Monday, 16 April 2018

Oliver: Pet of the month - Hall of fame ( Feb 2018)

The owners of Oliver, a gorgeous 10 year old Hungarian Vizsla, contacted us after they noticed that he was drinking more than usual and urinating more too.

We asked them to collect a urine sample from Oliver and to book an appointment to see a vet. A urine test can help to provide information on the health of the kidneys and urinary tract as well as checking for the presence of glucose that can indicate underlying Diabetes Mellitus (sugar Diabetes). Oliver’s urine was tested and the findings were unremarkable apart from it being slightly lower in concentration (more dilute).

There can be many causes of polydipsia (increased thirst) and polyuria (production of large volumes of urine), so the next step was to carry out some further tests on Oliver to discover the cause of his symptoms.

Oliver was examined by vet Cathy who then collected a blood sample so that she could evaluate his organ function and electrolyte status. The results showed that his liver enzymes were elevated, of which there can be many causes. The next step was for Oliver to come in for the day to have an ultrasound scan of his abdomen and to have a specific blood test called a bile acid stimulation test; this tests how well the liver is functioning. Oliver was such a well behaved boy and lay very still to allow Cathy to perform the scan.

Cathy looked at the structure, size and health of his liver which showed some age related changes. She also scanned his spleen, kidneys and bladder, the result of which was normal. Oliver had not had any breakfast as he needed to be fasted for the first part of his blood test, so he was quite happy when the nurses gave him brunch, as the second part of the blood sample needed to be collected two hours after food. 
Cathy received the results of Oliver’s bile acid stimulation blood test; it showed that his liver was working properly and she concluded that his symptoms were not the result of liver disease. 

With kidney and liver disease ruled out, Cathy was suspicious that Oliver's excessive thirst and urination might be the result of a rare condition called Diabetes Insipidus (water diabetes).There is no specific test for this, so other conditions had to be excluded before starting treatment. 
A common hormonal disease called Cushing’s can also cause symptoms like Oliver’s, so this firstly needed to be ruled out (or ruled in). Cathy arranged for him to come in to the hospital for multiple blood samples. Again Oliver was a model patient, allowing the nurses to take his blood without any fuss. The results showed that Oliver did not have Cushing’s disease.

Cathy prescribed some antibiotics for Oliver so that she could also rule out a kidney infection (pyelonephritis) Oliver wasn’t showing clinical signs of a kidney infection other than frequent thirst and urination, and a urine test was negative for bacterial growth, but in some cases the condition can be ‘hidden’. Oliver's symptoms did not improve with the antibiotics so lastly Cathy asked Oliver's owners to collect a series of urine samples from him over a day so that she could test how well he was concentrating his urine; a test called specific gravity. This can be variable in pets, but Cathy could see from the results that Oliver's urine was dilute. It was now appropriate for Oliver to trial some medication to treat Diabetes Insipidus.
Diabetes Insipidus is a condition where the body fails to maintain water balance. It is a rare disorder and not to be confused with Diabetes Mellitus  which is caused by a deficiency of the hormone insulin. Diabetes Insipidus is caused by an insufficient production of a hormone called anti-diurectic hormone ( ADH)  that regulates the body's ability to absorb water from the kidneys. Generally the condition is considered to be idiopathic in nature, which means that what exactly causes this disorder is not known with certainty.

Oliver is now being treated with the drug Desmopressin that mimics the action of ADH. They are in the form of drops that are applied to his eyes. His thirst and excessive urination have decreased and the concentration of his urine over a three day period  is now at an adequate level. Cathy is very pleased with Oliver's response to the medication and will next see him in a month to repeat the urine test. Oliver's owners are continuing to  monitor his drinking and urination at home, ensuring that he has access to fresh water at all times.

For his gentle nature and patience with having blood samples taken, Oliver is a much deserved pet of the month!  💙