Chronic Utis In A Young Male

[Guest happygrey]

One month ago today, Bentley had what I thought was a UTI and ended up having round after round of tests which turned up...nothing.

 

The thread about it is here

 

The $1000.00+ worth of tests he had a month ago include:

 

2 separate Kidney Panels

Pre-Anesthsia Profile

Cysto

Urine Culture and Sensitivity

X-rays of the bladder and kidneys

Level 3 U/S of the bladder and kidneys

 

For treatment he received sub cutaneous fluids, iv fluids, and left after 3 days of in-house day hospitalization (we brought him in every morning but took him home in the evening) on a round of 30 Clavamox at 375mg. I never quite understood why he needed the Calvamox -- since nothing showed up in the testing and cultures. Is it even a broad spectrum antibiotic? However, we finished the round like good doobies. The vet wanted to extend the round after it was completed, but I declined. Now roughly 2+ weeks after finishing the Clavamox, Bentley appears to have another UTI! He had two accidents in the house yesterday evening, and appeared to have some reddish tinge to his urine in one of them.

 

We are seeing another vet today for a second opinion. I am at my wits end, and do not have another $1000 to burn.

 

All of his tests save for the bloodwork and RBCs in his urine were normal. The blood values that were off are a BUN of 28 and a CREATININE of 2.1 WBC counts were all normal, and both RBC and WBC morphology were normal. A few other values were high though, these include:

 

HGB: 21.2 (range 12-18)

HCT: 55.2% (range 37-55%)

MCH: 26.4 (range 19.5-26 pg)

MCHC: 38.4 (range 32-36)

 

What could be going on here? He's otherwise healthy, young (turned 3 in July), eating and drinking well -- spunky and bratty as all get out. He's a bit subdued today (probably in pain) but still ran in the yard and eats like a pig. I gave him some Tramadol this morning to help with the pain.

 

Any advice or suggestions on where to go from here would be very helpful!

Edited November 3, 2011 by happygrey

[Guest snakes]

I'm no vet or lab analyst, I am a human nurse, however from the lab numbers and nothing else it would point to him being slightly dehydrated, maybe some mild kidney dysfunction (which can come with dehydration). I know you said he drinks enough, but maybe he needs more than the usual pup? Maybe something in his food is more salty that his body doesn't tolerate, or he just needs a low salt/kidney diet?

Of course with dehydration comes UTI's.

Cranberry (they make it is capsules) can be helpful for that.

[GreyTzu]

Are both of his nuts gone? Really gone? As in you know they were both there because you personally saw both of them before the big zip?

 

Enlarged prostrate is another thought.

 

With the U/S the vet should have seen it and/or a nut if one was left behind.

[Guest happygrey]

Are both of his nuts gone? Really gone? As in you know they were both there because you personally saw both of them before the big zip?

 

Enlarged prostrate is another thought.

 

With the U/S the vet should have seen it and/or a nut if one was left behind.

Actually, they are both gone and I did see them because he came to us unneutered. We had him neutered. No problems or anything unusual was reported to us at the time.

 

U/S turned up nothing abnormal. Neither did the x-rays. Nor was any bacteria found in the culture and sensitivity...

 

I'm no vet or lab analyst, I am a human nurse, however from the lab numbers and nothing else it would point to him being slightly dehydrated, maybe some mild kidney dysfunction (which can come with dehydration). I know you said he drinks enough, but maybe he needs more than the usual pup? Maybe something in his food is more salty that his body doesn't tolerate, or he just needs a low salt/kidney diet?

Of course with dehydration comes UTI's.

Cranberry (they make it is capsules) can be helpful for that.

Thanks for the insight. I will definitely go over his food choice with the vet today and ask about cranberry pills. They are a holistic practice so I think they will be very open to it.

 

Would a high normal Cl value in his bloodwork indicate dehydration? I just came across one of the panels that showed it at 122 and the range was 109-122.

[tbhounds]

Nothing wrong with the values you posted-- you would expect a high hct and hemoglobin #'s in a gh.

Maybe it's time to ask for a referral to an internist or a urologist.

Blood does not always mean infection it could be inflammation.

[Brooker914]

If there was no bacteria cultured last time, then it was not a UTI. I would repeat a urinalysis (cystocentesis) with a culture and sensitivity since he's having accidents again. If no bacteria is grown again, then antibiotics are NOT warranted and I would recommend seeing an internist. Bloodwork you posted looks pretty normal for a greyhound. Was anything else on the urinalysis last time found? (pH normal, no protein, no or little bilirubin, etc?

 

Edited to add-was the ultrasound done by a boarded radiologist, or a general practitioner? Not that a GP can't do a great job with them, but maybe the images should be reviewed by a specialist?

Edited November 3, 2011 by Brooker914

[GeorgeofNE]

I cannot tell you how much money I have spent on George and his urinary problem. So here's our bizarre tale!

 

There is NOTHING wrong with George, according to all of the tests and even the ultrasound. But for the first year I had him, he couldn't hold it. Nothing helped, including a dog walker. It wasn't a housebreaking issue, an anxiety issue, so my vet and I assumed it was a health issue.

 

It makes no medical sense at all--but after a year of frustration and tests (and cranberry pills!) and tons of antibiotics, he STOPPED! Stayed dry for two full years. Started peeing in the house again last August. More tests. All negative. Ultrasound. He has no physical deformity, etc. More antibiotics, lots of them, working on a theory. Problem slowed, but did not stop.

 

Then one day, not related in any way to his peeing, I stopped his daily dose of NSAID. All the sudden it was flood time again! It was only then that a light went off in my brain that last August (see above) my vet had changed his NSAID dose from 50 mg. to 35. It was almost exactly then his accidents started. So I put him back on 50 mg. He has not had an accident in 16 weeks!

 

I an not suggesting your dog needs an NSAID. I'm just letting you know I feel your pain and frustration, and sometimes something IS wrong that they just can't seem to figure out!

 

It was most likely NEVER the antibiotics that "cured" him the first time (we assumed that the 14 weeks of Baytril had done it), but simply putting him on an NSAID for his aches and pains.

 

Who the heck knows what it is, but clearly it is some sort of inflammation in some part of him that makes him pee without an anti-inflammatory! And the reason the second round of antibiotics seemed to slow the problem is that Doxy has a mild anti-inflammatory effect (according to Dr. Feeman).

 

I call it "The Curious Case of George."

 

 

Edited November 3, 2011 by GeorgeofNE

[Xan]

I just put this in another thread, but to quote myself:

I'm absolutely NOT an expert in this, but I've had great luck adding pure cranberry juice to my cats' food. They don't mind at all, oddly, and so far no more UTIs. If what he has is a low-grade infection that might not be showing up in labs, this might help. Cantharis is also great to help with bladder irritation.

Good luck! This is no fun for either of you, I'm sure!

 

[Guest greyers]

I cannot tell you how much money I have spent on George and his urinary problem. So he's our bizarre tale!

 

There is NOTHING wrong with George, according to all of the tests and even the ultrasound. But for the first year I had him, he couldn't hold it. Nothing helped, including a dog walker. It wasn't a housebreaking issue, an anxiety issue, so my vet and I assumed it was a health issue.

 

It makes no medical sense at all--but after a year of frustration and tests (and cranberry pills!) and tons of antibiotics, he STOPPED! Stayed dry for two full years. Started peeing in the house again last August. More tests. All negative. Ultrasound. He has no physical deformity, etc. More antibiotics, lots of them, working on a theory. Problem slowed, but did not stop.

 

Then one day, not related in any way to his peeing, I stopped his daily dose of NSAID. All the sudden it was flood time again! It was only then that a light went off in my brain that last August (see above) my vet had changed his NSAID dose from 50 mg. to 35. It was almost exactly then his accidents started. So I put him back on 50 mg. He has not had an accident in 16 weeks!

 

I an not suggesting your dog needs an NSAID. I'm just letting you know I feel your pain and frustration, and sometimes something IS wrong that they just can't seem to figure out!

 

It was most likely NEVER the antibiotics that "cured" him the first time (we assumed that the 14 weeks of Baytril had done it), but simply putting him on an NSAID for his aches and pains.

 

Who the heck knows what it is, but clearly it is some sort of inflammation in some part of him that makes him pee without an anti-inflammatory! And the reason the second round of antibiotics seemed to slow the problem is that Doxy has a mild anti-inflammatory effect (according to Dr. Feeman).

 

I call it "The Curious Case of George."

 

 

WOW... JUST WOW! That is the craziest thing and I just had to comment on that! Poor George, and poor YOU... what a rollercoater ride you both have been though! He is so lucky to have just a patient owner such as yourself.

 

I will say, interestingly enough, and having nothing necessarily to do with George per se, but last month I had my first ever kidney stone. The urgency (and pain of urgency) I felt was absolutely overwhelming. It was mostly worse than the physical pain I felt as it passed. I literally could not step away from the bathroom for more than 5 minutes. I took the drugs as little as possible because I did not like how they made me feel, BUT When I was on drugs to help with the pain, the urgency almost all but went away. Reduced enough that I could sleep for an hour or two at a time instead of waking every 5-10 minutes to get up again. Not sure if this is the same mechanism that George had regarding his pain meds, but something was related in my case, big time.

Interesting story with George.

 

For the OP, I wish I had some advice to give you. After so much time trying to find an answer and now having the problem reoccur, it must be incredibly frustrating and I hope this time there will be an easy (and cheap) answer and fix for him.

Edited November 3, 2011 by greyers

[Guest happygrey]

Thanks everyone for the input. GeorgeofNE that is one wild tale. I wonder why the NSAIDs seem to work. I'll tuck it away.

 

If there was no bacteria cultured last time, then it was not a UTI. I would repeat a urinalysis (cystocentesis) with a culture and sensitivity since he's having accidents again. If no bacteria is grown again, then antibiotics are NOT warranted and I would recommend seeing an internist. Bloodwork you posted looks pretty normal for a greyhound. Was anything else on the urinalysis last time found? (pH normal, no protein, no or little bilirubin, etc?

 

Edited to add-was the ultrasound done by a boarded radiologist, or a general practitioner? Not that a GP can't do a great job with them, but maybe the images should be reviewed by a specialist?

 

U/S was done by a radiologist and the new vet told me that he'd done an excellent writeup (uh, the old vet told me nothing specific other than "nothing had been found") -- but she told me that nothing was remarkable about it. Apparently he even looked for some weird, rare kind of worm that would have shown up in his kidney/bladder. (YUCK!) There was nothing -- but she remarked on how extensive his writeup way. She was unfazed by all of his blood values, and, like me, had not understood why he'd been on Clavamox when no bacteria had grown out. She said, "some vets just do that." She seems to know GHs very well.

 

I liked her quite a bit more than the vet who last treated Mr. B. Plus Bents wasn't at all afraid of her.

 

She did say that there was a small chance that his muscles might be breaking down due to how athletic he is. We also did a long walk about 1.5 weeks ago. Bents runs daily in the yard, and sometimes pretty crazily, so she could be on to something. She ran a bloodtest called a CK to check for it. Again, she said it was unlikely, but she wanted to check.

 

For now she recommended plenty of access to water (and suggesting putting other bowls down around the house instead of just the one they all go to) and plenty of trips outside. She'll call me tomorrow and we'll go from there. I still don't have any answers, but at least I'm not having him undergo needless expensive tests "just cuz."

 

I'm feeling better about it -- but of course, will feel best when he's back to normal!

[GeorgeofNE]

When George had his ultrasound, my vet called and said, "Well, there's good news, and bad news" and I said, "He's 100% normal, right?" and she said yes. That was good news, but also bad news, because that was really our last gasp at trying to figure it out!

 

If you need any advice on belly bands and Serenity pads, I know much more than I ever wanted to about urine containment!

[Batmom]

Does he take any medications or supplements besides the Clavamox?

 

You might see some blood in the urine after unusually strenuous exercise but you wouldn't expect to see accidents / discomfort from that.

 

Hope your new vet can get to the bottom of things.

[Guest happygrey]

Does he take any medications or supplements besides the Clavamox?

 

You might see some blood in the urine after unusually strenuous exercise but you wouldn't expect to see accidents / discomfort from that.

 

Hope your new vet can get to the bottom of things.

No, nothing else.

 

New vet did say that she thought it was unlikely, but the test isn't that expensive and seemed worth running.

 

I am no longer thinking he's in pain. He seems more or less his old self.

 

I'm anxious to hear if anything grows out from the urine sample I gave them today. At least I feel that there's a better chance of open communication with this new vet.

[Guest Swifthounds]

She said, "some vets just do that." She seems to know GHs very well.

 

In addition to antibiotic properties, abx like clavamox also have anti-inflammatory properties that will provide some relief in addition to any antibiotic effect, so most animals experiencing urinary discomfort will get some relief regardless of whether it's a bacterial infection causing the issue.

[krissn333]

One of my male IGs seems to get chronic UTIs. When we run tests, the numbers are always just off enough to indicate mild UTI. Someone suggested I try apple cider vinegar and raw honey.

 

For him (he weighs about 15 lbs) he gets 1 teaspoon Bragg's apple cider vinegar (bought in the health food/organic section of the grocery store), 1 teaspoon of the raw honey (also from the health food section), and about 1/4 cup water with his kibble twice a day. The honey has antibiotic properties. It also cuts the taste of the ACV.

 

It has worked well for us and we've not had a UTI recurrence.

 

Solid Gold also makes a supplement called Berry Balance that I've heard good things about, but haven't used myself.

[JJNg]

She did say that there was a small chance that his muscles might be breaking down due to how athletic he is.

Is he still having the reddish tinge to his urine, and has a urinalysis been run from this new episode? Reddish discoloration to the urine caused by muscle breakdown can be easily distinguished from blood on a simple urinalysis. When the urine is centrifuged, actual blood in the form of red blood cells will separate out and be visible as cells under the microscope. Breakdown of muscle or blood cells will result in myoglobin or hemoglobin which discolors the urine but the color remains after the urine is spun down and there are no cells seen.

 

Has he had any white blood cells or protein in his urine either last time or this time? What's his urine specific gravity and pH?

 

Glad to hear you're repeating a urine culture. I'm assuming it was a clean, mid-stream catch if they're running it on the sample you took in? If the culture confirms a UTI, that would be the most straightforward explanation of his signs. If it's still negative, then you may need to look further.

[Guest happygrey]

She did say that there was a small chance that his muscles might be breaking down due to how athletic he is.

Is he still having the reddish tinge to his urine, and has a urinalysis been run from this new episode? Reddish discoloration to the urine caused by muscle breakdown can be easily distinguished from blood on a simple urinalysis. When the urine is centrifuged, actual blood in the form of red blood cells will separate out and be visible as cells under the microscope. Breakdown of muscle or blood cells will result in myoglobin or hemoglobin which discolors the urine but the color remains after the urine is spun down and there are no cells seen.

 

Has he had any white blood cells or protein in his urine either last time or this time? What's his urine specific gravity and pH?

 

Glad to hear you're repeating a urine culture. I'm assuming it was a clean, mid-stream catch if they're running it on the sample you took in? If the culture confirms a UTI, that would be the most straightforward explanation of his signs. If it's still negative, then you may need to look further.

 

Yes, the urinalysis is being repeated. There wasn't much urine but I guess it was as mid-stream as I could get it. No protein and no WBCs last time. Gravity was 1.014 and Ph of 5.5. There's no range given on those, so I am just assuming they were normal. No one said anything about them.

 

Bentley seems very much back to his old self, and is even peeing by lifting his leg again, rather than squatting. The whole thing is very confusing!

Edited November 4, 2011 by happygrey

[JJNg]

Gravity was 1.014 and Ph of 5.5. There's no range given on those, so I am just assuming they were normal.

Glad to hear Bentley is back to his normal self. A USG of 1.014 is pretty dilute, but that may be normal if it was from the middle of the day after he'd been drinking a good bit. You can check a USG on a urine sample from first thing in the morning to see if he's concentrating his urine normally.

 

Does he still have any blood in his urine? Was it confirmed to be blood (RBC seen on sediment) or was it discoloration from hemoglobin/myoglobin?

[Guest happygrey]

Gravity was 1.014 and Ph of 5.5. There's no range given on those, so I am just assuming they were normal.

Glad to hear Bentley is back to his normal self. A USG of 1.014 is pretty dilute, but that may be normal if it was from the middle of the day after he'd been drinking a good bit. You can check a USG on a urine sample from first thing in the morning to see if he's concentrating his urine normally.

 

Does he still have any blood in his urine? Was it confirmed to be blood (RBC seen on sediment) or was it discoloration from hemoglobin/myoglobin?

Thanks for the info. The sample was not from first thing in the morning, it was from later in the day when I was bringing him out often. Nothing abnormal was found in the new urinalysis; no bacteria and no blood, and the CPK was normal. The gravity and pH values are from the urinalysis he had a month ago not from the latest test.

 

Since he had such an extensive workup a month ago, we are now going to watch him and see if this happens again. He's returned to his normal self and seems perfectly fine. At this point we have no explanation of what the incident was, but at least he is back to normal. I guess this could be just another of his quirks.

Edited November 5, 2011 by happygrey

[kudzu]

Went through many years & a couple K of my pay trying to find the source of my dog's cystitis symptoms. I say symptoms because only once did he actually appear to have a UTI. The rest of the time it was just symptoms. One test you haven't mentioned is a cystourethrogram. Has anyone mentioned that? Am not suggesting you need to get one done. But that was one of the many tests run on my dog.

 

In the long my dog had neurological problem effecting his bladder & urethra, along with the rest of his lower motor neuron system. I seriously doubt that is your pup's problem but for my guy the UTI & his (no longer idiopathic) cystitis were side effects of urinary retention.

 

ETA: In the midst of all the above years of vet insanity (insanity of the vet med events not the veterinarians themselves) I learned of Intersitial Cystitis. One of the suggestions was filtered water. What the heck, I thought, that's a cheap thing to try. BINGO! episodes were instantly reduced by at least 75% or more. If he drank tap water you were sure to have a problem. What have you got to loose.

 

AND... The other thing that was sure to cause an episode of horrid proportions was cranberry based supplements. Go figure!

Edited November 5, 2011 by kudzu