Speaker 1: You're listening to Petlifradio dot com.
Speaker 2: Hey, good morning or good afternoon, depending on where you
have could be in the country at this very moment.
I am your host, Doctor Jeff Wover. We're here with
you for the next thirty minutes on Ask Theavettes. But
Doctor Jeff the only live show here on pet Life
Radio Live call in, and that means I want to
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eight eight A two once again eight seven seven three
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all you have to do is join another conversation. It's
that easy, and we want to hear from new As
a matter of fact, we are here to help you
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So you can lose free advice. My job here, And
if you've been listening, I am trying to make veteran
medicine practical. It it's become so specialized, it's become you
so advanced that people lose sight of the simple things.
And you know a couple of my favorite expressions. If
it looks like a duck, walks like a duck, waks
like a duck, it's probably a duck. So stop looking
for the darn zebra when it's the duck. And speaking
of zebras, here's another one I love. If you're running
along the beach in Malibu and you hear hoof beats
chasing you from behind, what are you thinking? And anyone
who lives out here in Malibu might know that it's horses,
So why are you looking for zebras? When I say
this to veterinarians all the time, why did you run
that test? Why did you do that? What took you
on that path? You ever even ruled out the most
obvious things first, And that's why I'm here to try
to get everybody thinking simple. My favorite rule the kiss rule,
Keep it simple, stupid, and I use it and I
say it all the time. So we have been if
you've been paying attention, if you've been listening, I'm going
through an entire series of the endocrine systems and all
the things that can go wrong, from Cushing's disease to
Addison's disease, which is one is a hyper secretion of
the adrenals, the other one is a hypo secretion of
the adrenals. We talked about thyroidism, and again we have
hyperthyroidism which we see in cats. We have hypothyroidism which
we see in atalogs. Then we got to the diabetes
melodist and again everything seems to be double well. We
have two types of those, diabetes type two and diabetes
type one. Type one is what we see in dogs,
is the same as the human type one judile set diabetes,
which is what we call insulin dependent diabetes. And then
we also talked about type two diabetes, which between cats.
That's more similar to the human type two, which is
adult onset diabetes often associated with obesity, and as we
discuss that cats, we tend to feed them inappropriately, pushing
too much dry food, too many carbs. Cats are obligate carnivores.
They need meat, and too much carbs has the same
effect on them as human deter obese has on them.
The obesity has on them, and they are prone to
type two diabetes, which though insulin sometimes is necessary, there
are also other ways, depending on the case, depending on
the pet, to successfully treat type two diabetes diet, some
oral medications, etc. And we may not need or maybe
just start on insulin for a short while and then
gradually wean them off and have them on a non
insulin protocol for type two diabetes. Now, there is also
what's confusing, as we discussed, is that many of these
conditions present similarly. You know a hallmark of for example,
Cushing disease, sometimes even addisons, but definitely diabetes. Melodice is
excessive water drinking, excessive ping. So when you see these
dogs urinating, drinking and urinating and drinking and urinating, with
these casts drinking and urinating so frequently, of course we
have to worry about kidney issues. Of course we have
to wear bet bladder issues. But also we can't forget
to rule in or rule out the possibility that this
could be a cushing disease, this could be an ADISONI,
and this could be a diabetic etc. Now there is
just to confuse things, and I'm going to try to
keep it simple. Stupid, I'm going to try to keep
it simple. But there is another diabetes out there, one
that is not nearly as common as the diabetes melodice,
which is the sugar diabete. Is the insulin dependent or nondependent,
but where the blood sugar rises off the charts high
when it gets past a certain levels just two hundred
and fifty milligrams portest later, then it kind of spills
out into the urine and we start seeing signs of glycosura,
which means glucose in the urine, a clear sign that
there is probably one of the diabetes melodis is on
board type one if it's a dog, type two if
it's a cat. Now, the other diabetes we see is
called diabetes incipitous, and that that is the water drinking diabetes,
and that happens where the kidneys are supposed to interact
with the body and the blood, and there's usually a
signal coming from the brain through a hormone called adh
antidiretic hormone that basically tells the kidneys whose job it
is to filter out all the fluid that we drink.
For example, I'm sure none of you have ever gone
out and had a few too many beers. I'm sure
that's never happened, but if it were to happen, you
certainly know that when you get to a certain point,
everything that goes in is coming right back out because
you are now overhydrated. The kidneys feel they're reading the bodies,
the blood, the hydration status of the body and saying,
oh my god, we have way too much fluid already,
So everything that comes through, we're just going to filter
and urinate it right out. Conversely, for those of us
that might do some running or heavy duty exercise and
you're sweating a lot, you're getting very dehydrated. You know
that when you urinate at that time, the urine is
very concentrated, it's very yellow, and as opposed to being
excessively hydrated. Well with diabetes incipidus, the brain, the body
the kidneys are not reading the signals properly. Either there
is a lack of the hormone the ADH, or the
kidneys aren't reading it. They're not responding appropriately to the ADH.
So what's happening is that you end up with continuously
drinking regardless of the hydration status of the body. It's
not being read properly, so everything that comes in goes
right back out. In other words, we cannot concentrate the
urine appropriately for the needs the status of the body.
And fortunately, as I said, this doesn't we don't see
it nearly as commonly as some of the other diabetes,
but it's certainly something that needs to be evaluated. And
it's a problem because these dogs, especially, we see this
in dogs are drinking like crazy and they're urinating like crazy,
but everything is perfect. The only thing you see on
a laboratory work is a isosdeneric urine, which basically is
urine that has the same salute concentration of water, and
the kidneys are not able to concentrate, they're not able
to dilute. It is just the same, and regardless of
how little water they have, the urine is coming out
as if they've been drinking water for the last four
hours NonStop. But because they're losing so much dilute urine,
the body is reading the fact that now we are
thirsty because it interact with the first center of the brain,
and now they are drinking continually to make up for
the loss. And it's an annoying condition. Or first of all,
it's annoying for any of you that have had dogs
with diabetes and sippetis because you are have to walk
these dogs very often. And if you don't have a
dog your door, or if you have like really expensive
berber carpeting, you are going to be one upset pet
parent because all you'll be doing is walking every twenty
minutes half hour. I mean, as fast as they drink,
it's coming right back out, regardless of as I said,
the hydration status of the body. And it gets really
frustrating because you want to do the right thing and
to make matters even more complicated, because that's what I
like to do, is take the complicated and try to
make it a little simple. There is another condition that
we often see which we have to rule out when
we're trying to make a diagnosis of diabetes and sippitis
and that is something we call and we see this
very commonly in puppies, and not even I don't even
little teeny puppies. I mean, you know eight to ten
to twelve month old puppies that they're not quite there
in that young adult stage every four two years of age,
and they have what's called psychogenic polydipsia. And this is
a case where there is absolutely nothing wrong with the body,
nothing wrong with the anti diuretic hormone, nothing wrong with
the kidneys, nothing wrong with the brain. Everything is working
in concert, in unison. It's perfect. These dogs just like
to drink and they don't have a turnoff switch. So
they go to that water bowl because they've played for
a little while, and instead of drinking I don't know,
a cup, they drink a gallon and they keep drinking
and they'll run over to the water bowl whenever it's full,
and they just like to drink. So clearly, let's go
back to that original beer scenario. What happens when you
are drinking more than your body needs. It all comes
out in the urine as very dilute urine, and you're
scratching your head and saying, wait a second, that's exactly
like diabetes and sipitus. They're drinking a ton and it's
coming out straight clear. Austenic Urine means that the solude
concentration of water. It's between what we called one point
zero zero eight and one point zero one too, if
you want to get a little technical, But the key is,
oh my god, now we have a little bit of
a diagnostic challenge, and we have to sort of sift
through that challenge because we have to know the difference,
because it's a tremendous difference in treatment. I mean, one
is a little behavior modification and starting to ration water
and the other one, Oh my god, the other one
is a real treatment. It's a condition that we have
to deal with. So that, as I said, so when
it comes to things like that, we have to sit there.
Speaker 3: You know.
Speaker 2: I always feel like a good diagnostician is we ever
watched Doctor House Gregory House, Remember House MD. That was
a show where it really took the art of diagnostics
and highlighted the techniques involved in and one is you
really have to I say, to be a good diagnostician,
you have to get a really thorough history. And that's important.
That's why if you've ever been referred to a specialist,
whether it's a dramatologist, whether it's a behavior specialist, whatever
the case may be. One of the most important things
that you are going to spend so much time initially
getting that thorough history, because that is going to help
rule in a lot of possibilities. It's also going to
rule out probably more than it's going to rule in
where you're going to say it can't be that, because
if it were, then it's all going to be doing XYZ.
Just he's not doing X y Z.
Speaker 1: It's not that.
Speaker 2: So the goal here is to reason, to think, to analyze,
and then to choose the appropriate tests to help you
come up your diagnosis. And as I say, and this
is my soapbox, you don't feel, and your veterinarians shouldn't
feel that they have to do all the tests in
one day, unless, of course, you're faced with an emergency
situation and you need to rule everything out now. But
most of these conditions are not emergencies. Your pet's been
living in them for weeks, for months. The extra two
to three days is not going to make a difference,
and you want to approach them by getting a thorough
history and doing your work so having said that, we're
time for a quick little break. When we come back,
we are going to talk about some diagnostics involved and
treatment of how to tell do we have a psychogenic pollidipsy?
Do we have diabetes incipitous as opposed to diabetes melodist
and let's get some answers for you and let's figure
out how to treat it. Don't go well with right
back here on pet Life Radios. Ask the vets with
doctor Jeff and I'm doctor Jeff Weerbert.
Speaker 1: Don't go away, We'll be right back right after these messages.
Stay tuned.
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Speaker 1: Every week only on petlife Radio dot Com. Let's Talk Past,
Let's done Past, Talk about Life.
Speaker 5: Radio, Hetline Radio.
Speaker 1: Pet live Radio dot.
Speaker 2: Com And welcome back you are You're live with doctor
Jeff Berber, your host for the next ten or twelve
minutes or so. Here on bet Life Data, wh asked
bets with doctor Jeff. Before the break, we were sifting
through a new kind of diabetes for some of you.
It's called diabetes incipetus. It's the water diabetes where the
body is not correctly talking to its each other parts,
the kidney's, the brain, the blood, the hydration status, et cetera.
And these dogs, typically dogs that have this disease will
just continually drink and drink and drink. The urine is
always coming out very dilute, and the fault may be
a number of things that could be either the lack
of antidiretic hormone coming from the brain or the lack
of receptors in the kidney that the ADH is there.
So what's happening is everything that comes in is going
straight back out. And these animals are always there for
thirsty and they continually drink, and every time they drink
urinate more, and clearly you could see the vicious cycle.
So we need to make a diagnosis, and a number
of ways. There is the old fashioned way, which I
still like doing as a matter of fact, is called
a water deprivation study, and that is on the following premise.
If you have a dog, for example, as I mentioned before,
the break was psychogenic polydipsia, or a dog which just
for some reason likes to drink or is drinking more
than it really should, but everything is working properly. Think
about it. What would happen if we mechanically physically remove
the water from this dog. Well, what's going to happen
is that the urine will start to concentrate, because nothing
was wrong, the only thing, the only problem there was
that they were drinking too much. So you physically stop
them from drinking too much, and within a few days
the urine will start concentrating. Everything's normal, and then you're
going to stract your head. You go, perfect, this is
not de eyes, not diabetes and sippetis, it's psychogenic. We're
just gonna have to start monitoring our dog's water intake. Now,
what would happen to a dog, however, that has true
diabetes and sippitus where there's a either a lack of
the antidiretic hormone the eighth or there is a problem
with the kid not with the receptors not evaluating how
much ADH is there. It's not responding to the ADH
is there. So what's gonna happen is that even though
you withhold water, the kidneys are still going to be
creating dilute isoseneric urine. So there we have a problem
because there we have to provide the eighty eight in
one form or another, and that's where we have some
options you know, to use there. So let's to make
it simple that when you start withholding water initially, and
if you do it abruptly from a dog that has
been urinating excessively because the water the urine is very concentrated,
you can suffer what's called for a while medullary wash out.
So that is that there nothing is working in the
kidneys even though everything is fine, but they're so washed
out because of all the dilute urine, the dilute fluid
it's going through that it takes several days. Again, So
even though it's gonna work, if you just automatically, like
the night before the tests, withhold water and do what's
called the twenty four water deprivation, having had these dogs
drinking so much, even a psychogenic polydipsia, it may still
show the next day that the dog is still urinating
very dilute urine, and you might think, oh my god,
then this dog must truly have diabetes zippitis and start treating.
But that's inappropriate because what we have to do is
to in order to avoid this concept, this potential for
medjul a wash out, we need to start withholding water
and measuring water and only giving your dog the amount
of water it should have, and you work that out
with your veterinarian for several days before the beginning of
the actual twenty four hour Now, when we get to
that point, we do a few things. We continually it's
done in the hospital, and we are our stopping point
for this test to determine whether this is a psychogenic
problem or true diabetes andcipitous one of two things. Either
the urine starts to concentrate we typically say above ten
twenty one point two or even ten twenty five. Then
we know that the kidney's are working fine. The AD
eight is working fine, they're reading the AD eight. Everything
is perfect. This dog just likes to drink. Or you've
gone so long that the dog has lost ten percent
of its body weight, meaning if it's a twenty five
pound dog, if it loses two and a half pounds,
and the urine is still dilute, meaning the dog is
not concentrated even after that, and this could before the
twenty four hours, this could be an hour seven or
eight or ten, then you stop the test because now
you're looking at dangerous dehydration and you can therefore pretty
safely assume that yes, your dog has diabetes and sipetus. Now,
with the advent of a newer medication, what a lot
of dogs are doing is saying this, and it's again
it's a great way. It's actually easier. It's expensive because
the stuff we have to use is very expensive, and
that is getting a product it's actually really meant to
be used as a nose dropping people. It's a spray
and it's something called desma pressin' And what we do
is you have to get it. As I said, it's
very costly, and you have your veterinarian. You have to
open it because it's got those one of those sealed
like aluminum rings around. It's very hard to get in
there because it's in one of those like pump sprays things,
you know, for nose and we undo it. We put
it in a little yorker a little bottle with it,
or like an eye drop bottle, and you can put
like a drop in the eye once a day, and
it's really cool. It's so easy to use and it
works beautifully. If in fact, your dog has diabetes and sippitis,
I want you to think for a second, how with
this amazing drug, how might it still not work? All right,
I'm gonna do this. This is the jeopardy question. Done, done, done, Okay,
right anyway, Well, here's the thing. If the problem is
which it normally is, the issue in the case of
diabetes and sippitis, has to do with the amount of
anti diiretic hormone coming from the brain, then the glands
that do all this then what's going to happen is
the the body is going to respond beautifully. All right,
there's a whole cascade of events where the brain, as
I said, signals the glands and they spit out the ADH,
the kidneys respond, and you end up with concentrated urine.
What happens, however, if the problem is not the amount
of anti diuretic hormone it's being secreted from the glands,
but rather the kidney's receptors responding to the ADH, then
you have a different problem because now it's not the
ADH it's the problem. It's the kidneys aren't working. So
we're still not going to have a response if even
with this chemical, this medication going in the eye drops,
because what's happening is the kidneys are the problem. They're
not responding, and that's just stuff. That's a whole different ballgame,
one that is a lot more of a challenge because
there's really no way to turn these recepts. Well I
never say never, but not a simple way or a
clearly used technique, easily use technique to turn these receptors on.
So it just means that we're gonna have to live
with the excessive water drinking and you have to let
them drink and let them urinate because there's really no
way to get to the bottom of it. So again
psychogenetic polydipsia, you withhold water appropriately and to avoid medullary
wash out. You do your test over several days. You
minimize the water intake based on just their body weight.
Then you do the twenty four hour They are going
to respond. Done deal. Now you know for treatment all
you need to do is control their water intake. Diabetes
and sipetus the more common one, which is an antidiuretic
hormone issue. We make the diagnosis either they did not
concentrate at all or they lost ten percent of their
body weight during the test. Then you know it's time
to have to treat with the desert pressing, which is
probably the best way to go. It's a little expensive,
but very worth it. It's an eye drop. You alternately
recommend alternating eyes. It gets absorbed, it provides the impetus
to the kidneys as the adaight's antidiretic hormone. Then these
animals do just fine. And lastly, we have the type
of dietet beads and scimpetus where they're not reading the
antidretic hormone. And these are ones that you really are
not easily controllable because the problem is there's no way
really turn on these receptors that're either are not functioning.
Why this happens, we're not sure. I still would recommend
you have to go through the test anyway, but that's
one you're going to see your veterinarian. Your veterinating might
send you to a board certified veterinarian internist, someone who
works with the endocrine system, the hormones, the kidneys and
might be able to make some suggestions to help you out.
So if you have any questions about this, I want
to hear from you. If you send us an email,
tell us about a problem your pet's been having, especially
with Remember there's a lot excessive water drinking, excessive urinating.
As you know now, it covers a wide range of possibilities,
and our challenge is to make the diagnosis appropriately, to
differentiate between all of them and make the right call
for you. And again there's complications along the way because
a lot of times we see older dogs that have
can currently cushings and diabetes. Melodist boy, that makes it
tough for us. So send us a question. You can
get a hold of me at Dr Jeff Doctor Jeff
at petlife radio dot com and we will have to
answer once again. I want to take our sponsors, pro
Sent Pet Products and Calm, and we will be here
next week. I think we're gonna I want to start
a whole series on eyes. So we're gonna talk a
lot about eye problems, if any of your pets have
had them, what they are, how many there are. There
are quite a few to think about. So we'll get
started and next week, the week after that, I'll be
coming to you live from Orlando, Florida again. Doctor Dan
mcfade will be my co host, and we're gonna probably
talk about some really high tech stuff in veterinary medicine
and just some basics about what you should be looking
for in your veteran Have a great week, see you
next week.
Speaker 1: Let's Talk Pets every week on demand only on petlive
radio dot com.