Pixie the thirteen year old male neutered Papillon dog

Like most  dogs, Pixie has been fit and healthy for most of his life. It was only two years ago, when he was eleven years old, that things began to go wrong. Dorrie noticed that, all of a sudden, Pixie was drinking more water than usual, and at the same time he started to have urine accidents in the house. Up until then, he had always been perfectly house trained.
Dorrie realised that there was probably a medical reason for this sudden change in his behaviour. He had always been so reliable and predictable up until then.

pixie was brought for a check up

When she brought Pixie to me for a check up, there was almost no need to do a blood test to make the diagnosis: when I sniffed his breath, it smelt sickly sweet, almost like honey. I did the blood test anyway, and it confirmed what I suspected: Pixie had developed diabetes mellitus. His blood sugar was sky high, which is why his breath smelt so sweet.
Increased thirst and urination, like Pixie, is the most obvious sign of diabetes: the sugar in the blood goes so high that it leaks through the filters of the kidneys into the urine. The sweetened urine then draws extra fluid into the urine from the blood, and this extra excretion of fluid from the body means that dogs need to drink more water to replace it.
The good news is that diabetes can be effectively treated: Pixie was given a tiny injection of insulin twice daily(about a twentieth of a teaspoonful, given using a very small syringe and an ultra fine needle).
Dorrie quickly learned to give Pixie his injections (while he is tucking into his food, so he never notices it happening). And the blood tests confirmed that his blood glucose returned to normal, as expected.
But something odd happened (or more accurately, didn’t happen). Pixie’s huge thirst and urinary accidents did not stop: he was as bad as ever.

cushing’s disease was diagnosed

The focus now moved onto another disease that sometimes accompanies – and complicates – diabetes: it’s called Cushing’s Disease, or more long-windedly, Hyperadrenocorticism. This develops when a small, benign tumour grows inside the dog, producing excessive quantities of cortisone, a potent hormone. The extra cortisone has a wide range of effects, including making it more likely that the dog will develop diabetes, and also including making the dog drink more water and pass more urine. So when a diabetic dog’s blood sugar returns to normal, yet the animal is still drinking far too much water, it’s often worth doing the specialised blood test needed to diagnose Cushing’s Disease.
I carried out this blood test, and the results confirmed what I’d suspected: Pixie had Cushing’s Disease as well as diabetes. This is treated with a twice daily capsule, so Dorrie now had to give an injection and a capsule, twice daily. This combination treatment did the trick: Pixie’s thirst went back to normal, and he stopped creating puddles on the kitchen floor.
He remained more-or-less stable for two years, but last week, he came back to see me, and the problem was a familiar one: he was drinking more water, and he was making puddles on the floor again.
My first thought was that perhaps his diabetes or Cushing’s Disease had changed, and maybe he needed higher doses of medication. But an in-house blood glucose test, showed that his diabetes was well controlled, and the test for Cushing’s Disease also had normal results. So why was he drinking so much this time?
A third test gave me the answer: I collected a urine sample, and used a dipstick test to measure the various chemicals and cells that it contained. The results were clear: Pixie’s urine contained high levels of blood and protein, indicating that he was suffering from a urinary tract infection (UTI). This is common in diabetic pets, because when there’s sugar in the urine occasionally (eg in between insulin injections), bacteria can multiply more easily in the urinary tract, from the kidneys down to the bladder. When this happens, again, the classic signs include an increase in thirst and an inability to hold on to urine in the normal way. Puddles around the house are a typical indication of a urinary tract infection.
It’s usually easy to treat this problem: a course of antibiotics kills the bacteria in the urinary tract, and normal urinary health and function resumes. There is a risk that the bacteria involved may be resistant to the normal antibiotics, so before starting Pixie on antibiotics, I sent off a urine sample for full culture. This will tell us which bacteria are causing the problem, and it will also discover the most appropriate antibiotics to treat him.
While we were waiting for results, I started him onto the standard antibiotic that’s likely to be effective. Within twenty four hours, his thirst had settled and he’d stopped having accidents. The test results are still important, as we need to be certain that any underlying infection is fully cured by using the correct antibiotic.
It’s unusual for a dog to suffer from all three of the most common causes of increased thirst and urinary accidents in the home, all at the one time.
But Pixie is a remarkable dog: he has a huge personality for such a little animal, and understandably, Dorrie adores him.

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