I've compiled these tips to help practitioners deal with common problems or situations in a manner that will help improve
a patient's outcome, simplify the diagnosis, and minimize complications in daily practice. You may already use many of these
tips, but you may also find new ones to help you with long-troublesome problems.
#1 In dogs with a recent onset of urinary incontinence, rule out polyuria and polydipsia as possible causes before initiating
drug therapy. Some clients may not be aware that polyuria and polydipsia can be linked to urinary incontinence, so they may not report
the polyuria and polydipsia. Polyuria can overwhelm the capacity of the sphincter in dogs with marginal sphincter function,
resulting in urinary incontinence. Correcting the underlying cause of polyuria and polydipsia usually resolves the incontinence.
#2 Perform a urine culture, regardless of urinalysis results, in any dog that presents with poly uria and polydipsia, signs
of urinary tract disease, or an endo crinopathy. The urinalysis may not show marked signs of inflammation, and bacteria may not be seen, in many disease states. This situation
is particularly true with diseases that cause dilute urine production, suppress immune function, or otherwise inhibit the
normal urinary tract defense mechanisms, such as diabetes mellitus and hyper adrenocorticism. In addition, occult pyelonephritis
may cause polyuria and polydipsia. It is acceptable to not perform a culture in a dog that is experiencing its first episode
of lower urinary tract signs consistent with cystitis. But perform cultures if subsequent episodes occur.
#3 Manage hypoglycemia in toy breeds or puppies by administering L-carnitine. Hypoglycemia in toy breeds or puppies can be frustrating since the most popular recommendation is to provide frequent feedings,
which may or may not resolve the problem. Some human infants with fatty acid oxidation disorders respond to L-carnitine, which
helps move fatty acids into the mitochondria for energy production.1 I use L-carnitine (50 mg/kg orally twice a day) until the puppies are 9 to 12 months old. In my experience, the hypoglycemic
episodes diminish or disappear, the puppies are more active, and weight gain is more rapid. When supplemented with L-carnitine,
these puppies don't seem to need the intensive feeding schedules recommended for managing hypoglycemia in toy breeds, and
most do fine with twice-daily feedings. L-carnitine tablets and liquids are available at health food stores.
#4 Treat dogs with chronic vomiting for Physaloptera species infection before doing extensive work-ups. For otherwise healthy dogs with chronic low-grade vomiting (one or two times a day), good appetites, no weight loss, normal
blood work results, and negative results on a fecal examination, treat for the stomach worm Physaloptera species before performing an endoscopic or a surgical gastroduodenal biopsy. Administer fenbendazole orally (75 mg/kg daily)
for five days plus one day of pyrantel pamoate orally (7.5 mg/kg). Pyrantel can be given on the same day as fenbendazole.
Repeat this treatment in three weeks. These doses are higher than the labeled doses, but I have found them to be successful
after numerous treatment failures at the recommended doses.
#5 Think Addison's disease! In my opinion, a serious problem in private practice today is not including sodium, potassium, and chloride concentrations
in many in-house serum chemistry profiles. When you examine a young- to middle-aged female dog with a history of intermittent
vomiting and lethargy or anorexia, polyuria and polydipsia, or possibly an acute episode of shock, bradycardia is a good indicator
of hypoadrenocorticism. The bradycardia may be relative (i.e. a heart rate of 100 beats/min may not seem slow but is in a dog that presents in shock with 10% dehydration). So in these
dogs, be sure to measure sodium, potassium, and chloride concentrations to further support the diagnosis, and perform an ACTH
stimulation test to confirm it.
A buccal mucosa bleeding time test is a simple way to evaluate predisposed breeds for von Willebrand's disease before elective
surgery. Since von Willebrand's disease is common in Doberman pinschers, Chesapeake Bay retrievers, Scottish terriers, German wirehaired
pointers, and Shetland sheepdogs, presurgical evaluation is prudent and can be inexpensively performed with a buccal mucosa
bleeding time test.