I am about to lose my sanity.
Heidi is a great dog. She is obedient, trainable, smart, calm, and everything else I always wanted in dog - including housebroken. That is, until recently.
Her urine culture grew e .coli - A TON of e.coli. This is the most common bacterial isolate of dog and cat urinary tracts, likely due to contamination of the vulva with fecal matter and bacterial migration up the urethra. This was probably especially true in Heidi. She's been in heat for the last week, and her vulva was enormously swollen. It is likely that fecal matter caused a UTI.
The sensitivity showed that luckily, the e. coli was sensitive to pretty much every antibiotic. I started her on Clavamox - a penicillin (amoxicillin) that has been clavulanated to improve its efficacy against nasty little microbes. Within 2 days, Heidi should have been on the mend.
She's not. She's still urinating and drinking massive quantities, going out every 3 hours, and still losing control in the house. It's not small accidents, either - we're talking 2 liters of dilute urine. Oddly enough, it seems to only happen when she sleeps. She always wakes up in a pool of urine. She was spayed on Tuesday, and the vet that did it mentioned that her bladder was massively distended in surgery. I noted the same thing when I ultrasounded her to obtain a urine sample. Despite having just urinated about 2 gallons in my car, she had a huge bladder.
I'm starting to REALLY worry that the urinary tract infection was a symptom of a larger problem. Pyelonephritis? Cushing's disease? A urine retention problem? I have no anwers at the moment, only frustrations. And dog beds soaked in urine.
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hmmm if she were my dog and you were my Vet I would get you to pull some blood, run a full panel and include an ACTH stim test. That will rule out Cushings and Addison's... not that I am a Vet but I am just saying....
Elizabeth: With her being sick, I cannot currently test her for those diseases. A state of illness, such as a UTI, will interfere with cortsiol production naturally and give you false positive results (esp on the low dose dex suppression - the gold standard for diagnosing Cushing's). Addison's is certainly a possibility, but again, I can't do much about that unti the UTI is cleared up.
Is this Euthyroid sick syndrome? I know that this can cause issues when trying to diagnose Hypothyroidism and often newly diagnosed Addison's dog are often misdiagnosed at the same time with hypo-t or a few weeks before the Addison's diagnosis. Later further testing often finds them not to have hypo-t.
Here's a question for you, if a dog has say major abdominal surgery could that interfer with cortisol production in the same way as a UTI or other major infection?
I hope Heidi is feeling better soon.
Major abdominal surgery does cause some degree of adenocortical depression, yes. Usually, it is clinically unimportant. In septic dogs and cats however, a recent syndrome called adrenal exhaustion has been recognized. In animals that are septic, they have often exhausted their supply of cortisol, and they become pseudo-Addisonian. A physiologic dose of steroids (0.2mg/kg) can treat this condition.
Euthyroid sick syndrome is different. If an animal is sick, and the veterinarian suspects hypothyroidism, they cannot test at that point. Systemic illness lowers thyroid hormone levels anyway. You have to wait until the animal is well before you can test thyroid levels. Hypothyroidism is one of the most over-diagnosed conditions in veterinary medicine, partly for this reason.
Checked for diabetes?
All of Heidi's initial bloodwork is completely normal. There is no hyperglycemia, she did not have glucose or ketones in her urine - thus, no diabetes mellitus. I've checked for all the obvious things that cause PU/PD - so currently, I am left with the unusual - pyelonephritis, possibly Cushing's, diabetes insipidus, pyschogenic polydipsia, etc.
I'd be concerned about a neurological problem causing the urinary retention. I'm an equine veterinarian and I've seen older horses with this issue.
Hope Heidi feels better soon. I love Dobes - sweet dogs.
A neurologic, bladder retention problem is certainly on my list of r/o...I'm guessing a trip to see the IM specialist will be shortly in order.
On the bright side, this morning, she only dribbled a small amount of urine.
Only dribbling is much better... I am hoping she just needed a little longer to get better.
ok I understand that extreme stress from a UTI could cause a false postive on the ACTH and the low dose dex suppression test for Cushings because under stress they put out more cortisol. But I would not have thought it was possible to deplete their cortisol enough to get a false positive for Addison's with a UTI?
Not questioning your judgement here just trying to get my head around it.
Neurologic bladder retention? All we kept hearing in school was if we understood the micturition pathway we could diagnose better. What I remember-- UMN dz turgid bladder, difficult to express. LMN dz, large, soft bladder dribbling urine. Fits LMN dz better but I have a feeling there are a lot more subtleties than what we learned as first years-- all I remember learning about LMN dz is that it is usually the result of trauma damaging the LMNs, which clearly does not fit in this case. (I also remember that they are not strictly speaking LMNs as they are not innervating skeletal muscle under voluntary control but for some reason they get called LMNs anyways-- the whole thing was pretty confusing.)
And what is an IM specialist?
Why do our own pets always get the wierd, hard to diagnose/treat stuff? Good luck!
I misspoke, Elizabeth. You CAN test for Addison's at this point, and it is certainly a differential. Her clinical presentation is certainly not classical - but then, Addison's disease is the "great pretender." If this continues, an ACTH stim will certainly be one of the next round of diagnostics, along with an abdominal ultrasound.
Hermit Thrush: IM specialist = internal medicine specialist/internist. As for whether this is a neuro bladder - it's currently rather hard to determine. One way is to palpate the bladder and find out if it's easy or hard to express. Heidi was just spayed and pexied on Tuesday, so firm abdominal palpation is uncomfortable for her, and she becomes tense - thus, I cannot feel anything.
Ok now my head can stopp spinning.. But hey I learned a lot with the research I did on Cushings.. and we do see plenty of dogs with Addison's because of theri cushings drig treatment. So thanks for that!
I do hope it is not something serious with Heidi.
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