignans given at approximately 1 mg per lb now. If this is a product that has 20% content of lignan per 40 mg of product, then the lignan content is only about 8 mg (20% of 40). If so, I’d give it every day.

Regarding Trilostane -
I don’t know that much about trilostane at this point, except that it usually increases both androstenedione and estradiol levels. This doesn’t always cause the dog any problems, but in some, clinical signs of Cushing’s will re-occur at some time point; presumably due to the increase in these sex steroids.

Regarding stim test numbers -
These are good numbers for the cortisol, but this is expected with the trilostane. If estradiol and androstenedione were determined, I can almost guarantee you that they would have been increased.

My next observation/question - I told her –okay-but his symptoms have returned. He has distended stomach, much increased water consumption, lots of panting and now I can tell he is losing his coat. We usually have him clipped every 4 weeks because the heat bothers him so. I had to cancel the last appointment because there wasn’t enough there to clip. That was 2 weeks ago. Today, he could use some “neatening up” but on his body there really isn’t enough there to justify a clipping.
>>I would say that the sex steroids have increased a considerable amount, like they almost always do with trilostane.

I asked the vet if we might be headed for Lysodren and she said she did not think so.
This sometimes has to be done, when the sex steroids increase to the point that clinical signs return, when the dog is on trilostane.

Do you think he is still Atypical?
It would look that way if you did our adrenal panel while on trilostane. The sex steroids are almost always (I’d say always) increased when a dog is on trilostane. Many dogs tolerate this for long periods; others come back with clinical signs of Cushing’s, and a switch to Lysodren may be indicated at that time.
and....finally -

If you do our canine adrenal panel (sex steroid panel) at some point, I’d suggest going off the trilostane for 2 or 3 weeks. Otherwise, you won’t be able to tell if it’s increased adrenal disease, or more likely, sex steroid build-up due to the effect of trilostane

I'm waiting for my vet call today. They did tell me that the urine culture came back good. I'll let you know about my conversation with the vet whenever that happens.

When the panel was done, Palmer was not yet on Trilostane.

-Susan

gpgscott

08-06-2009, 06:40 PM

Susan,

I have to tell you straight.

There is no reason to fear Lysodren. It is clear to me that your Dr. does not favor Lysodren and I really cannot understand why.

It is clear that Trilostane increases the hormones which contribute to the symptoms you are reporting.

The good thing is that Palmer is largely Atypical and would most likely not require a loading of Lysodren, which is the most difficult phase.

If this was me, I would suspend the Trilo, do a new UTK panel and then start the Atypical treatment of lignans/melatonin and then consider adding a maint dose of Lysodren after a period of time.

Best. Scott

Susan, I tinkered with your post to put Dr. O's comments in red including the ones you had difficulty with, in the process some of the >>> were lost but I think I have Dr. O's all in red, please let me know if I didn't get it right.

frijole

08-06-2009, 09:02 PM

Susan, 3 yrs ago when my dog was diagnosed I was clueless and scared. I had to fire my first vet and move on to a 2nd one. By then I had read about both trilostane and lysodren and I was really preferring trilo. Problem is the vet had never used it and I wanted his experience.

So I went the lysodren route. I was scared but it is really not a big deal. It is dangerous when a vet doesn't follow the protocol and communicate clearly with the pet owner. If both take it seriously (which should be done with any chemo drug) there is no reason to fear.

After reading here for 3 yrs I am not relieved that I went with lysodren because I have seen many dogs like yours that go on trilo thinking it is a cure but learn later that they must switch. Plain and simple I lucked out.

Do not fear - we will help you thru this should decide to switch. I am glad that you heard back so quickly from Dr O. Hang in there! Kim

Bailey's Mom

08-07-2009, 01:11 PM

Heard back from the very busy vet - we are going in on Monday for a blood pressure check and to discuss what's ahead.

MiniSchnauzerMom

08-07-2009, 05:25 PM

Hi Susan,

I'm glad you got the response from Dr. O with all that great info and that you have an appointment with Palmer's vet on Monday for a discussion. This info will certainly help your vet in determining a course of action/treatment for Palmer that will relieve those symptoms he has been experiencing.

Hope you have a productive appointment on Monday and that Palmer's bp readings are good. Take care and will be watching for your update.

Louise

Squirt's Mom

08-08-2009, 01:52 PM

Hi Susan,

Thanks for posting the response from Dr O. Isn't he great? It would be so easy for him to just blow us off as pests, but he always responds and is always so kind.

I hope you have a great session with your vet Monday and that Palmer can get to feeling better soon!

Hugs,
Leslie and the girls

Bailey's Mom

08-08-2009, 03:50 PM

Hi-
I only have a moment. When the vet's office called to set up the appointment the vet (Jennifer) passed along answers to my 4 questions.
#1 Would it be advisable to run a UC:CR test?
Answer-she can do it, but doesn't feel it is necessary.

#2. Discontinue flax seed oil.
Answer-agreed.

#3 Is she able to run an adrenal panel?
She thinks so-she has to check.

#4 I want to try Lysodren.
Answer-make an appointment for Monday, we'll discuss treatment options then. She thinks it may be premature.

She is consulting with an Internist and another vet person over the weekend.

Okay-back to just me. I don't know why she is resisting the Lysodren. At the very beginning it was mentioned as an option.

I would really appreciate (I know I've been told before) getting some "ammo" to support my case on Monday. Any comments anyone can offer will be greatly appreciated. (Especially UC:CR)

Thanks.

Susan

Bailey's Mom

08-08-2009, 03:52 PM

PS-yes Dr. O IS great. :D:D:D I'd like to meet him. He's thorough and prompt and talks so I can understand him.:):)

(I love these little icons!!)

-s

labblab

08-08-2009, 04:41 PM

Hi Susan,

I have only a moment to post right now, but I did want to give you some thoughts regarding a couple of your questions. First, as to the advisability of performing the UC:CR test: It is a simple test to run, and the results might give you a more complete picture as to whether or not Palmer's once-daily trilostane dosing is keeping his cortisol level well controlled throughout a 24-hour time period. If you do decide to run this test, however, it has been suggested to us that the most accurate approach is to collect and pool urine specimens on three successive mornings:

Many studies have shown that the only way to accurately gauge urine cortisol levels is to obtain the first morning voided urine sample on 3 consecutive days and then pooling the urine to run a UCCR. When done in this fashion it is likely an accurate test. Otherwise there is likely too much day to day variation to make a single random cortisol very helpful.

Dave Bruyette DVM DACVIM
Dr. Bruyette is a member of our forums, and has further elaborated that if you do choose to collect and pool urine samples, they should be refrigerated until you take them to your vet for analysis.

From what Dr. Oliver has written, however, I think the broader issue is whether or not trilostane is currently a good treatment option for Palmer at all. If it is not, then the question of once vs. twice daily dosing for optimal cortisol control really becomes a moot point. And in that vein, should you choose to perform another full adrenal panel, your vet really needs to coordinate the testing with Dr. Oliver. I see that in his reply to you, Dr. Oliver's suggestion is to stop the trilostane altogether for two to three weeks prior to performing the test. Otherwise, it is impossible to separate out the dog's naturally occuring adrenal hormone profile from the elevations caused by the trilostane itself. You do not want to go to the effort and expense of performing the test until the results will be meaningful.

Having said all this, I have to agree with the other folks here who are encouraging you to consider shifting to Lysodren and discontinuing the trilostane altogether. So I hope that is an option that you will be able to discuss more thoroughly with your vet on Monday.

Good luck!
Marianne

Squirt's Mom

08-08-2009, 04:58 PM

Hi Susan,

The biggest argument in favor of switching to Lyso is Dr Oliver himself. Dr O is the premier researcher in the area of Atypical Cushing's and therefore is the one source to be relied on. If he says, and he has, that Trilo will always cause these other hormones to increase, then you can bank on it. "The sex steroids are almost always (I’d say always) increased when a dog is on trilostane. "

This one statement is all I would need to hear in order to make the decision to stop the Trilo immediately and make the switch to Lyso after the UTK panel is run - no debate necessary.

Your vet can make the blood draws for the UTK panel but cannot run the test itself - unless something has changed very recently, the Uni. of TN in Knoxville (UTK) is the only lab in the country, perhaps the world, that currently does this testing. I know it will be difficult to let that month pass with Palmer receiving no treatment, but you are already dealing with cush signs so it won't be such a change. The wash-out period is crucial, tho. Especially since he has been on the Trilo for so long. His adrenals need time to return to their untreated state for the test to be accurate so that wash-out is very important.

I think you are making the right move, Susan, and Palmer will be much better for it.

Hang in there!
Hugs,
Leslie and the girls

frijole

08-08-2009, 06:12 PM

Hi Susan, boy have you been a busy camper this week. ;) Good job and know that we all needed coaching on this stuff in the beginning....

#3 Is she able to run an adrenal panel?

Leslie is correct - she only has to submit the sample. Make sure she submits it directly to the Univ of TN and doesn't send it to her regular lab as they will just mark the price up and send it to the univ of tn!!

#4 I want to try Lysodren.

I would print out some of our posts where we have pointed out that trilo can cause problems within atypical cushings dogs do you have it handy. Tell her you know that the Univ of Tenn is the only lab that does the testing for atypical and that you made direct contact with the Dr. there that advises vets on what to do. Print out his email and read it to her. She cannot argue with this world expert.

I think she is unfamiliar with lysodren or had a bad experience. Please make sure that she does not give you any lysodren yet. This is important. There needs to be a washout period between trilo and lysodren. So first get the test done and see what Dr. Oliver writes out on the results sheet for your vet. Then, assuming he will recommend lysodren... go with the dosage amount that HE recommends and the timeframe HE recommends. This way HE is telling your vet what to do. This is a win/win for your vet as she will have her hand held by an expert. You get peace of mind that he knows what he is doing!

Good luck and great job. Kim

Bailey's Mom

08-08-2009, 06:30 PM

Y'all are sooooo nice :cool::cool::cool:
Thanks very much for the encouragement. I will get my notes ready. I may be back before Monday with a question or two.

=Susan

Squirt's Mom

08-08-2009, 08:20 PM

Ask away, honey! We are all here for you and Palmer!

Hugs,
Leslie and the girls

Bailey's Mom

08-09-2009, 12:33 AM

Hi-
I sent "Jack" (that's how he is signing his emails now) the question about my vet being able to "do" the panel. He says she can-(get the samples) and sent me a link to detailed instructions on how to do it.
(He even responds quickly on weekends!):D:D:D:D:D

Bailey's Mom

08-09-2009, 12:45 AM

Leslie and the girls-
"The sex steroids are almost always (I’d say always) increased when a dog is on trilostane. "
Why is this a "bad" thing?

Also-one of my concerns is that the vet now thinks that Palmer is regular cushings'. Jack said that if Palmer was on Trilostane when they did the panel-he is. Well, he was not on the Trilostane then. I know we've had part of this discussion before.....can we again?:confused::confused::confused:

-Susan

Squirt's Mom

08-09-2009, 04:51 PM

Hi Susan,

Why is it a bad thing if the other hormones are elevated even tho the cortisol may be controlled? Because the other five hormones will cause the same damages in the body as the cortisol will if not controlled. They also cause the same signs as cortisol. The Trilo is more than likely NOT controlling those other hormones and is, in fact, causing them to be even higher than they would be in an untreated state (this is based on his continuing/worsening signs). The Trilo will lower cortiol, but it also elevates the other hormones that Palmer is over-producing naturally. For a pup with hormones OTHER THAN cortisol (like Palmer), Trilostane is a two-edged sword...helping one area (cortisol), while making another area worse (Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and/or Aldosterone).

In looking at Palmer's cortisol history, it is kinda puzzling to me. Has he had an ultrasound lately? If not, I highly recommend he have one soon. Based on the first ACTH through UTK, he does not have true Cushing's, but that post number has jumped all over even after treatment with the Trilo. So if it were me, I would want to be sure there isn't some other cause for his cortisol to be elevated - and fluctuating. You may remember that Squirt was diagnosed as PHD (true Cushing's) but since that splenic tumor was removed, her cortisol has returned to normal levels. Dr O was saying that if he was already on the Trilo when that test was done, then it would have lowered the cortisol giving a much lower reading than it would have if not treated - therefore leading to a diagnosis of conventional/true Cushing's. Since he was NOT on Trilo at that time, his cortisol levels do not support that diagnosis at that time. That could have changed over time, tho.

If it were me and my pup, I would stop the Trilo immediately - today; schedule an ultrasound asap; set up the UTK test for a month from now assuming the U/S is good. I am not sure of the life of melatonin and lignans in the body, but I would also stop them within a week to be sure the UTK panel reflects his true, untreated state. Then, assuming the UTK results still support the Atypical diagnosis even if the cortisol is elevated, tell my vet we would be switching to Lyso. IMHO, the experiment with Trilo has failed miserably for him and he continues to suffer as indicated by his continuing signs which means damage continues to progress.

I hope this helps.
Hugs,
Leslie and the girls

Medical complications from untreated Cushing's:
http://www.k9cushings.com/forum/showthread.php?t=195

StarDeb55

08-09-2009, 06:20 PM

Susan, I don't have much to add to what Leslie has already told you. The other hormones are still considered to be various types of steroids. Excess steroid, whether it is cortisol or one of the intermediates, does damage to the internal organs over the long term. This is why with a diagnosis of Atypical it's extremely important to get those intermediates under control. Lysodren will do that for you. The "catch 22" here is going to be estradiol as estradiol is also produced in non-adrenal tissue, such as adipose & I believe brain tissue, also. This is why the lignans + melatonin is used to control the non-adrenal production of estradiol. All adrenal produced hormones will be controlled by lysodren. I would almost bet that you will not have to put Palmer through a typical lysodren loading phase, & will simply need to add a maintenance dose of lysodren to his melatonin + lignans. If you & your vet want to see just how serious the effects of trilostane are on the intermediate hormones, you can have that UTK panel done right now. If you need to see what the levels are in an untreated state, Palmer will have to have a "washout" period of 30 days before the UTK panel can be done.

Debbie

Bailey's Mom

08-10-2009, 05:13 PM

Hi folks-

Now, let's all take a deep breath...............:(
First, Palmer's blood pressure is just fine.:D

Now-this is where we stand. We have agreed to give Palmer Trilostane, one capsule in the AM (30mg) and 1/2 capsule in the PM. We tried that before and Palmer had an immediate reaction. If the same occurs, we will immediately stop the Trilostane and that will be the end of it.

Regardless of how that turns out, we now have an appt. with an Endocrinologist. Sadly, not until 9/1. I'm not sure if he'll choose to run any tests or not, but Palmer will be fasting before we go. I know with Trilostane in his system it may skew the results.

If the Endocrinologist agrees with the Trilo. treatment.....I don't know what. (Well-yes, I do. The vet will not support us if we go against the two of them.) If he agrees with the Lysodren, after a wash out period we will start that. The vet will support that. So I guess the bottom line is this dude gets to determine whether or not we're going to need to change vets. (Anybody still with me?)

(I really hate having to write this to you guys. I got boxed in a bit here. There are no good viable options for a different Vet nearby.)

Jennifer states she does not have a problem with Lyso. She feels we had such good results when we first started the Trilo and that to switch now ("that we may be so close to having this solved") is just not the right thing to do. She also said she feels she is being pressured into doing something that goes against what she believes is the best treatment, at this time. She said that if the Lyso did not work, we'd be right back trying to find an answer with the Trilo. I reminded her that she offered Lyso as an option in the beginning. She remembers that....but it gets back to giving the Trilo a good chance.

The endocrinologist is at the place where we went for the UTK sample to be drawn the first time, so if we want to do that, we'll be all ready to go ahead with it. She is sending us to a different doc from the one we went to originally. I think the first go round we got the luck-of-the-draw amongst the Internists.

I gave her a modified transcript of the emails from Dr. O. (I removed any references to her.) His words were highlighted. She says she wants to and will read that. I think she was quite surprised to learn I had been conversing with Dr. O.

She made reference to my research. She said she admired all I had done. BUT-she could tell from my questions that I did not understand it completely. :mad::mad:She said some of my questions just did not make sense. :confused: :confused: (I do think this was a defensive reaction.)

My husband has not taken part in all this stuff, so when she asked him what he thought his response was that he did not want to run a lot of unnecessary tests. She had said the UC:CR was one example of a test she felt was unnecessary. She said it would not really tell us much at this point. She said it was a tool to determine if the pet had Cushings' at the start.

I don't see the harm in getting a second opinion. I know it will cost more time if we wind up going to the Lyso. I feel it would be much more costly, dollar and time wise, if we had to switch vets now.

I wish I had different news, but that's where we stand for now. I will take all of the volumes of documentation I have to the Endo. I will especially point out Dr. O's responses.

Please don't think I don't have the backbone to fire the vet or that I lack wanting the best of care for Palmer....for dollars or for any other reason. Perhaps this will resolve itself in the next day or two if Palmer has the same reaction to the increased Trilo. If we end up sending a sample to UTK, I will alert Dr. O that it is coming.

I hope you all will stick with me as we try to figure this out. I DID NOT ignore your many suggestions. As I said before-I really appreciate all you have to say and all the time you have taken.

-Susan

Squirt's Mom

08-10-2009, 05:26 PM

Hi Susan,

Of course we will stick with you! I am very concerned about Palmer, tho, and will continue to advocate stopping the Trilo. It really blows my mind that your vet will not take the word of a world renown doctor concerning the effect of Trilo on the other hormones involved in Atypical Cushing's. With Palmer's continuing signs I fail to understand what more she is looking for as an indication it is not doing the job. It is my fervent prayer that Palmer does not suffer as a result...well not much longer anyway before she listens to those who know more than she - meaning Dr. Jack Oliver.

I am sorry you are being torn like this and hope you understand that our goal is what is best for Palmer. Hopefully there are many things we don't understand in his whole picture.

Hang in there!
Hugs,
Leslie and the girls

Bailey's Mom

08-10-2009, 11:12 PM

Leslie and the girls-
Thanks so much. I'm glad you understand.

I was just thinking about the topic of replacing my vet. Another consideration I have is that if something of an urgent nature were to happen to Palmer, I'd have to go another 45 minutes to find the nearest qualified vet. It is best for Palmer to have that resource available. Hopefully this 3 weeks will not be harmful to him.

He had his extra 1/2 capsule tonight. No reaction so far.....but it did not happen until the following day the time we attempted to increase his dosage before.

-Hangin' in here.....................

Harley PoMMom

08-11-2009, 02:02 AM

Hi Susan,

I'm sorry you're going thru such a rough time with Palmer and your vet...I wish she would of let you run another UTK panel tho. :o

But what is done...is done...I also wish there was a cushing-computer out there...all you have to do is type in all of your pups numbers and poof it tells you what to do.

We know you love Palmer very much and no one doubts that, we just don't understand the logic of vets sometimes.

I'm hangin here with ya. :)

Love and hugs.
Lori

gpgscott

08-11-2009, 10:34 AM

Susan,

We are here to share our experiences and research. It is our goal as a group to help people not place burden on them.

You do not need to justify your descisions to any of us, all any of us here really owe another is common courtesy.

There will be people here who no doubt may disagree with Palmer's treatment based on what you have related to us. No one does it to berate you or your Drs.

I continue to wish you the best in your treatment of Palmer and hope the new Dr. brings clarity to his treatment.

Scott

Bailey's Mom

08-11-2009, 02:46 PM

Thank you Lori and Scott.
It is possible we will run another UTK test when we go on 9/1. I just plan to take all the information I have; all the test results and see what happens. I also plan to present my case, if necessary.

-Susan

Bailey's Mom

08-11-2009, 02:49 PM

Question-I spoke today with a woman who use to groom dogs. She asked if I could still pick Palmer up. I thought she was referring to weight. She told me Cush dogs get to a point where it hurts them to be picked up. Any idea if that's one of the symptoms? I've never read nor heard of that before. Palmer did yelp when I picked him up over the weekend.....and I had/have no idea why. I picked him up very carefully as I always do.

Thanks.

s

Harley PoMMom

08-11-2009, 04:45 PM

Hi Susan,

I know I have to be careful on how I pick Harley up...the overall tenderness of his tummy area...I think this is bc of his enlarged liver and prior bouts of pancreatitis that showed up in his U/S. Their skin gets paper thin too sometimes...our poor pups. :(

Love and hugs.
Lori

ventilate

08-11-2009, 06:32 PM

Susan;
As far as picking up a cush dog, I cant comment, I have giant schnauzers that wt 90 lbs so there is no picking them up. I do however help lift Nike into the truck and I pick up her hindend by putting my arms under her belly close to her back legs and it does not seem to bother her at all.
You mention that you give 1/2 cap of trilo. It is not recommended to open the caps, in fact it can be dangerous. I know with lysodren it can be a carsinogenic and can be dangerous to pregnant women. When cutting the lysodren tabs gloves should be worn, a seperate pill splitter should be used, papertowels should be used to clean up so it can be thrown away. I would guess Trilo would be the same. With Trilo being in caps I am concened. You can take your caps to a compounding pharm and they can split your pills for you into the dose that you need.
I understand you concern about your vet, as you say it may not be an issue anyway. It is important to have a vet you can talk to as treating this condition takes the expertise of the vet and the eyes of the owner and both are as important.
Doing a UK panel with the dog on trilo may not show anything helpful. Hopefully if they want another test they will have you do a hold on the trilo to be sure it is washed out of the system before doing the test or It will skew the results.
Good luck
Sharon

Bailey's Mom

08-12-2009, 01:15 AM

Sharon-
I am aware of the danger with the capsules. I was hoping not to need compounding......hoping we'd be off Trilo now.
Dr. O did say to wait three weeks with Palmer off Trilo before doing another test. I am glad you mentioned that.....I had temporarily forgotten.
I guess we're just stuck on hold until we see the Endocrinologist. Palmer had his first extra 1/2 capful tonight. Tomorrow might be when we'll see a reaction....if there is one.

Bailey's Mom

08-16-2009, 07:26 PM

Hi Gang-

Just thought I'd give an update on Palmer with his increased 1/2 capsule of Trilostane. He has had no apparent adverse reaction to the increase. His water consumption has decreased remarkably. I think the panting has lessened as well. It appears his tummy has gone down 1/2".

So far, so good. :):)

gpgscott

08-16-2009, 07:53 PM

Susan,

I am happy to hear that symptoms are better.

Please continue to be vigilant.

Thanks for letting us know.

Scott

Harley PoMMom

08-16-2009, 09:14 PM

Susan,

I am glad too that Palmer's symptoms have gotten better.

1/2" less on the tummy, Wow, this has to make Palmer feel better.

Here's hoping for continued improvements.

Love and hugs.
Lori

Squirt's Mom

08-17-2009, 09:55 AM

Hi Susan,

Good to hear that his signs seem to be getting better! Hope there is no adverse reaction and that he is feeling better soon. I measure Squirt
's belly, too, and hers fluctuates by 1" but she's never had the pot-belly common in Cushing's. I'm just a worry wart. :p

I know you are watching him like a hawk...just keep it up! If any of his cush signs remain, get worse, come back, etc.....well, you know what I'm gonna say I'm sure...;):)

Keep up the good work and let us know how Palmer is progressing on the new dosing schedule.

Hugs,
Leslie and the girls

Bailey's Mom

08-30-2009, 06:46 PM

Hi,

All is well here in Palmer Land. Improvement on symptoms continue. Friskiness has picked up.

I am probably going to need to contact someone on compounding of medications. I've looked a little on the web. Can anyone who has done this tell me how they started? I know the vet can get it done but her markup is horrendous.
Thanks,
Susan

StarDeb55

08-30-2009, 06:52 PM

Susan, a lot of us use Diamondback Drugs, diamondbackdrugs.com. They have a uniform shipping fee & will ship anywhere in the country. They are local for me, so I'm not exactly sure what their procedures are for out of state, but it's probably on the website.

Debbie

Roxee's Dad

08-30-2009, 06:52 PM

Hi Susan,
Seems many here use Diamondback pharmacy. It's on line and your vet can call in or fax a prescription.

Very glad all is well in Palmerland. :):D:):D

MiniSchnauzerMom

08-31-2009, 04:32 AM

Hi Susan,

Glad to hear that Palmer's symptoms continue to improve. I also recommend Diamondback Drugs. They are reasonable, prompt and great to deal with.

Louise

Squirt's Mom

08-31-2009, 01:00 PM

Hi Susan,

Glad to hear that Palmer is doing well! Friskiness is GOOD! Has his hair started to come back in? signs going away again?

Keep in touch, or I'll have to come looking for you! :p

Hugs,
Leslie and the girls

Bailey's Mom

08-31-2009, 10:02 PM

Thanks for all the replies!! Diamondback drugs should give you guys a commission!!:)

Leslie - Palmer's hair seems to have stopped thinning out. :D We got him groomed one week ago and he looks terrific. We have him cut very short since he minds the heat so and his black/gray hair gets so hot so fast. I was looking him over yesterday with the hair issue in mind....I don't see any bald spots and don't really see anything unusual. :D:D:D

His appetite has picked up a little, but I'm not concerned yet. My husband has been doing the feeding lately and I think he's a bit stingy with the food. (not purposely) He's drinking a lot of water....but nothing like he was there for awhile.

Our temperatures have taken a bit of a drop, so I can walk him more regularly.....and longer distances. In another 30 days he'll be allowed back on the boardwalk and he absolutely loves going there. He always meets several other doggies and they're usually pretty nice.

I'll keep you posted on any changes. I expect we need to do another stim test within the next month and I'll have to be talking with the vet about the compounding thing. All's been pretty "quiet" on the home front.

-Susan and Palmer:D

Harley PoMMom

08-31-2009, 10:14 PM

Susan,

Do you still have the appt. with an Endocrinologist tom. for Palmer?

Bailey's Mom

09-01-2009, 10:34 PM

Lori-
We canceled the appointment for the time being. We want to see how Palmer continues to do on the increased dosage.

And I think I'm going to stop bragging about his improvements. His tummy looks really big tonight.:confused::(:eek:

His poor little midriff is just too big for his frame. I sure wish this had never happened.:(:(:(

Bailey's Mom

09-01-2009, 10:35 PM

Lori-I meant to ask....what kind of doggie is it in the picture sitting in front of the larger black dog? Sooooo cute!!

Squirt's Mom

09-02-2009, 11:59 AM

Hi Susan,

You know we are keeping a close eye on you and Palmer, and want the very best for both of you. So I am glad that his signs seem to getting better, if ever so slightly...a step forward is always good, even if it's baby steps. ;) The heat has been affecting my pack, too, but we have had some nicer days recently and they really appreciate them. They have all felt a bit better!

Please keep in touch and let us know how Palmer is doing.
Hang in there!
Hugs,
Leslie and the girls

PS.
Ok, Lori, I gotta know about that little baby, too. I had not noticed it before, their coats blended together in my old eyes and the big one just looked really fuzzy! Now I can see another set of eyes in that big baby's chest! :rolleyes:

Harley PoMMom

09-02-2009, 06:32 PM

Hi Susan,

I too, am glad that Palmer is improving, even baby steps are huge improvements.

The little guy is a Pomerdoodle (Pomeranian/Poodle) named Tink/Tinker, tho I don't see any Pomeranian in him at all, and he is a handful. :eek::D The big guy behind him is his house-mate, a Rottweiler, named Ziggy, the most gentlest dog, plays so nice with Tink. Ziggy weighs 150lbs, Tink weighs 15lbs, now. I believe in that picture Tink was just 4 months old. I just talked to my girlfriend, Dusty, about him, and she said Tink is so strong minded, she's having one heck of a time house training him. :(

Love and hugs.
Lori

Bailey's Mom

09-03-2009, 10:09 AM

Lori-
Well that explains it. Palmer is a PomePoo! Aren't they just wonderful? :) I love all the smaller poodle mixes. Their faces just always seem so expressive. Palmer is very strong minded as well. He will not listen and come when called, if he has something more interesting to check out. :(:mad::eek::eek:

It's funny the two have matched up. I tried several months ago to talk Bob into our acquiring a puppy now. I got a very firm, flat, "NO!!!" I thought it would be good for Palmer and give him more exercise. Palmer likes dogs his size.,...the 15 - 20 lb range.

Have a good weekend, all!

-Susan

Harley PoMMom

09-22-2009, 07:49 PM

Hi Susan,

It's been quite a while since we heard from you...was wondering how you and Palmer were doing, hope everything is fine.

Love and hugs.
Lori

Bailey's Mom

09-23-2009, 10:10 AM

Hi Lori....thanks for seeking me out!

We are ding quite well here. :D:D Palmer's tummy has decreased, it seems. He is a lot friskier. :) His appetite is good-less than it was. We'll go back for an ACTH test in one month.

The only problem we're having is he frequently gets stiff necks. Last night was the worst. He almost doubled over in pain and cried.....and kept crying. I was able to massage it out. It really tears at me when he cries.....and he has never had an ongoing cry such as last night. Fortunately he will let me pick him up to work on it.

He's here sitting on my lap, making one handed typing a necessity!:eek:

In 10 days we get to return to the boardwalk for walks. I'm eager to get back to that. He loves the short ride and most times meets other four legged friends.

Oh-one other thing...his hair is growing at about 1/2 the rate it used to grow. At least we're getting a break on grooming costs!:D

If not before, I'll be back in one month with the ACTH test results.

-Susan

Harley PoMMom

09-26-2009, 11:16 PM

Hi Susan,

It's great that Palmer's symptoms have improved and he is friskier :D

I wonder what the stiff neck issue is tho...hmm...I have no idea, but I'm glad that you're able to massage it out for him...you're such a wonderful mom.

If not before, I'll be back in one month with the ACTH test results.I hope before :D , but if not :( , I wish you and Palmer the best of luck with the ACTH test.

Love and hugs.
Lori

MiniSchnauzerMom

09-27-2009, 01:22 AM

Hi Susan,

Congratulaltions.....sounds like Palmer is doing well on his treatment and the symptoms have diminished.

I would certainly check out Palmer's painful neck issue with his vet. Something's not right for him to be doubled over in pain and crying. I'm glad your massage is helping him but if it was me, I'd sure want to investigate and get to the bottom of what is causing this.

Good luck with Palmer's upcoming ACTH next month.

Louise

Bailey's Mom

10-06-2009, 10:29 PM

Hellooooooooo friends!! :):)

Palmer went in for his ACTH stim test yesterday. I just got the results and his Pre is 1.8; his Post is 3.6. He is truly enjoying this cooler weather and we are back to walking along the boardwalk. (Why don't some folks teach their pets that snapping is a No-No?):mad::mad::mad: Palmer loves to say "Hi!" to anyone he encounters....especially little kids and dogs his size....but he says "Hi!" to all of them. He wants to say "Hi!" to the back door, but I'm trying to get him trained (at 12 1/2?) to greet them at their noses or ears. We've encountered nasty dogs 2 or 3 times. The owners seem to think.........Oh, that's nothing. Don't do that Fido. Yikes!!:eek::eek::eek::eek:

Anyway-back to Palmer - he is playing with his toys.....that means he gets a stuffed toy, throws it up in the air and looks for it to land. Repeat that. Repeat that. :D:D:D I can get him to chase a toy once or twice....then he seems to say - I'm on to this game....you're not gonna run me all over this house!! So-the toy playing is back big time. The tummy continues to be a good bit smaller. The eating is mostly regular. The water consumption has come down with the cooler weather. Whereas last test time I felt like he was slipping away, I now feel like he's doing great.

So-no changes on the meds. Still one capsule in the AM and 1/2 in the PM. (Trilostane) And that's about all the news (thankfully, I guess.):):cool:

I've given you all a rest now......now I'd like to hear back from each of you telling me how you and your loved ones are doing!!:D

-Susan

Roxee's Dad

10-06-2009, 10:45 PM

Hi Susan,
Great news. :D:D:D

So happy for you and Palmer.

Stuffed toys are always a challenge in my house. Rozee like to chase and fetch, sometimes bringing it back within arms reach and as I go to grab it she turns her head. Brat :D

Littlebit like to chase and run with the stuffed toys, and sometimes destroying them. :eek:

Mickee, well he just likes to sleep. His age is catching up with him. Never was a toy player:(

Harley PoMMom

10-06-2009, 11:00 PM

Hi Susan,

It makes me so happy to read your cheerful post about Palmer...boy it's been a little bumpy here and there tho, huh? The pre of 1.8 is getting a little on the low side...but your such a wonderful and watchful mom, I know you'll keep an eye on him.

he is playing with his toys.....that means he gets a stuffed toy, throws it up in the air and looks for it to land. Repeat that. Repeat that.I can see Palmer doing this...:D:D Oh Susan, doesn't this just make you feel so good when your pup feels so much better and they act like more of themselves, like they did before they had cushings. I am just so, so happy for you and Palmer...keep up the good work...Great job.

Love and hugs.
Lori

sunimist

10-06-2009, 11:32 PM

Wonderful news Susan! Just what we like to hear. I am so happy Palmer is enjoying himself. Way to go big little guy!

Did you ever find out what the neck pain was all about?

Shelba and Suni

gpgscott

10-07-2009, 07:53 AM

Susan,

That is great, it is good to know that Palmer is happy and playful. And you deserve a break from all the stressing over him.

I hope the neck issue is fleeting.

Hear ya on the snapping dogs, guess you just have to be on the lookout when among strangers.

How long is the Dr. going to go between stims? The pre number we are told is not that important, in fact some Drs. will skip a pre draw as a cost savings measure. A low pre most likely indicates a very relaxed pup. Your post number is right in the range desired and that coupled with symptoms will be your guide to further treatment. I would keep a close eye on the hairgrowth issue and make notes which will be useful as you continue to treat.

Best wishes. Scott

Bailey's Mom

10-27-2009, 03:30 AM

Hi friends-
I've been a bit busy-meant to get back before this.

Palmer's neck deal hasn't happened since I last mentioned it to you. :) Oddly though, now I am experiencing great neck pains.:(:mad: It has been awful but I am being treated for it and it seems (?) to be getting less of an issue.

The space between Palmer's ACTH stim tests for now is 4 months. I did get Trilostane via Diamondback drugs. Thanks for all who helped out there. I got one month's supply to try out. Half of them are chews, the other half are capsules. He likes the chews! One less "fight."

He is now also taking Glyco-Flex III chews for his limping/arthritis in addition to the Tramadol. It's weird-I've been given Tramadol for my arthritis pain. He likes the Glyco chews also.

We've pretty much gotten the administration of the plethera of medicines down pat now. He still is looking good. He's still puppyish at times. We are back to the "Wanna go for a ride/walk??" down to the boardwalk. He's fallen right back into that. He starts getting fidgety and "talking" when we are 2 blocks away from where we park. And, I may have wishful thinking, but I think maybe some of the hair is coming in a bit thicker. His once lush tail is now about 1/5th the original thickness, but it still puffs up nicely.

So that pretty much brings you up to date.

I hope everyone is doing well. I love hearing back from you.

-Susan

Harley PoMMom

11-01-2009, 04:45 AM

Hi Susan,

It's just absolutely fantastic that Palmer is doing so great and I am so relieved that the neck issue didn't continue, but I am so sorry that you are hurting tho. :(

I did get Trilostane via Diamondback drugs. Thanks for all who helped out there. I got one month's supply to try out. Half of them are chews, the other half are capsules.Chews huh, didn't know that they made the chewable kind...always learning new things. :)

My boy Harley is doing great, still running after his frisbee during the day and playing with his toys at night...at 13 y/o. :D At the end of Dec. he'll get the full work of tests :eek: poor guy, but I have to make sure his cortisol is still within the normal ranges and he is due for a full adrenal panel anyways plus there are other things we have to check, like his BP for one, and I want his vet to really take a good look at his teeth...boy I hope that money tree soon starts to grow. :p:)

Hopefully we will hear from you soon, we miss you and hearing about Palmer.

Love and hugs.
Lori

Bailey's Mom

11-02-2009, 07:00 AM

Hi guys and gals!
We're doing pretty well here. Palmer is playing a bit rough and I have a bandage on my arm to prove it!!:eek::eek:

The hair seems to be growing a bit better.

The ACTH stim tests are 4 months apart now...unless there is cause for concern.

Diamondback can flavor chews in either chicken or beef. It adds $1 to the cost of each chew.....but if that prevents having to fight to get his medication in him, it's worth it.

Not a lot going on here. I had to go to the hospital to get two skin thingies removed. Tuesday my husband goes in for removal of one. It will be the first time he has had to have a medical procedure done. He says he thinks he's relaxed about it. I dunno. I think crankiness, shortness and a bit rough handling of Palmer, and stomping around seems to indicate to me he's not so relaxed!!:mad::mad::(:p

We have a wolf roaming our area. He's been seen in our neighborhood. He comes out at night. Don't know what would happen if he and Palmer "met". Hope not to find out.

Palmer's limping is a bit worse. I had to carry him part way home from our walk the other day. I have an arthritic toe which needs a minor operation. Maybe I'll take Palmer along with me and they can reduce his arthritic pain!:D:)

I hope everyone remembered to set their clocks back. If not, you'll be early somewhere today!

Please keep in touch. I will also.

-Susan

Franklin'sMum

11-02-2009, 07:15 AM

Hi Susan,
I am very happy to hear Palmer is frisky and doing well :)
Sorry to hear about your arm, though :(
4 months between tests... FANTASTIC!!!!!
Hoping your toe operation goes great, and also that your hubby calms down.
All our best to you and yours
Jane and Franklin xx

MiniSchnauzerMom

11-07-2009, 09:53 PM

Hi Susan,

Glad to hear that Palmer continues to do well. Hope he finds something else to chew on besides your arm when he's feeling frisky!!! :D

Thinking positive thoughts that the skin thingies you had removed pose no problem for you and ditto for your hubby.

Take care,
Louise

Bailey's Mom

11-20-2009, 03:10 AM

Hello friends-
Took Palmer to see the vet today. Tuesday evening he was unable to get his rear legs to support him. :eek: He's been limping pretty badly as well. :( I was getting concerned that maybe he had suffered a mini-stroke. The vet says Palmer has no cartilage left in all four legs. :eek::eek::eek: She hears lots of crunching going on in there. She completely ruled out anything like a stroke.

His blood pressure was good. He needs to lose weight. (still) She gave us Cod Liver Oil to add to the already long list of meds/supplements.
I asked her about walking him when he was limping and she said not to. She said to get his exercise around the house or in a confined area where he could "quit" when he wanted to. As a double knee replacement person myself, I can really understand how he feels. Poor little guy.:( She also mentioned some medication which is injected. She would do the initial dose and we could carry on after that at home, or continue to go there for injections. They would be twice a week. My husband can't stand to even look at needles. Since Palmer bit me when we first started to give him some of these medications, I'm not about to try an injection.

Vet thinks he looks "awesome" considering his health issues.

Just wanted to update you all.
Susan

Franklin'sMum

11-20-2009, 10:10 AM

Hi Susan,

I'm sitting here overjoyed that Palmer hasn't suffered a stroke:D:D:D
That's great news! Also great that the blood pressure is good:D
Can they do anything about the no cartilidge situation? Or is that the needle med you mentioned?

All the best,
Jane and Franklin xx

Casey's Mom

11-21-2009, 10:16 AM

Hi Susan, I think your vet may be talking about Adequan injections for Palmer which is what Casey takes for her arthritis.

It works very well for Casey and has made a huge difference in her mobility.

Squirt's Mom

11-21-2009, 11:53 AM

Hi Susan,

Good to hear from you and Palmer! But so sorry to hear about his little legs. :( My heart just stopped when I read your second sentence saying his legs couldn't support him. You must have been terrified to see that happen. Bless your heart!

I can well imagine the pain he is in. :( I hope the cod liver oil will help, but if not, holler and I will give you some alternatives. The Omega's are what can help the joints and you want the highest EPA and DHA you can find to do the job most efficiently.

Another dietary tip - avoid all veggies from the nightshade family, except sweet potatoes. Nightshade veggies include potatoes (not sweet potatoes), tomatoes, eggplant, sweet and hot peppers (including paprika, cayenne pepper and Tabasco sauce), ground cherries, tomatillos and tamarillos, garden huckleberry and naranjillas, pepinos and pimentos. These things are part of a family of food called the Solanaceae family, and they are known to increase inflammation. Sweet potatoes are in another family and do not promote inflammation.

Please let us know how that sweet boy is doing. Yes, I said "sweet"! Your arm just got in the way of his mouth just like my body parts get in the way of my Goldie's mouth from time to time. But they are both simply perfectly sweet! :p (Have you noticed that us moms and dads can get kinda delusional from time to time? LOL )

Hugs,
Leslie and the girls

Bailey's Mom

11-23-2009, 09:19 PM

Hi guys-
Just a quickie to let you know I am having computer problems. Be back in touch soon. I hope.

Susan

Squirt's Mom

11-24-2009, 10:27 AM

Hi Susan,

Hope you get things worked out. We'll be here when you do! :D

Hugs,
Leslie and the girls

Bailey's Mom

12-09-2009, 07:39 AM

Hi -
The computer is working....not all the info I want is back in there, but I'm getting there slowly.
Palmer had no more of those neck pains until two evenings ago. He had one each of the past two evenings. The limping was really bad last night, so I gave him and extra 1/2 pill of the Tramadol. It seemed to take care of it for a few hours.
He growled at me a little bit last night, kind of under his breath, when I was attempting to get him to eat the Tramadol.

He has now taken to sniffing out every little crushed piece of any pills he is eating. He eats what is acceptable to him and spits out the rest on the floor.:eek::eek: We do our best to get all of each medication in him, but some days we are more successful than others.

We go away on Sunday for a week so he will be in "camp." It always bothers me some when we have to leave him there. He loves it there but he's sure ready to go home whenever we return.:D:D

I got this Rx for a new topical gel to treat arthritis pain. It does wonders. If I ever have any left over, I'll save it for Palmer!! (just kidding) It would be nice to be able to give him some relief.

Just wanted to stop by and say hi. I hope all had a pleasant Thanksgiving.

-Susan

Squirt's Mom

12-09-2009, 11:17 AM

Hi Susan,

Glad you are back on the wire! :D I think I would go absolutely nuts without a computer! :eek: Well, ok....nuttier! ;)

I'm glad he hasn't had a lot of neck pain and that he seems to be coping with the arthritis ok. He must have been hurting, tho, when he growled at you. :(

Do you have a mortar and pestal? Ruby has gotten wise to some of her meds so what I have done is crush them up very fine and mix the powder in some cream cheese or sweet potato or cottage cheese and she gobbles it up! Do check with the vet or pharmacist first, tho, to be sure it's ok to crush the med you are using.

Enjoy your trip and I hope Palmer enjoys his visit at "camp". ;)

Hugs,
Leslie and the girls

Bailey's Mom

12-10-2009, 04:02 PM

Hi Leslie and "TG" ,

We are off to the vet in about 5 minutes. Palmer has had persistent, consistent, separate neck pains for the past 24 hours. He's fine and then suddenly he's crying out. Since he'll be in "Doggy Camp" for the next 6 days, starting Saturday, and just because it's so concerning, we want to have Jenninfer DVM look at him. They're fitting us in. They don't always do that.

We have.....well I have, been crushing Palmer's meds up. We have used peanut butter, cream cheese and hiding it in his food with a little ham or chicken to trick him. He's become wise to all attempts. Sometimes we can just put it in a pill pocket and he'll take it. There are two meds we seem to get away by doing that. The rest, including his food, he seeks out the med and spits it out.:p:p:p

He's eating less now because we want to be sure he finishes his food and gets the meds. Once he realizes there's nothing else coming, he will go for it. He still usually tries to spit out any bits he can find. Bob doesn't "get it" and does not crush the pills very well. I try to get it done, whenever I can.

I'll be back with the vet's opinion as to this neck thing. I hope it's nothing really serious.

-Susan

Squirt's Mom

12-11-2009, 01:49 PM

Hey Susan,

Looking forward to the vets thoughts on his neck issue and hoping it's nothing serious.

This little boogers can get so smart about things like meds! It's amazing how they can pick out such seemingly small amounts from the rest of the food. As long as it just SMELLS like it might have something edible on it, Squirt will take anything! :D My little Miss Piggy!

Hugs,
Leslie and the girls (TG :D:D cute!)

Bailey's Mom

12-24-2009, 07:34 AM

Hi!
Better late than never. The vet examined Palmer thoroughly and checked for possible spine injuries. She poked and prodded and Palmer did not object. She said if it was a disc, spine issue, he would not have been able to tolerate what she had done without complaining.

She gave us an antibiotic for 10 days plus a Rx for muscle relaxant. As we were going away the next day, I sent all pertinent information between Vet and kennel. We also left instructions for what to do in an emergency if the vet is not available.

We went off on our trip. I was a little worried. We got back last Friday and the Hound Hotel told me that they had no incidences of which he was aware. :)

Since we've been home there have been no seizing of his neck. The doctor agreed we could stop the muscle relaxant but keeping an eye on him. He's been great through all this.

So that's where we stand. He's getting excited about Christmas now. He has been playing very gently.

Best wishes to all of you for happy holidays and a wonderful new year. It's great having you as friends. :D:D:D

-Susan

Squirt's Mom

12-24-2009, 11:34 AM

Hi Susan,

Well, isn't that perplexing...but I am glad the muscle relaxers, or something, seems to be giving him some relief from these episodes. And how great that he didn't have any problems while ya'll were away on your trip, I know that was a relief!

Hope you and yours have a wonderful Christmas!
Hugs,
Leslie and the girls - always

Harley PoMMom

12-24-2009, 03:31 PM

Hi Susan,

I have no idea either of what could be causing these episodes with Palmer...poor pup. :( And hopefully they won't come back.

Wishing you and yours a Happy Holiday too!

Love and hugs,
Lori

Bailey's Mom

12-25-2009, 06:55 PM

Happy, happy holidays to you all!! :D
You're great friends and have been quite a comfort to us (Palmer & me.) :)
He pooped yesterday and I needed to get some junk out of his tail. (Does anyone else wipe their pups butt??) His poor little tail is so thin of hair. :(:(
He was like an old man, today, with the unwrapping, but he seems fine and still no return of the scary neck things. :) He's eating well....and less. I think he lost a little weight while we were gone, but he's put it right back on! (I just can't resist giving him treats, although I'm trying to cut back on them a little.) :eek:
We've had a very nice day. Cloudy, but not wet yet. They're calling for a good soaker tonight and all day tomorrow. We do NOT need the rain!
In case I'm not back here until after a week, Happy, Happy NEw Year to you all. Let's hope that 2010 brings us nothing buy joy!! :):):D:D

Love and hugs to you all!
-Susan

Harley PoMMom

12-25-2009, 07:19 PM

Happy Holidays to you too!!

Oh Susan, With Harley and Bear any orifice that needs wiping gets it. :eek:;):p:D In fact if they have a dingleberry (a piece of poop) on their behinds they come to me and want me to get it off of them...it's so funny to watch, Bear, my black Pom. is the worst, he acts like that dingleberry is lethal to him!

So happy to hear that there were no more neck episodes for Palmer, and maybe the rain coming is what's making him feeling like a "old man" today. I know the changes in the barometric pressure does a number on me and I can tell you before-hand when it is going to rain or snow.

Let's do hope and pray that 2010 brings us nothing but joy!!

In case you don't get back here...Happy New Year, Susan, and we love you.

Love and hugs,
Lori

Roxee's Dad

12-25-2009, 07:44 PM

it's so funny to watch, Bear, my black Pom. is the worst, he acts like that dingleberry is lethal to him!

That just got me to laughing out loud:D:D:D

I wish Rozee would tell me but nooooooo, instead she sits down and trys to wipe it off ususally ending up in an unplanned bath:eek:

But yes we do butt wiping here too:o:):D

littleone1

12-25-2009, 08:21 PM

Hi Susan,

I'm glad Palmer hasn't had any more episodes with his neck.

I also wipe Corky's hiney. I've been doing it for quite awhile. He's so use to me doing this, that when he poops, he stands there and waits for me to see if he needs to be wiped.

Have a Happy New Year.

Terri

Bailey's Mom

03-20-2010, 12:54 AM

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

03-20-2010, 01:18 AM

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

03-20-2010, 02:01 AM

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

03-20-2010, 11:32 AM

Hi Susan,

So good to hear from you! :cool::) And with good news to boot! :cool: 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! :cool: I'm glad that did the trick for Palmer!

I would love to see him chasing the "bug" on wheels! That sounds hilarious! :p 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. :eek:

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

03-20-2010, 05:55 PM

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? :o:o:confused:

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:D:D:D. When you turn it on, it has headlights that light up. :cool::cool::cool: 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!!:cool::)
Thanks for responding....it's so nice hearing from you all. I will try to get back here more frequently.

-Susan

labblab

03-20-2010, 06:01 PM

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

03-20-2010, 06:09 PM

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

04-05-2010, 05:23 AM

Harley PoMMom

04-05-2010, 06:20 AM

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

04-06-2010, 04:45 PM

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/vetoryl_Treatment_and_Monitoring_Flowchart.pdf

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

Marianne

Bailey's Mom

04-06-2010, 09:43 PM

Thanks Lori. That's a big help and I'm glad you explained about those results only coming from UTK.

Marianne - thanks for the link and for your thoughts. Palmer is feeling better today-except for this sudden burst of hot weather.

Guys-keep an eye on the photo page. I now have pictures of Palmer with his new toy.....plus there is one from the snow you might get a kick out of.

-Susan

Bailey's Mom

07-04-2010, 01:15 PM

Hi! :D

I just wanted everyone/anyone to know Palmer has been doing well. He goes in next week for testing. Apart from the 90+ degree heat, he is doing very well. The belly has trimmed down.....he's not eating as much. His thirst seems to be moderate. The distended tummy is a good bit smaller. His energy level is pretty good for such an old dude! All in all he is managing the summer pretty well. We go in for a test next week...just the regular 4 or 5 month test. The walks are not as long....but then it has been in the 90s for quite a while. He is still very playful and seems to be "truckin' along" just fine for now.

I am happy to be able to post such a positive report! :):):)

-Susan

mytil

07-04-2010, 01:19 PM

I am happy to hear Palmer is doing better!

I merged this thread with your other one so others can see how far you and Palmer have come. :)

Terry

Harley PoMMom

07-04-2010, 01:40 PM

Hi Susan!

It is always great to hear from you and Palmer. So very happy to read that Palmer is doing so well. The heat and humidity is just awful! :eek: Wishing you and Palmer the best of luck with your stim results. Please keep us updated.

Love and hugs,
Lori

Squirt's Mom

07-04-2010, 03:20 PM

Hi Susan!

Good to hear from you again and especially to hear that Palmer is still doing so well!

Keep in touch and let us know how the test turns out.

Hugs,
Leslie and the girls - alawys

Bailey's Mom

07-27-2010, 07:39 PM

Hi guys-

Palmer's test results were outstanding. I've not had time to input all the detail, but I will get around to it.

I'm here to let you know Palmer has been very sick. He has eaten maybe a total of 1/2 cup of food in the past week. His medicine is administered via his food, so he has not been getting his meds. He has had diarrhea since Wednesday. He was mostly not drinking water. He does not appear to be out of sorts otherwise.

We went to the vet yesterday and she gave us diarrhea medicine. She also gave Palmer fluids, saying he was dehydrated. Lots of fluids. He looked like he had football pads on! He has started drinking more water, but the diarrhea remains unchanged. She called this afternoon to see how it was going and I told her "no change." She has now given us appetite inducer, something to settle his stomach and a tube by which we will hopefully be able to give him his meds without getting bitten. :mad:

The next step, if we need one, would be fecal testing. That's close to $300. The next step after that, if that doesn't provide us with the answer, is a sonogram. That's over $500.

His tail is down. He likes being by me but not too close.

I knew you guys would understand how hard this hits. We are coming to a crossroad and, if he does not get better, and does not start eating, we're going to have some hard choices to make. We had to go through this process with our first dog and taking that action was the hardest thing I've ever had to do......and I've had some bumps in my life.

We're giving it a day or two and then we'll revisit how he's doing.....if he's eating and not having diarrhea and is keeping his fluid level up.

The ACTH stim test was just about perfect. This is quite a shock.

-Susan :(:(:(

StarDeb55

07-27-2010, 07:50 PM

Susan, $300 for fecal testing, that is OUTRAGEOUS! I just had fecals done on both of my boys, & the total for both of them was $110. All they do is screen the sample for the possible presence of parasites. IMO, I would be asking just exactly what kind of testing is being done on the sample, & why so unbelievably expensive.

I'm so sorry to hear that Palmer is not doing well. Hopefully, the medicine & fluids will help. Have you been given medicine called flagyl or metronidazole for him?

Debbie

zoesmom

07-27-2010, 07:56 PM

I wonder if the part of the fecal testing cost is the giardia blood test. I was considering doing that on our new pup Cooky but everything I read says it's very expensive. Unfortunately, the usual fecal test does not pick up many cases of giardia, and that might well be a possibility for Palmer. I also found that there's a medicine (dewormer, basically) called panacur that is supposed to be effective in cases of giardia and that it may be cheaper to just give that drug than to run the test for giardia. At least, that's what I was reading. Sue

Harley PoMMom

07-27-2010, 07:57 PM

Oh Susan,

I am so sorry Palmer is feeling so ill and I do hope and pray that he feels better soon.

When was he last dose of Trilostane? His vet did tell you to stop giving him Cushing's meds, right?

Will he eat baby food or chicken broth without onions? Plain, unspiced canned pumpkin can be given to our pups for diarrhea.

Keeping you and Palmer in my thoughts and prayers.

FWIW, I just had both of my boys done...fecal tests and giardia tests, the giardia test is a seperate test. The total for both of my boys was $200.00. My vet charged me $80.00 each for the giardia test.

Love and hugs,
Lori

Squirt's Mom

07-27-2010, 08:35 PM

Hey Susan,

Oh, I don't like reading this post, honey. :( You sound so defeated. :( Don't let it get to you just yet, ok?

Since the ACTH was good, then we can assume he isn't overdosed...unless there was a major error on the bloodwork. So that would lead the thoughts to parasites or an inflammation/condition in the digestive system as the next thing to look at. Squirt has had several bouts of spirochetes but meds took care of them with no problem. She also had a round with giardia several years ago and that was much tougher to get rid of...but the testing wasn't near that expensive! I wouldn't have been able to afford it at that rate. geez.... I wonder if this is a special fecal test of some sort? I can't remember the drugs she was given for the giardia but it seems like there were 3 different ones at the same time, and she was one sick little girl.

Is there any way the vet could keep him on fluids and IV meds for a day or two? That would give his system a chance to settle down and not have to digest meds, food, etc. If not, you might ask if there is a liquid alternative for the drugs he needs now. And that does not include the Trilo, melatonin or lignans. I would withhold all of those for now...give only what he has to have to help his system right now. I wouldn't try feeding him right now, either. Let him have 24 hrs or so without anything solid and see if that helps at all. You might also add some Pedialyte to his drinking water. The plain, unflavored kind.

Don't give up hope. OK? We will help you and Palmer fight this. He is a tough little fellow, and so are you. So just keep your chin up, sweetie.

Hugs and prayers for you both,
Leslie and the girls - always

gpgscott

07-27-2010, 08:59 PM

Susan,

They go through periods up and down.

Like the others I am thinking it is not the Cush treatment.

The Cush treatment can lead to other issues as a Cushpup is imunosupressed.

A dog eats. A dog which will not eat is sick.

I also do not get the exhaustive fecal tests.

I think you need heart/liver results.

Scott

Bailey's Mom

07-27-2010, 10:14 PM

Debbie-One of the four medications we've been told to give right now is the metronidazole. The vet specifically told me to give the Trilostane.
Re: fecal testing-it is a number of tests. 3 I think.

I'll bring up spirochetes and giardia blood test. Regarding the eating-He has not eaten anything for one week. NOTHING interests him.

Lori his last dose of Trilo was 1/2 hour ago.

Scott-he has a heart murmur, but it seems okay to the vet. The liver is a possibility-when they gave us the original ACTH results-the special place, not Palmer's vet...the doc spoke of a liver biopsy. The cost for that was out of the question and the vet seemed to be playing that down.

Thanks to all of you for such a quick response. I am indeed very upset. This is my little guy. Your support is wonderful. I'll give you an update tomorrow.
Susan

frijole

07-27-2010, 10:20 PM

Susan,

Sorry to hear that Palmer isn't eating. Annie just went thru a similar situation - no diarrhea but stomach cramping and she would hardly eat. Here are the tests I had done:

complete blood panel
B12/Folate (can indicate bacteria in intestines)
Pancreatitus
Ultrasound (to get a good look at what is going on with organs)

After those tests and more that I have forgotten and 2 months of no progress I took my dog to Kansas State (closest specialists) and they did a bunch of tests and finally got the dx when they did an endoscope. She had a nasty bacteria in her stomach that had caused ulcers and bleeding. Sores going all up her esophagus. Who would have thoughts.

Just sharing in case that helps you at all... Kim

gpgscott

07-27-2010, 10:35 PM

Susan,

Is he drinking without being coerced? And if so is his thirst normal?

I think this is one ounce/lb/day.

Scott

Bailey's Mom

07-28-2010, 12:41 AM

Thanks Kim. I am on my computer to put together a fax to send to the vet so she'll have it first thing in the AM. I will include your thoughts.

Scott-there is NO coercing Palmer to do anything. His water intake has slowed down from what it was earlier on. When he comes in from outside, he usually goes right for water. The quantity, however, does seem to be down a good bit. He had two major messes on the carpet this evening....he didn't even let me know he wanted to go out. I don't understand what could be coming out since nothing is going in. We tried rice, this evening, and I just tried some very small bits of steak. The steak he was eating....it was our last resort. Now-nothing. I just played with him a little bit-pushing my hand around his head and he playfully gnawing on my hand.....very gently. He has been shivering this evening.....but the house does get cooler for sleeping. He won't touch the treats.....we have tried everything. I'm guessing at this point he has gone beyond feeling the hunger.

I just don't know where to go with this. He had four needles stuck in him yesterday-three for fluids and heartworm test. He screamed. I've never heard him make that sound. It was almost like a sharp moan.

I think we're meeting with the vet tomorrow. I'll keep you all updated.

Thanks.

Susan

Casey's Mom

07-28-2010, 12:49 AM

Susan I am so sorry to hear about Palmer - here's hoping he will find something tasty enough to start eating again and that the vets have some answers for you tomorrow.

We are here for you honey,

Harley PoMMom

07-28-2010, 07:31 AM

If it were me I would definitely stop the Trilostane. If Palmer is not eating he is not absorbing the Trilostane properly: CLINICAL PHARMACOLOGY:
Trilostane absorption is enhanced by administration with food. http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Missing a few doses of Trilostane, I don't think, will do any harm, in fact it might be what Palmer needs. Even though his ACTH numbers were perfect just maybe they were too low for Palmer. One can not go by numbers alone, one should take in account the way the pup feels too. JMO. Keeping you both in my thoughts and prayers.

Love and hugs,
Lori

BestBuddy

07-28-2010, 07:50 AM

I'm with Lori on this one. I would not be giving trilo to a dog that wasn't eating.

Palmer is obviously feeling pretty awful and so I wouldn't want to make him feel any worse. Skipping a few doses wouldn't hurt and it may just help.

Hoping for some good news.

Jenny

lulusmom

07-28-2010, 09:23 AM

Hi Susan,

I am so sorry that Palmer is having such a tough time right now. I would assume your vet has done bloodwork, yes? Can you please post the abnormal results for us, including the reference ranges? Has your vet told you what he thinks the problem is? Pancreatitis, renal failure, primary liver disease?

I absolutely agree with the others....there is no way I would be giving my dogs Trilostane if they were in Palmer's condition. No way, no how!!

Glynda

frijole

07-28-2010, 09:27 AM

Susan, Just wanted you to know we are all thinking of you and wishing the best for Palmer. Big hugs, Kim

Bailey's Mom

07-28-2010, 10:16 AM

Good Morning.

Palmer had another round of diarrhea around 2AM....outside :D

After that we were able to give him about an ounce or so, if that, of sandwich turkey. He turned up his nose at bread.

This AM he got up and had a good amount of water. I just tried to get him to go for a walk and he is not interested.

Sent my fax off to the vet and have not heard back yet.........she'd just be getting in about now. I know she will call when she can.

He has become more needing of closeness.... of which I am happy to oblige :)

More news as it becomes available.

Thanks to all of you for being so supportive.

-Susan

zoesmom

07-28-2010, 11:59 AM

Just curious as to what those 'outstanding' ACTH results were? Sounds like it's been 3 or so weeks since the test was done. Do you have the specific results or can you get them and post???? Because I know from experience with Zoe, that one time her numbers fell dramatically - to .7 and 1.6 when she'd always been difficult to get below 5. Don't know to this day why it happened. But it's possible so I wouldn't rule out an unexpected drop in the last couple weeks. Sue

PS - then again, if it is something like that, by stopping the trilo, you might see improvement. Electrolyte testing could shed some light.

Bailey's Mom

07-28-2010, 10:56 PM

Hi Gang-

Saw the vet late afternoon. She okays the stopping the Trilostane.
We are running three different "tests."
Fecal test which will include parasite testing and Giardia test.
Complete blood panel.
B12/Folate test

I am also going to make an appointment to see the internist for a consult and for abdominal ultrasound. If the aforementioned tests give us an answer, I can cancel the Ultrasound.

Palmer had his last bout of diarrhea at 2AM. His total intake today has included some water and two 1" length pieces of a Snausage.
He is more sedate today.

I asked the vet if at some point we would administer nutrition and she says if he doesn't get better, we can do that.

Palmer will go in early tomorrow AM to have his blood drawn and so the vet can get another "look" at him. The fecal results should be back tomorrow.

The vet is perplexed, so far, as to what is causing all this. We did have a lawn treatment one week ago, today. Palmer often chews on grass. I don't know if that occurred before we could get the stuff watered in. The vet said one week later is entirely possible to be continuing to have a reaction to that, if he did it.

Okay - here are the test results from 7/8/10.
(You will find a number of earlier results posted earlier.)
Pre ACTH 3.7 Range 2-6
Post ACTH 4.8 Range 60-018.
We had high results in the following;
Alk./phosphatase 567 Range 10-150
GGT 18 0 - 14
Bun 57 7 - 27
B/c ratio 35.6 no range shown
Anion gap 25 12 - 24
Neutrophil Seg 82 60 - 77%
Auto Platelet 799 164 - 510 Thous/ul
Absolute neutrophil Seg 13694 3000 - 11500/ul
WBC 16.7 5.7 - 16.3 Thous/ul
He was low in the following;
MCHC 31.8 32 - 36 g/ul
Lymphocytes 8 12 - 30%

If it comes down to needing a liver biopsy, we are not going to put Palmer through that. That was raised when we first tested w/UTK and at that time we agreed we would not put him through that.

So that's today's events. He is sluggish and not drinking much water-but drinking some. We have tried a gazillion different foods and he has interest, but then turns away. He's crashing on his bean bag bed now and we'll go cuddle up in our bed soon.

As always-thanks for the support and the suggestions.

Susan & Palmer

frijole

07-28-2010, 11:26 PM

Susan, I don't know if you know what Palmer's normal water intake is per day but I would measure out water and start tracking it. While food is important - water is critical. Annie went as low as 1/4 cup one day.

You have probably tried all foods known to man but just to be safe... when their tummies are upset they always say to try the simplest easiest things to digest. Homemade chicken broth, white rice, chicken breast are my standbys. There were days when broth was all I could get her to take.

Heating food makes it more attractive. Try giving him things that are easy to digest to see if that helps. I assume you tried canned food - have you tried totally new food groups like venison, buffalo etc? You can find them at most pet stores. Usually combined with sweet potato. I also cooked sweet potatos. Annie did eat those. Boil eggs and give only the white part - it is a protein source.

Try sneaking some pedialyte into his water for extra nourishment. Babyfood (chicken, sweet potatos)

I didn't realise you had just done a blood panel. There are enough things elevated in the last one to perhaps point to something. Maybe Deb has some thoughts.

Was Palmer eating when that panel was done? Annies lymphocytes were off as well due to her bacteria infection.

Other than diarrhea - do you hear his stomach growling/gurgling? Can you feel it churning? I know this is tough because I just went thru it and you feel so helpless. I send my very very best wishes your way. Kim

StarDeb55

07-29-2010, 12:48 AM

Susan, the couple of things I see are the elevate WBC, & absolute neutrophil count. The elevations are not extreme, but they are an indication that there is probably an infection somewhere. That BUN is pretty high, but was Palmer's creatinine normal. Dehydration will elevate a BUN, but as long as the creatinine is normal, this may not be a kidney issue. I don't have time tonight to recheck the past couple of days posts, but were the result of the stim you posted at the beginning of the month before or after Palmer got sick? If they were before, I think it's imperative that you run a stim ASAP. Even though trilo should clear the system in about 12 hours, if Palmer's adrenal glands have suffered any damage, this may be the actual problem. What has the vet said about trying some prednisone to see if it might help?

Debbie

PS- Concerning the pred, it won't hurt Palmer. The several times that Harley has had a severe round of vomiting for unknown reasons, my vet has always wanted me to try the pred, first. When he showed no improvement with the pred, we started looking at something else besides Cush related problems. Actually, I just went back & checked those results, the BUN /creatinine ratio appears to elevated. The normal range that I found looking around is 4-27. Granted it's not elevated a lot, but it's enough that I think it might be worthwhile to ask the vet about the possibility of early renal failure. I don't think renal failure is the core problem, I think there is something else going on that is increasing the stress on the kidneys.

Bailey's Mom

07-30-2010, 12:14 AM

Well-I may have at least a little bit of good news. First-the fecal reports came back and were negative for parasites and Giardia.
Today's events are-Palmer was shaking this morning. :( That's not like him. I covered him up and cuddled him. He went to the vet and when he returned, we watched tv together on the bed. Palmer was not eating and not drinking. Mid afternoon he took a good bit of water. I tried everything I could think of, once again, and he turned his head away at all of it. Kim-thank you for mentioning the chicken. It's been discussed before and I tried it last week and had no luck. With him not drinking and not eating and this being day #9, I was very concerned. In addition, the vet's office is closed Saturday and Sunday. The vet saw Palmer this morning, and took the blood sample, and (I could not go) did not tell my husband anything new or different. I was figuring we'd need to get nutrition in him by other means before the end of tomorrow.

I was getting back to being really upset and had to go out for an hour. On my way back, thanks to the reminder about the chicken, I stopped and picked up a cooked chicken breast. (And it was $2 off because it was cooked @11:30 and the meat guy wanted it to go!)(This was 3pm.) (It had been kept very warm.) I came back home and let Palmer sniff the grocery bag. It looked like he had interest. I started slicing and chopping away and put down about 1/4+ cup. HE ATE IT!!!!!!!! :D:D:D:D He did not finish the bowl, but went back several minutes later and then did finish it off. I cut up some more, another 1/4 cup, and he ate that as well. The only "bad" thing about it is about 3/4 hour later he was heaving, but what came out was like a few spit balls. The chicken stayed down. I didn't want to give him any more than what I had because he hasn't eaten for so long and I didn't want the stomach reacting to too much food. We got him right outside and he just kind of sat around staring off into space. When he came back in he went and retrieved this huge squeaky, fluffy duck he has. It's as big as he is! That is his Linus blanket. Whenever he gets uneasy, he heads for the duck. He plays with it at other times. (As a matter of fact, he "uses" it to stimulate himself. He doesn't always achieve his goal, but he still keeps trying.);)

A little later I took him outside while I watered some plants. He went to the end of the driveway and I told him to stay out of the street. (We live on a cul de sac. I mostly didn't want him going over to a neighbor who doesn't like Palmer. ) So he sat at the end of the driveway.....just as if we had an invisible fence! We went around back to water a couple more plants and he saw a gal friend of his. He went over to greet her, as she was heading toward him and they visited. Buffy, the friend of his, is about five years younger. They have always gotten along and even played and romped, but his age is beginning to show. He doesn't romp much anymore. So we hung around as the dogs visited and I visited with the owner. We came back inside and watched tv together. So far (this is 11pm) everything is staying down. His water intake seems to have gone back to normal. He was looking, kind of, for more food, but I wanted to "reenter" eating at a slow pace.

He looks brighter. He's hangin' with me now. So hopefully we have turned a corner. He is scheduled for an ultra sound next Wednesday, but if he continues to improve, I am going to cancel that. I still look forward to the remaining test results and will post them when I get them. I should have at least one tomorrow, if not both. The vet says she'll call us Saturday if they come in that day. Our son is going to come visit for the weekend and that should be very positive for Palmer (and for my son.)

So-all in all, it turned out to be a positive day. :D:D Nothing has come out the back door since the diarrhea almost 48 hours ago. There can't be much left to come out........before the chicken. We will hope for a good night's rest and an even better day tomorrow.

I'll check back in tomorrow and let you know if this continues.

Susan

Casey's Mom

07-30-2010, 01:01 AM

Wonderful news Susan!! Maybe you could try some mushy cooked rice, mixed with cooked chicken and I cook some sweet potato and green beans and add that too. I have never seen a dog turn away from my homemade dog food and its easy on their stomach.

I was thinking about you tonight when I went through Casey not wanting to eat today. Its very scary so it must have been extremely hard watching that for 8 days.

Love and hugs,

frijole

07-30-2010, 03:52 AM

Glad to help! I would keep anything else you want to add to the mix separate vs adding them into the chicken because that way if he doesn't eat the new items you don't have to throw away the whole batch. Plus you can test one item at a time - like we do with drugs. Do it slowly so you can tell what is working and what is not.

I could not figure out annie's pattern until after the dx I realised that she could only eat foods that were soft and didn't hurt that nasty throat and her ulcers!

Annie had the shivering! Full body shivering. She had it for quite a while and it came and went. I am convinced that is pain. (or was in Annie's case)

Have you noticed any tummy growling or gurgling? Gotta be if you had diarrhea right?

Anyway.... glad to hear some great news. Keep it up Palmer!

zoesmom

07-30-2010, 01:32 PM

So you stopped the trilostane a couple days ago and things began to improve, right? Like Debbie, I'm suspicious that maybe his cortisol did take an unexpected nosedive for whatever reason. Palmer's numbers on July 8 were good, but could have fallen in the two weeks after that. Did the vet suggest how long to withhold the trilo? Sue

Bailey's Mom

07-30-2010, 03:17 PM

Hi-
The trilostane is being discontinued for "a few days."

Today is not so good. The vet called and said his Kidney enzymes are elevated and she thinks he is dehydrated again. She wants him to receive fluids intravenously for 48 - 72 hours....and of course, we're coming up quickly to another weekend and those nasty "emergency" rates. Her office can do it, but there is not 24 hour monitoring there. They will be closed as of 5PM tonight. She would have someone come on in and check Palmer...maybe it would be her. The Emergency ER will have 24 hour monitoring over the weekend, but neither Palmer nor we have ever been there. Then the vet suggested we take him to Annapolis where he is scheduled for the ultrasound on Wednesday. If he went in today, we'd get the ultrasound done on Monday but by a different DR. We are trying to get an idea of the cost for any of these. So far I know the Ultra sound, consult and weekend emergency rates will be a minimum of $786. That doesn't include any fluids nor the boarding rate. The Annapolis place won't give me any idea-they say the vet will have to call. So we are now waiting for the vet to call us back so I can tell her that. Then we'll be waiting for the vet to call back with the #. Bob wonders if we can wait to take him until Monday. Then he'd be there already for the consult on Wednesday. I asked her what would happen if we just did not do this and she says she cannot answer that-since we don't really know what the problem is.

Today-he is back to not eating. He seems ok, but he has seemed ok pretty much all along. He never has looked seriously ill. So now the discussion revolves around how much are we willing to spend to continue on this path. If he is having renal failure or if they find a tumor with the ultrasound, we would not be pursuing further action. We are not going to subject Palmer to surgery. So we could go through a lot of expense (they're talking over $2000) just to find out we can't do anything.

That's where it sits. This just is not a pretty picture. I am also wondering if we should just get back to treating the Cushing's and not pursue this....but then we still have the issue of him not eating. I'm not willing to watch him starve himself to death.

I don't know....I just don't know. I can't promise real regular updates, but I will try my best to get in here at least once every 24 hours. Please pray for Palmer.

-S

Roxee's Dad

07-30-2010, 04:31 PM

Hi Susan,
My thoughts and prayers are with you and Palmer.

I saw that Debbie suggested trying Pred earlier. Just wondering if you did try any pred.?

littleone1

07-30-2010, 04:53 PM

Hi Susan,

I'm so sorry to hear about Palmer.

When Corky had to be rehydrated, it was done 2 days in a row at the vet's, but he was also, at the recommendation of his vet, being given Pedialite at home. He didn't have to stay. This might be an option that might help Palmer over the weekend.

Terri

Harley PoMMom

07-30-2010, 05:24 PM

Subcu fluids can be done at home and by the furbabies parent...Steph was doing this for sweet angel Pallie.

Keeping you and Palmer in my thoughts and prayers.

Love and hugs,
Lori

Casey's Mom

07-30-2010, 06:44 PM

Susan the pred I would try - it sure helped Casey last night and it can't hurt. I would also try pedialite - and Lori's suggestion of the sub cutaneous fluids - once the vet shows you you can do it yourself.

Prayers and tight hugs,

frijole

07-30-2010, 07:48 PM

Susan, You know Annie and I are sending positive thoughts and warm hugs your way. Kim

Bailey's Mom

07-31-2010, 01:13 AM

Hi-

What a day!! Palmer is now resting (hopefully) in the Emergency vet's.

It's almost midnight and we just got back. They took xrays and said other than slight enlargement in his heart, everything looks great. They did a "mini" sonogram and didn't see anything that concerned them. They will retake the blood test to check his Kidney levels once or twice over the weekend. He is on IV fluids until Mon AM. He will then be seen by one of their Internists. They are going to call us twice a day over the weekend. We will get a call Monday AM to discuss what they found, didn't find, and what's next. He has a heart murmur which concerned the doc we saw, but we've known about it-he's had it "forever" and we were told not worry.

He was a real sweetheart for the two hour trip there. He was pretty calm when we got there. He's tired of being poked, but he tolerated the temp taking fairly well-other than wanting to sit down!:)

So-we can call anytime we want and get a status report. We could visit him, if we wanted. I feel good about our decision to take him there instead of the local Emergency vet or our vet, whose office will not be staffed now until Monday.

We did not get to try the predn. Nor did we get to try the Pedialite. He's just still not drinking a lot, is dehydrated, and is back to not eating.

Our son met us there and we took fifteen minutes or so to go to a nearby park, take some pictures, and let Ryan and Palmer visit. Palmer was so surprised to see Ryan when we met up. Palmer was very happy, somewhat excited and I think it did him a lot of good. Ryan takes wonderful pictures, so I'm anxious to look at them tomorrow. We took family pictures and Palmer pictures (Palmer being part of the family pictures, of course!!)

That's all for now. If I have any news over the weekend, I'll post it. Otherwise, I'll update on Monday evening.

As always-thank you all for all of your suggestions and support.

The vet's office got a nice picture....I'll try to add it to Palmer's gallery.

-Susan

acushdogsmom

07-31-2010, 02:49 AM

lulusmom

07-31-2010, 03:30 AM

Susan,

I agree with Cushy....I believe you made the right decision too. I'm sure sorry that Palmer is having such a terrible time right now and I'm praying for the little guy and sending positive thoughts your way. I'll be watching for your updates.

(((Big Hugs)))
Glynda

Franklin'sMum

07-31-2010, 08:59 AM

Hi Susan,

Sending thoughts and prayers yours and Palmer's way for a full and speedy recovery.
Jane, Franklin and Bailey xxx

Squirt's Mom

07-31-2010, 02:32 PM

Hey Susan,

As hard as I know it is, you absolutely made the right decision to take Palmer on in to the ER. He will have someone close by at all times this way and they will be able to start trying to find out what is wrong with him.

I hope they can get him back on his feet and that he is back home with you very, very soon.

Keeping you all in our prayers!
Hugs,
Leslie and the girls - always

Bailey's Mom

07-31-2010, 04:45 PM

Hi-

Some hopeful news, at last! Our vet consulted with the ER vet. They concur that they think Palmer has pancreatitis. The think Palmer got into something which has caused this damage. If that is the case, I think the felon is the grass treatment. Palmer either ate some of the treated grass, before I got it washed in, or by walking on it, he then licked his paws and ingested that way.

Thanks to all of your for saying I did the right thing. I had a bit of a struggle with my husband, but I could not have sat here all weekend knowing it was possible for Palmer to die.....as they told me. We have had 2 calls from the ER updating us. I called them first, at 5AM, and the DR came to the phone to tell me how Palmer was doing. She called back around 9 and gave us the AM report. She summed up what she was saying with "He looks very happy and he is very comfortable." I told her THAT was what I wanted to hear!!!

Later the vet called, while I was out, and spoke to Bob. That was when we got the pancreatitis news. Our vet had gone by her office to get the results of the B12 test. After telling Bob that she had talked with the ER doc and what they thought, at this point, she said to email her if we had any questions............she would check her email throughout the weekend. My only question now is how do you treat this? The vet also reinforced that Palmer was exactly where he should be and getting just the treatment he needed. She was glad he was where he would have 24hr supervision. Palmer has even eaten a little bit, they say.

So-so far no BAD news. He will still have the sonogram on Monday and I am hoping we will be able to pick him up in the afternoon. Our vet said she felt, if follow up treatment was needed, that they could accommodate that at their office.....thus making it less stressful on Palmer-he would be near home and I guess go back and forth as needed....and way less stressful on me!!!!!!!!!

We will get another ER doc report later today. The doc I spoke with @5AM will be on again tonight. I'll call her before I go to bed, probably, and get her "read" on the situation.

Two summers ago, Ryan got pancreatitis. It took FOREVER to get a diagnosis. The first we were told was that a mass the size of a deck of cards had been found. The surgeon wanted to run a gazillion tests in order to avoid opening "my beautiful boy" up. I kept wondering why they could not just take a biopsy. It felt like we were losing a lot of time and not treating this thing, the way we were going. In my mind, the deck of cards had gone from one deck to 15 decks! :eek::eek: Well, his pancreatitis shrank pn its own and, over 4 months or so, all returned to normal. Yesterday he said he thought it would be funny if Palmer had pancreatitis, since that is what he had back then. (They're soooo competitive! Each so wanting attention!!)
When we got the news today I told him I could just have asked him for a diagnosis and saved myself a LOT of money! (just a joke.) :o

So-that's where we are now. I miss my little guy but am very hopeful he will be back home soon. :)

-Susan

Harley PoMMom

07-31-2010, 04:59 PM

I would ask them to run a specPL test to confirm the pancreatitis. The specPL will test for the lipase that is specific for the pancreas only.

Harley has pancreatitis also, his last specPL test results were 900! :eek: I think the lysodren had something to do with those high results because his results a couple months before that were 303 (0-200). Altho he is showing no symptoms I keep an eagle eye on him. Much is to do with diet, feeding a very low-fat diet is important and feeding several small meals through-out the day helps alot too.

We are here for you and Palmer and we all will help you.

Love and hugs,
Lori

Squirt's Mom

07-31-2010, 05:20 PM

Hi Susan,

A positive update, even if it is pancreatitis! That can be dealt with! ;)

Squirt has had one bout of acute pancreatitis brought on by the spleen surgery and it scared the crap out of me! On top of just being out of major surgery for 4 days, she starts showing odd signs and I go into full panic mode! Thank all the stars, she hasn't had any more problems with it!

That was when I learned that fat is the enemy when the pancreas is inflamed. Actually, any food or water by mouth is not recommended for 24-48 hours so the organ has time to calm down. So Palmer is exactly where he needs to be! :)

Several things can cause the pancreas to act up - handling in surgery as in Squirt's case, diet, age, other illnesses (Cushing's to name one - :rolleyes:, and the all time favorite - idiopathic, ie. no known reason. It is a highly sensitive and reactive organ and it doesn't take much to get it upset. The grass treatment may have been the cause but who knows? The key now is to prevent further flareups. I hope Palmer has the same experience Squirt has had and there are no further episodes!

Hugs,
Leslie and the girls - always

Bailey's Mom

08-01-2010, 12:31 AM

Lori-our vet ran the specPL test before Palmer went over to the hospital.

I just spoke with the night doc (same one as last night.)-they ran the blood test and find his Kidney #s are coming down. Bun is down 22 points to 41, Creatine is down from 4.4 to 3, Phos was at 6.9 and is now normal at 5. They are going to cut back on the fluids some, since the numbers are coming down and because of their concern about his heart murmur. He is still not eating :eek: and he is now sleeping. He will need a bland diet-more carbs, not too much protein or fat.

This has all made me respect our vet even more. She has been "spot on" about him since we started down the path with Cushings'. I really like the hospital he is in. They are very attentive to both the patients and the parents.

I didn't sleep much last night..so I'm off to bed. I really miss my little guy.

Thanks to all.

-Susan

Squirt's Mom

08-01-2010, 11:10 AM

Mornin' Susan,

Hope you got some rest last nite. I know how taxing all this can be.

Looking forward to another positive report this morning. Hope Palmer has eaten a bit; now that his numbers are coming back to normal, maybe he will start feeling better and get an appetite back.

Hugs,
Leslie and the girls - always

Bailey's Mom

08-01-2010, 08:19 PM

Hi-
The morning report offered no changes. He is getting a bit less in fluids. He still had not eaten.
The evening report, which I just got, has little change. He has eaten a bite or two. The day nurse will be the one to look to if Palmer is not there when we go to get him. She thinks he is so sweet and so cute. (Which OF COURSE he is:D:D:D)
We will get an early am report. He records will be transferred over to the Internist side. We should receive a consult around noon. He will probably have another blood test in the AM and then the ultrasound.
Sure is a big, quiet house without him..:(:(:(
-Susan

frijole

08-01-2010, 09:14 PM

Susan, Thanks for keeping us updated. We have our fingers and toes crossed here for Palmer. He is in the best of hands right now. Take care of yourself as well! I know it is so hard. Hugs, Kim

Squirt's Mom

08-01-2010, 09:19 PM

Hi Susan,

Thanks for letting us know how Palmer is doing today. I hope tomorrow will be even better!

Hugs,
Leslie and the girls - always

Bailey's Mom

08-02-2010, 04:49 PM

Well, it's Monday. Palmer is still in the ER hospital. Basically there is no change in his situation. He did take "a couple of bites" last night. They were transferring his records to the Internist side of the place but neither of the two docs we wanted worked today. We opted to have him stay where he is today and then he will be seen by the doc we want tomorrow. I'm REALLY missing him now. It was okay-not preferable-but tolerable the first few days. I knew that was where he was getting the best treatment. They've asked us if we want to come see him, but I think that would just confuse him and its a 4 hour round trip. He is still on IV fluids. They've added back his Denamarin.
We should get an update later this afternoon. I don't expect to hear much different.

I tried to talk Bob into getting a puppy last year, so they would have each other to play with and so their lifetimes would overlap. He wouldn't have anything to do with it. That little puppy would be good company now.:(:(:(:(:(:(:(:(:(:mad:

-Susan

Casey's Mom

08-03-2010, 12:27 AM

Susan I am holding on to good wishes and positive thoughts for you and Palmer right now.

Love and hugs,

Squirt's Mom

08-03-2010, 10:21 AM

Hi Susan,

Any word on Palmer yet this morning? Anxiously waiting and hoping for a really good report!

Palmer is such a precious boy and has taught me so very much since ya'll came here. It is my sincerest wish that he will be back home with you, in your arms again, following you around as usual very, very soon!

Hugs,
Leslie and the girls - always

lulusmom

08-03-2010, 10:53 AM

Susan, I've been thinking about you, Bob and Palmer and I'm sending postitive thoughts your way.

Bailey's Mom

08-04-2010, 12:53 PM

Hi......

We are going to pick him up to bring him home this afternoon. We turned down doing a blood plasma transfusion. It would have meant another night's stay and another $1000.

Ryan, our son, is coming down for the weekend. We got Palmer the spring before Ryan left for college. Even so-Ryan not being around all the time-he still feels like Palmer is his dog, too.

He will need subcutaneous fluids. He is still not eating. My hope, our hope, is to get him home and smother him with love. We are hoping to make it to Monday. Any time after Monday will be a bonus. No more testing, prodding or poking. No more cages.

This has just been such a whirlwind and such a shock-coming from out of nowhere. I know I'll be worthless for much else for the next # whatever days. Postings may become somewhat sparse. All my time is for Palmer now.

-S

Squirt's Mom

08-04-2010, 02:13 PM

Hi Susan,

My heart is breaking for you. Smother Palmer with your love, hold him close to your heart, and remember the best of times with him.

Know we are all with you, Palmer, and your family.

Hugs, prayers and white light,
Leslie and the girls - always

frijole

08-04-2010, 03:02 PM

Susan - Please know that we will ALL be sending tons of love and warm thoughts to you, your family and most of all Palmer. Glad to know he will be home and surrounded by those who adore him. We are here if you need us and when you want to update us. Meanwhile know you are all loved. Kim

littleone1

08-04-2010, 03:10 PM

Hi Susan,

I know this is very dfficult for you and your family, but I am glad that Palmer is home with you. Enjoy the precious moments with him. Give him all of his favorite foods, and he might eat for you. I know you will give him lots of love.

My thoughts and prayers are with you, Palmer, and your family.

Spiceysmum

08-04-2010, 03:29 PM

Hi Susan,

I really feel for you right now and know how heartbreaking it is for all of the family to see Palmer like this. Thinking of you all.

Linda

labblab

08-04-2010, 06:53 PM

Dear Susan,

Beaming you strength and comfort during these coming days. It was six years ago this very weekend that we were supporting our beloved Cushpup Barkis under very similar circumstances. It is so very hard. But during these hours, you will be able to tell Palmer how much he means to you, and what a good boy he is. You will be preparing him for his passage -- whenever he is ready to make the journey -- with grace and love. And perhaps once he is home again and surrounded by his family, he may start to eat again and that journey will be postponed until another day and another time.

Whatever the future may hold, we are here for you and for Palmer and for your family.

With warmest thoughts and healing wishes,
Marianne

Bailey's Mom

08-05-2010, 03:46 PM

Palmer has crossed over the bridge.

lucygoo

08-05-2010, 04:06 PM

Susan,

I'm so very sorry for your loss of sweet Palmer.
Warm wishes to you,
Gina

bgdavis

08-05-2010, 04:27 PM

Susan,

I'm so very sorry. I hoped that Palmer would hold on til Monday and that your son could say his good-bye.

It's so very hard to lose our beloved furry friends.

Hugs,
Bonnie and Angel Crissy

labblab

08-05-2010, 04:29 PM

Dear Susan,

I, too, am so very sorry. Thank you so much for telling us what has happened. We are here for you, and we will remain by your side. And we will always remember and honor Palmer here. He shall never be forgotten.

In loving memory of your precious boy,
Marianne

sunimist

08-05-2010, 05:19 PM

Dear Susan,

My heart is breaking for you. It's so very hard and painful, I know, but please know our thoughts, love and prayers embrace you during this sad time.

My deepest sympathy to you and your family.

R.I.P. Sweet Palmer. We will remember you forever.

((((HUGS))))

Shelba and Suni~~

Sabre's Mum

08-05-2010, 05:45 PM

Dear Susan

I am so sorry for your loss. My thoughts are with you.

Take care
Angela and Flynn

BestBuddy

08-05-2010, 06:10 PM

Dear Susan,

I am so sorry Palmer crossed the bridge. Over the last few days your posts have been putting little cracks in my heart and today when I get this sad news it has just shattered. I know you must be feeling it so much more and all I can do is let you know how sad I am.

Jenny

Bailey's Mom

08-05-2010, 06:25 PM

Thank you all for your kind words. I will post more when I can.

Bonnie-our son came down last night. He is here until Saturday and Sunday. He got a few more pictures of Palmer before we left here. He went with us and the three of us, with our wonderful vet, set Palmer free.

The pain is absolutely incredible.

-Susan

Harley PoMMom

08-05-2010, 06:26 PM

Dear Susan,

I, too, am so very sorry for your loss of sweet Palmer. My heart goes out to you and your family at this most painful time. Please know that we will always be here for you.

Peace sweet Palmer

With Heartfelt Sympathy,
Lori

littleone1

08-05-2010, 06:34 PM

I am so very sorry for your loss, Susan. My thoughts and prayers are with you and your family at this difficult time. Palmer is now free from pain and suffering. Godspeed Palmer.

Hugs,

Terri and Corky

zoesmom

08-05-2010, 06:46 PM

Susan - My heart goes out to you and your family. As hard as it was, I think you made the right choice. And I understand how important it was to have had your son there. Palmer was able to cross the bridge, surrounded by those who loved him most. ((((Hugs)))) Sue

judymaggie

08-05-2010, 07:00 PM

Susan -- I am so very sorry to read that you had to let Palmer go. I am glad that your son was able to be there with you as you said farewell. Take care!

hfurlotte

08-05-2010, 07:30 PM

Hi Susan..........I have been away from the site for a while dealing with Zoe Claire and everytime I come to check in it was getting harder to do as we know our girlie is doing her best to continue her time here with us. Our thoughts and prayers are with you and your family in this extremely difficult time Palmer is playing on rainbow bridge free of all pain.
Hugs always,
Heather and Zoe Claire xoxoxox

frijole

08-05-2010, 07:37 PM

Susan, I share your pain and loss. I am so very sorry to hear the news. I am glad that your son could make it down in time and the three of you were there to send our newest angel to the bridge. Please know I will be thinking of you all and sending alot of love. We'll be here for you when you feel like coming back. Hugs, Kim

lulusmom

08-05-2010, 08:01 PM

Susan, I am so very sorry for your loss and I too am glad that your son was able to say goodbye to Palmer. I don't believe there is any thing tougher than letting our babies go so my heart goes out to you and your family.

Godspeed sweet Palmer.

Glynda

Loladog

08-05-2010, 09:17 PM

Susan,

I'm so sorry to read that you lost Palmer.:( My thoughts are with you and your family.

Take Care,

ChristyA

08-05-2010, 09:39 PM

Susan,
I am so sorry for your loss. The pain is incredible as you said in a previous post. I hope your memories of Palmer will help you through the pain. One day you will think of Palmer and the tears won't well up and spill over. One day you will be able to speak of Palmer and not cry. Until that day remember that Palmer loved you with all of his heart and that is why we cry. Someday when you are feeling like remembering Palmer's antics you can come here and tell us all, we would be more than happy to listen and share too.
Take Care,
Christy

Squirt's Mom

08-05-2010, 10:58 PM

Dearest Susan,

Tears roll down my face as I read your posts about Palmer. Thankfully your son was with you today; I am sure Palmer knew and was pleased that you were all gathered with him.

This decision is never easy, even when we know there is no other option some small part of us holds onto the hope of a miracle. Then the time for miracles is gone. And we are left to face the coming days under a blanket of grief and pain so heavy it can bring us to our knees.

Many of us understand your pain and share it's burden with you. Please know we are here any time you need to reach out, or need a soft, safe spot to land, or to scream, or cry, or whatever...we will be here for you.

Susan, you were the best mom Palmer could have had and you worked so hard on his behalf to make sure he was getting the best of care. Don't let those little voices tell you any differently.

We will be keeping you and your family in our thoughts and prayers.

Our deepest sympathy,
Leslie, Squirt and our angels, Ruby and Crystal

Casey's Mom

08-05-2010, 11:08 PM

Susan I write this with tears in my eyes. You were the best mom Palmer could have ever hoped for and I hope you know that and know that he knew how much you loved him. Godspeed to our newest angel.

Love and many hugs,

Bailey's Mom

08-05-2010, 11:15 PM

Thank you all. I know you all understand the struggles we have had.

One tale to tell-when we got Palmer, we were at the beach but still living in Arlington. Our son did not come down with us that weekend but bid us farewell saying "Don't let the fact that I'm not there with you stop you from getting a puppy."

We chose Palmer from three of one litter. He had "that" look in his eyes. He had soul. When we drove back to VA on that Sunday, poor little Palmer had no idea what was going on. I held him most the way.

When we got to the house, Ryan came out to meet his new "brother." I set Palmer down on the sidewalk to the house. He was all coal black then....actually brindle-he had some gorgeous brown hair mixed in with the black. He walked to the edge of the sidewalk and stepped into the grass. As his little paws touched the grass, he immediately raised them. He had never been on grass before. It fascinated him.

This afternoon we got the results of the final test that was run on Palmer.

" Diagnostic findings and information:
cPL - remains very elevated at 710 ug/L (normal < 200)"

His numbers were not coming down. He had very bad pancreatitis, a lesion on his liver (type unknown) and his kidneys were breaking down. He has not eaten in over 2 weeks, for the most part.

Today he had a hard time looking anyone in the eyes and his eyes were pleading "Please help me." It was very peaceful. It is so very hard. This will take quite a while to adjust to. He was such a sweet dog and such a good boy.

Thanks for listening. I can't take anymore of this right now.

-Susan