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.

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.

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.  

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.

The drinks are on me....

I picked Murphy up from the vet last evening and was told the vet would need to work out the plan and dose and call me later today.  When he got home, he went right to the water dish.  I thought he would never come up for air and I actually had to interrupt him so he did.  Last thing I needed was him having an episode of syncope from his heart murmur slurping up that much water.

We did have a dry night last night.  Surprised given all the water he had earlier in the evening, but given how restricted he was during the day, that might have helped.

So how rare is Diabetes Insipidus?  Consider this, the clinic has 11,000 patients and out of those 11,000, Murphy is now one of three.  Yup, three in that massive amount.  Now if this were the regular form of diabetes, the count would be much higher.   But I have to have a dog with an odd condition not often seen.

Since I knew the probability was high this would be the diagnosis, simply based on the symptoms and research; I began making calls to find out the medication cost.  If this were DI, then the medication would be Demopressin Acetate or Ddvap.  First I called Target: $139.95; Walgreens (always the most expensive) $159.95 and then Walmart at $119.58.  Ok, so Walmart had it the cheapest locally, but what about not so local?   Back to my good old North Drug Store in Canada.  There the medication was $48.  Yup, you read that right, $48 down from $119.   The down side would be that Murphy would need medication now, not just three weeks from now, which is the average shipping time.  This meant I would need to suck it up for one prescription and make like Houdini and pull cash from my ass.  Yeah, I know, it's not a trick he was known for, but I bet at a private party he was a hoot.

I asked the vets office if they would be willing to write a prescription to our friends in the north because of the price difference.  Let's just say, the vets office was blown away by the savings.   This afternoon Dr. Heidi called up to inform me that she would be happy to write a prescription to Canada and she would call one in, unless I wanted to wait.  Yeah, I'd like to just pay the $48, but I couldn't in good conscious let Murphy continue to be a peeing, water soaking sponge for another three weeks.  He was miserable and so was I.  He was tired of getting up at night, so was I.  He was tired of waking up in pee and I was tired of the wash.

Tonight I picked up the meds for Murphy, it comes as a nasal spray.  How does one give a nasal spray to a dog you might ask?  Well, through the eye of course.  No, seriously, it is in the eye.  I had to buy a cheap bottle of saline eye drops, pour them out, rinse the bottle and then transfer the fluid from the nasal spray bottle to the eye dropper.

As an FYI, the best way to accomplish all of this is as follows:

• Buy cheap, cheap bottle of saline drops
• CAREFULLY remove the dropper cap WITH CLEAN WASHED HANDS
• Pour out drops and rinse bottle with hot water, drain upside down in paper towel
• Take a syringe with a needle (ask the vet for a couple) and carefully holding the bottle of precious liquid, withdraw it into the syringe and squirt it into the dropper bottle.  Repeat until you have it all transferred
• Replace cap on dropper, making sure it's tight.  

I also found a website that sells the droppers, www.carolina.com, get the smallest 7ml size for $1.55 each.  

Murphy is starting on a one drop per eye once a day.  We're going to see how it goes for two weeks and we may need to increase it to two drops per eye daily.  For now, I set it by his little daily pill minder (yes, he has one) and administer the drops with this heart meds.   One very important reminder is to make sure he has water available at ALL times.  So I guess I will need to leave the baby gate down so he can get to his dish.  I may end up rethinking that, but we'll see how he does and how many times he goes down and stands barking at the door. 

Cross your fingers everyone, I'll let you know how it goes. 

Water, water, everywhere, and all a drop to drink....

When I became a dog mom to Murphy 14 years ago, I never thought I would find myself blogging about dog pee.  But then again, life always manages to throw you a curve when you least expect it or worse, when you need it least.

Murphy is a rat terrier and a great one at that.  He did his time as a pet therapy dog at two nursing homes and as a demo dog for a training center.  In his day, he was an incredible jumper, showing off his "able to leap tall buildings" talents by jumping as high and higher than the big dogs in demo.  He was a star, all he was missing was a cap with a big M on the front.

After having been diagnosed with a severe heart murmur a month ago, he went on Lasix for two weeks and Enalapril for life.  Since he was asymptomatic (no coughing or wheezing) life went on.   Then about two weeks ago, I began to notice he was drinking more and more and worse, he was putting out an ungodly amount of urine. I wondered how a 15 pound dog could possibly urinate that much and as often as he did.   It didn't even look like urine anymore. The term "yellow snow" became "off white snow" then just "snow" as it became as clear as the liquid going in.

Discussion with his vet, Dr. Pat resulted in two considerations:  a) possible UTI, though he was peeing loads, not dribbles; or b) it may be a result of a side effect of the Enalapril.   I expected this when he was on the Lasix, but he had been off it for more than a week.  We decided to take him of the Enalapril for a few days and then reassess our position.  He was getting me up one to two times a night so he could pee like a race horse.

For a few days, things went along fine, the peeing and drinking seemed better, but by the weekend, it was back.  So I decided to take a urine sample in.   This was actually easy since he stood and urinated for a good minute straight each time. The sample was very clear, but very pale.  My vets office ran the sample and Dr. Heidi came out to report the sample was fine, no sugar or infection but it was so diluted that we could be missing something.  She decided to try him on a course of antibiotics just in case.  She also mentioned the possibility of a rare condition called Diabetes Insipidus.  A form of diabetes where the kidneys can no longer concentrate urine.

The next morning, I discovered that Murphy had wet his pillow on the other side of the bed.  When I took the case off, I discovered this had been going on for a while. It was very stained, but because the urine was so diluted, there was no odor.  The next morning, Murphy got off the bed about 3 a.m. gave a quick whine and promptly urinated on the carpet.  I of course yelled at him to stop, but he just hung his head and kept going.  Clearly, this was beyond his control.  It was such a massive amount, it took an entire roll of toweling to soak it all up, along with a heavy dusting of baking soda to absorb anything I missed (great tip: buy it by the big box in the laundry aisle at Wal-mart).  Then he went outside and urinated another world champion cupful.

By Monday I was back to calling the vet.  The next day I had to go to the office for meetings, it meant Murphy would be crated for the day and I expected a wet crate, but what I got rivaled Noah and his flood.   Murphy had put out what had to be a gallon.  The layer of three crate pads was so soaked, I could wring them out. And if that wasn't enough, he went outside and urinated three more times, a huge amount each spot and then kept going out about each hour and doing the same.  Dr. Pat's office called and decided that a water deprivation test would be needed.  We scheduled it for the next day as I just wanted some answers and to find out how to fix him.

As a result of the water test, he couldn't have any food or water after 10 p.m.  I simply just covered the large water dish with a very heavy wooden cutting board.  Off to bed we went.  By this time, I was putting waterproof pads on the bed and on his pillow and just washing them daily.  Around 4:30 a.m. he gave a little whine and I felt the bed, yup, wet.  Outside we went where he urinated another quart. He came in, and stood at the water dish which was covered up.  Reluctantly, he came back to bed.  About five minutes later, I could hear thumping and discovered he had gone back down to the water dish to try and figure out how to lift that board up.  I shagged him back to bed and put the gate up at the top of the steps.  I couldn't help but think how consumed he was with his desire/need for water.