By Dr Sophia Yin
The problem with treating pets is that they can’t tell you what’s wrong which can make being a veterinarian quite tricky. For instance for the general practitioner in a busy area of town, not a week goes by where someone comes in with an animal with an old festering wound or a large relatively slow growing tumor, who says, “It just appeared yesterday”. Or owners who have no idea if their pet’s appetite or energy level are normal. Luckily for veterinarians, sometimes owners are quite observant and help draw a beeline to what’s wrong.
Take for instance my visit with Mrs. Ecks and her dog Whyzee.
It went something like this:
I entered the room and there she was, sitting expectantly on the exam table. An 8-year old adult Chihuahua as soft as a stuffed burrito. She stood and wagged her tail at me and her whole rear-end followed.
Why was she here? Vaccines? Routine geriatric exam? Heart disease? Dental Work-up? As usual, a view from across the room yielded scant clues. Luckily the record held a hint.
“Urine problem,” it stated in the familiar handwriting of the hospital receptionist.
Good. That narrowed it down to about twenty or thirty conditions. I was ready for more information so I made my move.
“Hi, Mrs. Ecks. What can we do for Whyzee today?”
“Well for the past few days she’s been drinking a lot, urinating a lot, and her breath smells like acetone. She also seems much hungrier than normal.”
A suspiciously simple diagnosis, I scanned Mrs. Ecks for a hidden camera. Was she a spy sent by the hospital owner to check on my diagnostic abilities? Probably not. If so, the case wouldn’t have been so easy. Was she a nurse? Did she already know what Whyzee had? Or was she just a very astute owner with an uncommonly accurate sense of smell?
While examining Whyzee, I politely drilled Mrs. Ecks like a detective looking for signs that the story was fake. “How long has this been going on? Has her appetite changed? Does she squat frequently and urinate frequent small amounts? Has she had any accidents in the house? Has she been raiding the garbage can? And so on. When I was satisfied with my preliminary investigation, I asked her the big question.
“Do you know what disease you’ve described?”
“No. What?” She looked at me with a face as innocent as Whyzee’s.
Many Diseases Cause Excessive Drinking and Urination
Theoretically, Whyzee could have one of many diseases leading to excessive water drinking and excessive urination. These could range from a brain tumor affecting the thirst center of the brain to the more common kidney disease, liver disease, adrenal gland disease, diabetes mellitus, and cancer of the lymph tissues. These latter diseases cause both dogs and cats to urinate excessively and consequently they have to drink enough to keep up on their water balance. Water restriction in these cases leads to dehydration, which can quickly cause the kidneys to conk out.
Whyzee’s new-found voracious appetite, which often presents as a dog that suddenly starts raiding the garbage can, pointed either to diabetes or to Cushing’s disease, a disease of the adrenal gland, which rests on top of the kidneys and produces corticosteroids and other hormones. Both diseases can also lead to increased infections. Whyzee didn’t have any external signs of infection and a urine culture to help diagnosis bladder or kidney infection wouldn’t be back for a few days.
Her bad breath was the giveaway. The majority of dogs with death breath have dental disease, but Whyzee’s were sparkling clean. Sudden bad breath can signal systemic diseases such as kidney or liver failure. Both organs play a part in ridding the body of toxic nitrogen compounds and when the compounds build up in the body, their odor is sometimes detectable on a dog or cat’s breath. Mrs. Eck’s description of an acetone odor though, indicated diabetes. Acetone and related compounds build up in the blood of uncontrolled diabetics.
As you might guess, smelling a pet’s breath is not a definitive diagnostic test, even along with the other appropriate history. Only a thorough exam of the urine and blood could tell for sure and show whether Whyzee had other problems too. Her lab results, like her owner’s description, read like a blurb out of The Textbook of Canine and Feline Endocrinology: Sky high glucose in both the blood and urine. It was the glucose in the urine that was drawing water with it thus leading to excessive urination. Whyzee clearly had diabetes, and according to the blood work, it was uncomplicated by other diseases.
Untreated diabetes can progress to vomiting and diarrhea, loss of appetite and thirst, and eventually coma and death, so we immediately started Whyzee on insulin. Since sensitivity to administered insulin can also cause serious signs, including seizure and death, we also monitored her in the hospital for the first day or so too.
Of course that was just the start. From now on Whyzee would require special care. A select diet, daily insulin injections, and regular veterinary visits to check blood and urine for glucose and signs of other disease. Fortunately as with humans, pets often manage very well with this care and they can be trained that getting their injections and visiting the hospital are fun—which make both easier for everyone. And, if Mrs. Ecks was always as observant as she revealed that day, I was betting I’d be seeing them both of them around for some time.