Polydipsia in a geriatric boxer - What's more likely?

RE: Polydipsia in a geriatric boxer - What's more likely?

Anthony Todd — Fri, 17 Jun 2016 18:27:04 GMT

You do talk a load of dinovet tosh Anthony most of which I dismiss but its always intrigued me why you believe boiled water has any magic powers over the stuff straight from the tap.

When you've done it as often as I. and other dinovets, have and seen the dramatic reduction in water intake, or not, then you can say it's tosh.

I always assumed it didn't taste as good, to the dog.

As usual you dismiss it without crediting me with any experience success or common sense added to that is the fact that you haven't actually even tried it, nor can provide any evidence to the contrary.

Do you really think I post this advice based on no experience of these cases at all?

Your post says more about your "tosh" than mine, I submit.

PS I forgot to mention that on the first consult it is important to ask the owner to measure water consumption accurately ie by giving a known amount of water to the animal.

Do not rush into tests and exams until polydipsia has been definitely established!

Surprising the number of animals [certainly in this day of multitests and examinations, I'll bet, and this thread looks like another] that turn out to be drinking a normal amount of water, but their intake has not been measured, certainly not mentioned, unless you say a "lot" is a measurement...

RE: Polydipsia in a geriatric boxer - What's more likely?

David Mills — Fri, 17 Jun 2016 14:13:53 GMT

[quote user="Martin Atkinson"]This: 'Killing a dog that otherwise isn't that unwell through an Addisonian crisis'?[/quote]

Taking the worst case scenario and making it likely. Do you think trilostane inhibits all cortical activity? Needn't start at full dose, depends on other tell-tale signs being present etc.

Don't knock it until you've tried it...who do I sound like now??

RE: Polydipsia in a geriatric boxer - What's more likely?

Martin Atkinson — Fri, 17 Jun 2016 12:45:59 GMT

[quote user="David Mills"]Month of vetoryl at reasonable dose. What's to lose?[/quote] This: 'Killing a dog that otherwise isn't that unwell through an Addisonian crisis'?

I'm surprised at you David.

[quote user="Anthony Todd"]Only boiled water [as I have said many times before] often dramatically reduces consumption in a normal dog, which this one sounds like.[/quote]You do talk a load of dinovet tosh Anthony most of which I dismiss but its always intrigued me why you believe boiled water has any magic powers over the stuff straight from the tap.

RE: Polydipsia in a geriatric boxer - What's more likely?

Neil Wheadon — Fri, 17 Jun 2016 12:03:21 GMT

[quote user="Anthony Todd"]I've done it many times with the dog at home, weekends are best so the owner can distract the dog with walks, attention, or food and in a normal dog never had a problem. Should get some change in SG after 12 hours only.[/quote]

So have I in the past and would agree with Anthony that sometimes we think the owner can't do it and so it turns into a 'time sucker' for a nurse

When I have done it, I've simply admitted the dog and got the owner to come in a few times during the day and let them take it for walks and collect the samples. I can then weigh and moniter (or a nurse)

Previous posts have eluded to these cases being quite common where a low SG and polydipsia 'self cures'. Whilst people are keen to publish and collate a positive, I do wonder how common these cases are and maybe we simply can't explain it, saying oh it was probably medullary washout and Anthony's tip of flat boiled water is a good one and one I use for vomiting dogs to stop them gorging water.

Neil

RE: Polydipsia in a geriatric boxer - What's more likely?

Anthony Todd — Fri, 17 Jun 2016 00:12:55 GMT

[quote user="Virginia Campbell"]in case it keels over with dehydration[/quote]

I've done it many times with the dog at home, weekends are best so the owner can distract the dog with walks, attention, or food and in a normal dog never had a problem. Should get some change in SG after 12 hours only.

If the dog appeared desperate then a little boiled [cold!] water was fine,

Seemed such a logical cheap and obvious thing to do first.....

Of course I never did it in a dog I thought might have any serious underlying renal or other problem, and I was usually pretty sure that this "test" would prove to the owner that it was "idiopathic".

Quite often we found that, actually, when measured, the dog, in fact, wasn't drinking overmuch; other times we found that some owners were incapable of measuring how much the dog actually drank, as they forgot to mention the fishpond, for example.....

RE: Polydipsia in a geriatric boxer - What's more likely?

Virginia Campbell — Thu, 16 Jun 2016 23:45:39 GMT

Medullary washout can muddy the waters a fair bit with water deprivation testing if you just bring a chronically polydipsic dog in and set to. I'm too nervous to do the gradual water restriction and sodium supplementation thing at home prior to the test, in case it keels over with dehydration or salt poisoning.

Also, although it costs the practice nothing in kit or lab fees, a water deprivation test does chew up a lot of nurse time (and also some vet time as, being ultimately responsible for the dog's safety and welfare, I like to keep an eye on it myself through the day). It's the kind of thing everybody underprices.

RE: Polydipsia in a geriatric boxer - What's more likely?

Anthony Todd — Thu, 16 Jun 2016 22:52:08 GMT

[quote user="Francisco Gomez"]I agree, Idiopathic [/quote]

Probably, limit water and check SG is the easiest and cheapest way before you rush off and do all the expensive stuff.

"Tons of water" needs to be quantified, for example on day one; it may be normal if the dog is in a hot house, for example.

Only boiled water [as I have said many times before] often dramatically reduces consumption in a normal dog, which this one sounds like.

We've been here more than once and it amazes me that everyone seems to rush to bloods and all the expensive [and usually negative!] tests before doing the simple obvious things first ie establishing consumption accurately and seeing if the animal is able to concentrate urine, by deprivation.

The dog is apparently normal after all, so maybe, or probably, it is another one that just likes drinking loads of water....

RE: Polydipsia in a geriatric boxer - What's more likely?

Francisco Gomez — Thu, 16 Jun 2016 20:11:12 GMT

[quote user="Anthony Dennison"]

there is a potato in her brain somewhere

[/quote]

I agree, Idiopathic Brain Potato seems to be the most logical diagnosis for my patient Anyway, I called them today and ask to check water intake properly and call me back with the answer - I can't get hold of ddvap drops anyway.

RE: Polydipsia in a geriatric boxer - What's more likely?

Anthony Dennison — Thu, 16 Jun 2016 09:55:15 GMT

My nurses dog presented almost exactly the same, and was putting on weight despite her being very hot with the food (she's obsessed with nutrition and was very upset her dog was putting on weight despite her trying to control the weight!). We did full bloods, ionised calcium, abdo scan, heart scan (twice) and also scanned her thyroid. Urinalysis was very similar to your case.

Urine cortisol:creatinine ruled out cushings. DDAVP trial did nothing. Did a thyroid panel and T4 was slightly low, and the thyroid on ltrasound scan was slightly hypoechoic so we trialled low dose levothyroxine, showed signs of thyrotoxicosis!

In the end we just let the dog be, she's on some heart meds for aortic stenosis but the PU/PD seems to have self resolved to a degree. We both agree we think there is a potato in her brain somewhere

RE: Polydipsia in a geriatric boxer - What's more likely?

Francisco Gomez — Thu, 16 Jun 2016 09:23:37 GMT

[quote user="David Mills"]

I'll lay you my referendum vote this is cushings.

Month of vetoryl at reasonable dose. What's to lose?

[/quote]

That's a horrible deal - I hardly will have the time to confidently confirm Cushing's (which IMO requires of further testing and start some treatment, and see if it works) before next week!

Anyway:

[quote user="David Mills"]

What's to lose?

[/quote]

Killing a dog that otherwise isn't that unwell through an Addisonian crisis? Or Am I being scaremongering to Bremain levels?

RE: Polydipsia in a geriatric boxer - What's more likely?

David Mills — Wed, 15 Jun 2016 23:49:59 GMT

I have treated umpteen dogs that are postman-diagnosis cushings on presentation with vetoryl without further testing.

I'll lay you my referendum vote this is cushings.

Month of vetoryl at reasonable dose. What's to lose?

RE: Polydipsia in a geriatric boxer - What's more likely?

nikki — Wed, 15 Jun 2016 22:47:25 GMT

My parents own a similar case! 14.5yr old Boxer. Had one kidney removed 4.5yrs ago due to a whopping 15cm mass that turned out to be benign. Drinks gallons and now doesn't seem to know when he needs to pee either so just walks round the house spraying it out! SG: 1.012. Has had various UTI's cultured and treated but doesn't resolve the PUPD so guess consequence rather than cause. Blds normal, abdo scan was unremarkable. Would love to know why he drinks sooooooo much! Parents not overly inclined to really do much more as he is happy, they don't mind mopping the floor and are aware he's reaching the end of his days.

RE: Polydipsia in a geriatric boxer - What's more likely?

Virginia Campbell — Wed, 15 Jun 2016 22:00:12 GMT

Forgot to say, would add a wee shake of salt to each feed to avoid hyponatraemia if using desmopressin.

RE: Polydipsia in a geriatric boxer - What's more likely?

Virginia Campbell — Wed, 15 Jun 2016 21:43:16 GMT

I'd put my money on a Boxernoma in the brain. I would also stick my neck out and try the drops.

RE: Polydipsia in a geriatric boxer - What's more likely?

Neil Wheadon — Wed, 15 Jun 2016 20:30:34 GMT

[quote user="Francisco Gomez"]I agree - I wonder what problems would I encounter if I used it. I know there is a sort of 'partial' DI with higher SG, but I don't know how common this is. All previous cases I have treated for DI, their SG were about 1.005 or so...[/quote]

Why??

Money better spent on diagnostic test surely? see Robins reply.

Neil

RE: Polydipsia in a geriatric boxer - What's more likely?

Francisco Gomez — Wed, 15 Jun 2016 19:52:16 GMT

[quote user="Jenny Boyd"]

Another one for saying USG too high for DI....

[/quote]

I agree - I wonder what problems would I encounter if I used it. I know there is a sort of 'partial' DI with higher SG, but I don't know how common this is. All previous cases I have treated for DI, their SG were about 1.005 or so...

RE: Polydipsia in a geriatric boxer - What's more likely?

Jenny Boyd — Wed, 15 Jun 2016 19:40:31 GMT

Another one for saying USG too high for DI....

RE: Polydipsia in a geriatric boxer - What's more likely?

Robin Grimmer — Wed, 15 Jun 2016 19:28:15 GMT

DI would have a much lower SG. Cushings is probably the most likely, you could do a urinary cortisol ratio, but what's the point. If they can't do an investigation then they certainly won't be able to afford to treat and monitor Cushings. If the dog is otherwise well just tell them to buy some incontinence pads.

RE: Polydipsia in a geriatric boxer - What's more likely?

Francisco Gomez — Wed, 15 Jun 2016 18:53:28 GMT

Thank you, just what I was thinking - anyway, how do you treat DI these days? Could ddvap drops (if found!) be dangerous to use in this situation?

RE: Polydipsia in a geriatric boxer - What's more likely?

Thomas Johnson — Wed, 15 Jun 2016 16:28:09 GMT

[quote user="Francisco Gomez"]

I'm of course not going to give this dog a vetoryl tablet without proof of this being what the dog needs - but What is in your opinion the most likely cause with the extremely limited information we've got and do you think things like DI are too unlikely with this SG?

[/quote]

I would agreed that diabetes insipidus is unlikely with this SG. I would be considering Cushing's with the elevated ALKP, but would be worried by the elevated ALT so would have liver disease in mind as well.

RE: Polydipsia in a geriatric boxer - What's more likely?

Neil Wheadon — Wed, 15 Jun 2016 16:19:01 GMT

Finger in the air time, why should you guess if they won't pay for it?

The dog is well, so weigh it, get them to 'properly' measure the polydipsia and get another urine sample for SG in a few weeks

I think true DI is pretty rare but have seen quite a few well dogs 'self cure' amazing how many of these have a rising SG after a few weeks

Far too little information and you've ruled? out the main ones, assuming it isn't brewing a pyo. You could take a blood smear and look at the WBC count yourself I guess.

Neil