Dogs cannot talk. It follows that any means by which physiological information may be gathered - particularly if the process is painless - is of vital importance in the treatment of Addison dogs.

Charles Wehner noticed that when he was close to extremis, he would always have a burning sensation in the skin (Chloracidosis), and great difficulty sleeping due to "rheumatic"-type pains. What made things worse was that just as he was about to sleep - having forced himself - he was overcome by an irresistable urge to empty the bladder.

Staggering (because the blood-pressure was failing) to the toilet, he was disappointed to find that only a few drops were released. This pattern might repeat six, seven or eight times in the night before he finally got to sleep.

Living at that time in Saarbrücken, Saarland, Germany, he went to a laboratory equipment supplier and bought Van Urk`s Universal Indicator test strips. These are small pieces of plastic, about two inches long by a quarter, having a dyestuff on them.

They are red in acid, at about pH 4, and as the pH rises through neutral into the alkaline, they pass through orange, yellow, green and blue to black at about pH 11.5.

They invariably went black when dipped in Wehner`s urine at such times. This is extremely alkaline.

It turns out that the bladder has only one sensation - FULL, so that any irritant - acid, alkali or infection - will cause an urge to expel the contents. Thomas Addison`s last case (Greenhow 89) is described in the Wilks report (follow the link) as having a "DRIBBLING OF URINE", which was stopped by Dr. Aldis prescribing STEEL. Gaget, in the Martineau thesis also urinated in small amounts - "L’urine conserve toujours les mêmes caractères; elle est excrétée en petit quantité."

The enormous alkalinity is the result of loss of ALDOSTERONE from the Zona Glomerulosa of the adrenal cortex. This, under the orange fibrous layer, is the topmost active layer.

The loss of this hormone also results in the release of alkali in the duodenum and along the intestinal tract - causing duodenal ulcers and lesions of the gut. Although less serious than acid ulcers, these lesions are a recurring theme in Addison`s disease.

It is aldosterone that is substituted by Florinef when medicating.

Returning to the subject a dribbling of urine, we have a slight problem. This may be unusual in a human - but is a sign of cultural identity in a dog, as it marks its territory. How can we distinguish the natural spraying from the symptom of disease?

By MEASUREMENT!!!!

The test strips in 1979 cost about one pfennig each - there were a huge number in the box. A search of the Internet reveals two modern equivalents, which cost ten dollars per hundred from Alpha Omega Labs. That`s just ten cents each - even today. Other suppliers were found, but they seemed to charge about 25 dollars per hundred.

The author, Charles Douglas Wehner, has no commercial interest in these companies or products.

Merck 9590 has four separate indicators, so that the pH may be estimated more exactly by matching all four.

Merck 9583 covers only the top (alkaline) part of the range with more accuracy, with a single row of indicator.

James Carr of Alpha Omega Labs informs me that these are actually made by Merck`s associate company EM Sciences, and that more examples can be seen at http://www.altcancer.com/phstrips.htm, and purchased at http://www.altcancer.com/ord1.htm. I have no financial interest in this.

It would be useful if test-strips containing decolorizing charcoal were made, especially for the measurement of urine. The porous paper sachet would be moistened at the back. The urine would soak through the charcoal, losing any pigment such as might upset the reading. Then it would soak through to the front where it would react with the indicator. Tests would, of course, have to be made, to ensure that the pH reading is not altered by the adsorption or absorption of hydrogen ions by the charcoal.

For those who can afford them - particularly after you have gained experience with test-strips and want to move on - very good ion-sensitive field-effect-transistor pH meters exist. These range from a single decimal place after the point to three places.

Here are a few meters from IQ Scientific Instruments. Charles Wehner cannot recommend them, because he has not tried them. Years of working in a laboratory, with wet-bulb pH meters, taught him that they are too cumbersome and too prone to calibration drift. However, the arrival of the ion-sensitive field-effect transistor (ISFET) makes calibration more stable, and allows for portability.

IQ 150	IQ 240
IQ 400	Minilab

Such instruments may also be suitable for measurement of BLOOD pH, which is another subject. It would be wise to seek out the smallest ISFET probe, however - to keep options open. For urine measurement, one or two places after the decimal point will be adequate. Three would be over-kill.

In use, you simply dip the test-strip or probe into the urine - having made sure that there has been no contamination of the urine. The measurement should take place as soon as the urine is released, because carbon-dioxide from the air will lower the pH, giving an over-optimistic reading.

Owners of Addison dogs should do the test on their OWN urine, or on the urine of a healthy dog. This is so that no panic will result from perfectly natural fluctuations. As you gain experience, you will learn to identify when the dog is indeed losing sodium, due to insufficient medication with mineralocorticoid. When the pH reading are within the range found in a healthy specimen, the Addison dog can be said to be "standardised". No guesswork here!

I understand that dogs have fewer - or even no - sweat-glands. This is to prevent their body odour from interfering with their sense of smell. That is why they pant in the summer to lose body heat. The nose is also extended to take it further away from the smell of the body.

If this is so, the major routes by which sodium is lost will not be skin, gastric system and urine - as in a human - but just gastric system and urine.

This should make the urine pH test a very precise one in the dog, for standardising Florinef.

When a patient is over-dosed with mineralocorticoid, the blood pressure rises without any rise in blood sugar or red-cell count. This is the iatrogenic form of Conn`s disease. Under-dosing produces alkaluria and acidaemia. The exact balance between these two extremes can only be found by proper measurement.

Indicator test-strips are of LOW accuracy, but do not need calibrating. Electronic instruments MUST be calibrated accurately - or meaningless results may be obtained. However, electronics gives the better precision.

Three-figure pH measurement is perhaps TOO ACCURATE. For example, an instrument might give pH 7.123 - but how do we know it is not 7.122 or 7.124? TEST SOLUTIONS of three-place precision are not on the open market - so the instrument may be CAPABLE of three places, but the calibration cannot be achieved. This can lead to a sense of false security.

When pooling data, it is important that the exact name of the tool used to find the pH is given. Pooled data has to be replicable, in that different people in different places repeating the same experiment under the same conditions will obtain the same results.

Tests for pH of urine are best combined with tests for BLOOD PRESSURE - another painless process. Dogs come in all shapes and sizes, so the correct blood-pressure for your pet has to be obtained by consulting the vet. If high pH, indicating sodium loss, is combined with low blood pressure, you can be DOUBLE-SURE that the dog is under-dosing on mineral steroids.

A final point on the subject of PAIN. James Wootten was received into Guy`s Hospital where he was "cured" of rheumatism. In fact, it was the acidosis - and Charles Wehner knows from experience that with lots of rest, the pains abate and there are NO unpleasant after-effects.

Overdosing with Glucocorticoids like Prednisone or Prednisolone leads to OSTEOPOROSIS and other long-term arthritic conditions. The after-effects may result in the need for joint replacement, or may be incurable. Over-dosing is therefore worse than under-dosing.

The with-holding of treatment, however, would be cruel. The loss of sodium via the urine leads to a loss of water. The blood becomes thick. Circulation fails - due to BOTH the thickness of the blood and loss of energy of the heart. Then, the concentrated solutes of the blood produce CLOTS, as observed by Greenhow, which cause the death.

So the prudent Addison dog-owner uses measurement to ascertain whether sodium loss is occurring, and gives the minimum of medicine that puts it right.