My black lab mix Abbey has had a problem with leaking urine. It literally
drips out of her at this point. It started out as an intermittent problem.
We have taken to the vet several times for this. He has put her twice on
medicine(it's the one that was in cold medicines for humans until it was
recalled). He also suggested it might be a bahavioral problem. Her urine
was tested , and came back negative, although it was somewhat diluted. The
other option I was given was to put her on hormones, but I really don't want
to start a 1& 1/2 year-old dog on a lifetime of hormones, and their
side-effects. We are really at our wit's end here--is there such a thing as
a doggy urologist? We live in upper New York, are close to Connecticut, but
are willing to travel to solve this problem for our dog( she is just
miserable). Where could we find a top-notch animal hospital, or specialist?
In addition, Abbey was diagnosed with hip dysplasia around her first
birthday. Unfortunately, she was too old for the surgery that can correct
this problem at that age( it's not hip replacement, but the newer option)
She has been on Cosequin, with great results. She runs, jumps, and behaves
perfectly normal. I only mention this because I wonder if the two could
possibly be related?
Any suggestions you can give me are greatly appreciated. I use your site
often for information.
Thank you, Dagmar
Answer: Dagmar-
Canine incontinence can occur for a number of reasons. In a young dog, it is
helpful to try to be sure that there isn't a cause for the dog incontinence
that can be cured, prior to treating it symptomatically. Your vet may
already have made an effort to do this, or it may be necessary to seek the
help of a specialist.
Incontinence can occur because there is an increased urge to urinate that
the dog can't control, when there is a decrease in the ability to resist
urine flow for hormonal, neurologic or anatomical reasons and occasionally
as a behavioral problem. Of these, hormonally responsive canine incontinence is
the most common cause.
If the phenylpropanolamine (PPA) was effective when you were using it but
the canine incontinence returned, hormonally responsive canine incontinence is the most
likely problem. If it did not help at all, the failure doesn't rule out
hormonally induced dog incontinence, though. Some dogs do require estrogen
replacement therapy. Usually it is possible to use low enough dosages that
adverse side effects are unlikely. I really can't remember having a serious
problem from the use of diethylstilbestrol (DES) for pet incontinence, but we
have had some problems with other estrogens, so there is some reason for
concern when using estrogens. Phenylpropanolamine is available under the
brand name "Proin" as a medication for dogs.
If the PPA was not effective, it would probably be a good idea to see a
specialist to try to get a complete work-up to rule out non-hormonal causes
of canine incontinence such as misplaced ureters, bladder stones, chronic lower
urinary tract infections and neurologic problems. It may take dye contrast
X-rays of the urinary tract to establish that the system is anatomically
correct and functional, culture and sensitivity testing of urine extracted
directly from the bladder, X-rays for bladder stones and a general work-up
to rule out other systemic problems in order to feel comfortable going
ahead and using hormonal therapy.
Unfortunately, I am not able to tell you who does this sort of workup in
your area but the veterinary schools (Cornell, Tufts) are usually a good
choice and there seem to be several referral centers in the New York area
(the Animal Medical Center in Manhattan, for example). Your vet can help
you find a specialist and most are happy to do this.
I couldn't find any information that suggests Cosequin (tm) or other
glucosamine/chondroitin products lead to dog incontinence. We have seen several
dogs with severe hip dysplasia who we think would urinate where they were
laying because getting up was too painful. We believe this to be the case
because pain relief or hip replacement therapy ended the problem in these
dogs.
Good luck with this. Don't rule out using estrogens entirely. We have found
them to be useful and not very likely to cause problems, so far. Checking
to be sure estrogen therapy is necessary is a very good idea, though.
Mike Richards, DVM
6/16/2001
Treating canine incontinence in dogs
Question: Dear Dr; I have a dog with spayed female canine incontinence. For over
a year I have treated her with ppa (acutrim) with total success. Unfortunately,
this drug is now unavailable. Hormonal tx is out of the question since she
has liver disease. My vet has no answer for me, and I am at my wit's end.
Any suggestions? Thanks in
advance Annette
Answer: Annette-
I am sorry for the delay in replying to your question. There are several
medications that are currently
being used to treat canine incontinence in dogs in an effort to find one that replaces
phenylpropanolamine
(PPA). They are:
1) Diethylstilbestrol (DES), which is a synthetic form of estrogen. There
is some fear of bone marrow
suppression when using DES but I do no recall ever experiencing this problem
in practice, so I
presume it is rare. I know of no reason that DES can not be used when there
are changes in liver
function, but your vet may know something that I do not. DES is currrently
only available from
compounding pharmacies but all the ones that we deal with have it, so it is
readily available.
2) Imipramine (Tofranil Rx), a tricyclic antidepressant, causes urine retention
in some patients treated
with it, so it is being used in the hopes this effect will occur in patients
with canine incontinence. Initial
reports are encouraging, but that is often the case when people are looking
for a substitute for a
medication and want to have good results.
3) Pseudoephedrine (Sudafed tm) causes similar effects to phenylpropanolamine
but has not been
used extensively. The dosage is 30mg for small dogs and 60mg for big dogs.
I have been using 30
lbs. of bodyweight as the dividing line between large and small. I have not
had enough reports back
from owners yet to know if this is working at all.
4) Some compounding pharmacies still have phenylpropanolamine powder and
can custom make
capsules with the appropriate dose for a patient who needs this medication.
It is worth calling around
to the various compouding pharmacies (or checking online for veterinary compounding
pharmacies)
to see if one of them has this medication. Your vet should know of some of
these, as well. There are
several that advertise nationally.
Good luck with this. I hope that one of these suggestions is helpful if you
have not already found a
solution to the problem.
Mike Richards, DVM
1/8/2001
Phenylpropanolamine's alternatives
Question: Hi, Dr. Mike -
I'm sure I won't be the first, nor the last, of your clients/correspondees
to ask just what you will recommend to take the place of the now-defunct
phenylpropanolamine. I am just sick that I can no longer obtain Dexatrim,
or other OTC meds, to control BOTH Trudi's and her Boxer-sister-Fanci's
(Fanci's is the typical spayed-female-leakage, brought on by advancing
years) canine incontinence.
A brief note on our CRF gal, Trudi. Twenty-two months after the original
diagnosis of chronic CRF was handed down, she is still doing remarkably
well. The herbal iron tonic I discovered about 4 mos. ago has really
created a huge improvement in her looks, stamina, eating patterns,
demeanor. We continue to have small episodes of pancreatitis, which (so
far) can be controlled by removing all food for 24 hrs. Strangely,
although she LOOKS so great, her blood chem values have changed
little; outwardly, the only sign that she's a CRF gal is her
constant-and-profuse shedding.
Dr. Mike, I sure hope you'll be able to give us a tip as to what (either
OTC or Rx) we can use to control the canine incontinence from now on. Thanks in
advance.........your advice has always been valuable to us!
Regards, Rozanne
Answer: Rozanne-
Phenylpropanolamine is still available from some compounding pharmacies.
I
know of at least two in our area that still have the powder to make this
medication and I believe that it may remain available through compounding
pharmacies.
There are alternatives to phenylpropanolamine. The one currently being
talked about the most on the Veterinary Information Network (www.vin.com,
a
service for veterinarians only) bulletin boards is impramine (Tofranil Rx),
1 to 2mg/kg of body weight every 12 hours, up to 15mg twice a day. I have
not used this medication because we have had good success using
diethylstilbestrol (DES) and have been able to obtain this medication from
our local compounding pharmacy. We usually use 0.5mg per day for 5 days for
small dogs, or 1mg per day for large dogs. We then try to lengthen the
interval, usually reaching a once weekly or twice weekly dosage in most
female patients. We usually try testosterone in male dogs but generally
have to combine this with something else, such as phenylpropanolamine, so
when our supply of this runs out, we will have to consider other options
for our male patients, probably. I am hoping that when we run out of
phenylpropanolamine the compounding pharmacies will still be able to get
the medication.
Mike Richards, DVM
12/4/2000
Leaking urine and accidents - medication related in Samoyed
Question: Help! My samoyed has suddenly forgotten what it means to be house
trained. She is currently on medication for myositis, predinose 30mg
every other day, and when she started to leak urine, she was put on
phenylpropanolamine (now down to 25mg on the days she gets her
prednisone). In the last week, she has started to have accidents in the
house, even after she is brought in after being out for a while. I let
her out several times during the night and still she slips. Is this
related to the medication?
Thanks. P.A.
Answer: P.A.-
It is very likely that there is a relationship to the medication with the
sudden change in urinary habits. Sometimes prednisone can make it easy for
bladder infections to occur, so it would be worth having her checked by
your vet for this. Bringing a urine sample that is less than 4 hours old
can be helpful, just in case it isn't possible to get a urine sample at the
vet's office. Prednisone can also sometimes push a dog with a tendency
towards diabetes into exhibiting signs of that disease and the urine will
help to rule that out.
If the urination problems are not related to cystitis there is still a
chance that the prednisone is contributing, since it does make dogs drink
more and urinate more. In that case, it may be necessary to try to find a
lower dose that will control the myositis but not induce excessive
urination. Sometimes it isn't possible to do that but it is worth trying.
Sometimes when dogs start to have accidents in the house for medical
reasons the behavior becomes self supporting since dogs like to urinate
where they have urinated before. Cleaning the area carefully with an
enzymatic cleaner and working hard to catch her urinating so that you can
reinforce that it is not acceptable behavior with a loud "NO" can
help to
restore her old and better habits.
Good luck with this.
Mike Richards, DVM
12/21/99
Incontinence in older Ibezan Hound
Q: Dear Dr. Mike,
I have a ten year old female ibezan hound who was spayed three years ago.
This morning she was lying on the couch, and I was petting her. When she got
up, there was a small puddle of urine. She is totally housebroken, and had
just been walked, so I was very surprised and concerned to see this. To my
knowledge this has never happened before, and we were recently at the vet
who gave her a clean bill of health. Your input on this
matter would be greatly appeciated. Thank You A. K.
A: A.K.
Incontinence is not unusual in older female dogs. It is probably occurs at
a slightly younger age in spayed females and may be a little more common in
them. The history is typically exactly what you have seen, urine leakage while
laying down or while asleep. It is best to rule out bladder infections and
causes of increased urination such as diabetes and Cushing's disease as contributing
factors. Your vet may feel that this was accomplised during the recent exam
but it would be best to check with him or her on this. Incontinence responds
well to treatment in most cases. Usually the first medication tried is phenylpropanolamine
but estrogen supplementation is sometimes also used first. Whichever medication
is used, the other one is available if there is treatment failure. In many
instances we find that treatment for a couple of months will often stop the
problem for some time and that going on and off of medications doesn't seem
to make them less effective when it is necessary to use them again. Let your
vet know this is happening and I think you'll find that treatment works well.
Mike Richards, DVM
9/21/99
Incontinence - possible causes in Golden
Q: Dr. Richards
I was reading the letter from Maggie about her 2 year old Golden Ret. who
has been suffering with canine incontinence. Our 6 yr old JR terrier had the same
problem as a 3 yr old and we pursued the same suggested treatment as
Maggie's vet prescribed, with no results. We decided that we would have to
live with the 'leaking' and proceeded to 'waterproof' the house as much as
possible.
However, after a few years of other medical problems, we recently found
that Charlotte suffers with liver shunt and hydrocephalus. But during our
exploration of her liver problems, the surgeon discovered a kidney stone
blocking one of her ureters. The stone was removed during exploratory
surgery, and since that time there has been no more urine 'leakage'. I am
confident that the stone may have played some part in that problem. Is it
possible that stones can be transient enough to sometimes cause this
situation? We treated Charlotte at various times for what we suspected as
urinary tract infections, on the basis of urinalysis results. Can existing
stones be a cause of the positive test results? Thanks for your expertise.
Maureen
A: Dear Maureen-
There are a number of possible causes of canine incontinence. Small stones in the
ureters, bladder or urethra can definitely cause signs of canine incontinence. It
is conceivable that there could be recurrent episodes of canine incontinence
associated with stones from metabolic causes, such as urate stones. These
tend to be formed in larger numbers than struvite stones and it is not
uncommon to find hundreds of small stones when these are present.
Incontinence is commonly encountered in veterinary practice. The majority
of cases are probably estrogen responsive canine incontinence. In a spayed female
dog in which canine incontinence shows up after the surgery it is very tempting to
ignore other possible causes and treat for this one. Especially since it
can be pretty expensive to test for all possible causes. In a dog in which
canine incontinence is not responsive to therapy or when there are reasons to
suspect other causes may be present it is important to know what else can
lead to canine incontinence and to eliminate as many of them as possible through
appropriate testing.
It is important to consider several different things when dealing with
canine incontinence. As a first step it is important to establish that the problem
really is canine incontinence and not just an increase in the need to urinate
causing the dog to urinate in the house because it has to. Disorders that
increase the amount of urine produced and therefore the need to urinate
include diabetes mellitus, hyperadrenocorticism (Cushing's disease),
diabetes insipidus, uterine infections, kidney failure, administration of
corticosteroids and some other medications and other more infrequent
causes. It is important to let your vet know if your dog is drinking more
than normally and urinating larger volumes than normal. There are also
diseases and disorders that increase the urge or need to urinate without an
increase in actual urine volume. These include cystitis, bladder stones or
stones elsewhere in the urinary tract, cancer in the urinary tract and
prostate disease in males.
There are also a number of disorders that are considered to be forms of
canine incontinence that are not related to estrogen levels. Neurologic disorders
affecting the nerve supply to the bladder can lead to canine incontinence. There
are several classes of these disorders. In general the bladder is large and
distended due to the loss of nerve function. This is a hint that there may
be neurologic causes. Many practitioners do not feel confident in their
ability to diagnose neurogenic bladder disorders and if they are suspected
it may be necessary for a neurologist to help in the diagnostic process.
Large bladders can also be a sign of an obstruction to urine flow beyond
the level of the bladder, such as a urolith (stone) in the urethra,
especially in a male dog and cat.
Some dogs are born with their ureters, the tubes that connect the kidneys
to the bladder, misplaced. When this happens it may lead to continuous
urine leakage, especially if they miss the bladder entirely and implant
directly into the urethra.
There are also dogs with behavioral canine incontinence. Stress or excitement can
lead to urine leakage. Another behavioral condition some dog owners confuse
with canine incontinence is submissive urination. This is a form of voluntary
urination, so not truly canine incontinence, that occurs when a dog is very
submissive. These dogs usually roll over when approached, show their
undersides and urinate a little or sometimes a lot.
This isn't really about canine incontinence, but urate stones are fairly common
in
dogs with portosystemic vascular shunts. It is probably a good idea to
consider the possibility of these stones in any dog with liver shunts. Any
bladder stone can cause or make it seem like cystitis or canine incontinence is
present, both by mechanically obstructing the urinary tract and by
irritating it and creating a better environment for bacterial infection.
I am glad you thought to write about this. It is good to be reminded to
think about all the possible problems that can lead to any particular sign
or syndrome sometimes.
Mike Richards, DVM
Urine leaking in Golden
Q: Hello, I have a problem with my 2 years old female golden retriever (spayed
around 6 months of age). I notice when she is asleep that she is leaking
urine. It started while she was on antibiotics Apo-Sulfatrim 480mg due to
an ear infection (I though it was a side effect). There is no bladder infection.
My vet is convinced that this is canine incontinence and suggested the use of
ESTROGEN SUPPLEMENTATION. I heard that this medication can cause serious
side effects.
I'm looking for a homeopathic treatment.
I would like to know if you have any suggestions.
Thank you
Maggie
A: Maggie-
I am sorry, but I have no experience at all with homeopathic treatment.
The two most frequently recommended treatments for canine incontinence in female
dogs are estrogen supplementation and phenylpropanolamine (Propagest TM,
Dexatrim TM).
The most successful estrogen supplement was diethylstilbestrol (DES), which
is currently hard to find. Estrogens do not cause side effects with great
frequency but the side effects can be very serious, including suppression
of the bone marrow's ability to produce red blood cells that may not
respond to withdrawal of the medication. We never experienced this side
effect in our practice but it was worrisome enough that we preferred to
attempt treatment with phenylpropanolamine first whenever possible. We have
not had much success with alternative estrogen products that have been
suggested since DES has become harder to find.
Phenylpropanolamine is a decongestant and is the active ingredient in
Dexatrim (TM), the product used for appetite suppression in humans. As far
as I can tell there is no appetite suppressive effect in pets. It does not
seem to have serious side effects but it often has to be given three times
a day to be effective and that is a drawback for many pet owners. Sometimes
it works for the majority of canine incontinence when it is given at bedtime since
many dogs are only incontinent when they are sleeping.
There may be herbal or homeopathic treatments for this problem. If you have
an interest in them, there are veterinarians who use these treatment
methods in their practices.
Mike Richards, DVM
Incontinence after neuter
Q: I am in search of solutions to two problems that I am having with my 10
month old male pug "Pepper Boy". He is having a urine leak from
his penis since approx. 1 month after he was neutered at 8 months. My local
Vet. gave him a 2 week supply of antibiotics but this did not clear up the
problem. The second problem is a bald spot that has developed on his shoulder.
We have tried various creams but these have not helped. The Vet. thinks it
is a fungus but can not rid him of it. Any help you could provide in solving
these problems would be greatly appreciated.
A: I guess I would be suspicious of hormonally based canine incontinence in a dog
that developed urine leakage after neutering. Usually this will not occur
this quickly and it isn't a common problem in male dogs but it just seems
like a reasonable possibility once infection seems unlikely (the reason for
the antibiotic treatment first). It is usually responsive to treatment with
testosterone replacement and sometimes only a couple of injections are necessary
to stave off the problem for long periods. It might be a good idea to take
bladder X-rays to rule out bladder stones and consider a general chemistry
panel to rule out causes of increased urination before attempting canine incontinence
treatments.
If your vet has taken skin scrapings from the sore and not found parasites
then I have no other good suggestions for diagnosing this problem other than
considering a skin biopsy if it won't clear up. They can be very helpful in
difficult cases of skin disease.
Mike Richards, DVM
Urinary Incontinence in Rottie
Q: Dear Dr mike, My female Rott is a year old and she is house broken, and
when she sleeps now we see on her bed it is wet so i have been watching her
and she didn't do this before, what could be wrong with her, could she have
a cold ?She dont have any thing else. thanks
A: Your dog probably has urinary canine incontinence. This is an inability to hold
urine in the bladder. When dogs urinate where they are sleeping or particularly
if they urinate when laying down and awake, this is the best possibility.
It is important to rule out a bladder infection, bladder stones and diseases
that cause increased production of urine, such as diabetes before deciding
that canine incontinence is the cause of urine leakage. In addition, there are several
causes of canine incontinence, which respond to different treatments. In almost all
cases, it can be controlled, though. Your vet can help with this problem,
almost for sure.
Dimetapp tablets for canine incontinence
Q: Dr. Mike, In the case of urinary canine incontinence, what do you think of the
use of Dimetapp extentabs (twice daily if necessary 12 hours apart). ????
A: Dimetapp tablets contain phenylpropanolamine and a second ingredient (brompheniramine)
which probably isn't necessary to administer but also probably isn't harmful.
It is usually less expensive to use phenylpropanolamine (generic of Propagest
Rx) by prescription just because of marketing/packaging costs but if it is
more convenient to use this formulation and the antihistamine doesn't cause
drowsiness or other side effects I see no reason not to.
Mike Richards, DVM
Leaking urine
Q: Hello, Having a problem with my female German Shepherd - she is a little
over 7 years, been spayed around 6 months. I notice when she is asleep that
she is leaking urine, she also urinates quite a bit outside especially before
I start throwing her toy for her. She was overweight so I have had her on
a diet and she has lost a few pounds and at least has a waist now. She drinks
a lot of water and is always warm (panting). I was wondering if the spaying
could have damaged the muscle that controls her bladder. We have noticed quite
a few wet spots where she lays and it seems to happen only when she is relaxed
and asleep. She has a normal appetite, looks healthy and is energetic. I would
appreciate your comments. Thank you
A: Spaying does not damage the urinary sphincter muscles, to the best of
my knowledge. It does cut down on the estrogen levels in the female dog's
body, though. This can lead to a loss of muscle tone and possibly mucosal
thickness in the bladder, which does often lead to canine incontinence. Most dogs
with this condition will respond to estrogen supplementation, usually using
diethylstilbestrol (DES). Many vets prefer to try phenylpropanolamine (Propagest
Rx, Dexatrim Rx) first, though. This medication is less likely to cause side
effects than estrogen supplementation. Some dogs require both medications.
The most serious side effect of DES is bone marrow suppression. I think this
must be pretty rare because we have used this medication in our practice for
eighteen years now and have not seen this in any of our patients. We have
seen it using other estrogen products and feel that it has to be considered
as a risk due to those experiences, though.
I do not know the percentage of spayed females with this trait and it does
occur naturally in older female dogs who have not been spayed. It does appear
to happen more commonly in spayed females, though.
There are a also a number of neurologic causes of canine incontinence. It is important
not to overlook any evidence of neurologic disease in an incontinent dog.
Also, it is important not to overlook causes of increased urine production
that may be contributing to an canine incontinence problem. Diseases like diabetes,
hyperadrenocorticism and kidney failure can all cause an increase in drinking
and urine production which can show up as canine incontinence in a dog that previously
did not have problems with urine retention.
Hope this helps.
Mike Richards, DVM
Incontinence in a 7 year old Pug:
Q: Dear Dr. Mike: We have a 7 year old male pug that has developed canine incontinence
recently. Our vet has been treating for bladder and kidney infections with
various medications for several weeks but the problem continues. The vet seems
to be stumped by this and we would like to know if you have any suggestions.
Thanks.
A: It sometimes takes a little while for a vet to become convinced that canine incontinence
really is canine incontinence, especially in a young or middle-aged dog. Usually
we try to rule out bladder infections, bladder stones, neurologic disorders,
hormonal disorders that increase urine output and all other possible causes
of urinary problems that we can eliminate before giving up and accepting that
canine incontinence is present. I can't fault this approach because most of the time
I do the same thing. Often, we will try antibiotics to make sure that cystitis
isn't present, then suggest X-rays of the bladder and a general lab panel
to try to rule out obvious hormonal disease like diabetes. Bladder stones
seem to be a relatively common cause of canine incontinence in male dogs in our practice.
Sometimes the history is so strongly supportive of canine incontinence that we go
right to exploring the possible causes of it first - neurologic and hormonal
disorders being the most common causes of canine incontinence in dogs.
Once your vet is convinced that this is canine incontinence and not something else,
he will probably try hormonal therapy if no obvious neurologic disorder is
present. In male dogs, this is usually testosterone by injection since a convenient
oral form of the hormone isn't available as far as I know. Most of the time
the injections can be spaced around a month apart. If neurologic signs are
present, they will be treated based on exactly what your vet finds. Good luck
with this.
Mike Richards, DVM
Continued:
Q: Dr. Mike: Thank you for your response and advice about our pug's canine incontinence.
I have some more information that might be helpful in discovering what is
wrong with Wally. You will recall that he is a 7 year old, male pug. The doctor
has been treating him for three weeks with no success. She says that he has
blood in his urine as well as protein. This would lead me to believe he has
a bladder infection, but why doesn't medication help? She x-rayed him and
found nothing. Blood tests showed that his white blood cell count why slightly
elevated but nothing extreme. Any more suggestions? Thanks!
A: I would be more worried about bladder stones and bladder cancer in a dog
that continued to have blood in the urine after three weeks of antibiotic
therapy. It is difficult for bacteria to resist antibiotics in the bladder
because the concentrations of antibiotics in the urine are often many times
the concentration of the antibiotics in the blood, since they are often filtered
intact through the kidneys, which results in them being in urine in high concentrations.
The non-surgical approach is to consider either contrast X-rays (air or a
constrast solution can be injected into the bladder to help outline stones
that don't show on X-rays or a bladder tumor) or ultrasound exam. The other
approach is to consider exploratory surgery to see if a cause of the problem
can be determined. In our practice, which is pretty rural, clients often elect
to have exploratory surgery rather than traveling to a specialist for ultrasound
exam or paying for contrast X-rays when there is a strong chance surgery may
be necessary later. Avoiding surgery is important to other clients and they
opt for the more advanced testing procedures.
I hope you find a reason for all of this soon.
Mike Richards, DVM
Incontinence in Akita
Q: My one year-old Akita has developed frequent urination and a mild cough.
Her urination is in small amounts and coincides with coughing..This started
when we came home from a hike in the woods. She has not had any health problems
and is spayed. Thanks.
A: I'm sorry, but this is a problem that you're going to have to get your
vet to resolve. It is possible that your Akita is experiencing canine incontinence
and some dogs do have more problems with urinary canine incontinence after exercise
or excitement. It makes some sense that coughing might exacerbate a problem
with canine incontinence but one is young for the problem and it would be a good
idea to have the cough checked out if it continues, anyway. If canine incontinence
is the problem it is usually possible to treat it with estrogens or phenylpropanolamine,
so your vet should be able to help out.
