Help-Vet Stumped

[Guest Catherine]

This may be a little long:

 

My girl Ruthie is 12 1/2 years old. She started to have full bladder accidents in the house in November. All bloodwork normal. Urine not well concentrated but acceptable-diagnosed with Ecoli UTI. Responded to antibiotic and cleared-no more accidents for three or four weeks.

 

One evening acute onset of symptoms-had to urinate every two hours over night (full bladder)-was excessively drinking water between urination that night only-would not eat breakfast. Vet trip-Blood work again all in normal ranges. Urine was lowest dilution possible w/out being water. Had x-rays and ultrasound of abdomen and chest-no stones-no abnormalities. Diagnosed with a Proteus (sp?) UTI. Treated with antibiotics and culture cleared and urine concentrated again.

 

Now-a month after all clear and a month w/out accidents in the house-she has this same acute presentation last night. Every two hours frantic to pee-full bladder-very dilute-excessive water intake to the point of vomiting water-would not eat this morning. She is back at the vet now for her third blood and urinary panels in as many months. I am sure she will come back with some sort of UTI. BUT-this crazy acute onset has no predictors before hand. One afternoon fine-that evening crazed to pee and drink. She is not eating anything unusual. Water bowls are not empty when I get home from work. Any ideas where else to look for the underlying cause? I think we ruled our diabetes insipidis last time since she started to concentrate her urine again once we cleared up the Proteus.

 

Thanks all! Hope someone has some insights to share!

[Tallgreydogmom]

Have you thought about a consultation with Ohio State? You could fax them her lab work to start with. You can find out about a consultation at their website, just google "greyhound health and wellness program".

 

Prayers for Ruthie. Seniors are the best

[turbotaina]

Some dogs just need a really long course of antibiotics to clear a UTI.

[Guest Energy11]

Have they ruled out Diabetes (*both types), and Cushings Disease?

 

http://www.dogdiabetessite.com/diabetes/mellitus-dogs.html OR http://www.vetinfo.com/canine-diabetes-insipudus-symptoms.html

 

OR http://www.peteducation.com/article.cfm?c=2+2097&aid=416

 

ALL have the symptoms you are describing, and there are certain tests for all.

 

I, too agree, with an OSU consult. You can email what you posted here to Dr. Couto, and he, or one of his staff, WILL respond. guillermo.couto@cvm.osu.edu

 

Sending you lots of love, hugs and prayers, too! Dee and The Five

[tbhounds]

As some of our girls age their body shapes may change do to loss of muscle mass. She may now have a a different angle to her vuvla allowing the urine to pool in that area allowing bacteria to have a field day. You may need to wipe her after she urinates.

[dmdsmoxie]

Dennis Mckeon, AKA Rockingship, had this to say to an adopter having issues with her dog suddenly starting to urinate in the house and there being no medical issues.

 

Kidney flush has been done in the kennels in Ireland and here for many years.

 

Here is what to do.

 

Half a package of pearl barley in a pot with a gallon water

bring to a boil then simmer for 2 hours, let cool

 

Starting tomorrow morning I'm to take about 6oz of this stuff (which looks like the top layer of scum

in a cesspool, eeooow!) place in a dish and microwave until it just liquefies again. Then add about 2oz

of milk, cream or half and half to make it more palatable. I've been assured the dog will actually consume

this readily. In about an hour, the hound should have to piss like a racehorse. This process is to be

repeated 4 times a day for 5 days and he'll have sparkling clean kidneys and I'll have dry carpets again.

 

 

 

 

And a piece of the recipe needs clarification - you strain the pearl barley and discard, its the pearl barely

water you want to use.

 

Dick

[Jackandgrey]

I would also suggest a longer course of antibiotics might be in order. Sometimes the usual length of time just doesn't do the trick.

 

That sounds fascinating Dick. Can't hurt!

[Guest Catherine]

She took the antibiotics for 21 days and we recultured her urine at the end of the cycle and it grew out completely clean. Can she have a false negative?

[CaliforniaGreys]

She took the antibiotics for 21 days and we recultured her urine at the end of the cycle and it grew out completely clean. Can she have a false negative?

 

How long did they wait to re culture when the antibiotics were stopped?

[Laurenbiz]

A false negative is possible...

 

Has you vet had experience with Greys before? I ask this because of an article I read recently in the adoption packet we got with Bernie. Since we took him to the vet a few weeks ago, I was reviewing all the info that GPA gave us in his folder.

 

I read about the fact that vets need to know how to interpret Greyhound hematology results from other breeds. The article gave lots of info about how a normal white blood cell count in most dogs is 50, for example, but for Greyhounds, the normal level should be 15, for example. (I don't remember the values - I'm just throwing out some numbers here!)

 

So, if your vet possibly doesn't know about the differences in interpreting the bloodwork of a Greyhound compared to other breeds, you may be getting some jumbled, inaccurate information about Ruthie's 'normal' bloodwork.

 

This is my guess - and I may be totally wrong. When I read your post, it reminded me about that bloodwork article I read not too long ago.

[turbotaina]

She took the antibiotics for 21 days and we recultured her urine at the end of the cycle and it grew out completely clean. Can she have a false negative?

 

Recalling a conversation with my vet a while back, yes, if the culture was done immediately after ceasing antibiotics. I think you need 10 days after cessation. This is why a lot of vets don't want to just prescribe an antibiotic willy-nilly before they can culture the urine.

[greyhead]

She took the antibiotics for 21 days and we recultured her urine at the end of the cycle and it grew out completely clean. Can she have a false negative?

Yes, you can get a false negative if you reculture too soon.

 

We've been having a similar problem with a male, though leakage these days rather than full bladder incontinence. He is on his fourth round of antibiotic. He keeps relapsing because he was infected a long time before a culture diagnosed him. As has been said, a long long course of antibiotics is required.

 

Well, I also think that the usual 10-day course of a/b's is not sufficient for an infection of this duration, but the vet has been conservative and following usual practices. He relapsed two days after stopping the first round of a/b. We did a second round and he was good for two weeks after that, as far as I could tell, but then relapsed again. He leaked all the way through the third round, so I requested a fourth.

 

We observed our dog licking his back end a lot and are speculating that he was transferring E. coli from there to his penis. But we'll see what happens next. We're almost at the end of this fourth round, and we still have leakage. So I'll be asking the vet to either extend the treatment or switch to another a/b.

 

One vet said to reculture in 3-4 days after end of a/b's. Another vet said, no, that's too soon to catch a recurrence. We retested after two weeks and found the E. coli again. (Proteus I don't know about specifically, but if my dog had it, I'd Google it and see what the story was. Might be especially hard to get rid of.) But I think being conservative with a/b's in a situation like this is the wrong approach. I think not giving *enough* a/b is what causes bacteria to develop resistance, because there are some still *alive* who have had a taste of the a/b but not been killed. So I think we should just *nuke* them with a lot of a/b until the symptoms disappear and then for some time longer just to be sure!

[kudzu]

Three things-

1. That barley/kidney flush recipe is getting saved. Must do a little searching for more info on it. Quite intriguing.

 

2. Can you find any other commonalities to the episodes? I had a male dog who did this if forced to hold his water for an entire work day, multiple days in a row. It nearly always started on a Friday evening after the vet office had closed. When the pattern changed it was almost always because something in our schedule changed. Sometimes he had a UTI but other times not.

 

3. My cat currently has a difficult to clear UTI. Had it first a few months ago, cleared with 2 weeks Baytril. Symptoms recurred on Friday, New Years Eve. Vet couldn't manage to get sample for urinalysis but we chose to treat with Baytril anyway rather than wait until Monday & risk an e-vet visit over weekend. After 14 days of Baytril the follow up visit showed UTI was still there. Vet switched him to 14 days Clavamax. I asked about doing a culture since they'd gotten a large enough sample. He said it likely wouldn't culture anything even if the bacteria was resistant to Baytril. Something in the antibiotic effected culturing in the lab. After 14 days the infection was still there but things had definitely improved. So we are now going back tomorrow after over 5 weeks of this. I hope it's finally cleared.

 

Good luck with your girl.

[Guest Catherine]

She took the antibiotics for 21 days and we recultured her urine at the end of the cycle and it grew out completely clean. Can she have a false negative?

 

Recalling a conversation with my vet a while back, yes, if the culture was done immediately after ceasing antibiotics. I think you need 10 days after cessation. This is why a lot of vets don't want to just prescribe an antibiotic willy-nilly before they can culture the urine.

 

Thanks! I need to look back and see how long it was after we stopped the antibiotic that we tested. I think just two or three days. We waited to see what grew before we started her on an antibiotic and used the specific antibiotic the Proteus was reactive to which-- of course --is an injectable only antibiotic so I would hate to have to go through that again.

[JJNg]

Hey Catherine! Good to see you here (although not the current topic). As others have already suggested, I'd consider a longer course of antibiotics (4-6 weeks or longer), and re-culture at least 5-7 days after finishing the antibiotics. I'm assuming your vet is culturing her urine again, prior to starting antibiotics? Since her episodes of increased urination and drinking seem to coincide with confirmed infections, that seems to be the most likely cause. Especially if her concentration goes back to normal after the infection is cleared (what exactly was her specific gravity when it was concentrated after treatment?). And it also sounds like your vet has done a thorough workup to rule out metabolic/systemic causes.

 

One other diagnostic test to consider would be cystoscopy to actually get a look into the urethra and bladder to make sure there are no abnormalities that might have been missed on ultrasound. If your vet doesn't have an endoscope, this might be something that requires referral to a specialist.

 

Will keep Ruthie in my thoughts that this is nothing serious, and Willow hopes her momma is feeling better soon!

[Burpdog]

Are you using filtered water? Burp had the worst recurring infections. We finally got rid of them with 21 days of baytril and I switched to filtered water. No more UTIs.

 

There seems to be a lot of e coli infections and they are tough to clear up!

[greyhead]

Are you using filtered water? Burp had the worst recurring infections. We finally got rid of them with 21 days of baytril and I switched to filtered water. No more UTIs.

 

There seems to be a lot of e coli infections and they are tough to clear up!

How did you do the filtering, with a built-in unit? a PuR pitcher? (Hm, do I want to give up real estate in the fridge or under the sink?) Is there something about tap water that encourages these infections to persist, do you think?

[Batmom]

Forgot to mention in my PM (nothing secret, just told many times here) -- We rechecked urine after @ 5 days WHILE ON the new antibiotic, and then rechecked+recultured 7-10 days after the antibiotic was finished. I can't remember if we cultured the WHILE ON sample or just did the strip test + looked at the sediment. While all those checks/cultures added up to be pricey, the antibiotic we were using runs @ $6 a day, and my vet felt wanted to make sure it was doing the job. He said that he has treated UTIs that were cured only by using a combo of 2-3 antibiotics. E. coli isn't usually that hard to knock out but Proteus is a beast.

[Burpdog]

Maybe the ones I am thinking of are the proteus. I'm thinking of Chickie that Marilyn had (I think it was her). Took forever to get her infection gone.

 

How did you do the filtering, with a built-in unit? a PuR pitcher? (Hm, do I want to give up real estate in the fridge or under the sink?) Is there something about tap water that encourages these infections to persist, do you think?

 

I use a PUR filter that attaches to the faucet. Don't know about tap water but I do know one of my vets does the same thing and came to the same conclusion. I think if you have well water, assuming the water has been tested and is good well water, you would not need to filter.

Edited February 5, 2011 by Burpdog

[Batmom]

You could be thinking of E. coli, Diane. Some of them are hard to clear, too -- kind of a tossup with that bug, depending on which strain you get, and dogs tend to reinfect themselves with it. (Proteus, there's almost never a tossup -- all hard to kill.)

[kudzu]

Are you using filtered water? Burp had the worst recurring infections. We finally got rid of them with 21 days of baytril and I switched to filtered water. No more UTIs.

 

There seems to be a lot of e coli infections and they are tough to clear up!

Wow, I am so surprised to read this. I stopped mentioning the tap water problem to anyone because no one believed me. We found with my dog that tapwater was indeed a prime irritant of his problems. Filtering with a simple Britta filter attached to the faucet or the pitcher type made all the difference for him. It cut back his incidents from several times a month to only several times a year. When traveling I usually just bought distilled water. And I say distilled because some bottled waters were apparently not filtered in a way that helped him. 

 

And while we're on the subject of the bizarre things that caused problems, I will mention that highly acidic foods also caused him problems. That actually lead to many problems briefly when we tried cranberry based supplements. Instead of helping his problems it made them worse. I am not trying to say this is what may be causing your girl problems. My guy was really strange. I found that many of his symptoms and the items that appeared to trigger them were similar to interstitial cystitis. You can Google that and find more info.

[Guest Catherine]

Hey Catherine! Good to see you here (although not the current topic). As others have already suggested, I'd consider a longer course of antibiotics (4-6 weeks or longer), and re-culture at least 5-7 days after finishing the antibiotics. I'm assuming your vet is culturing her urine again, prior to starting antibiotics? Since her episodes of increased urination and drinking seem to coincide with confirmed infections, that seems to be the most likely cause. Especially if her concentration goes back to normal after the infection is cleared (what exactly was her specific gravity when it was concentrated after treatment?). And it also sounds like your vet has done a thorough workup to rule out metabolic/systemic causes.

 

One other diagnostic test to consider would be cystoscopy to actually get a look into the urethra and bladder to make sure there are no abnormalities that might have been missed on ultrasound. If your vet doesn't have an endoscope, this might be something that requires referral to a specialist.

 

Will keep Ruthie in my thoughts that this is nothing serious, and Willow hopes her momma is feeling better soon!

 

Hey Jennifer! Thanks! We did run an extra liver test this time too to supplement the bloodwork and urine culture. All normal! Except white bloodcells which are up. Is the cystoscopy where they inject dye into the bladder? We are considering this if this is not another Proteus infection. Thinking that perhaps we didn't clear it like we thought we did. She also has a discharge (high bacteria in it) this time that they noticed though no redness or swelling. My two boys have been very sniffy of her (I HATE this word)vulva this time too which is different.

 

Thanks everyone for all your help! Let's hope it is a reinfection of proteus and a longer course of antibiotics is the fix...we just have to wait for the culture to grow out.

[JJNg]

Injecting dye into the bladder sounds like an x-ray contrast study - another form of imaging that would provide more info about any abnormalities in the urinary tract. The goals of both a contrast study or cystoscopy are similar, although cystoscopy uses a fiber optic scope to look directly inside the urinary tract. Hopefully it's just a infection that wasn't completely cleared, and you won't have to take that next step.