January 7th 2011 7:07 pm
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Unfortunately these past couple months I have not been feeling my best. My mom has taken me to see the vet a few times, but no one is quite sure what is going on. We have done several tests, but still no diagnostics. Mom doesn't want me to worry about finances, but I know funds are low and we are wondering what the next best option is. This is the summary that the vet sent over. Please, if you have any suggestions, we need your help.
Much love, Emmet
Emmet was examined on 1/4/2011 at 09:26 AM for internal medicine consult. Seen by Dr. ****, Residency Trained in IM.
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 owner knows.
Emmet constantly seeks water (sink, faucet, tub, toilet), he will urinate in his crate and drink it. Owner 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).
1. Polyuria, Polydipsia
2. Poor appetite with weight loss
Temperature: , Pulse: 120 Strong beat / good, Respiration: 20
Weight: 20.000 kg, 44.00 lb, 0.74 m2
Appearance: thin, dry hair coat, BAR, water seeking in exam room
Oral Cavity: normal
Heart / Lungs: normal
Musculoskeletal: Thin, BCS 1/9
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. Owner 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.
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.
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).
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.
Fair to Guarded Long term, pending diagnosis and possible response to treatment options.
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.
Owner has done a great job so far so let's try to keep going and see how well we can help Emmet.
Collection method: free catch
Odor: slightly strong
Specific gravity: 1.025
Abdominal Ultrasound revealed:
Liver & Gallbladder: Within normal limits.
Left Kidney: Within normal limits.
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.