Should we start triclosane? (8 y/o Jack Russell/Chihuahua mix)

[Mommywriter]

My 8-year-old Jack Russell/Chihuahua mix has been on phenobarbitol for seizures for about 5 years. The medication makes the episodes less frequent but recently they started happening every other week. After several tests, the vet has now diagnosed her with Cushing's and wants to start her on 10 mg. Triclosane/day. Here's the thing: Although tests found dilute urine and all the other markers of Cushing's, we haven't noticed any symptoms in her. She doesn't drink or pee excessively, doesn't seem to have any other symptoms either (unless the more frequent seizures are a sign of Cushing's--? Our vet has had us up her dose of phenobarb for that and so far so good). I'm wondering if we should really start her on Triclosane or take more of a wait and see approach. I'm just concerned about the possible side effects of the new medication, and also all the other tests she's going to have to get to monitor it. Thanks in advance for your thoughts!

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[Maya]

Hello and welcome!:) I think you are going to have to be a bit more specific. What tests did your dog have done? What were the actual results? We need to know this in order to advise you.
Leah

[Steph n' Ella]

It would be really hard to treat your little guy with such a strong drug b/c you know the dosage is right when your dog's symptoms like excessive thirst and excessive hunger start getting better. Yes, please ask your vet for copies of your tests and post them here! There are some great experts around here who can help!

[Mommywriter]

Sorry. :o

They did a whole battery of tests--blood tests, urinalysis, etc., to start and the results showed that she had "low urine specific gravity" and elevated alkaline phosphitase (900). They said that meant it was either a UTI or Cushing's.

So to rule out a UTI, they did a urine culture and that came back negative for a UTI.

At that point, we took her in for a Dexamethasone Suppression Test, Low Dose/High Dose. I didn't get a copy of the numbers that came back on that, but whatever the readings were, the vet said it's definitely pituitary-dependent Cushing's. I just called them and asked them to fax me the actual results, so should I post those numbers when I get them?

[Steph n' Ella]

Yes! Since many vets are not familiar with Cushings, reading the test can be a challenge and people here have read them a million times!

Also, I would post what the USG was and the normal range. Include method of sample (free catch or cystocentesis--needle into bladder at vet office). Was the sample the first of the morning after removing water bowl all night or taken in the middle of the day? These things make a difference!

When you post the abnormal liver enzymes, they will be especially helpful b/c, again, those here who routinely view cush-dog's blood work can usually tell if the numbers are consistent with what they have seen in the past. So please post the exact number with the lab's normal range.

[molly muffin]

Hello and welcome. yep, that is exactly what you are going to want to do. Post results and ranges for anything like an LDDS, ACTH and anything that is high or low when it comes to blood work. Within Normal range results don't need to be posted.

I just make sure now, I didn't use to, that I get copies of all lab work and keep it in a file at home. This is especially good in case for any reason you have to go to see a specialist or make an emergency ER visit. Not just in relation to cushings, but for any reason. They want to know what the historical lab results are usually and it's nice to have them readily available to you.

I was told Molly definitely had cushings and all her tests, including ACTH and ultrasound said yes, it was. Then the LDDS came back as normal. So, while she might be on the road to cushings, she is still suppressing and not quite there yet. Since she isn't exhibiting any real signs of cushings, I've not started her on any of the meds yet.

Every dogs story is different though and only you can know when to start medication and if you are comfortable that the diagnosis is correct at that time. For us, the time hasn't arrived. It might at her next test, we'll cross that bridge when it gets here. If she was exhibiting lots of the signs of cushings, and every test came back positive, then I might feel differently about it.

Like most say, it's a long journey and a slow progressing disease usually, with no cure, only control of symptoms.

hugs,
Sharlene

[Mommywriter]

Thanks, everyone, for everything so far! My husband and I are so torn up over this and worried that if we don't start medication right away we'll be harming Sydney. But we also don't want to put her on something that will do more harm than good--and like I said, I don't really see any of the symptoms that the vet is saying she *must* be experiencing!

So, these results are for the most recent blood tests, which were done three times (every four hours). They're calling it a Cortisol Serial 2 (DEX):

Cortisol Sample 1: 7.1 (HIGH) Reference Range: 1.0-5.0
Cortisol Sample 2 Dex: 2.4 (HIGH) Reference Range: 0.0-1.4
Cortisol Sample 3 Dex: 5.5 (HIGH) Reference Range: 0.0-1.4

It's really tough for me to understand the report. The interpretation section says that cortisol level less than 1.4 is consistent with PDH--and that a level less than half the baseline at either 4 or 8 hours is consistent with PDH. I guess the latter is true but the former is not (?!).

The USG read was definitely not taken first thing in the morning or after taking away the water bowl. Urine was taken with a needle at 11AM. They found elevated phosphitase of 900 (normal is 131). Is that the USG read, or is there another number I should ask for?

I'm waiting for them to fax me the numbers on the urine culture.

Thanks again, everyone. What an amazing community this is!

[Mommywriter]

Okay! Here are the initial urinalysis results that were abnormal:

Specific Gravity: 1.010 (LOW) Reference Range: 1.015-1.050
pH: 7.5 (HIGH) Reference Range: 5.5-7.0

Those don't seem all that outside the normal range to me, though!

As noted before, though, the Alkaline Phosphotase was 902 (HIGH); Reference Range is 5-131

[frijole]

:D Hi! I know you really need another opinion! ha Anyway.. There is no need to rush cushings treatment as it isn't an 'instant killer'. Specialists in the field say "don't treat if there aren't symptoms".

FYI non adrenal illnesses can cause false positives on the ldds test you did. It happened to me and others so you really don't want to rush into treatment. Lots of things cause high liver enzymes (alk phos) ..

Hoping members who have used pheno barb will respond to how it interacts with lysodren and trilostane (2 drugs used to treat cushings). I know it is tricky.

On the blood panel that was done that showed the elevated alk phos - were there any other values that were above or below normal? If so, please post them along with the range for normal. That gives us a big picture of what could be happening.

Don't worry - we've seen it all! :D Kim

[Mommywriter]

<< On the blood panel that was done that showed the elevated alk phos - were there any other values that were above or below normal? If so, please post them along with the range for normal. That gives us a big picture of what could be happening. >>

Nope--on that panel it was just the alk phos that was elevated.

The Specific Gravity and pH on the Urinalysis were also slightly low and slightly high, respectively. Everything else was normal.

[lulusmom]

Hi and welcome to the forum.

It is well known that phenobarbital increases alkaline phosphatase and also interferes with the kidney's ability to concentrate urine so the low specific gravity could also be attributed to the phenobarbital. This would be especially suspect if the urinalysis was done after your vet increased the phenobarbital dose.

The sole purpose of treatment is to remedy problematic symptoms and if your dog has none, I'm not sure why your vet is rushing to treat. Phenobarbital does not interfere with the LDDS test, which as Kim has already mentioned can yield false positives in the face of stress or nonadrenal illness. If I were in your shoes, I would definitely take a wait and see approach. The reason for this is 1) blood and urine abnormalities are few and can be attributed to phenobarbital, 2) lack of symptoms and 3) lack of testing for validation of the ldds, especially in view of 1 and 2.

Glynda

[MBK]

I just wanted to welcome you as a fellow JRT lover. Glynda has given you great advice. There is absolutely no reason to rush to treatment when you aren't seeing any symptoms. You know your dog better than anyone.

[Steph n' Ella]

I am so glad you got good advice over the weekend. Your USG at 11 am is not very telling...if your dog had a big gulp of water after breakfast, that can make the urine dilute (low USG). If your vet is interested in getting doing more testing (urinalysis) do a free catch first thing in the morning. This will show a better picture of your pup's kidney function. Some here have come up with good methods for that free catch...involving ladles, Tupperware lids, and coolers with ice packs! This is how we get our kicks! :o :p ;) :D :eek: :rolleyes: :cool:

There are many here whose dogs are on pheno and can give you some good advice on that front.

Good luck!