Coonhound is sick and we can't figure it out!
---------------------------- Presenting Complaint: Emmet was examined on 1/4/2011 at 09:26 AM for internal medicine consult. Seen by Dr. *****, Residency Trained in IM. History: Emmet is a 1 year old Coonhound that was adopted 6 months ago from One Tail at a Time. Since adoption Emmet has been displaying increased water consumption; increased urination did not start until mid-November. His appetite has been waxing and waning, he prefers to eat Beneful wet food instead of dry but is still at times skipping meals. Emmet's activity levels have also decreased over this time going from a playful and energetic young dog to now a quiet and reserved dog. Blood work was largely normal and urinalysis and culture in November revealed pyuria and mild hematuria, USG 1.028. Dr. *** started Emmet on Amoxicillin at that time for a suspect UTI or pyelonephritis; the urine culture was negative. Emmet has had no improvement on the antibiotics and is still having the same symptoms. A weight loss of 5 pounds since adoption has been noted with muscle wasting and very thin physique (was up to 49# last summer). Emmet is currently not on any medications, current on his vaccines and has no allergies as far as Kathleen knows. Emmet constantly seeks water (sink, faucet, tub, toilet), he will urinate in his crate and drink it. Kathleen crates him when she is not home without water and restricts his water access at other times during the day, but she is unsure of how much water he drinks (or would drink, if given the opportunity). Diagnosis/Problem list: 1. Polyuria, Polydipsia 2. Poor appetite with weight loss Examination: Temperature: , Pulse: 120 Strong beat / good, Respiration: 20 CRT;1-2, mm;pink Weight: 20.000 kg, 44.00 lb, 0.74 m2 Appearance: thin, dry hair coat, BAR, water seeking in exam room Eyes: normal Ears: normal Nose: normal Oral Cavity: normal Heart / Lungs: normal Abdomen: normal Musculoskeletal: Thin, BCS 1/9 Neurological: normal Skin: flaky, 5-7% dehydrated Lymph Nodes: normal Other Comments: Rectal exam: moderately fluctuant urinary bladder on palpation just over pelvic brim, otherwise unremarkable (anal sacs moderately full). Communication with client/Consent: An estimate with a range of cost was provided for the plan today. Family consented to provided services. Some disease processes are obscure and not readily evident at first, especially in an older pet. Identifying your pet's illness may require serial monitoring, at times repeat testing to identify trends/changes and maintaining an accurate, current problem list. In other words, the reason for your pet's illness may not be clear at first and several “levels” of testing may be necessary, usually from least invasive to more invasive. We also discussed at length that Emmet's problem is very frustrating, can require multiple levels of testing and may not have a good outcome. Clearly his current signs are not very compatible with being a good indoor pet dog. **** is carefully considering her next steps, which could include re-homing him to a farm for an outdoor life (with unrestricted access to water) or euthanasia. Treatment/Diagnostic Plan: Review medical record Carefully consider next steps, create estimate for continued diagnostics It would be helpful if we could let Emmet drink as much as he would and measure his USG (urine concentration) and body weight over a 24-48 hour period. This time period could possibly be combined with a modified water deprivation test, which includes a DDAVP trial. Other general considerations include: blood pressure measurement, plasma and urine osmolality, serum bile acids, ACTH stimulation, GFR analysis, infectious disease screening. Medications: No medications dispensed or indicated at this time. Possible consider DDAVP (hormone supplement) trial and/or thiazide diuretic trial (has a mechanism to inhibit urine output). Diet: Encourage small meals frequently. Consider offering different types of foods including canned puppy foods to entice and encourage weight gain. Consider home cooked meals including plain cooked meats (chicken, beef, and turkey) mixed with cooked carbohydrate (pasta, rice, potatoes). Avoid chocolate, raisins, all grapes, onions, and garlic. ** Possibly he is so preoccupied with drinking that he does not "remember" to eat or feels too full with water to eat? The reason for his poor appetite and weight loss is not clear. This may require a separate investigation. Follow up plan: Recheck as needed based on decision to move forward with additional diagnostics, CHANGES AT HOME, and/or treatment options with your family veterinarian or AETC. We discussed possibly having Emmet with us later this week or the end of next week (I am in this location on Thursdays and Fridays consecutively) for continued testing. Prognosis: Fair to Guarded Long term, pending diagnosis and possible response to treatment options. Clinical Summary: Based on evaluation today Emmet has two main problems: 1) urinating and then drinking too much, 2) poor appetite with attendant weight loss. The reason for these two problems is not yet clear, nor it is clear whether they are related to each other - he could have two different problems. His relatively normal lab testing, x-rays and abdominal ultrasound rule out many major groups of diseases. Yet of course the reason for his signs is still not evident. At this time it seems most likely that he has Diabetes Insipidus, this is a form of hormone deficiency that is not very common and can have two main subtypes (brain or kidney). It seems less likely that he has developed a psychogenic ("behavioral") drinking problem because his urine should be more concentrated than it is, especially since he is so young, and it appears that 1) he is urinating too much and then 2) drinking to compensate (not the other way around). It appears much less likely that there is a metabolic (liver, kidney), endocrine (Addison's, thyroid disease), infectious or anatomic (ectopic ureters) component but none of these possibilities have been fully explored so it is possible. Overall this appears to be a very, very challenging case and even with identification (possibly a "diagnosis by exclusion") of a cause, treatment options may be limited. **** has done a great job so far so let's try to keep going and see how well we can help Emmet. Hospital Services: URINALYSIS: Collection method: free catch Color: yellow Turbidity: clear Odor: slightly strong Specific gravity: 1.025 Glucose: neg Bilirubin: neg Ketone: neg Blood: neg pH: 5.0 Protein: neg Urobilinogen: neg Abdominal Ultrasound revealed: Liver & Gallbladder: Within normal limits. Right Kidney: Length: +6.51cm Left Kidney: Within normal limits. Length:+ 6.51cm Left Adrenal: + 2.40cm x 0.466cm; right adrenal gland not well visualized but area appeared normal. Spleen: Within normal limits. Soft tissue structure near bladder, mid line: length 1.36cm, probable lymph node. Urinary bladder: normal. Impressions: largely unremarkable study. |
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| I hate it when they say blood is "largely normal." That's a worthless phrase. Just for grins, what was his blood sugar level? When was it drawn in relation to when he last ate - and how much had he eaten. Though I have to admit when I first read the symptoms, my thought was DI. |
| Did I miss his thyroid readings? Diabetes was first thought. I agree, DI and DM which is actually better since the cost to keep a dog with DM (Diabetes mellitus) is huge, injections several times a day. DI still requires meds and the dog must have access to water at all times. Has he been tested for Canine Erlichiosis? Other blood parasites? The blood work does not appear to have Leukemia....that should have shown up with the first few tests. I'm assuming there is nothing wrong with the teeth or tonsils, the pathway to the stomach is free if pain. If the dog wants to drink, make it nutritious. Broth both meat and veggie. Maybe the food could be in a thick soup texture, start with rice gruel watered down with chicken stock. Can the vet consult with the local vet med hospital? More brains are helpful. |
Simon had very similar symptoms - if you go back and read my posts, you can see lab work and tests, etc. - Way easier than me trying to summarize and repost here again.  (It's here in the medical section).Initial thought was DM - Diabetes mellitis, or regular diabetes. However his blood sugar fasting was normal. Another friend with a basset was having some similar symptoms with their 2 y.o.. After extensive testing, he was diagnosed with DI - Diabetes insipidus. I'll read it more (the results) in detail tomorrow, just wanted to send off a quick reply tonight. |
| Thanks for the suggestions. I will find out if he had a thyroid test. What is the test for finding out if it is DI? The plan is to bring him back for more testing, and if that is the suspected issue, I will suggest they do that first. Also, what is the treatment? |
| The test for DI is a water witholding test to see if the urine will concentrate. A chemical....DDAVP will help the dog concentrate urine. If this proves to be the cause, then depending on what type of DI, a drug will be required for the rest of the dog's life. Even still, if it is DI "you" (I realize this isn't your dog) can forgo any treatment and just make sure the dog has plenty of water....hence back to the nutritious water since the need to drink outweighs the poor thing's need to eat. Here's a website: http://www.caninediabetes.org/pdorg/diabetes_insipidus.htm |
| Panda's always been a big water drinker (NOT to the extent of this boy though) and has always had more dilute urine. She started again a few weeks ago with big time drinking and then accidents at night and even when rolling over so we started picking up the water dish at 7pm again. She was still having accidents so I then shaved her down and it stopped. We've tested for different things over the years including for DI to be certain she could concentrate. Specific gravity before testing was 1.010 which is very dilute. We withheld water for 12 hours and the concentration was over 1.035 so she was able to concentrate. One vet had said, "If she had diabetes insipidus, I would expect values consistently below 1.008." As always though, with anything I share, verify the values with the attending vets!! One note though about DI... withholding water from a dog with DI can be deadly so it has to be done with vet approval. Panda's currently at the vet having her stomach and esophagus scoped again. She must have canned dog food at noon or she'll vomit. Blood work has been fine and so has her appetite. But she has vomited flecks of blood (could be as benign as a ruptured blood vessel due to the force) and a more significant amount one time so we've been withholding all supplements for a couple of months now. The loss of weight is most concerning for this Coonhound. It seems the blood sugar should have already been checked but sometimes things are missed so they need to verify it. My concern would be that maybe there was something in his mouth, esophagus or stomach that was making eating uncomfortable for him IF all blood work is normal. His stool has been checked for any signs of blood... no vomiting, diarrhea or fever? Heck, I'm not a vet though... just talking from a pet owner's viewpoint. Hill's prescription diet a/d helped Kaytee gain some weight early on. Not sure if it would be appropriate for this boy. http://oesusa.com/Supplement.jpg "...For the nutritional support of pets recovering from serious illness, accident and surgery..." http://www.hillspet.com/products/pd-fel ... anned.html I hope the docs and family can get this baby healthy again.  |
Heather - here is the response from my friend Melissa in regards to Oliver (who is a basset and some hound mix...see any pattern here???)  The problem is that there isn't a specific test just for DI. So they had to run tests to rule everything else out first. They of course did a lot of urinalysis tests to check the specific gravity. They also did the stim test to test for Cushings to rule that out. Then the last thing was the water deprivation test that they can do to see what happens when you do limit water. In a DI dog you will be able to tell a difference. For us we kind of by luck did this on our own as the doc said to limit his water and that is when Oliver got really really bad so they immediately said to not limit any water to him and to try the drops.. So they decided to try the drops and voila, he is not drinking as much and is finally concentrating his urine! Has this dog had any tests done so far?! I know that Oliver's specific gravity was low but not as low as usual with a DI dog, which is what threw them off for a bit. 1.010 is water and his was around 1.016 or 1.017 every time we tested. I know that he tested at 1.025 after having the drops, so that is much improved! I would say if DI is a question and they don't think it is Cushings then try the water depravation test. I would just tell them not to limit water at all if they think it could possibly be DI. Oliver was drinking close to 2 gallons of water a day before the drops! Feel free to give the owner my email if they have any questions. Melissa I will send her the lab info on this guy as well... |
| Heather - and here is Melissa's response after I forwarded her the lab work on Emmet. They went through a LOT and several different vets (finally at the U vet school) to get a diagnosis. And, Oliver is doing really well now! ******************* From reading that if it was my dog I would do the ACTH stimulation and then try the trial of the DI drops if that didn't show anything. I wouldn't spend the money on the modified water deprivation test because the drops will tell you pretty rapidly if it is DI, so you can save money. Just an fyi...the drops are not cheap. For a small nasal bottle (5ml) I pay $140. I have to give Oliver two drops twice a day, so four drops a day. It is hard because a lot of the diseases that they list as possibilities all have the same symptoms. The dogs specific gravity is as high as Oliver's is on the DI drops, so he seems to be concentrating well. With the muscle loss and not eating it really does sound possibly like Addison's or Cushings. My friend has an Addison's dog and he went down hill really fast and had a lot of the same symptoms. Although, if they are limiting water and he really does have DI that could explain it as well. A DI dog can die if they don't get the water that they need. So until they figure it out I would tell them to give the dog all the water it wants. I just dealt with the side effects of that (cleaning up pee). ************ and my vet told me the same thing - I kept watering Simon and cleaning up pee. It's his body attempting to regulate itself. And it did work, and amazingly it finally resolved.  I am amazed, but so so happy! Getting all the other things under control let his body fix itself, he wasn't that far gone so I'm incredibly lucky I still have my Simon. |
| Lets hope it is not 2 things, say Addison's and DI. As for the DI peeing, there are the belly bands for boys for when he can't get out in time. |
SheepieBoss wrote: Lets hope it is not 2 things, say Addison's and DI. . As for the DI peeing, there are the belly bands for boys for when he can't get out in time. Yep, we lived with them. I had to get more, as they were getting overflowed and washed/dried so often. Had to go beyond a pad in it - I bought toddler diapers and they would be soaked. If it goes in, it has to come out...and it sure did!Melissa and I were at an event planning meeting for our basset rescue at one of our member's houses. We had both our boys with - at that time they were both bad off and we had to keep them with us. (We were each 2-3 hours from home, from opposite directions) You should have seen us with our water and pee bands and pads and diapers....  |
And you thought diaper bags were behind you  Yep, when Splash could no longer concentrate, she ended up in people diapers. Can't remember, I think they were adult size. |
| Heather-thanks so SO much for posting and thank you to everyone for your thoughts and suggestions. They will definitely be taken into consideration. The specialist that Emmet has most recently seen wanted to do the water deprivation test which involved Emmet staying at the hospital for two days, the first day with unlimited water and the second day with restriction and then comparing the concentration of his urine. Unfortunately, after all the testing that has already been done funds are running low (and this is a very expensive test). My biggest concern besides Emmet's health is what tests will be most beneficial for him at this point. He has good days and he has bad days. Sometimes he can go a day or two with no accidents, and there are some days where he will wake up repeatedly in the night because of an accident. I cannot tell if he is in any pain, but he definitely is not the same active goofball of a dog that I brought home, and as Heather mentioned, he is a bag of bones and he continues to lose weight. It is very concerning, and it has been quite an emotional journey. |
| Then probably best just to keep water handy at ALL times and deal with the puddles. Food...whatever will go down at this point. I'd try a modified BARF diet with supplements. |
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