Does Any Of This Make Sense?

[duncan41]

Short history: Since Suze and her sister adopted us in 2006 when they were 25 months old, Suze has had episodes of incontinence (only while asleep); each February/March and August/Sept. Each episode lasted about 3 weeks with no intervention on my part other than taking her to the Vet for bloodwork and UA, all of which were negative. Because of changes in my household, at the start of her Feb, 2009 episode, I took her to the Vet and asked for help; again bloodwork and UA were negative. Vet prescribed Proin. 48 hours later she was at the E-vet, dying from renal failure. With help from the power of GT and the wonderful Vets and caregivers at the E-vet, she pulled through. The only lingering evidence of the ARF was a Creatinine of 2.5.

 

Episodes of incontinence remained the same until this cycle, which started August 13. The Vet recommended a course of Ciproflaxicin but it had no effect. Took a wait-and-see attitude and watched for any change. Due to the prolonged duration and the increasing frequency and volume of the releases, took her to the Vet on Thursday, did a UA and a complete Senior Panel (even though she is only 7) with the following ABNORMALTIES as analyzed by IDEXX:

 

AST (SGOT): 58 (Ref range: 5-55 U/L)

CK: 423 (Ref range: 10-200 U/L)

Cholesterol: 393 (Ref range: 112 - 328 mg/dL)

TCO2 (Bicarbonate): 29 (Ref range: 17 - 24 mEq/L)

T4: .5 (Ref Range: 1.0 - 4.0 ug/dL) The sample is now being analyzed for Free T4; not sure about T3 or Free T3.

 

There was a TRACE of blood in the UA.

 

The CBC was not based on Greyhound values, so those were slightly abnormal, but all within range for a Greyhound, and a pleasant surprise Creatinine of 1.4!

 

She is eating normally and with enthusiasm (Taste of the Wild, with a heaping tablespoon of Merrick canned food, omega 3-6-9, Springtime's Longevity at half the recommended dose, Animal Essentials Plant Enzymes and Probiotics and a half dose of an antioxidant made from ground raspberry seeds), drinking normally, poops are good, but she's not up to par. She normally does a couple of laps around the yard once a day or at least performs some "doughnuts" in the sandpit, but the last week or so, she goes out to urinate (we take her out every two hours from 5:00 am to 10:00 pm) and then runs back in the house.

 

She has been x-rayed twice (Feb & Oct 2011) to check for bladder stones or a mass (negative) but there is evidence of calcified spinal discs. She shows no sign of pain, discomfort or gait problems.

 

After this most recent x-ray, she is very bruised on one side and the lower abdomen. The main bruise was quite large (round, 3 inches in diameter) with smaller bruises that have since disappeared. It appears as though there is another large bruise, maybe 2" in diameter, that has formed since yesterday morning. I have a series of daily photos showing improvement and sent the first one to my Vet this morning. She is concerned but perplexed - asked about rat poison (not even a remote possibility!!!) but indicated that since the smaller bruises are disappearing, that is a good sign. Will call her again tomorrow about the new bruise and will ask about running tests to rule out a clotting disorder.

 

Oh, this is getting to be a marathon posting, but here are my questions:

 

1. What do the Chem Panel abnormalties indicate and is there any connection to the incontinence?

2. Is there a remote possibility that the low thyroid is contributing to the incontinence?

3. What to do about the abdominal bruising?

4. Is the trace of blood in the urine significant?

 

Thank you for your patience. I would appreciate any and all ideas and suggestions.

 

Linda

 

10/20: Saw Dr. L who treated Suze's ARF in '09.

Abdominal Ultrasound - negative

B/P: 184

Rectal exam: negative

Temp: 99.8

 

His biggest concern was the photo of the post x-ray bruising - said her bloodwork was "boring". Took blood for all the usual suspects plus Von Willebrand factor. Just received a call that the manual platelet count was "normal". Will do a cystocentises after she finishes the Ciproflaxacin for a culture and UPC. He's a little concerned about the BP, but it was done at the end of the appointment, and even though she is extremely stoic, he said he could tell she was pretty stressed, so will repeat it when we take her back 5 days after the Cipro is gone.

So far, so good. Will update when the rest of the puzzle pieces are presented. In the meantime, Suze seems to be feeling a little better. Please keep her in your thoughts. I miss my "alpha dog"/best friend. I don't care if she's incontinent forever, as long as she's happy and feels good.

 

 

11/15: Oh, this is so frustrating! Lots has changed since 10/20. All CBC and Super Chem Panel results were normal after retesting by the Internist. BUT, throid panel is confusing/conflicting: TSH is out of range on the high side with the T4 and FreeT4 at the low end of normal. She is also being treated with Benazepril for HBP, after readings of 260 then 230 after 20 minutes. PCRs were all negative. Test results for Von Willebrand's Factor came back at 62% which is like being "a little pregnant" from what I have been able to determine. Dr. L is out of town until Thursday, so I don't know what his feelings are regarding this latest piece of the puzzle or whether to do the cystocentesis to get a culture going. Suze is still very incontinent (can't go much longer than 90 minutes without an accident) and is still lethargic and just not her alpha dog self. Her appetite is good, poops are normal. I have weaned her off kibble and she is now eating a salt-free, home cooked diet.

 

My question: Would you treat with Soloxine to see if it would influence both the thyroid and the vWF? I have read about the connection in humans and understand that the canine connection is unproven but "bears further investigation". Is DES off the table now due to the vWF?

 

Thank you for bearing with me during this excruciatingly long journey! I don't care about the diagnosis - I just want my dog back! I love her more than....................well, I know you all understand how much that is.

 

Linda

Edited November 16, 2011 by duncan41

[Batmom]

Abdominal bruising: I'd want a platelet count ASAP. Tonight if you see more or worsening bruises, tomorrow morning first thing if not.

 

Blood in urine: It's always significant. I'd redo the urinalysis and, assuming she's been off antibiotics for at least a week, get a culture. If the culture is negative, I might be inclined to do an ultrasound of the bladder and kidneys, and perhaps a microalbumin urine test and UPC (urine protein:creatinine ratio) (both those check kidney function).

 

Bloodwork: Looks OK to me. You can see higher cholesterol with low thyroid but her chol. isn't really high enough to get excited about.

 

Thyroid: It's a possibility, but also a possibility -1- nothing wrong at all, -2- low thyroid due to other illness (and therefore not treatable with thyroid supplements).

 

Other: Check her blood pressure.

 

Sending best thoughts for your pup!

[tbhounds]

Have you had an abdominal ultrasound done? I would also have a manual platelet count done-- make sure it's s manual count not the auto count that's included in the CBC.

I do have to comment about the proin. I almost lost one of my girls after one dose of proin. Never used it again- she ended up taking DES without problems.

Have you ever run a tick panel?

Edited October 18, 2011 by tbhounds

[duncan41]

1. Abx: she's in the middle of a "just-in-case" course of Ciproflaxicin. Since it doesn't appear to be having any effect, would it be wiser to stop now and have the repeat urinalysis done sooner or wait and see if the abx change anything?

2. Is cystocentesis preferred to a clean catch for a good culture?

3. Tick panel was done twice during ARF (Feb 2009). All negative.

4. What is normal blood pressure for a Greyhound?

5. Last ultrasound was done in 2009 during her 6 month, post ARF check up.

 

I just rechecked the bruisng with an LED flashlight. They look much better! I think the pink tones of the artificial lighting in my house exaggerated the red tones in her skin with less definition but when the blue tone of the LED hit the bruises, they took on definition and appear to be 50% less intense than this morning! Will reserve further enthusiasm until I get a good look at her in a full roach.

Edited October 18, 2011 by duncan41

[Batmom]

I'd stay the course of the Cipro.

 

Greyhound bp can be mildly elevated (@ 10% IIRC) over other breeds. You also have to allow for some white coat syndrome (bp is higher at the doc's office).

 

It might be worth having the same clinician redo the ultrasound? If it was digital, then could be compared with current, and that might tell you something.

 

FWIW, my angel Zema had some incontinence when fed commercial dog food (including prescription low-salt food). Fed a homeprepped, limited ingredient, very low salt diet, the problem disappeared. She did have high blood pressure which no doubt contributed, and she didn't have the on-again, off-again symptoms your pup is showing.

 

Glad the bruising is maybe better and no worse.

[MaryJane]

Did you by chance see them take the x-ray - reason I ask is that the bruising might have been caused by a bit of rough handling. As others have already noted, you might want to have the platelets checked just in case.

 

On the urinary incontinence - I noticed that she had a UA but, did she have a culture? Did the vet suggest putting her on cranberry pills?

 

As to the blood in urine - it indicates irritation and the cause of that could be the reason for the incontinence.

 

The red raspberries extract - you might want to discontinue for a bit until you can check whether it could be having an aspirin like effect (causing bleeding).

 

RED FLAG - also seeing the omega 3-6-9 (in addition to the red raspberries) and if this is from fish oil then that could also has "aspirin like" tendencies for bleeding.

[macoduck]

Regarding the odd cycle of incontinence - hormonal maybe? I wonder if there's a possibility that some girlie parts were not completely removed during her spay.

[3DogNite]

I need to think on this, but what Batmom says: platelet count! the bruising is not good! and tbhounds says: ultrasound ~ and i think the tick panel is a good test to do~~ these things sound like a really good starting place.

 

I'm going to consult my "voo-doo" people and see what they come up with, and get back to you. I'll be emailing you

 

in the mean time to sweet Suze

and a for you!!!

 

sorry you are starting down this road of diagnostics.

I hope we can find a good reason for all the abnormalities!

 

stay strong and positive!!!

L-

[Guest LindsaySF]

I don't have anything to add that Batmom and Tbhounds didn't already mention. Just wanted to pop in and say that Sophie has been on DES for a year with no problems. So that might be an alternative, if you rule out a medical cause for her incontinence. Oh and if she still has anything off in her urine after the course of antibiotics, I'd insist on a urine culture. Good luck!

 

 

 

 

 

[duncan41]

Did you by chance see them take the x-ray - reason I ask is that the bruising might have been caused by a bit of rough handling. As others have already noted, you might want to have the platelets checked just in case.

 

On the urinary incontinence - I noticed that she had a UA but, did she have a culture? Did the vet suggest putting her on cranberry pills?

 

As to the blood in urine - it indicates irritation and the cause of that could be the reason for the incontinence.

 

The red raspberries extract - you might want to discontinue for a bit until you can check whether it could be having an aspirin like effect (causing bleeding).

 

RED FLAG - also seeing the omega 3-6-9 (in addition to the red raspberries) and if this is from fish oil then that could also has "aspirin like" tendencies for bleeding.

 

Didn't see the x-ray process, but from the position of the largest bruise, it is most likely from being held down. The smaller, petechiael bruises were of more concern, but since they have disappeared, and the other bruising seems to be resolving, I am leaning toward a little rough handling. BUT, I will have a platelet count done by hand tomorrow.

UA was from a clean catch. No culture. There was a trace of protein in the sample (dip stick test); the reason for the follow up Comprehansive CBC, Chem 25, and a "real" urinalysis. Only a trace of protein in the follow up UA. Culture will have to wait until the abx are gone.

 

Will discontinue the omegas and the red raspberry seed antioxidant.

[duncan41]

Regarding the odd cycle of incontinence - hormonal maybe? I wonder if there's a possibility that some girlie parts were not completely removed during her spay.

 

I thought the exact same thing! But I was told that if there had been some girlie parts left behind, they would actually have the reverse effect if this is indeed spay related incontinence. Any remaining girlie parts could be a source of estrogen which should lessen the incontinence, not aggravate it.

[duncan41]

I need to think on this, but what Batmom says: platelet count! the bruising is not good! and tbhounds says: ultrasound ~ and i think the tick panel is a good test to do~~ these things sound like a really good starting place.

 

I'm going to consult my "voo-doo" people and see what they come up with, and get back to you. I'll be emailing you

 

in the mean time to sweet Suze

and a for you!!!

 

sorry you are starting down this road of diagnostics.

I hope we can find a good reason for all the abnormalities!

 

stay strong and positive!!!

L-

 

Thanks! I needed that! Yes, first thing in the AM I will be asking for a referral to my favorite specialty clinic for an ultrasound and whatever else they recommend.

 

Question: Should we ask to see the same Internist who treated her ARF or his boss in order to get some "new eyes" on the subject?

[duncan41]

I don't have anything to add that Batmom and Tbhounds didn't already mention. Just wanted to pop in and say that Sophie has been on DES for a year with no problems. So that might be an alternative, if you rule out a medical cause for her incontinence. Oh and if she still has anything off in her urine after the course of antibiotics, I'd insist on a urine culture. Good luck!

Thanks!

Ah, yes, the subject of DES. My Vet gets a look of horror in her eyes when the subject of DES comes up. She doesn't like to be pushed, so I haven't grilled her under a spotlight about why she reacts that way. I have read that it can promote bone marrow suppression, but that's usually associated with a much higher dose than would normally be prescribed. Normal course is 5 days on then off until the first sign of leakage and that determines the time inbetween doses? So if there are 5 days between episodes, the dose would be given on day 4.

 

Is there something else that I should know about DES side effects?

Edited October 18, 2011 by duncan41

[JJNg]

Ah, yes, the subject of DES. My Vet gets a look of horror in her eyes when the subject of DES comes up.

Probably depends on when she went through school, and the instructors she learned from. I remember being taught the risks of bone marrow suppression, and that PPA should be the first line drug. In practice, I find that many vets still use DES as their first line drug, and feel it is safer than PPA. There are even many experts/specialists who say that while bone marrow suppression is a hypothetical possibility, they have never seen it happen when used at the typically prescribed doses.

 

I'm also hoping to see more info on the new medication, Incurin, that was recently FDA approved. It's another estrogen product, has been around in Europe for a while, and is supposed to be shorter acting and safer than DES. I believe it needs to be dosed daily. It's supposed to be produced by Intervet, but when I asked our rep about it a few weeks ago, he didn't have any new info on when it might actually be available.

[duncan41]

Have an appointment with an internist on Thursday at 9:00 am. Here's my "grocery list":

1. Abdominal ultrasound

2. Manual platelet count

3. Microalbumin urine test

4. UPC

5. Blood Pressure

6. Tick panel

7. Von Willebrand screening. I threw this one in at the last minute.

8. Am contemplating having a complete thyroid screening done by MSU or Hemopet.

 

Any other suggestions? Thank you all so much!

[3DogNite]

That is quite a list, but it should get you to the answer!

keeping you and Suze in my prayers that the diagnosis is quick and an easy fix!

 

:goodluck

[KF_in_Georgia]

In case of future bruising, you can circle the bruises with a Sharpie and snap a photo. Then use that for future reference in terms of whether the bruises are expanding (extending beyond the marker lines) and getting darker.

[tbhounds]

Urine culture??

[duncan41]

Urine culture??

 

Yes, my Vet added that to my list when she called to confirm the referral.

 

Another observation on my part: Suze is quite the hotbox - seeks out the tile instead of her nice cushy bed. If she lays on her right side (which is about 95% of the time), I can guarantee you that she will have a release. She had one earlier that was less than 2 hours since she was let outside. Yet, after cleaning her up, she bribed her Dad for some banana, plopped down on her left side and slept for 2-1/2 hours, and not a drop. I watch her like a hawk and have never seen a time that she has had a release while laying on her left side. Is it just a coincidence?

 

In case of future bruising, you can circle the bruises with a Sharpie and snap a photo. Then use that for future reference in terms of whether the bruises are expanding (extending beyond the marker lines) and getting darker.

That's a great idea! I didn't' think about marking for changes - I did take several progression photos but used a photo wizard program to draw circles around the images, not on the dog. I will be sure and do that if it should happen again. Thank you for the suggestion!

[duncan41]

Update Post# 1.

[KF_in_Georgia]

He's a little concerned about the BP, but it was done at the end of the appointment, and even though she is extremely stoic, he said he could tell she was pretty stressed, so will repeat it when we take her back 5 days after the Cipro is gone.

 

When she gets her BP checked, face her away from any doorways where she can see people passing. When Sam's at the vet, he watches the crack under the door and if he sees feet passing the door, it's as if his prey-drive kicks in and his heart and respiration skyrocket. (And this is a sedate 11-year-old who's never raced or lure coursed or otherwise chased prey.) I have to turn Sam's head and nestle him against my chest so he can't watch the door so the vet can get a semi-normal set of vitals.

 

[duncan41]

He's a little concerned about the BP, but it was done at the end of the appointment, and even though she is extremely stoic, he said he could tell she was pretty stressed, so will repeat it when we take her back 5 days after the Cipro is gone.

 

When she gets her BP checked, face her away from any doorways where she can see people passing. When Sam's at the vet, he watches the crack under the door and if he sees feet passing the door, it's as if his prey-drive kicks in and his heart and respiration skyrocket. (And this is a sedate 11-year-old who's never raced or lure coursed or otherwise chased prey.) I have to turn Sam's head and nestle him against my chest so he can't watch the door so the vet can get a semi-normal set of vitals.

 

 

They always know where the door is, don't they?

 

Suze was actually already laying down before the tech came in to do the test. I'm telling you, this girl is really, really stoic. The way this clinic was set up, there are two walls and a hallway separating the exam rooms from the lobby and the exam rooms are on the opposite side of the building from ICU. This building was constructed as an animal specialty hospital - the attention to detail is amazing! You can't see or hear anything in the exam rooms!

 

Can anyone out there tell me about their experience with diabetes insipidus? Initial symptoms, diagnosis, living day-to-day? DI and Cushings were placed on the list of possibilities. To start, we were asked to monitor her water intake. Having read descriptions of dogs draining water bowls repeatedly throughout the day, how much is "a lot" of water for a Greyhound?

Edited October 22, 2011 by duncan41

[Batmom]

BP: I wouldn't be concerned about a vet's office reading of @ 180. IIRC 160-180 is high normal for a greyhound.

 

Drinking: For a 75 lb dog of moderate activity level, up to @ 12-13 cups per day would be considered normal. So for a 60-65 lb female, maybe @ 10? I'd have to check on the multiplier for that. Usually with DI the dog is drinking considerably more -- as in, draining bowls every time they're filled. LindsaySF has a DI dog and could provide more info.

 

 

 

[duncan41]

This isn't even close to being scientific, but I put 5 cups of water in each of the three raised feeder/water stands yesterday morning at 6:00 am and this morning there was a total of 6 cups left, so 9 cups of water was consumed by 3 dogs (68, 66 and 72 pounds) in 24 hours. There was an additional 2/3 cup added to each of their two meals.

By coincidence, (or rmaybe not since she doesn't feel good), Suze has been drinking exclusively out of her own bowl lately. If I use very flawed logic, since there was exactly 1 cup of water remaining in her bowl this morningl, she consumed 5-1/3 cups of water yesterday.

 

I know I'm trying to make myself feel better, but if Suze really does have DI, wouldn't it be likely that ALL 15 cups of available water would have been gone in 24 hours?

Edited October 22, 2011 by duncan41

[Batmom]

Your logic seems pretty sound to me . Really hoping all this is due to UTI and then taking antibiotics (and maybe not feeling 100% because of the meds), and she will be back to herself soonest.