Murphy went in for his latest water deprivation test yesterday. The news is very disappointing. Murphy's specific gravity had been 1010 and yesterday, it was 1013. While it is an increase, it is a very, very small increase. Dr. Heidi is looking for 1025 at least and we are a long way from that.
Worse news was that my 14.1 pound dog is now down to 12.7 pounds. A significant drop in his weight. He eats so little. I've taken to crating him with his food until he decides to eat. Now I know what my parents felt like then they made me stay at the table until I cleaned my plate.
So what now? We decided to up his desmopressin to .04 for a few weeks and see if that brings any changes. We'll do another water test in a few more weeks and see if he continues to drop the weight.
He seems happy. When they brought him out to me, he was up on his legs, all excited that I had come back. He barks at me for his treat after his twice daily shots; but he also sleeps most of the day away. He sleeps about 22-23 hours a day but he still sits with me in the morning when I watch the news.
I know I will not have him forever and I'm trying to take it in small increments. So for now, I just want to get through the summer.
Murphy
Murphy: Diagnosed with Diabetes Insipidus
Wednesday, May 4, 2011
Wednesday, April 27, 2011
Some days are better than others....
I've been remiss at posting. In early April we switched Murphy to injections of the desmopressin nasal spray as it's more concentrated than the actual injectable formula. I started him at .02ml, but move him up a bit o .03ml.
I keep a daily record of how much water is left in the dish at the end of the day, but it's getting harder to go with that method. Since everyone is spending more time running outside, they all drink more, so the 1000ml in the dish for three dogs just isn't cutting it anymore. Most days I have to add water because Fuzzy Wuzzy the hairless plays so hard and drinks a lot after playtime. Still, I never add more than 300-500ml and then there is still a bit left.
Murphy went through a really bad few weeks. He had all but stopped eating. He had been enjoying the Beneful tubs, but that went by the wayside. Then we changed him over to the Natural Balance meat rolls. He ate that for a few days, then stopped that too. He dropped several pounds and his hip bones, ribs and spine began to show. I tried to coax him with all kinds of things, nothing worked. I was pretty worried since this is how his sister started in the months before her passing. But it looks like I have managed to figure it out. He gets fed in his crate now, where he doesn't have to worry about the puppy who frequently tried to hover nearby.
Nights are still a crap shoot. I put a belly band on him nightly with a Poise pad inside. The diapers didn't work and regular pads in the belly band didn't either. The Poise hold about 2 cups if it comes to that, which it doesn't. The most wet we've had is 4.2 ounce pad (plain pad weighs 1.2 ounces). My biggest problem is taking the pad off in the morning before I send him outside. LOL...once he starts he can't shut it off and then that pad weighs about a pound. I've only done that twice, so it's not been bad. I track the weight of the pads if they are wet. He will go a few days at a time with a dry pad.
Next week he goes for another water deprivation test to see if we are making progress. Wish us luck.
I keep a daily record of how much water is left in the dish at the end of the day, but it's getting harder to go with that method. Since everyone is spending more time running outside, they all drink more, so the 1000ml in the dish for three dogs just isn't cutting it anymore. Most days I have to add water because Fuzzy Wuzzy the hairless plays so hard and drinks a lot after playtime. Still, I never add more than 300-500ml and then there is still a bit left.
Murphy went through a really bad few weeks. He had all but stopped eating. He had been enjoying the Beneful tubs, but that went by the wayside. Then we changed him over to the Natural Balance meat rolls. He ate that for a few days, then stopped that too. He dropped several pounds and his hip bones, ribs and spine began to show. I tried to coax him with all kinds of things, nothing worked. I was pretty worried since this is how his sister started in the months before her passing. But it looks like I have managed to figure it out. He gets fed in his crate now, where he doesn't have to worry about the puppy who frequently tried to hover nearby.
Nights are still a crap shoot. I put a belly band on him nightly with a Poise pad inside. The diapers didn't work and regular pads in the belly band didn't either. The Poise hold about 2 cups if it comes to that, which it doesn't. The most wet we've had is 4.2 ounce pad (plain pad weighs 1.2 ounces). My biggest problem is taking the pad off in the morning before I send him outside. LOL...once he starts he can't shut it off and then that pad weighs about a pound. I've only done that twice, so it's not been bad. I track the weight of the pads if they are wet. He will go a few days at a time with a dry pad.
Next week he goes for another water deprivation test to see if we are making progress. Wish us luck.
Saturday, April 2, 2011
Sigh......
It's been a crazy couple of days. Murphy had a 3 night run of being dry thanks, I think, to the Proin medication. The eye drops are doing nothing for him, so I approached my vet about injecting the nasal spray vs. using it as drops as suggested by folks on the DI Yahoo group. I am pretty sure she thought I was on crack. She said there was no way you could inject the nasal spray, only the actual injectable formula. I insisted that folks were using it as the nasal spray is more concentrated and hence, a much smaller amount is needed. She wasn't convinced.
I gathered up all the information from the folks on the group and faxed her all the information hoping she would see that the information was accurate. Sure enough, she called yesterday afternoon and had confirmed it and decided we could give it a try. Murphy got his first injection of .02 last night.
Now let me tell you, .02 is an incredibly small amount. It's about the same about as 2 drops. On a 100 ml/10 unit insulin syringe, it's 2/10th of a unit, just two of those tiny little lines. Bifocals? Hell, you need a magnifying glass. He has had 2 doses with no change so far, but he seems like he might be drinking a bit less. If after a few days on .02 it isn't working, I may bump him up a bit. I have to at least try this, the eye drops weren't working either. If neither method works, then I think we need to look at this as a possible case of nephrogenic DI, which has little treatment options other than thiazides.
I gathered up all the information from the folks on the group and faxed her all the information hoping she would see that the information was accurate. Sure enough, she called yesterday afternoon and had confirmed it and decided we could give it a try. Murphy got his first injection of .02 last night.
Now let me tell you, .02 is an incredibly small amount. It's about the same about as 2 drops. On a 100 ml/10 unit insulin syringe, it's 2/10th of a unit, just two of those tiny little lines. Bifocals? Hell, you need a magnifying glass. He has had 2 doses with no change so far, but he seems like he might be drinking a bit less. If after a few days on .02 it isn't working, I may bump him up a bit. I have to at least try this, the eye drops weren't working either. If neither method works, then I think we need to look at this as a possible case of nephrogenic DI, which has little treatment options other than thiazides.
Tuesday, March 29, 2011
Not so good news today....
Murphy went back to the vet today for another water deprivation test. He failed miserably. He is not concentrating his urine at all despite the medication. Dr. Heidi now suspects this is nephrogenic DI, which means the receptors in his kidney's are not responding to the ADH hormone. If that's the case, plying him with all the desmopressin in the world won't help him.
So for now, we're continuing the drug, along with Proin to help him wetting at night. He goes back in 2 weeks for a third water test.
Poor fellow, he wets the bed nightly. We've tried doggie diapers and baby diapers with a hole cut for his tail, but none of the fit well. They also needed to be so tight to stay on, it made it hard for him to move. So tonight we're going to try a belly band with a Poise pad inside.
Sunday, March 20, 2011
Dry nights...at last
Murphy has been on the eye drops for a week and while he was drinking significantly less, he was not staying dry overnight. I can certainly see how owners who haven't had their pets diagnosed could think they have a dog who is just become "old" or "senile." Here I was, wondering how on earth my normally reliable dog couldn't have the presence of mind to at least bark and tell me he had to go out, but rather just pee in his sleep and even after he did this, still not get up and bark.
My bed isn't just Egyptian cotton sheets anymore, it's a longer waterproof crib pad on one side of the bed, topped by another waterproof pad and a very thick, but plush woven bath rug. I've removed the pillow on his side so I can keep the pads in one place.
He's been on one drop in each eye each night and that hasn't done it. So rather than go to two drops each night, I've opted to try one drop in the eyes in the morning and in the evening. It seems to have been the ticket.
If Murphy wakes during the night and I hear him licking, be it a leg or whatever, I am feeling for wet. Lucky for both of us, the last several nights have been dry ones. I am hopeful that we have turned the corner.
I am still planning on installing a dog door so I can leave the house for a few hours without worry. He does seem to have the ability to hold it during the day about 4 hours, which is good, but not good enough, especially if I have to work in the office for the day. This coming weekend, I have a pet expo and he'd be in his crate 8-9 hours. Normally, this is not an issue, but with this disease, it is. He can't be restricted from water or he could dehydrate as his body still pulls fluids out of his organs and tissue. I thought I could gate him in the kitchen with some pads, but this is Murphy, the dog who would do anything to try and please me. I know him, he will try barking to call me to let him out and when I don't come, he will try and hold it, even in unbearable agony, until he no longer can, then he will cower in shame over his accident. So after much thinking, I decided to just take him to the expo with me. He is, after all, the reason I work with the rescue. At least there I can take him out periodically to the potty area. Even at 14, he is a shinning example of a wonderful rat terrier. He is my perfect boy.
My bed isn't just Egyptian cotton sheets anymore, it's a longer waterproof crib pad on one side of the bed, topped by another waterproof pad and a very thick, but plush woven bath rug. I've removed the pillow on his side so I can keep the pads in one place.
He's been on one drop in each eye each night and that hasn't done it. So rather than go to two drops each night, I've opted to try one drop in the eyes in the morning and in the evening. It seems to have been the ticket.
If Murphy wakes during the night and I hear him licking, be it a leg or whatever, I am feeling for wet. Lucky for both of us, the last several nights have been dry ones. I am hopeful that we have turned the corner.
I am still planning on installing a dog door so I can leave the house for a few hours without worry. He does seem to have the ability to hold it during the day about 4 hours, which is good, but not good enough, especially if I have to work in the office for the day. This coming weekend, I have a pet expo and he'd be in his crate 8-9 hours. Normally, this is not an issue, but with this disease, it is. He can't be restricted from water or he could dehydrate as his body still pulls fluids out of his organs and tissue. I thought I could gate him in the kitchen with some pads, but this is Murphy, the dog who would do anything to try and please me. I know him, he will try barking to call me to let him out and when I don't come, he will try and hold it, even in unbearable agony, until he no longer can, then he will cower in shame over his accident. So after much thinking, I decided to just take him to the expo with me. He is, after all, the reason I work with the rescue. At least there I can take him out periodically to the potty area. Even at 14, he is a shinning example of a wonderful rat terrier. He is my perfect boy.
Tuesday, March 15, 2011
Some improvement is better than none.
Murphy has been on the Desmopressin for almost a week. I confess, I had hoped for better results. He isn't drinking as much, but he is still urinating a massive amount daily. Thankfully, I work from home, or his crate would be a daily mess. He can't hold it the 4 hours or less until my lunch and he is still getting me up in the middle of the night or worse, an hour before the alarm goes off. He is also still doing some bed wetting, though he has opted not to sleep in the bed the last few nights, which is kind of a relief, as I don't have as much laundry to do. From what I can tell, he is keeping his crate and dog bed dry.
I think I'll go a few more days on the one drop per eye and then opt to try two drops per eye or perhaps one drop in the AM and one drop in the PM. Otherwise, he seems perfectly healthy; demanding as ever for his nightly cookie. Has a great appetite too.
I've looked into a patio door doggie door and hopefully, I will get enough back on taxes to take the plunge. It will help so much for both of us.
Friday, March 11, 2011
DI Explained
So just what is Central Diabetes Insipiuds anyway? The most common misconception is that it's like the widely known form of diabetes which requires insulin. Nothing could be further from the truth. DI is a rare form of diabetes. For example, in the veterinary practice where Murphy is a patient, there are 11,000 clients and he is only the 3rd animal they have diagnosed.
DI is the inability to produce ADH (antidiuretic hormone), the hormone that controls the bodies ability to regulate retention of water, allowing the kidneys to conserve water and concentrate urine. Concentrating your urine is the difference between really yellow urine or really pale urine. If you have ever drank a lot of fluids (or beer) and noticed that the more you go, the less yellow your urine is, that's because your taking in more than your body needs to retain, so it immediately passes it out of the body without concentrating it. In other words, for a DI pet, their body doesn't know it's supposed to conserve fluids for later, it thinks it needs to keep taking it in and passing it back out.
This disease is completely different from the more common and know form of diabetes, DM or Diabetes Mellitus, which is related to insulin production and the bodies ability to produce it (type 1) or the bodies ability to use the insulin properly (type 2). Insulin plays no factor in DI.
Symptoms can be similar in both kinds of diabetes, both can cause extreme thirst, which then translates into excessive urination. In DI, the urine will not contain glucose (sugar). Dehydration is a serious condition that can occur in diabetes insipidus if animals are restricted on water intake as the body continues to pull fluids out of the body even when no fluids continue to go in. This is how Murphy managed to still urinate such an incredible amount while he was in his crate for the day, even though he had no access to water. Death due to dehydration and loss of electrolytes can result when owners take water away from an undiagnosed DI animal. Once an animal has been diagnosed and treatment is begun, water should never be withheld. The dog will also need a place to urinate if he is left home for more than just a few hours. Potty pads can be used or you might consider, as I am, about installing some form of a doggie door.
Many vets do not immediately recognize the symptoms of DI. A dog that suddenly looses their housebreaking skills may be seen as having a bladder infection. The condition however will not resolve following an attempted course of antibiotics. Some owners believe their dog has just developed a behavior problem. The end result for many of those pets is surrender or euthanasia. Vets may check for diabetes, but the sample will show no sugar. Pet owners should consider DI if a pet, long housebroken suddenly begins to urinate in the house.
Currently, there is really only one treatment in the form of DDVAP/Desmopressin Acetate. It comes in pill form and can run $250-$350 for 90 pills; injectable which is about $60 per 1ml ampule and a nasal spray which can run from $120-160 per 5ml. The nasal spray is the most common treatment for a dog. Rather than use it in the spray form, it is used as an eye drop. This does require you to put the drug into a sterile eye dropper bottle. See my March 10th blog for notes on this.
I hope this has provided some good information and understanding of disease. I'll be learning for a long time to come, I am sure.
DI is the inability to produce ADH (antidiuretic hormone), the hormone that controls the bodies ability to regulate retention of water, allowing the kidneys to conserve water and concentrate urine. Concentrating your urine is the difference between really yellow urine or really pale urine. If you have ever drank a lot of fluids (or beer) and noticed that the more you go, the less yellow your urine is, that's because your taking in more than your body needs to retain, so it immediately passes it out of the body without concentrating it. In other words, for a DI pet, their body doesn't know it's supposed to conserve fluids for later, it thinks it needs to keep taking it in and passing it back out.
This disease is completely different from the more common and know form of diabetes, DM or Diabetes Mellitus, which is related to insulin production and the bodies ability to produce it (type 1) or the bodies ability to use the insulin properly (type 2). Insulin plays no factor in DI.
Symptoms can be similar in both kinds of diabetes, both can cause extreme thirst, which then translates into excessive urination. In DI, the urine will not contain glucose (sugar). Dehydration is a serious condition that can occur in diabetes insipidus if animals are restricted on water intake as the body continues to pull fluids out of the body even when no fluids continue to go in. This is how Murphy managed to still urinate such an incredible amount while he was in his crate for the day, even though he had no access to water. Death due to dehydration and loss of electrolytes can result when owners take water away from an undiagnosed DI animal. Once an animal has been diagnosed and treatment is begun, water should never be withheld. The dog will also need a place to urinate if he is left home for more than just a few hours. Potty pads can be used or you might consider, as I am, about installing some form of a doggie door.
Many vets do not immediately recognize the symptoms of DI. A dog that suddenly looses their housebreaking skills may be seen as having a bladder infection. The condition however will not resolve following an attempted course of antibiotics. Some owners believe their dog has just developed a behavior problem. The end result for many of those pets is surrender or euthanasia. Vets may check for diabetes, but the sample will show no sugar. Pet owners should consider DI if a pet, long housebroken suddenly begins to urinate in the house.
Currently, there is really only one treatment in the form of DDVAP/Desmopressin Acetate. It comes in pill form and can run $250-$350 for 90 pills; injectable which is about $60 per 1ml ampule and a nasal spray which can run from $120-160 per 5ml. The nasal spray is the most common treatment for a dog. Rather than use it in the spray form, it is used as an eye drop. This does require you to put the drug into a sterile eye dropper bottle. See my March 10th blog for notes on this.
I hope this has provided some good information and understanding of disease. I'll be learning for a long time to come, I am sure.
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