Excessive Water

[JMFS]

Yes, multiply those by 28 stairs and I haven't noticed any new muscles for me, lol.

Yes, it's in ounces.  I have a 32 oz measuring cup and I pour the left over water into that after each drink.  It's a bit over-the-top, but if you want good data you must persevere.  Good point on the measurement unit, I'll update my pivot table to include that.

Nothing special out out of the ordinary for Monday.  Yesterday was the only day they didn't get to play.  She eats Purina Pro Plan Puppy and is a wee piggy.  It's so difficult to tell if they're getting overweight and she was getting 4 cups per day, but I took that down to 3 - 3½ early last week because I think she was losing her waist.  Fridays are the days they get all the treats so we can go out to dinner.  I used to do peanut butter, but I've started cutting that with natural apple sauce (no sugar, just apples) to lessen the fat and salt.  Easier to put in the Kongs, too!

I've noticed her poop is very wet.  Still solid but wet.  We just got back inside and she did a 2x poo.  The first was fine, but the second was like, hmmmm, formed pudding?  It was solid, but not entirely.  I do get to squeeze her glands, too, despite solid poops.  Ugh, lol.  Hers are tougher than Gertie's and I think she needs and internal expression but I don't know how to do that one so that will be mentioned next visit.

I was hoping the husband giving her 6 oz in the morning would quell her thirst but so far it has not.  The vet hasn't responded to my message, yet, so I'll be calling a little later.  For now it's outside to go pee.

[JMFS]

All tests came back negative so I'm emailing them my spreadsheet and they're formulating a plan.  She said since 2004 she's only had one dog with a mental water issue.  Aren't We the lucky ones?  Lol.  I had a small break down yesterday.  I just wasn't sure I could do this and the husband said we need to take her back.  My heart just broke because there aren't many people equipped to handle an issue like this.  I need to put on my big girl pants, suck it up, and tackle this issue.  Then we can deal with allllll the other problems this child has.  I'm not really one to give up, and I'm stubborn to a fault.  Am I aggravated / irritated / frustrated as all get out?  Yep!  Am I going to let that stand in the way of this girl's chance for a good life?  Nope! 

The trainer from Gainesville is $275 / hr plus travel.  There is a local one, who even has a dog park named after her, who's $75 / hour, but dang if Covid hasn't caused her to put everything on hold.  I'd almost rather pay your airfare / hotel than hire this Gainesville gal (haven't actually priced it yet, lol)!  Her response email was gimmicky so I'm kind of red flagging her.  But, first things first, and that's Esther's water / holding said water. 

[JMFS]

Radiology appt tomorrow morning.  If she doesn't have kidney stones or something else they can find they'll refer us to a specialist.  I haven't even been able to work on Any other training with all the trips and accidents.  I restricted water today knowing we would be going out and she still managed to have 5 accidents (I was downstairs getting their treats together and husband was on the phone not paying attention).  Thank goodness for washable pee pads!

I'm not ashamed to admit I had a little breakdown day before yesterday.  Fortunately we're in a lull for the business, but unfortunately I'm still behind in getting people paid because I can't get more than 20 minutes to work at a time.  Crossing fingers it's kidney stones - that's something easily treatable.  The big Unknown and going to a specialist is a bit overwhelming.  I kind of doubt it's kidney stones - she's not in any discomfort and the girls are playing just as crazily as ever.  Husband keeps saying "give her back," but there are so very many reasons I keep telling him no.  I know he's just looking out for me because it's taking a toll on me with all the other things that are stressful.

[JMFS]

Xrays are showing everything is normal.  Specialist is next to see if our joking is a reality.  We've been saying it's almost as though her bladder or kidneys are being bypassed and the doctor confirmed that's an actual thing called Ectopic Ureter.  She said it Is possible it could be spay incontinence.  She gave us more trazodone for future visits.  She defecated and urinated during the x-ray but they were able to get it done.  She took the cloth muzzle okay, pawing at it half-heartedly and a verbal correction stopped that.  She also prescribed an anti-incontinence medication that I'm to give once every 24 hours to see if that helps because specialists are 3 months out on appointments.

They Did put all the notes on the receipt and the water experiment was only supposed to last 5 days.  I didn't expect it to be on the receipt so scanned and filed it.  Oops!  If I can find a wellness plan I'm going to switch Gertrude to this vet as well.  They confirmed they're still doing house calls and with us less than 5 minutes away that would be really easy for them.  The only thing I need to verify is how much water to give her and when since I'm not supposed to give it freely now.

https://www.dvm360.com/view/correcting-ectopic-ureters-juvenile-dogs

Both of the big girls are bathed and I'm showered and ready to go to sleep, lol.  All that activity sure will cure insomnia!  Crossing my fingers the medication will stave off the leaking.  I really am suspecting the bladder being bypassed because every time I've palpated for it to see if maybe I could express it to save us a trip or two I couldn't feel anything.  Now, take that for what it is because I don't know Exactly what I'm feeling for, but from the descriptions I should be able to find it if she's full and with as much as she drinks that girl should bladder should be quite taut.  Doc also said with the way Esther leaks (it basically sprays out as she's walking around) she's leaning towards the errant ureter theory.

They say 70 oz is too much for her so she's Right at the cusp with her 61 - 64.  Still trying to recall what was so special about that 80 oz day, but can't come up with anything.  Peanut butter is reserved for Fridays and I don't generally give them treats during the work week so who the heck knows.  The water drinking doesn't go hand-in-hand with the suspected incontinence causes, but she did say if she's losing all that water it makes sense she'd be drinking extra to re-hydrate.

Cross your fingers for us that the medicine works!  3 months is a long ways away and while I can sacrifice a week of work, I can't do 3 months!

[Adrienne Farricelli]

Thanks for the updates, I was wondering how it all turned out. Ectopic ureter and stones, I would imagine would have shown on the ultrasound/ x-rays, however, maybe they want you to see a specialist as they may be more skilled in reading images and may have better ultrasound machine. 

From what I know, in ectopic ureters, instead of being attached to the bladder, the ureters bypass the bladder and attach themselves elsewhere. In females, they tend to attach to the uterus or ***ina. Since none of these organs are designed for storing urine, leakage or urinary incontinence is most likely to occur. It's pretty rare, so the vets tend to leave it out and consider it only after crossing off the list more frequent causes- in other words, the "When you hear hoofbeats, think horses and not zebras" mentality. 

I hope that the medication helps keep her peeing more under control. It must be really draining for you!

[Adrienne Farricelli]

Hi Jennifer,

Was wondering how you have been coping with the excessive peeing, and whether the meds have been helping.

I hope the situation has improved as you wait to see the specialist!

[JMFS]

Gosh, it's already been 2 weeks?! 

My husband called Abbi's vet and we're getting records sent to him. He can do a dye contrast test and has a radiologist who can look at results sooner than November 30th.  That's the soonest anyone will see us, and University of Florida won't even schedule us, telling us people are calling daily to get appointments.  It's awful!  :(  It pains me to think of how many animals aren't getting treatment because of this.  That's just the appointment to get tests done.  If there's a surgery then that's going to be 2022, I'm sure!

The Proin isn't helping, but I'm still giving it in hopes it might - I'm desperate!  I'm giving her 6 oz every hour and taking her out every 30 minutes, but we still get accidents.  With the water diary she averaged around 60 oz of water so I did a little math and 6 oz is more than enough for the 12 - 14 hours she's awake.  More if they're active outside, of course.  I keep missing phone calls from the vet because our service is spotty.  They called on the 6th and I didn't get the message until the 16th.

I'm starting to think perhaps one ureter is properly attached and one is not.  She sometimes knows exactly when she has to go and she rings the bells to be taken out (attached).  Other times she just starts pacing around and that's when the leaks happen (not attached?).  I say leak but it's more like a spray and she lays it down Everywhere she trods.  A water / potty schedule helps with that a lot.

So I guess the update at the moment is that we're in a holding pattern until Abbi's vet and Esther's vet are coordinated (I'm not sure what the status is on the x-rays - they didn't send those to me, only the medical history / notes

Husband just got off the phone with Abbi's vet.  We're meeting with him tomorrow morning so maybe I'll have news.  Thank you for asking - I didn't even realize it's been so long since the last update!

[Adrienne Farricelli]

Oh, no! I was hoping that you would have had some relief. Taking her out every 30 minutes must be draining, like going backwards to early puppyhood. It's interesting how you say sometimes she seems to sense her bladder filling up and those stretch receptors at work, and other times she does not and her output is like spray. Certainly mention this observation to the vet tomorrow!

[JMFS]

So, I did mention that but yet they did Not find errant ureters.  What they Did mention was the bladder is tilted towards the pelvis.  He suggested trying estrogen in case it is spay incontinence since the Proin isn't helping.  He said we could go up in dose on the Proin, all the way up to 74 mg per day, or even split the difference and add 19 mg by splitting a pill.  I'm not keen on the Proin as the side effects can be horrendous, or fatal, and going up in dose is a bit scary.  I'm going to speak to Esther's vet about it and see if we should do only the Estrogen if the Proin isn't helping.

Off to read up about tilted bladders.  I guess I'm glad it's not surgery in her future, but at the same time there's no definitive answer and thus no course of action other than "try this."  He did mention a rarer form of diabetes, "insipidous," that we could test for.  I am keeping the Nov 30 appointment just in case we need more indepth imaging / CT Scan. 

I don't mind going out every 30 minutes Too much.  Yes, it's tiring, but eventually a rhythm is established.  My stress is that I struggle to get on / stay on task so my work is falling behind.  I'm my own boss so at least there's that, but at the same time, my husband and brother-in-law depend on me to keep on top of things and I feel badly for letting them down.  I've also been called out recently for being snippy to the husband because I'm frustrated.  😳

But!  Boy howdy, 250 mg of trazadone sure does make for a calmer Pester, er, I mean Esther.  It takes about 2½ hours to hit her and then she's cool as a cucumber.  She was growling quite meanly at a little scruffy older dog who was there.  It wasn't a playful growl.  They let us go into a room with her in case other folks walked in with other dogs and I think that worked quite well.  She could hear the voices and dogs but she was well under threshold (thank you, trazadone) and simply cocking her head to listen.  She was all grrr with the tech until she sniffed his hand and then she was okayish with him.  Best of all, she took the muzzle with barely a pawing at it.  I think we formed a positive association with doctors today.  I also think no masks helped immensely.  The older couple with the scruffy dog was sweet.  They were very curious about Esther and asking all sorts of questions and surprisingly understanding about her lack of socialization.  I daresay Educated about it!  That's a rare find.

Bonus item #2 is that he recommended the Leah gal (not the same as I was thinking about going to) and she's on the PPG site.  The doctor you and I looked at ended up being kind of gimicky like Bark Busters.  She sent me this blanket email response with all caps and bold and whatnot, which was a bit off-putting.  She was going to charge a travel fee (180 minute round trip / 150 miles or so) in addition to $275 / hour.  If she were our only option I'd do it, but when we have local folks (Letty Towles was recommended by Esther's vet and is $75 / hour and has a dog park here named after her, for example) the doc's is a hard number to crunch down on.  I'd pay you that much because I Know we'd be in good hands, but not her!  ;)

[Adrienne Farricelli]

Thanks for the update, 

Petra, my female Rottweiler, at some point started leaking as she got older leaving little-teeny pee spots in the areas where she was sleeping. The pee spots were tiny, the only sign that got my attention is that she was waking up suddenly at times and licking her private area. I remember the vet prescribed her Proin, and I too was at some point concerned about the side effects, and was going to ask the vet about an estrogen-like product such as DES or estriol (Incurin). Fortunately, in my case I found some natural supplements that helped control her leakage. 

It can get frustrating when it turns out being a matter of trying things to cross them off the list of differentials. I guess they have left DI (diabetes insupidus) for last, considering it quite rare, and therefore a "zebra." However, if there is still the possibility for this condition being at play, that's when it gets risky restricting water.

I think I mentioned DI at the very beginning of this thread, and how it's diagnosed through a trial of desmopressin, but the risk with restricting water in DI is that these dogs produce large amounts of very dilute urine and a dog who isn't capable of concentrating urine, can die from not getting enough water and consequent dehydration. As little as 4 to 6 hours of water deprivation may lead to dehydration, so keep in touch with your vet and ask whether limiting water intake is safe for her or not at this point. 

I am glad to hear that Esther is doing much better at the vet with the trazodone taking the edge off. Sounds like a nice starting point to implement behavior modification. Also nice to hear your vet vouches for a dog trainer who is member of PPG! 

[JMFS]

It gets better on the trainer.  He's going to "drop her a line" himself to let her know I'll be in contact!  Whew.  :)

Estriol is what he's recommending so I've sent that to Esther's vet to ask if they'll approve it through Chewy along with titrating Proin up to 54mg per his recommendation.  You're so right - we're at almost $1,000 to get an "I dunno" answer.  The money isn't a problem, it's the solution to money ratio that's disheartening. 

He didn't seem concerned about the 8 oz every 30 - 60 minutes depending on output (she outputs, I input) and was curious whether it was helping.  It does cut down on the accidents as it puts us on a predictable schedule, but at the same time with your warnings I'm constantly watching for signs of dehydration.  She's no longer licking the grass or pulling on the leash to get to puddles so I'm taking that as a positive sign that she's getting enough.

The Strangest thing about this is she can hold it through the night and hasn't wet the beds in months.  I give her water up until midnight, then enough to wet her whistle before bed, then the husband gives her 8 oz between 7 and 8:30 am so I can sleep.  So the longest she goes is 7 - 8 hours with a small drink in between.  I would expect a truly incontinent dog to wet the bed so maybe it's only when she's standing?  Like laying down pinches off the flow?  I have no idea and am grasping at straws at this point.

Petra's behavior is what the girls do when they have "fish butt" aka full glands.  They'll hop up out of a sound sleep and start licking.  Esther did that when she was younger with peeing, but it hasn't happened in some time.

[JMFS]

So no eptopic ureter - it's been definitively ruled out.  Here's the report:

Ultrasound Findings:

   Urinary tract ultrasound was performed.   The urinary bladder is pelvic in position and oblong in shape.   No evidence of bladder echogenic luminal material, calculus formation, or wall thickening is noted.   No sonographic evidence of ectopic ureter formation is noted.   The kidneys have good corticomedullary differentiation with normal cortical echogenicity; the kidneys are normal and symmetric in size with the left kidney measuring 5.75 x 3.08 cm in size and the right kidney measuring 6.23 x 3.05 cm in size.   No other urinary tract sonographic abnormalities are noted.    

Conclusions:        

Pelvic oblong urinary bladder.   No sonographic evidence of cellular bladder luminal material, calculus formation, or cystitis change.   No evidence of ectopic ureter.   Normal sonographic appearance of the kidneys. 

[Adrienne Farricelli]

Looks like you finally got a "diagnosis!" Sounds like pelvic bladder. I have access to a veterinary website for members and it says that it's usually diagnosed by x-rays with contrast, but an ultrasound may provide hints to it. So it could be a surgeon may want to do the x-rays to determine the exact position so if surgery must be carried out he's aware of it. The surgery should consist of tacking the bladder into a normal position (sort of like the stomach tacking they do in bloated dogs to prevent future incidences). It looks like meds though can be tried before going the surgery route. 

I think this now explains Esther's urinary problems. With the bladder in the wrong position it's unable to fill normally because it's being compressed. On top of this, the nerves that trigger the urge to urinate happen to be constantly stimulated, therefore more trips outside. I wonder if the fact she's able to hold it better at night is because she's laying down and the bladder's nerves aren't stimulated as much?

[JMFS]

That's what I was thinking.  She tends to be able to hold it longer in any laying position.  I was thinking there may be less pressure on the bladder, but your theory about the nerves is viable as well.

I don't think Proin has a loading dose but she sure does Seem to be less thirsty (even left her water last night) with fewer trips between drinks.  I upped her from 8 to 10 oz as a result.  As long as she gets her 60 - 65 per day she's good and she'll certainly let me know if she needs more. 

It's a relief to know it's Something and not just me being bad at potty training!  She's doing a new thing with ringing the bells persistently and then doing nothing outside. I'm wondering if she's misunderstanding the bells or if her body is sending her signals but the Proin is in effect or maybe it's even rehearsal from being accustomed to 14 - 17 trips per day.  So many what ifs with this girl!

Her primary care vet approved the Proin / Incurin combination.  We're going to change one thing at a time and the goal is to get her on the Incurin because I really dislike the side effects of Proin.  Sudden death with screaming terrifies me!  Normally if there's going to be a reaction she'd have had it by now, but simply having her on a medication that can do that concerns me for her future health.  It's only been out for 10 years so senior dogs who have been on it since puppyhood are just now entering their senior phase so long term effects aren't known, but should be in the next years.