PUPD help

RE: PUPD help

Michael Woodhouse — Thu, 06 Oct 2016 01:38:31 GMT

I don't really care how much the dog is drinking, if there has been a noted change in drinking habits (as there has here).

At that level the urine is hyposthenuric and actively dilute.

I too would do urine cortisol:creatinine and likely LDDST (my own dog has Cushings and was normal on ACTH stim. Ironically was a bit pu/pd but living with 2 vets we never got around to measuring 24 hour water intake. The other dog, puddles, streams make it realistically impossible. She drinks less now she's on Tx).

RE: PUPD help

Eilidh Corr — Wed, 05 Oct 2016 23:43:03 GMT

Semantics ... "Thirst" as perceived by the owner.

RE: PUPD help

Anthony Todd — Wed, 05 Oct 2016 18:40:04 GMT

[quote user="Eilidh Corr"]notable polydipsia[/quote]

Oh dear, oh dear, do try to keep up please.

RE: PUPD help

Eilidh Corr — Wed, 05 Oct 2016 17:15:37 GMT

For what it's worth, I do occasionally ask owners to measure water intake, but it really wouldn't cross my mind in this case. A dog with increased urination, urination voluntarily indoors plus incontinence, notable polydipsia, and "not right", with that SG ... won't do any harm to measure it but it won't really advance the work up, will it? It seems beyond doubt that it's really polydipsic, and even if you did a 24hr water intake, the owner is unlikely to be satisfied when you proclaim that their unwell, carpet-urinating dog is "normal", are they?!

So, I think the OP's approach so far is entirely reasonable. I wouldn't go for water deprivation test either, partly because it's a last resort and has risks, and partly because common things are common, and Cushing's is common.

Props to you OP - don't let anything on here dent your confidence. You're doing just fine

RE: PUPD help

Bob Russell — Wed, 05 Oct 2016 16:18:20 GMT

Not going to get drawn into a discussion over the value of measuring water intake but I do ask how big is the drinking bowl and how often do you need to fill it up? Is it empty when you fill it?

It amazes me how often the drinking a lot becomes drinking within fairly normal quantities!

Even with 4 medium sized, normal dogs it would be rare for a large bowl to be filled up more than a couple of times a day

RE: PUPD help

Anthony Todd — Wed, 05 Oct 2016 15:58:48 GMT

OK, I'll settle for a draw on the point..... except that IME owners inevitable response is "OK, but why is the dog drinking so much water?".....so you then say we better measure it.....

and they say " We've got 4 dogs etc. etc."

I get your point so a draw it is

RE: PUPD help

Robin Grimmer — Wed, 05 Oct 2016 15:51:29 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]What's cheaper, easier or more obvious than a urine dip and sg?[/quote]

Er, just asking the client to measure water consumption; cost £0, and even more obvious.

Has nobody on here had a "drinking a lot" dog that turns out not to be, 'cos I have?

[/quote]

Not always that simple. What if there's more than one dog? What if the water bowl gets knocked over? What if they lose count? A urine test is much simpler, cheap and in this case demonstrates that the dog definitely is pupd. I'm not saying I would never measure water intake, but it wouldn't be the first thing I would do.

RE: PUPD help

Anthony Todd — Wed, 05 Oct 2016 13:10:56 GMT

[quote user="Robin Grimmer"]What's cheaper, easier or more obvious than a urine dip and sg?[/quote]

Er, just asking the client to measure water consumption; cost £0, and even more obvious.

Has nobody on here had a "drinking a lot" dog that turns out not to be, 'cos I have?

RE: PUPD help

Clive Ansell — Wed, 05 Oct 2016 12:47:06 GMT

[quote user="Robin Grimmer"]

[quote user="Clive Ansell"]

[quote user="Sarah Keir"]The urine is hyposthenuric at 1.005- you don't need a water intake[/quote]

But it can't do any harm to measure it surely? I like to gather as much information as possible.

[/quote]

Won't do any harm but isn't going to give you any useful information in this case. Maybe if the sg were a bit more equivocal you might want to measure water intake to see if really is polydipsic.

[/quote]

Fair enough.

It may not be relevant initially, but could serve as a baseline, then measured over time could give an indication as to whether a condition is getting better or worse, or whether therapy is helping.

I always feel any information may be useful, and as I say cannot possible do any harm.

RE: PUPD help

Robin Grimmer — Wed, 05 Oct 2016 12:29:49 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]Maybe if the sg were a bit more equivocal you might want to measure water intake to see if really is polydipsic.[/quote]

Gee, just nothing will persuade some of us to do the obvious, easiest, cheapest first....

[/quote]

What's cheaper, easier or more obvious than a urine dip and sg?

RE: PUPD help

Anthony Todd — Wed, 05 Oct 2016 12:19:48 GMT

[quote user="Robin Grimmer"]Maybe if the sg were a bit more equivocal you might want to measure water intake to see if really is polydipsic.[/quote]

Gee, just nothing will persuade some of us to do the obvious, easiest, cheapest first....

RE: PUPD help

Robin Grimmer — Wed, 05 Oct 2016 11:55:04 GMT

[quote user="Clive Ansell"]

[quote user="Sarah Keir"]The urine is hyposthenuric at 1.005- you don't need a water intake[/quote]

But it can't do any harm to measure it surely? I like to gather as much information as possible.

[/quote]

Won't do any harm but isn't going to give you any useful information in this case. Maybe if the sg were a bit more equivocal you might want to measure water intake to see if really is polydipsic.

RE: PUPD help

Clive Ansell — Wed, 05 Oct 2016 11:22:08 GMT

[quote user="Sarah Keir"]The urine is hyposthenuric at 1.005- you don't need a water intake[/quote]

But it can't do any harm to measure it surely? I like to gather as much information as possible.

RE: PUPD help

Robin Grimmer — Wed, 05 Oct 2016 11:18:18 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]But the sg is really low so the dog must be drinking loads to replace the fluid lost or it would be pickled! [/quote]

But if we'd measured this "loads" before spending, what £200 plus on "tests" we would have known that anyway.....

Why do all the vet advice sites say, first up, measure the actual water intake, and not "bloods, urine etc. etc.?.

But what would Davies Referrals know?

Love to know how much the dog was.is actually drinking....

[/quote]

If you read the op, the first thing they did was a urine dip and sg. Cheap and simple and with an sg of 1.005 you don't need to measure water intake to tell the dog is pupd.

RE: PUPD help

Anthony Todd — Wed, 05 Oct 2016 11:11:02 GMT

Urine specific gravity values of 1.001 to 1.070 for dogs and 1.001 to 1.080 for cats can be considered normal depending upon the individual circumstances and must be interpreted in light of each clinical situation.

from

https://www.proplanveterinarydiets.com/media/1315/pur-urinalysis-clinical-handbook.pdf

but I suppose they are wrong too?

RE: PUPD help

Anthony Todd — Wed, 05 Oct 2016 11:06:35 GMT

[quote user="Robin Grimmer"]But the sg is really low so the dog must be drinking loads to replace the fluid lost or it would be pickled! [/quote]

But if we'd measured this "loads" before spending, what £200 plus on "tests" we would have known that anyway.....

Why do all the vet advice sites say, first up, measure the actual water intake, and not "bloods, urine etc. etc.?.

But what would Davies Referrals know?

Love to know how much the dog was.is actually drinking....

RE: PUPD help

Robin Grimmer — Wed, 05 Oct 2016 10:47:29 GMT

[quote user="K Burton"]

. I'm the first to admit I'm rusty as I've only recently returned to practice after a suicide attempt a couple of years ago,

[/quote]

Well done on returning to work and also for being so frank and honest about it. I've struggled with depression over the years but fortunately have never been that low. Nothing has changed that much in a couple of years , you'll be fine.

RE: PUPD help

Sarah Keir — Wed, 05 Oct 2016 10:44:29 GMT

K Burton, In my opinion, you do not need to measure the water intake - it would be academic. The owner has reported clear polydipsia and this has bothered them so much that they have taken the step to reduce the water intake. Anthony Todd is free to express his opinions too, but at this time and in these circumstances, I disagree.

K Burton, you are absolutely right, don't doubt yourself or that little thought that says I shouldn't restrict water even by doing a 'partial water deprivation thing' because YOU ARE RIGHT. Do not restrict water intake until you are sure and even then it needs to be done in a controlled and monitored fashion in a hospitilised patient. Our first edict is do no harm.

RE: PUPD help

Robin Grimmer — Wed, 05 Oct 2016 10:42:40 GMT

[quote user="Anthony Todd"]

[quote user="Sarah Keir"]

The urine is hyposthenuric at 1.005- you don't need a water intake. Also it is very dangerous to restrict water to these dogs until you have found the reason why her kidneys are actively diluting the urine.

[/quote]

But we don't know if the water intake warrants restricting 'cos we don't know if she is polydipsic unless we measure the water intake...... [and weigh the dog]

All the advice sites from vets say "measure water intake" and usually initially.

Not that I'm even worth reading, but it is surprising to find how many dogs that are "drinking too much" actually aren't......

[/quote]

But the sg is really low so the dog must be drinking loads to replace the fluid lost or it would be pickled!

RE: PUPD help

Clive Ansell — Wed, 05 Oct 2016 10:41:57 GMT

[quote user="K Burton"]I'm the first to admit I'm rusty as I've only recently returned to practice after a suicide attempt a couple of years ago, and I know a lot has changed over that time, so I thought it would be helpful to see other people's opinions[/quote]

I'm genuinely sorry to hear that, and I hope that you are getting all the help, encouragement and support that you need.

Seems from your OP that you are doing just fine, and what I and 99.99% of colleagues would do; a problems has presented, and you are investigating in a logical and methodical manner, and then asking for additional ideas when answers don't easily present.

Like you, I would want to exclude other differentials before embarking on any form of deprivation test; mainly cushing's and the presence of a Boxernoma" somewhere (see my recent thread on self curing diabetes insipidus)

RE: PUPD help

Robin Grimmer — Wed, 05 Oct 2016 10:40:36 GMT

Some cushings cases can have completely normal bloods, especially in adrenal dependant cases. I spent some time at a referral centre and most of their referred pupd cases turned out to be cushings. Urinary cortisol to creat ratio has a lot of false positives, low dose Dex is good.

I assume Ca levels were normal?

RE: PUPD help

Anthony Todd — Wed, 05 Oct 2016 10:34:21 GMT

[quote user="Sarah Keir"]

[/quote]

But we don't know if the water intake warrants restricting 'cos we don't know if she is polydipsic unless we measure the water intake...... [and weigh the dog]

All the advice sites from vets say "measure water intake" and usually initially.

Not that I'm even worth reading, but it is surprising to find how many dogs that are "drinking too much" actually aren't......

RE: PUPD help

Kathryn Burton — Wed, 05 Oct 2016 10:30:08 GMT

No I've not measured how much water the dog is drinking, but the owner said that it recently is drinking a vast amount more than it used to (spending most of it's time at the water bowl) so I felt it reasonable to assume PD. I was planning to do a LDDS and fuller urine testing on the dog, but my colleague suggested a partial water deprivation. I've never done a water deprivation test as it was my understanding that if the patient has something other than DI/psychogenic PD you could make things much worse by withholding water.

RE: PUPD help

Sarah Keir — Wed, 05 Oct 2016 10:02:49 GMT

RE: PUPD help

Clive Ansell — Wed, 05 Oct 2016 09:54:52 GMT

[quote user="Anthony Todd"]

Yet the actual amount of water drunk hasn't even been measured.....

Some dogs just like drinking water so check that first!

[/quote]

I would ask the owner to measure water intake, but always amazed at how many (owners) don't bother to do it

But the OP started off by saying that

"owner mentioned just not quite right over the past few weeks and also having urinary accidents in house"

So I feel that investigations so far are reasonable and indicated. may be worth full urinalysis including C&S, prot, crea, cortisol. Would also run an ACTH stim test.