Phenylpropanolamine (Proin) Vs Diethylstilbestrol (Des)

[Guest HuggableHound]

The issue, my 5 year old greyhound has been diagnosed with spay incontinence. Kidney values were checked all normal. 2 different meds have been recommended

1 - Diethylstilbestrol (DES) and
2 - Phenylpropanolamine (Proin)

 

I was hoping to get your feedback on side effects, dosage and symptoms of incontinence.

Chai has been on DES since March 1st 2013, the recommended dosage was 1 every day for 2 days, 1 every 2 days for 4 days then 1 every 3-4 days for maintenance. She was having some breakthrough at every 4 days so I switched her to every 3 days, still more breakthrough at every 3 days so she has just gone through every 2 days for 4 days and today there was more breakthrough

Thank you!

Carole

Edited April 14, 2013 by HuggableHound

[Hubcitypam]

Bella was on Proin with no problems. My vet had a reason for choosing it over DES in her case, but I forget what it was. I'm old and can't remember what she started at, but I was able to wean her down to 1/2 once a day. My vet said there are 3 kinds of dogs - those that need DES or Proin for the long term, those that need it only for a short while and the largest group that can be weaned down to a low dose. He told me "you be the vet" and if she was having problems on a lower dose take a step back up.

[krissy]

Proin is usually my first choice. Less blood monitoring. With DES blood work needs to be done many times in the first year to make sure there isn't estrogen toxicity causing bone marrow suppression. If Proin alone doesn't work then I double up with DES. Kili is on Proin following all her urinary surgery. Hopefully she will be able to come off it eventually.

 

The one thing that sucks about Proin is it is given 3 times a day. Many dogs can be taken down to twice a day. Versus patients that I DO have on just DES are lucky to be only giving it once a week.

[RaineysMom]

Rainey was on DES -- from what I've heard, Proin can be dangerous. IIRC ( and this was many years ago) she was on like 1 pill every day for 7, then every other for a week, then every 3, etc. until every 5 days. We never had any breakthrough thankfully, and we were able to go to 1 pill a week with no issues. She was on it for the rest of her life, and the last year or so she did start peeing in the house every single day but that was due to a brain issue (she developed epilepsy from the brain issue) and not the DES. While I can't be 100% sure the DES wasn't the cause of the later life peeing, I know in my heart it was the brain "thing" going on. Maybe you need to adjust the dosage?

[MaryJane]

This is funny because I've just had the same issue with my Lucy ...

 

Lucy went on DES and in her case, DES is preferred because she is a seizure girl and Proin may have a tendency to cause seizures. Proin can also cause issues with blood pressure and it might not be obvious that thee is an issue. DES might cause bone marrow suppression so there is a need to do blood work to check values (check gums often).

 

We started with a loading dose of 1 pill every 5 days, by day 3 the incontinence was gone. After the 5 days, we were supposed to switch to 1 pill every 7 days. On day 6, first day without pill, she had incontinence again. Talked to vet and the new procedure is to now do it every other day for 6 days and then every third day for 6 days and keep on decreasing until I'm giving the pill every 5 days.

 

I did briefly talk to one of her other vets a while back and his procedure was to start with a pill every day for 7 days and then do every other day for 1 week and then every second day for 1 week until it ends up being a pill every 5 or 6 days. It sounds like I should have used this procedure instead of the one from the prescribing vet ....

 

You might not be aware that there is a new hormonal (?) pill available but, more expensive and they need to take it daily.

[tbhounds]

May want to check out incurin :-)

[GreyPoopon]

I can echo what krissy said from the client perspective: Proin is a pain, especially if you have to give it a third time (the first two can go on meals), but blood tests for DES are an expensive pain. I've had pretty good success with Proin in some dogs, but others have trouble with it (diarrhea). At the moment, I have one on Proin and one on DES who seems to require it every 4 days.

[tbhounds]

Just want to add that while you need to be proactive about monitoring your hounds CBC when using des, bone marrow suppression would be an extremely rare accurance as the dose used for spay incont is a very, very low dose.

One dose of Proin almost killed one of my girls-you will never find it in my cabinet again.

[duncan41]

Three doses of Proin caused one of mine to go into acute renal failure. Never again.

[SarahsBlackPack]

My now 10 year girl Anel was diagnosed with spay incontinece at the age of 7 or 8, I don't remember which one any more. She's been on Proin since her diagnose with no probelms.

[KF_in_Georgia]

With Proin, watch for behavioral anomalies. My Jacey took it for about two days. Then I noticed she was pooping lots of white hair: she'd licked her thighs and back legs nearly bald. (She was a cow-doggie with patchy hair, so this wasn't as obvious on her as you might expect.)

 

Jacey had some behavioral problems to start with. She'd been through drugs and behavior modification for separation anxiety and she'd beaten the SA. When her behavior went "off" on the Proin, I told the vet never mind. We'd live with the incontinence, which was mild and actually cleared up on its own after a couple of months.

[Guest HuggableHound]

Thanks everyone.......I'm very concerned about the bone marrow supression, while she's on DES, which doesn't seem to be doing the trick even at every 2 days she's still having breakthrough so I'm going to get an appointment with her vet, get her blood work done again and make inquiries about Incurin.

[Batmom]

Assume she was checked and double-checked for urinary tract infection?

[Guest HuggableHound]

Yes, she was checked and double-checked for UTI

[CaliforniaGreys]

I have no experience at all with incontinence but what confuses me about that as a dx is, why can Chai hold it all night long with no issues? If she were truly incontinent, would she be able to hold it all night like she does? And the other thing that makes me wonder about the dx is the amount of times she needs to go out to pee and the amount she pees every time.

[Batmom]

I have no experience at all with incontinence but what confuses me about that as a dx is, why can Chai hold it all night long with no issues? If she were truly incontinent, would she be able to hold it all night like she does? And the other thing that makes me wonder about the dx is the amount of times she needs to go out to pee and the amount she pees every time.

 

Those are some good questions.

 

In classic incontinence, the dog involuntarily leaks urine when relaxed/asleep. If that is not what you're seeing, chances are that's not what she has and incontinence meds would create a risk of side effects without providing any benefit.

 

Is she going out often/seldom, peeing a little/a lot?

[Guest HuggableHound]

I walk Chai twice daily (8 and 4), long walks about 1/2 an hour and then she also goes out around noon and 2 or 3, she will mark many times on her walks and pee at least twice and I do believe she is emptying her bladder as when she marks the 4th or 5th time, there is barely a drop coming out. During the day, she doesn't have any accidents. It seems to be a window of around 5-7 when her accidents occur, not long after her walk at 4. She will have her after walk nap and soak through a double layered heavy fleece blanket on the couch or a fleece blanket, duvet with cover right through to the sheet underneath on my bed. She will then bug to go out and have what I consider a full pee. These 5-7 incidents is what I consider the oddest. Her last out may be at around 7 or 8 pm, she pees and doesn't go out until her walk at 8 a.m. and she has never had an accident during the night.

Originally when this started almost a year ago, she was treated at the vet twice, both times administered meds for a UTI but without a culture, just with a free flow sample taken right as I walked into the vet's office. Both times when on the meds her sporadic peeing at 5-7 stopped completely.

I have stopped giving Chai the DES as of 2 days ago as I was also worried about the risk of giving her something that is 1) not helping and 2) a med that is possibly incorrectly diagnosed.

[duncan41]

If she were mine, I would continue to withhold the DES and treat her as if she has a UTI. If the leaking stops, I believe you may have an answer.

 

Please look into I-therm. It cured my girl's 24/7 incontinence. I'm not a hocus-pocus kind of person, was totally skeptical but desperate. Proin caused her acute renal failure, and she also had a clotting disorder so DES was not an option, either. I was the happiest person on earth when the leaking totally stopped after the third treatment. Remission lasted 6 months at which time the leaking started again, so 3 more treatments and she was again leak free and remained so until the end.

[Guest HuggableHound]

I'm going to take her in this week and insist on an extracted urine sample, even though the last 2 free flow samples came back quote unquote crystal clear. I am at the point that I need to start ruling things out and working towards solving this.

[Batmom]

If you're going to do that, get it cultured. Also get a blood pressure check if you haven't had one.

 

 

My angel Zema had a similar problem -- fine at night, fine most of the day, frequent peeing with leakage for a period in the late afternoon - early evening. She did drink a good bit prior to that period so that may be a difference. In her case, the problem was 99% solved by changing to a low salt, limited ingredient, homeprepped diet. Her problem wasn't the oft-maligned "grains." There appeared to be something in commercial food that irritated her system and caused her to drink more than she needed, have to pee a lot, and leak. I tried for awhile to figure out what it was and then gave up. She was happy, healthy, and dry on what I fed her; really didn't need to know more than that. I'm not suggesting that's your girl's problem but it might be worth looking into if all else fails. Best luck!

[CaliforniaGreys]

I too would insist on them growing a culture. The fact that an antibiotic fixed the issue is a clue in itself. And the culture might just show that the first antibiotic she was on was not the correct one to knock out the bacteria

Edited April 16, 2013 by CaliforniaGreys

[Guest HuggableHound]

 

You might not be aware that there is a new hormonal (?) pill available but, more expensive and they need to take it daily.

Is that Incurin?

[MaryJane]

Is that Incurin?

 

Yes, it is - couldn't remember the name. If you try it let us know how it goes .....

[Guest HuggableHound]

Update:

Culture just came back this morning and nothing came up in her urine. Which is good but still doesn't tell me what is going on with Chai. So I talked to the vet, went through the whole story about her peeing and his next step is an xray on her kidneys and bladder to see if there's anything going on there.

So for the time being, it's pee pads everywhere until we can get this sorted out.

[duncan41]

Would an ultrasound yield more complete information? If there is something "suspicious" on an x-ray, ultrasound will be the next step anyway.