Vet Stumped - Frequent Drinking/urination And Thin Coat

[Guest mhall]

Jasper is having some medical problems that our vet can't figure out. Hoping you all can give me some suggestions for how to proceed.

 

A few months ago his coat started getting thinner. It's always been a little thin in a few spots, but now his butt is completely bare and in the past week or two he's developed bald patches on his neck. He also started drinking far more water than usual, and has needed to go outside up to 10 -15 times a day. Even with all the trips outside he is frequently leaking urine in his sleep, and sometimes when he gets up and walks around. He's also been hungrier than usual.

 

All of his blood work was "greyhound normal" and in spite of all of the water he's drinking he's still concentrating his urine. UA was negative (haven't done a culture, but could). The vet had been thinking Cushing's and his ALP was a little higher than last year but still well within normal limits. No high blood sugar, and no indications of liver or kidney failure problems.

 

Our vet is going to follow up with an internist and a dermatologist to get suggestions, but said an ultrasound of the liver/kidneys would likely be the next step. Any ideas what might be going on, or ideas for additional blood work or other tests? Suggestions appreciated

 

 

 

[lukasmom]

You might want to consider a consult with Dr Couto. He is the go to vet when other vets are stumped. He can be reached at coutovetconsultants@gmail.com. I believe it is $120 for consulting.

He is wonderful. He is speaking in Chicago next Wednesday and I can't wait to see him speak again.

Good luck.

My boy Luka naturally has a naked butt. I think it is kind of sexy on him but his was not caused by a health issue, he's just a naked boy.

[turbotaina]

Have you done a full thyroid panel?

[MaryJane]

Are you feeding a high protein dog food?

 

My Larry has both allergies as well as slight kidney issues and I found years ago that if he got more protein than his body could handle, he would drink up a storm and as a consequence, pee more. The same symptoms would also be caused if he had something he was allergic too (like chicken or noodles).

[NeylasMom]

Hypothyroidism, Cushing's, and diabetes insipidus would be high on my list (although you wouldn't expect concentrated urine with DI). I would just do the consult yourself with the internal medicine specialist. A full thyroid panel with MSU and a urine cortisol:creatinine ratio would be good places to start in the meantime, but this sounds like pretty classic Cushing's to me. Any pot-bellied appearance or skin changes other than hair loss (darkening primarily)?

 

ETA: If it is Cushing's, the urine cortisol:creatinine won't be all you have to do, but it's a simple non-invasive way to tell you that you're on the right track. If the test is negative then you have pretty much ruled out Cushing's (unless you want to consider atypical Cushing's, which is another ball of wax, but I wouldn't worry about that for now). If it's positive, then you'd want to consider the ultrasound and/or an ACTH stim test or dexamethasone suppression test to identify which type of Cushing's and how to treat.

Edited April 8, 2015 by NeylasMom

[Guest OPointyDog]

Our grey x GSD mix had similar symptoms and it turned out to be the adrenal form of Cushing's disease. I remember her labwork being confusing, and we had to go deeper into the testing and eventually had some imaging done of her abdomen to find the adrenal mass.

[Guest mhall]

Thanks everyone! I appreciate the suggestions and will follow up with the vet tomorrow or Friday. To the person who suggested contact Dr. Couto - we'll definitely consider it if further testing doesn't turn anything up/the internist doesn't have any other ideas.

 

Have you done a full thyroid panel?

 

Not as of yet, as his T4 was the same as it had been in previous years. Hypothyroidism would explain the hair loss, but what about the urination/drinking? I know T4 values alone are of limited clinical usefulness with greyhounds, but if they're stable is it worth pursuing a full panel?

 

Are you feeding a high protein dog food?

 

 

Fairly high protein, limited ingredient food that he's eaten for about 2 years now. He had food allergies manifest as skin issues in the past, but that was itchy raw areas not just hair loss. Did Larry develop drinking/urinating problems with a food he'd eaten for awhile, or did it occur with newly introduced, high protein things? There are limited protein sources Jasper can eat without issue and I'd hate to switch a food that's otherwise working if we don't need to.

 

Our grey x GSD mix had similar symptoms and it turned out to be the adrenal form of Cushing's disease. I remember her labwork being confusing, and we had to go deeper into the testing and eventually had some imaging done of her abdomen to find the adrenal mass.

 

Good to know - thanks!

 

Hypothyroidism, Cushing's, and diabetes insipidus would be high on my list (although you wouldn't expect concentrated urine with DI). I would just do the consult yourself with the internal medicine specialist. A full thyroid panel with MSU and a urine cortisol:creatinine ratio would be good places to start in the meantime, but this sounds like pretty classic Cushing's to me. Any pot-bellied appearance or skin changes other than hair loss (darkening primarily)?

 

ETA: If it is Cushing's, the urine cortisol:creatinine won't be all you have to do, but it's a simple non-invasive way to tell you that you're on the right track. If the test is negative then you have pretty much ruled out Cushing's (unless you want to consider atypical Cushing's, which is another ball of wax, but I wouldn't worry about that for now). If it's positive, then you'd want to consider the ultrasound and/or an ACTH stim test or dexamethasone suppression test to identify which type of Cushing's and how to treat.

 

This is very helpful - thanks. I asked about DI prior to getting the UA results back and the vet said she's looked for it a lot but in her experience it's pretty rare in dogs. I also assumed the concentrated urine made it unlikely.

 

No changes in body shape or skin that scream Cushing's, other than the hair loss. I do think he's maybe lost a little muscle mass all over, but he's also almost 9. One thing we have noticed, and that our vet commented on as well, is that he in general appears to be aging faster than his littermate sister.

 

We will definitely see the internist ourself if need be. I think our vet's hope was if they had suggestions for further testing prior to examining Jasper we might be able to avoid the trip - at least temporarily. Our work schedules and sharing of a car make it really difficult to schedule appointments during the week.

[cleptogrey]

when felix responded positively to the meds used for DI his water input was the only thing off. good coat- all of his #s of blood and urine were perfect. sounds like a form of Cushings which like addison's can be difficult to diagnose. W/ addison's they shut down- literally. Cushings is the coat/skin/water symptoms. good luck.

[XTRAWLD]

I don't have any other suggestions than what have been offered but thinking about your pup! This is a great place for info.

 

On a side note, I'm not sure if you are giving any supplements to aid in skin/coat or if its possible to fight on a dog that has Cushings. The thirst thing has me more worried than anything else.

Edited April 9, 2015 by XTRAWLD

[Blaidd49]

Yep, Cushings or thyroid top of the list to be ruled out. Both conditions can play by their own rules.

[Guest mhall]

Thanks again for all of the suggestions/good thoughts.

 

After consulting with an internist and dermatologist the thought is that Jasper has pyelonephritis and low thyroid. ALP is not elevated in about 10% of dogs with Cushing's, but given the lack of change in body shape and the non-Cushing's like pattern of hair loss (it's very thin or gone in commonly sparse areas on greyhounds - butt, legs, neck) everyone thought Cushing's was unlikely. The dermatologist said most greyhounds she sees with excessive hair loss in "typical greyhound areas" tend to be low thyroid.

 

So we're doing a full thyroid panel and a round of antibiotics. Our vet said we could do a urine culture first, but in her experience they can come up negative and a dog can still have a UTI or kidney infection that is causing symptoms. If the thyroid is normal and antibiotics don't help we'll pursue further testing for Cushing's.

[tbhounds]

I'll just say I'm glad you're running a full thyroid panel ---MSU?

[MaryJane]

Fairly high protein, limited ingredient food that he's eaten for about 2 years now. He had food allergies manifest as skin issues in the past, but that was itchy raw areas not just hair loss. Did Larry develop drinking/urinating problems with a food he'd eaten for awhile, or did it occur with newly introduced, high protein things? There are limited protein sources Jasper can eat without issue and I'd hate to switch a food that's otherwise working if we don't need to.

 

Larry went on a home-made diet shortly after I got him since he had the diarrhea problems. When I put dogs on elimination diets, I usually decrease the amount of protein in the food until I find a food that works but with him, I noticed that if I increased the protein, he drank more and pissed more (even though the diarrhea was resolved). His creat was a touch high and by itself, nothing to worry about. His specific gravity on a first morning specimen was just a tad low but, now with the creat started to hint that there might be some issues that were not fully showing themselves.

 

You don't have to change foods -- you can add in rice (white) for 1/2 the portion of the meals and see if the reduced amount of protein makes any sort of difference over a few days. I would not recommend doing this over a long-term period but, it could help you short-term identify whether the level of protein could be a problem.

[Guest mhall]

I'll just say I'm glad you're running a full thyroid panel ---MSU?

 

Our vet suggested Hemopet - any reason to use MSU instead?

 

Also, anything else you would recommend doing other than running a full thyroid panel at this point?

 

You don't have to change foods -- you can add in rice (white) for 1/2 the portion of the meals and see if the reduced amount of protein makes any sort of difference over a few days. I would not recommend doing this over a long-term period but, it could help you short-term identify whether the level of protein could be a problem.

Will keep this in mind for the future if we don't get answers/see results with what we're doing now. Thanks.

[tbhounds]

Hemopet is not considered---mainstream. MSU is typically where most clinicians tend to rely on.

[Burpdog]

 

Our vet suggested Hemopet - any reason to use MSU instead?

MSU is the known go to place and I bet cheaper than Hemopet