So Frustrated! Lots Of Testing, No Answers

[Guest greytsunshine]

My poor Max, 11 1/2 years old, has been tested beyond belief and we still don't have an answer to why he's peeing in the house! It started here: Previous Post

 

So that initial workup showed a urinary infection and hypothyroidism. He's on thyroid meds & that's all fine now. For the urinary infection, they gave him antibiotics based on the sensitivity test they ran. Retested for urinary infection after antibiotics finished and came back clean.

 

Due to the ongoing problem since that post, Max has had 2 more urinary tests & cultures (one of them cytocentisis), 2 ultrasounds (one performed by the specialist), multiple prostate exams & antibiotics for suspected prostatitis (recent ultrasound shows prostate is fine), multiple blood tests, kidney x-ray and probably other stuff that I can't remember now.

 

His regular vet did quite a bit of work ups and then sent Max to the specialist, who had to repeat most everything and then some. That's where we are now, waiting for the most recent complete blood workup. (This blood workup was clean previously, with the exception of the thyroid issue. The specialist wanted to run it again because it's been about two and a half months since the first one.)

 

After spending so much money and time, everything shows up FINE!!

 

Yet, last night he peed right in front of the door to go out without barking. My husband is now sleeping on a mattress downstairs so that he can let him out quickly but Max didn't even bark to go out! I'm getting ready to buy a portable steam cleaner & just deal with the accidents.

 

Thoughts?

[jetcitywoman]

Have you tried incontinence meds like Proin?

 

I feel for you, I have the same problem with Capri, but she's only 8. We have an appt with a behaviorist tomorrow and in the meantime we've put down one of those hard plastic chair mats with a towel over it in the place where she pees. Towel is easy to launder, and the mat protects the carpet. It looks like heck, though.

[4My2Greys]

I don't have an official diagnosis of what is causing them, but I'm going to share with you what has worked to eliminate Nadir's daily accidents. After numerous tests and no cause found I ask my vets to try him on gabapentin because I believe his accidents are caused by painful bladder syndrome. He also exhibited the same behavior of sudden urination like Max. It took a few days for the gabapentin to start working, but now the only time he has a problem is if I forget to give it to him or he eats something he shouldn't.

 

Edited to add that Nadir is 11-1/4.

Edited November 9, 2012 by 4My2Greys

[GeorgeofNE]

And the same basic answer as 4My2Greys with my 10 year old. Thousands of dollars of tests--as long as he gets an NSAID and his Gabapentin, he is FINE all day while I work (9 hours). If I even lower the dose by 25 mg., he can't hold it.

 

No answers, just more questions. I frankly could not care less WHY. All I know is what works. He apparently has something that pains him, and the drugs stop it. The pain makes him unable to hold his urine. No pain = no pee. Works for me!

[tbhounds]

Long shot---check the thyroid gland very carefully---have your Vet palpate it very carefully---my girl was what a thought developing spay incontinence--turned out she had a thyroidcarcinoma. After surgery the excessive drinking and urinating compleley stopped. Also, I assume they ruled out Cushings?

Edited November 9, 2012 by tbhounds

[Guest greytsunshine]

Interesting about the gabapentin. I'll also ask about proin. Vet did say that his bladder sits "low in the pelvis" but since he doesn't dribble randomly, meaning he gets up & walks down 3 stairs to the other room before he pees, she's inclined to think that's not the problem.

 

The vet specialist mentioned Cushings so I assume that will be ruled out with the latest bloodwork? Forgive me, but it's all starting to blend together...

 

Hmm...also need to ask about thyroid palpation.

[duncan41]

Do not give Proin without making sure that Max does not have high blood pressure, AND, do not, under any circumstances, give Max the dose based on the standard recommendation. Greyhounds have been known to have grave reactions to Proin. I know. I have one who did.

 

I would explore the recommendation by 4My2Greys and Susan before doing anything else. If that proves unsuccessful, I would explore I-therm treatments next. It cured my girl's incontinence.

[JJNg]

I wouldn't consider Proin unless he's actually showing signs of incontinence - dribbling urine, leaking while asleep or lying down so that there's a wet spot under him. If he always stands up and gets into position to urinate, he's not incontinent and medication like Proin is inappropriate.

 

Does he drink a lot and urinate more frequently than what you would consider normal? How long can he go between trips outside (or accidents)? Is there a chance it started as a medical problem but has now become a housetraining/behavioral issue?

Edited November 9, 2012 by JJNg

[Guest greytsunshine]

JJNg,

Yes, he drinks a lot & urinates more frequently than he ever used to. Vets say his urine is very "dilute". We were wondering if it's exactly as you suggested, a bad habit. He doesn't dribble or pee while he's sleeping. He typically sleeps in the living room and has never peed there. He pees in the room where the backdoor to the yard is, sometimes right in front of the door.

 

Also, he has ALWAYS barked to go outside. (We trained him to do that when we first adopted him.) In the past 3 weeks, he has peed in the house 3 times without barking, twice when we are either in the same room or the next room! Very out of character for him.

 

ETA: Sometimes he can go 8 hours without going outside (ex. all night) and other times he'll need to go out again after a couple hours. Most of the time, he really needs to pee & runs out to do his business. Rarely, he wanders, sniffs, etc before getting down to business.

Edited November 9, 2012 by greytsunshine

[JJNg]

If he's drinking a lot, urinating more frequently, and has dilute urine, then it's not completely behavioral/loss of housetraining. If all the standard testing is normal, some of the possibilities include diabetes insipidus, psychogenic polydipsia, early kidney disease, or may even be secondary to stress. You might consider asking your vet about a trial treatment for diabetes insipidus with vasopressin (desmopressin, DDAVP).

 

Especially with an older dog, if you can't get to the bottom of this, management may be your best option - frequent trips outside and minimizing mess and aiding with clean up by putting down a non-absorbent barrier and towels as jetcitywoman suggested.

[cleptogrey]

If he's drinking a lot, urinating more frequently, and has dilute urine, then it's not completely behavioral/loss of housetraining. If all the standard testing is normal, some of the possibilities include diabetes insipidus, psychogenic polydipsia, early kidney disease, or may even be secondary to stress. You might consider asking your vet about a trial treatment for diabetes insipidus with vasopressin (desmopressin, DDAVP).

 

Especially with an older dog, if you can't get to the bottom of this, management may be your best option - frequent trips outside and minimizing mess and aiding with clean up by putting down a non-absorbent barrier and towels as jetcitywoman suggested.

excellent suggestion!

we did the trial treatment for DI, w/ vasopressin tannate- worked wonders and save us many many dollars since testing is quite intense and $$$. for some reason my male responded really really well after 2 shots(a month apart) and symptoms were gone. DI is well described in the handbook for racing and retired greyhounds. my vet even used their lisitng of # for comparison when treating my pup last year.it's availabe in paperback thru amazon. i bought it at one of track stores- abeline, ks- i think.

[Guest 2dogs4cats]

The drinking, peeing and diluted urine makes me think kidney problem. Did you get a specific gravity with first urine? In the early stages, the blood work can be all normal.

[Guest greytsunshine]

Diabetes Insipidus was mentioned by his regular vet but he wanted to rule out other medical causes first. I think we are approaching that point.

[NHNora]

My rabbit went thru a similar issue, and after loads of clear tests, the vet calculated how much water he should drink each day. For 2 years I have been measuring water every morning and dispensing it throughout the day, and no more peeing outside the litter box. He's had a clean bill of health ever since! They figured it became a behavioral issue after the first real UTI.

[Guest greytsunshine]

So, the most recent blood panel came back all good. The vet wants to do a trial run (14 days) of Oxybutynin (Ditropan) which will allow his bladder to hold more urine.

[GeorgeofNE]

So, the most recent blood panel came back all good. The vet wants to do a trial run (14 days) of Oxybutynin (Ditropan) which will allow his bladder to hold more urine.

 

But what about the urine panel? Is his urine still dilute? Have you measured his intake?

 

I'm a bit perplexed why in five years no vet has suggested this drug for my dog--so off to Google it and find out why!

[Guest greytsunshine]

The "urinalysis and culture results were normal" but she did say his urine was dilute. There was no talk (from the vet specialist) of measuring his intake, etc. That was mentioned by his regular vet a while ago as a possibility before he referred us to this specialist.

 

I have to say that I'm a little confused about the new med...

[tbhounds]

It doesn't sound like he vet is addressing the underlying condition.

[Guest 2dogs4cats]

If it was my dog, I would withhold water and then run a specific gravity on the urine. You will get a better idea about kidney function. Diabetes would show up on the blood work.

[jetcitywoman]

This still sounds exactly like what we're dealing with on Capri. We noticed that she sometimes drinks the whole bowl of water at a shot, so were worried about her being pre-diabetic. An internist had us do a fluid intake test, and that ruled it out. She drank 5 cups and he said that a dog her size should drink 7 - 8 cups in a 24 hour period.

 

Unless you have too many pets to control, a fluid intake test is easy to do. For 24 hours, measure how much water you put into the bowl each time and measure how much is left before you replace it. That will tell you how much he's drinking.

[JJNg]

It doesn't sound like he vet is addressing the underlying condition.

 

That was my thought as well after I looked up oxybutynin, which wasn't a drug I was familiar with. It's used for urge incontinence, which is lack of urinary control due to muscle spasms in the bladder. Here's a good site with more info about oxybutynin. Urge incontinence is very rare in dogs, and for that to be the primary diagnosis, the dog would have to be normal otherwise. This drug would not address any underlying problem is causing the increased drinking and increased urine volume.

 

If it was my dog, I would withhold water and then run a specific gravity on the urine. You will get a better idea about kidney function. Diabetes would show up on the blood work.

 

I would caution against withholding water in a dog who is drinking and urinating a lot. If the problem is primarily increased urine production, the dog can become severely dehydrated very quickly. Water deprivation tests have mostly fallen out of favor because of the potential risks, and when they are done, the patient has to be monitored very closely.

[macoduck]

Regarding the dilute urine finding, was the test sample from an early morning fresh catch or later in the day?

[Guest greytsunshine]

It doesn't sound like he vet is addressing the underlying condition.

 

They've run so many tests & everything is coming up negative. He seems fine otherwise, no vomiting, diarrhea, fever, no other symptoms.

 

It doesn't sound like he vet is addressing the underlying condition.

 

That was my thought as well after I looked up oxybutynin, which wasn't a drug I was familiar with. It's used for urge incontinence, which is lack of urinary control due to muscle spasms in the bladder. Here's a good site with more info about oxybutynin. Urge incontinence is very rare in dogs, and for that to be the primary diagnosis, the dog would have to be normal otherwise. This drug would not address any underlying problem is causing the increased drinking and increased urine volume.

 

If it was my dog, I would withhold water and then run a specific gravity on the urine. You will get a better idea about kidney function. Diabetes would show up on the blood work.

 

I would caution against withholding water in a dog who is drinking and urinating a lot. If the problem is primarily increased urine production, the dog can become severely dehydrated very quickly. Water deprivation tests have mostly fallen out of favor because of the potential risks, and when they are done, the patient has to be monitored very closely.

 

The med choice seems odd to me. The regular vet called while I was out & I plan to speak with her & see what she thinks.

 

Regarding the dilute urine finding, was the test sample from an early morning fresh catch or later in the day?

 

Two samples were later in the day & the third & most recent was a cystocentesis.

[Guest greytsunshine]

Ok, so just talked with Max's regular vet & she says that they've ruled out the big, bad & ugly possibilities (kidney infection, kidney disease, tumors, diabetes, etc). We knew that. So, at this point, we can either do more testing to try to narrow it down or try the meds. If the meds don't work within a couple weeks, then we can always do further testing. That's the route we'll go.

 

Thanks for all your replies & advice & I'll keep this updated!

[NeylasMom]

No idea if you will see this, but if you do, did you ever find a cause or solution?