Big Trouble in Little Bladder

May 21, 2011 10:19 AM

Aaaaaaaaaargh! Doggy UTI! Please give me your advice for right now, and in the future.

My poor dog has had three UTIs in the last three years, so she's prone to this problem. I'd like to manage things to reduce the likelihood that she will get future infections, but if there's anything I could right now to make her feel better, I'd love to know.

Here goes the infodump:

Her urine showed struvite crystals and a "slight infection" -- but that was 10 days ago. By now, the infection is no longer slight. Grrrrrr.

She just started a course of Clavubactin, which is amoxicillin and clavulonic acid 500/125 (she gets 1/2 a pill twice a day). She had her first half last night, another half this morning, and is about to get today's second half (it's night now, here). The course is for 10 days.

This is for infection by Proteus Mirabilis that showed up in the urine culture. The results (dated May 12) show 10⁵ CFU/ML, whatever that means.

But she's so very miserable. She can't keep still, paces from place to place in the house, licks her lady bits pretty much constantly. Sometimes she just sits and pants. I just took her for a 30 minute walk, which has helped slightly.

Is there anything I can do to help her be more comfortable?

...........................................

The back story is that on Thursday, May 5, I noticed blood in her urine, but she had no outward symptoms of UTI at that point; her behavior was perfectly normal. On Monday, May 6, we took her to the Vet, and sent her urine for a culture, as well as keeping some for examination. We called him Saturday, and he said to call back Monday. On Monday, he told us she had struvite crystals and to get Royal Canin S/O kibble, and feed her nothing else for a month.

Now it get a little fuzzy. My husband had to go out of town, and I can't really communicate with this Vet well (my Greek not good enough, his English not good enough). After about three or four days (may 11 or 12), I asked my husband to call from where he was and find out about the results from the culture and ask about an antibiotic in addition to the special diet. The Vet reportedly said he didn't know why we were asking about an antibiotic. Just feed her the special food.

I kept feeding her the special food. By May 18-19 it was obvious to me that she had a full fledged UTI, with lots of licking and obvious discomfort. Also, by this time, she's hardly eating the special food. She should have 2 1/2 cups per day for her weight, age, etc., and she's eating less than one cup. Consequently, she's also not drinking much, which this food is supposed to promote. I start making her chicken broth to get more liquids into her, despite the fact that we were supposed to feed her nothing but the S/O.

Yesterday, the 20th, we took her back, and he (finally!) prescribed the antibiotic. So from the first moment I noticed something wrong until any actual treatment other than diet, it was 15 days, and the dog is miserable. He said since the infection was only "slight," and she wasn't showing any symptoms, he didn't want to prescribe an antibiotic in the beginning.

Does this make sense? Is it normal for an infection to just go away from an S/O diet? Because that seems weird to me.

I admit, I'm feeling a little bitter, because I pay attention to stuff like this, and take her to the doc when I know something is off, and this is the second time she's had a UTI that progressed to a really painful/miserable stage over weeks of back and forth, when I had spotted the problem almost immediately. The first time was even worse, taking a month of visits, etc. with no relief at all. That's why we switched to this Vet, despite the communication difficulty with him on my end. (And he has a great reputation among people we've spoken with, except for one person.)

Our Vet choices aren't unlimited, since we don't have a car, but I'm feeling very disillusioned. I see from the date on the lab report that the culture was finished by the 12th -- which also seems overlong, but whatever. If she had started antibiotics then, she would be almost finished with the course by now, and presumably okay instead of compulsively wandering around the house trying to find a place to lie down that doesn't "hurt."

Hence, my aaaaaargh. I wouldn't mind experienced opinions on this whole saga.

By the way, we aren't doing the special food any more. He said if she won't eat enough of it to make her drink and pee a lot, it wouldn't do much good. I'm making her meat & veg brothy stuff and doing the dance of the seven veils to get her to down it. (She's not a reluctant eater usually... quite the opposite. Her usual diet is very healthy and homemade.)
...........................................

GOING FORWARD... I want to take control of this health issue as much as possible. My action plan so far:

• I'm going to be adding a lot of liquid to her food. I make her food, and will continue to do so, but I'm going to make sure that she gets a lot more liquid in her actual meals.
• I'm cutting all dog biscuit type treats, which is the only not-really-healthy stuff she gets. I'm going to be giving her dried cranberries to replace some of that, and for the rest... not sure. Maybe S/O kibble. (She didn't hate for the first two or three days; if it's not her main food, it might do.)
• Filtered water. I already make sure her water is fresh all the time, in glass or stainless steel bowls that are washed daily, and that she always has water by her food bowl, and by her bed.
• Washing all her bedding (from the various places she lies down) every couple of days
• Wiping down her butt and lady bits with a gentle antibiotic wipe after walks.
• trimming around her butt and vulva areas between grooming visits
• More baths -- maybe three times a month? She's a dog with "hair" not fur; not sure what is best.
• Peepee promenades. She already has outdoor access to pee whenever she wants to, but she likes to wait for walks, so I'll be walking her for short urinary excursions in addition to our regular walks.

Any additional advice (or cluing in about why any of that is misguided) greatly appreciated! Sorry so long, but I suppose it makes me feel like I'm doing something here. :-I

posted by taz to pets & animals (19 answers total)

Has she had an abdominal x-ray? That should be your next step, since chronic UTI's are often related to bladder stones. The special diet is to change the acidity of the urine. Depending on her breed, she may be especially predisposed to stones (Bichons, for example).

More baths won't help. Probably won't hurt, but won't help.
posted by biscotti at 10:38 AM on May 21, 2011 [1 favorite]

She hasn't had an X-Ray this time. She did have one on her first incident (first, as far as we know) a couple of years ago, and it didn't show any stones.

Also, I forgot to say that she's mixed breed (probably poodle/terrier/something), about 30 lbs, around 5 years old.
posted by taz at 10:46 AM on May 21, 2011

(I also noticed I got my day wrong at the beginning: on Thursday, May 5, I saw blood in her urine, and on Friday, May 6 we went to the Vet)
posted by taz at 10:51 AM on May 21, 2011

"Does this make sense? Is it normal for an infection to just go away from an S/O diet? Because that seems weird to me"

No, infections won't just magically disappear with a change in diet. So yes, it is weird. I would find a different vet that you can communicate more effectively with (if that is possible).
posted by bolognius maximus at 11:08 AM on May 21, 2011

Well, AFAIK infections CAN go away with a radical change in pH (which is what prescription urinary diets do), but antibiotics are usually prescribed as well.

I would want an x-ray if this were my dog, especially since she hasn't had one in the last year.
posted by biscotti at 11:11 AM on May 21, 2011

Also, Veterinary Partner is a great place to do research on any pet medical problems, since it is written by veterinarians.
posted by biscotti at 11:17 AM on May 21, 2011

Thanks, biscotti; quick question – if one of your (female) dogs had an X-ray that did show uroliths, how would you proceed at that point? I know it's not a hugely useful question, because it would depend on number and size and other factors, but I guess I'd like to know generally what the current attitude is regarding surgery versus other therapy.

I have been thinking of getting an X-Ray, even though the Vet hasn't recommended it. At this point I was thinking I'll wait until she's over this current physical discomfort.
posted by taz at 11:30 AM on May 21, 2011

I have interstitial cystitis and one thing that has helped me very much is drinking Evian water - only Evian and no other water. It is as calming to the bladder and urinary tract as baking soda without the sodium. It takes all the "sting" out of your urine and that is huge.

I can't stress this enough. In France Evian baths are a certified cure for urinary tract diseases and the treatment is covered by their National Health Plan.

There is a very soothing gel, Emiritas, that you can get at Whole Foods that can be applied to the genital area as it gets extremely irritated and that makes the whole problem worse - increases the urge to go, etc. plus the burning can be terrible.

The Evian will help with eliminate the burning, also.

Good luck!
posted by Tullyogallaghan at 12:03 PM on May 21, 2011

I'm a veterinary technician, but I've no direct knowledge of your animal.

I agree with others' suggestions that you find a veterinarian that you are more comfortable communicating with. Your dog cannot tell the doctor what is going on. You must act as your dog's advocate when communicating with the veterinarian.

Is there anything I can do to help her be more comfortable?

Anti-inflammatory or pain medications are often prescribed to decrease the discomfort of an animal suffering from a UTI. Please do not give your dog any human medication intended to decrease inflammation or pain.

Does this make sense? Is it normal for an infection to just go away from an S/O diet? Because that seems weird to me.

It sounds as if your vet didn't want to prescribe antibiotics before knowing the results of the urine culture, which makes sense. Since the urinalysis did indicate the presence of crystals, he prescribed the S/O diet to decrease the pH of your dog's urine and to encourage your dog to drink more in order to dilute her urine, both to inhibit crystal formation. The offending bacteria can be the 'seed' around which the crystals form, so a dietary change would not be sufficient treatment. Once a urine culture indicates what kind of bacteria are present, the appropriate antibiotic can be prescribed.

I agree with others who have recommended radiographs. You have indicated that your dog has had recurring UTIs, but hasn't had an abdominal radiograph since the first incident. If it were my dog, I would want to know what's going on in there. A urolith obstructing your dog's urethra is an expensive and life-threatening emergency.

If the radiographs do show uroliths, you can proceed with strict adherence to the S/O diet (no treats or table scraps) to decrease their size, or you can go straight for the cystotomy. The latter has the benefit of recovering the stones for compositional analysis so that your dog can be treated appropriately.

None of the patients we saw at my practice required the ingestion of Evian to make a full recovery. Save your money for the S/O diet.
posted by Seppaku at 12:54 PM on May 21, 2011

I forgot to mention that a possible complication of a dietary change is that, if your dog does have stones, she could become obstructed as they begin to dissolve and she attempts to pass them.

Also, the infectious bacteria are usually present within the urolith, so an extended course of antibiotics must be prescribed so that, as the stone breaks up, the released bacteria do not re-infect the bladder.

As this may be a recurring issue for your dog, consider more frequent vet visits. Regular urinalyses and radiographs may be necessary.
posted by Seppaku at 1:12 PM on May 21, 2011

On preview, this is in answer to your first post!

Thanks, Seppaku. I knew that we needed to wait to see what the culture showed, but the report is dated May 12, and it wasn't until I insisted for the second time about getting an antibiotic that we got the Rx. The urine sample (minutes fresh!) was given on the 6th, the report on the culture is dated the 12th (which means, I suspect, that it wasn't sent right away), we finally got a prescription for the antibiotic on the 18th. Is it normal to wait until the dog is obviously suffering to prescribe an antibiotic? Even if the culture didn't show a "lot" of infection at that point, there was still an infection. Other than the recurring UTI thing, she's very healthy. Is it normal to expect a healthy dog to get over a bacterial infection on her own? Or just by a change of diet? I'm honestly asking, because I had the impression that this isn't current opinion.

I don't want to second-guess the professional, but here's my unsurprised face that the minor infection became a serious infection. I'm feeling angry, because if I'm understanding things I've read correctly, infection + crystals is more likely to result in stones.

I'm not at all a person who is always seeking pharma solutions. If anyone saw my medicine cabinet, they'd realize that I'm pretty much the opposite. I have aspirin, ibuprofen, some OTC thing for back pain and some cough medicine (and I'm not a young person!), and that's about it. I'm a very reluctant patient, myself, and haven't had antibiotics myself in too many years to count (over 10 years, for sure), but I'm watchful and careful about my dog, and take her to the Vet as soon as I see there is a problem. (and/but, it's absolutely out of the question that I would ever try to use human medication for her unless specifically directed to by a Veterinarian!)

^{tiny update: she settled down quite a bit in the last couple of hours, and finally actually seems to be sleeping; hopefully this means drugs are kicking in and she's feeling more comforable. She got her second pill half first, yay, because I'd really hate to wake her up.}
posted by taz at 1:45 PM on May 21, 2011

(Not your vet, not anyone's vet.) A thought about fluids: is her need bad enough that subcutaneous fluids could be an option? For a totally different condition, I'm giving my dog subQ fluids every morning, so I know it's something that is doable at home. She also got subQ fluids once years ago when she got dehydrated from vomiting five times overnight after eating tomato leaves.
posted by bentley at 2:03 PM on May 21, 2011

I got her to drink two large bowls of broth today. Her hydration is good, actually... it's just trying to get her to really drink a lot and flush out her bladder that's the challenge. The first day she ate her S/O food, she thought it was some sort of exotic treat, and ate it all and drank a lot and peed a lot, the next day almost as good; the next day, and every following day, she ate less, drank less, peed less, until I decided to start feeding her broth. It's not as effective as those first couple of days of S/O were, but at least I know she's getting a pretty serious amount of liquid... nearly the same, I would judge. But she's not peeing as much. :(
posted by taz at 2:21 PM on May 21, 2011

The urine sample was given on the 6th, the report on the culture is dated the 12th

Although I don't know how your vet handles their lab samples, at my practice a sample taken on a Friday would be sent overnight by FedEx to the lab, which wouldn't see it until Monday. Being an emergency and critical care facility, we have paid for priority service, so our samples are put at the top of the queue. If your sample came from a general practice, they may not have priority service. A urine culture can take several days or more, depending on the providence of the sample (free-catch vs. cystocentesis, for example) and whether or not susceptibility testing (to determine what antibiotic is appropriate) is performed.

Is it normal to wait until the dog is obviously suffering to prescribe an antibiotic?

I don't know what your veterinarian was thinking or if I would treat your dog (whom I've never seen) as he did. But until the strain of bacteria causing the infection and its susceptibility to various antibiotics is known, ie. until the results for the urine culture came back, how could one prescribe the proper antibiotic?

As I mentioned, anti-inflammatories and pain medications can be prescribed for the patient's comfort. And if you've ever had a UTI, you probably know that she was feeling uncomfortable when you first noticed blood in her urine. Some veterinarians are more concerned with pain management than others. I can't stress enough that if you are not happy with your vet and the way he has managed your animal's care that you shouldn't hesitate to seek a second or third or fourth opinion.

I know she's getting a pretty serious amount of liquid...But she's not peeing as much.

Lack of urination, straining to urinate or dribbling urination can indicate that she has become obstructed or partially obstructed by a stone.

Seeing as your dog was a rescue with unknown prior history and has been having recurring UTIs since 2008, I strongly suggest a thorough workup, particularly radiographs. Just a few weeks ago at my practice, we had a cute little mixed-breed mop-like doggie that had been dumped at the shelter with a UTI. Radiographs were grotesque. We opened up her bladder and she had enough stones in there to fill a coffee cup.
posted by Seppaku at 3:12 PM on May 21, 2011

I'll definitely get a radiograph, thanks, Seppaku! But if stones have formed, it's been in the last year and a half.

She's not urinating less than usual, she's just urinating less than while she was obliging enough to eat the S/O kibble. I'm trying to get her to drink and pee more.

Also, about the culture... again, I didn't expect a treatment until the report came back, but it came back on the 12th, and we didn't get an Rx for antibiotics until the 20th. That's what I don't understand. There was no intention of prescribing antibiotics until we called back again (after already having asked right around the 12th, when he apparently said forget about antibiotic, just feed the S/O), and said, look, she's really fucking miserable now. What's the deal again with the culture? Why aren't we giving her antibiotics?
posted by taz at 4:32 PM on May 21, 2011

I am not a vet. At the vet clinic I work at, we normally take a sterile sample directly from the bladder with a needle or a catheter and send it out for a culture and sensitivity (there are too many opportunities for contamination using a voided sample). We also very often start symptomatic dogs on a broad-spectrum antibiotic while we're waiting for culture results (usually Clavamox or straight amoxicillin), and then change or refill it depending on the test results. We also normally want a follow-up culture 2 weeks after finishing the course of meds to ensure that the infection has cleared. That said, I would definitely try to find a vet you can communicate better with, I think you are right to be concerned.
posted by biscotti at 4:39 PM on May 21, 2011

Hmmm...in people, a common indicator to test for diabetes is recurrent UTI's and yeast infections; I'd imagine it is the same for dogs. Especially since you mentioned that a change in food seemed to impact the infection. High sugar content in the urine equals increased risk for infection.
posted by sugarbiscuit at 5:29 PM on May 21, 2011

Make sure the dried cranberries don't have sugar, because that exacerbates the problem.
posted by brujita at 9:51 PM on May 21, 2011

Good point. I have health-store dried cranberries that I'll use for some of her treats after the course of antibiotics is finished... and I may as well mention for anyone else reading this that I decided not to give her cranberries now, because I've read that there have been some concerns about cranberry possibly hindering/delaying the absorption of Amoxicillin in humans, though one study shows that it's not enough to cause problems. Who knows with dogs? It's probably fine, but I figure I'll err on the side of caution.

Also, for anyone reading, cranberry should not be given to dogs (or people) with oxalate crystals/stones since it increases calcium and oxalate concentrations in urine.

Doggy update is that she's doing much better now. She slept all night, and her bedding was dry this morning. I've been finding wet spots the past several days, though I couldn't determine if it was leakage, or just a byproduct of constant licking.
posted by taz at 11:12 PM on May 21, 2011