Advice please: puppy urinating when asleep

RE: Advice please

Arlo Guthrie — Wed, 31 Aug 2016 09:00:34 GMT

Oh, and while I'm here, a reminder to everyone to title threads as descriptively as possible, so that readers can see at a glance whether it's an area they have an interest in / particular knowledge to share. This one was titled 'advice please', which could obviously cover anything. I'm editing to: Advice please: puppy urinating when asleep. Not sure if that is absolutely right Clare Tapsfield-Wright - feel free to change again if not!

RE: Advice please

Arlo Guthrie — Wed, 31 Aug 2016 08:50:03 GMT

[quote user="Robin Grimmer"]I think we are very fortunate to have a board certified specialist on this site to offer excellent advice. [/quote]

Couldn't agree more.

[quote user="Robin Grimmer"]But no, Mr Todd who by his own admission knows nothing about ectopic ureters as usual drowns the thread out with his boiled water and tests a waste of time etc. I think it's actually quite rude and about time Arlo Guthrie intervened.[/quote]

From where I'm sitting, I can understand how you might find Tony's posts, er, frustrating. But he is not a rude man. His posts are almost unfailingly good-natured and polite. And in his occasional PM to me, a thoughtful, kind man. A gentleman.

When I look back on this thread as an example, yes, I can see how his posts can sometimes get people's backs up. But then again, is the 'back to basics' reminder in these discussions a bad thing? Don't forget that there are many who come to these discussions completely cold, without the luxury of knowing each other as well as regular contributors.

Tony's challenging does, however infuriating it may be to some, seem to cause people to clarify points they've raised, or add more information (again, important for others coming to the discussion cold), or precipitate discussion about other things.

Anthony Todd, I do think (and have said it before) you need to consider when you post whether your 'challenging' might be read as criticism. Perhaps, as Andy said earlier, ask for clarification before writing something that could be taken as criticism.

Equally, I think anyone who is annoyed by something Tony has posted should try and rise above it and humour him (and I don't mean that patronisingly towards Tony. What I really mean is to try and read his posts in the good natured way I am quite sure they are written, and smile - instead of reading them with a 'grrr' and tearing your hair out).

[quote user="David Mills"]Censure would be at best unwise and at worst autocratic.[/quote]

I agree.

RE: Advice please

Andrew Kent — Wed, 31 Aug 2016 06:19:44 GMT

The incontinence from an ectopic can be positional or sub-clinical leading to other problems (infection, hydronephrosis etc). I suspect this is related to the position of the ectopic opening along the urethra so don't expect them all to drip constantly and would not discount an ectopic in a puppy with this history.

Equally many dogs do have multi-factorial incontinence with concurrent urethral sphincter mechanism incompetence, which is why some dogs have persistent incontinence after correction.

but the majority of dogs, even with atypical signs, are continent or much improved after correction suggesting the ectopic was the primary, or at least Significant contributing factor to the clinical signs.

Andy

RE: Advice please

David Mills — Wed, 31 Aug 2016 01:32:23 GMT

It must be the Lakeland Ale but Toddy hasn't been rude here. Yes, the usual cherry picking arguments, but his ethos is unwavering.

Equally, Andrew has been polite and merely suggestive of ddx and ways forward. His input is appreciated, but equally, as he's aware and no doubt welcomes, in our anecdote-reliant profession, should never be taken as gospel.

Censure would be at best unwise and at worst autocratic.

RE: Advice please

Anthony Todd — Wed, 31 Aug 2016 00:10:20 GMT

[quote user="Robin Grimmer"] I think it's actually quite rude and about time Arlo Guthrie intervened.[/quote]

Happy to be censured if warranted, and ignoring the snide and irrelevant I'll end with the same obvious questions:

Why is the incontinence only when relaxed ie "asleep"or "at night "?

Doesn't his sound like something relaxing and opening intermittently?

Why would a patent and therefore draining ureter only do so under these conditions?

It's been suggested that this is possible thus supporting the EU diagnosis, but is it the first thing to go for in a young bitch?

RE: Advice please

Robin Grimmer — Tue, 30 Aug 2016 20:10:37 GMT

I think we are very fortunate to have a board certified specialist on this site to offer excellent advice. As he explained ectopic ureters are quite common especially in this breed and can present in an untypical way. But no, Mr Todd who by his own admission knows nothing about ectopic ureters as usual drowns the thread out with his boiled water and tests a waste of time etc. I think it's actually quite rude and about time Arlo Guthrie intervened.

RE: Advice please

Andrew Kent — Tue, 30 Aug 2016 14:51:24 GMT

Oh Anthony, please can we avoid this thread descending to the same place as so many others.

I think it's clear from my post that I didn't regard the four episodes as persistence so rather than deliberately misinterpreting things to suit your own agenda can we agree to call it a day now? Otherwise we will end in yet another circle.

if you genuinely read it as such then please ask for clarification before criticism.

Andy

RE: Advice please

Anthony Todd — Tue, 30 Aug 2016 13:15:18 GMT

[quote user="Andrew Kent"]it wasn't persistent, therefore no investigations. [/quote]

but on four occasions, possibly more, has passed quite a quantity of urine when fast asleep. Enough to make a puddle not drips.

Durrrr, it was persistent which is why it was posted.

If it had been a client consulting a normal [modern] practice comprehensive investigations would, by now, be well under way or concluded.

RE: Advice please

Andrew Kent — Tue, 30 Aug 2016 12:49:22 GMT

"If this is persistent" seems fairly clear to me.

it wasn't persistent, therefore no investigations.

RE: Advice please

Anthony Todd — Tue, 30 Aug 2016 11:58:07 GMT

[quote user="Andrew Kent"]We are well aware of your low opinion of younger vets you don't need to bang your drum in every thread. [/quote]

Just because I criticise an approach doesn't mean I have a low opinion of younger vets and I do not.

Their knowledge is vastly more comprehensive, they, by examination, are vastly better educated.

That does not mean their approach, or "art", of practice is therefore correct.

Come on, everyone can see from the many examples on here, the common obvious causes of a presentation are not immediately dealt with.

Blood samples for a simple diarrhoea is an obvious example.

[quote user="Andrew Kent"]And as you will see in the thread nobody suggested immediate investigation of this case[/quote]

If this is persistent (and as Wynne says worth making sure nothing simple like UTI) then personally I would look to make sure there is no anatomical reason for this, with ectopic ureters being the most common.

This, from your first reply, doesn't seem to be going for the obvious, nor suggesting the simple first, nor delaying investigation.....

RE: Advice please

Andrew Kent — Tue, 30 Aug 2016 11:20:16 GMT

And as you will see in the thread nobody suggested immediate investigation of this case but it is appropriate (and comforting to an owner) to know there are routes to explore should things not improve with time.

We are well aware of your low opinion of younger vets you don't need to bang your drum in every thread.

Andy

RE: Advice please

Anthony Todd — Tue, 30 Aug 2016 10:25:20 GMT

[quote user="Andrew Kent"]so personally I think any puppy with odd and persistent (so not in this case) urinary tract signs[/quote](my bold)

My point exactly!

Seemed pretty obvious to me.....

My broader thrust, which is a criticism of a recurring direction in modern vet. practice is that rare and unusual conditions or diseases are given equal emphasis and explored, usually unnecessarily, more in a demonstration of erudition and the possible, rather than an immediate attempt to fix the probable.

Of course, if the treatment, and often there needs little, as in this case, fails then, and only then, should the rare and unusual be explored.

RE: Advice please

Andrew Kent — Tue, 30 Aug 2016 08:22:30 GMT

Hi Anthony

i wouldn't use google as a particularly good source of information on this as you often come across a lot of misleading information.

ectopic ureters have a hugely variable presentation from severe incontinence to no incontinence (and often just recurrent infections for example). its also probably under diagnosed because people don't look for it in less typical cases.

so personally I think any puppy with odd and persistent (so not in this case) urinary tract signs should be screened for this (or any other) structural abnormalities as its better to correct them sooner rather than later.

all diseases have more typical and more atypical presentations :-)

And I agree that infection alone doesn't typically cause incontinence, but it can tip dogs over the edge from sub-clinical to obvious incontinence when there are other factors involved.

Andy

RE: Advice please

Clare Tapsfield-Wright — Mon, 29 Aug 2016 22:02:23 GMT

Agreed but to be fair I was glad to have all the diff diagnosis and was only advised to pursue if problem persisted which it did not.

Pup unseen except by me and since no urine scalding, dry vulva rest of time , no urgency etc I was happy to wait and see. It's just interesting for vets to know that this can happen and resolve with maturity hence my update post. Knowing the variations of normal is very helpful for vets as otherwise we can assume pathology existing.

RE: Advice please

Anthony Todd — Mon, 29 Aug 2016 21:25:54 GMT

Any other reason ie larger drink of water etc. on that particular occasion?

Was she tired ie in a deeper sleep?

Still got to be a sphincter "weakness" problem, surely, rather than an "infection"

[TBH I don't know anything about ectopic ureters but I know a tiny bit about cystitis or bladder infections]

Signalment: 4-month-old intact female Golden Retriever
Presenting complaint: Owner is unable to housetrain; urine staining around hind end
Pertinent history: Always wet around back end; bad-smelling urine; urine culture results positive for Escherichia coli that is sensitive to amoxicillin-clavulanic acid; with treatment, odor resolved, but incontinence persisted

This from the first site I picked re ectopic ureter, sounds right to me but doesn't fit your dog

RE: Advice please

Clare Tapsfield-Wright — Mon, 29 Aug 2016 21:11:19 GMT

Actually Anthony she was dry at night in her crate, only urinated when asleep during the day which struck me as odd and why I wondered about petit mal. I appreciate advice from all quarters as this was a problem I had not been faced with or aware of in thirty years in practice and of dog ownership I was a bit non plussed.

RE: Advice please

Anthony Todd — Mon, 29 Aug 2016 20:57:57 GMT

[quote user="Clare Tapsfield-Wright"] I am not worthy[/quote]

Nor am I, but then I've yet to hear of an immature bitch that is incontinent only at night, with no urgency or frequency, and in large amounts, having a urinary infection, yet is fine all day when awake and alert.

When I do then you and I shall be considered for the epithet.....

RE: Advice please

Clare Tapsfield-Wright — Mon, 29 Aug 2016 20:44:18 GMT

[quote user="Anthony Todd"]

[quote user="Clare Tapsfield-Wright"]Thank you Andrew Kent [/quote]

It's just not fair, he talks of all sorts of possible complicated scenarios; the rest of us say "wait and see" and it fixes itself, yet he gets the thanks and the credit [I'm joking, slightly]

[/quote]haha , sorry Anthony , your replies are also very much appreciated. I am not worthy

RE: Advice please

Andrew Kent — Mon, 29 Aug 2016 16:37:48 GMT

Hi Clare

glad to hear things seem to have resolved - I think your plan to let her have a season is very sensible and I would do the same.

Andy

RE: Advice please

Anthony Todd — Mon, 29 Aug 2016 15:46:49 GMT

[quote user="Clare Tapsfield-Wright"]Thank you Andrew Kent [/quote]

It's just not fair, he talks of all sorts of possible complicated scenarios; the rest of us say "wait and see" and it fixes itself, yet he gets the thanks and the credit [I'm joking, slightly]

RE: Advice please

Clare Tapsfield-Wright — Mon, 29 Aug 2016 13:09:54 GMT

Just an update on my bitch puppy ( formerly known as Miss Piddleknickers ), she has not had any episodes for at least two weeks so problem seems to have resolved without treatment. Thank you Andrew Kent , this list is brilliant .

I think I will let her have at least one season even though it will be a logistical nightmare.

(Have edited this post as someone was offended by my terminology)

RE: Advice please

Anthony Todd — Thu, 04 Aug 2016 15:25:29 GMT

[quote user="Evelyn Barbour-Hill"]Mr. Todd, you owe me a pint for explaining your point to the forum.[/quote]

Better than I did, but then I thought modvets should be able to deduce that...

Or are you just going to test my theory....

RE: Advice please

Evelyn Barbour-Hill — Thu, 04 Aug 2016 15:12:07 GMT

[quote user="Anthony Dennison"]

[quote user="Anthony Todd"]Dare I suggest the dinovet approach of boiled [cold] water only in the evening to avoid excessive volume....[/quote]

I asked an endocrinologist about this at a recent CPD I attended. He could not find any scientific reason why this would do anything and couldn't understand why someone would.

[/quote]

It doesn't "do" anything. It may make water boring so the dog only drinks what it needs and doesn't drink a lot more because it likes drinking. It may or may not help but it's easily tried. There's no need for endocrinologists to sneer.

Mr. Todd, you owe me a pint for explaining your point to the forum.

RE: Advice please

Anthony Dennison — Thu, 04 Aug 2016 14:52:52 GMT

[quote user="Anthony Todd"]Dare I suggest the dinovet approach of boiled [cold] water only in the evening to avoid excessive volume....[/quote]

I asked an endocrinologist about this at a recent CPD I attended. He could not find any scientific reason why this would do anything and couldn't understand why someone would.

RE: Advice please

Anthony Todd — Thu, 04 Aug 2016 14:27:50 GMT

[quote user="robloxley"]Not sure how this fixes a UTI or ectopic ureter (if present)?[/quote]

See UTI answer above [only at night, when asleep??] Ectopic ureter I don't know about, but why not try the easy and likely things first.