Can Uti Be Missed In Diagnosis?

[jetcitywoman]

I've posted a few threads here and there about struggles we're having with Capri peeing in the house. She went a good couple years with perfect house manners, and then started having accidents again last fall. We've had her vetted six ways to Sunday, including an ultrasound of her liver, kidneys and bladder to make sure there weren't any tumors or anything. According to the vets, she's in perfect health. Okay, so... behavior issue.

 

Long story short: we removed and replaced the carpet in the room where she was peeing, actually removed a chunk of the plywood sub-floor and replaced it too! She was good for about a week and then had an accident again. Every time she does, we clean it up with enzymatic cleaner. We never punish her, just quietly clean it up. She never goes when we're watching, and she frequently asks to be let out. We started putting panties on her, until she started soiling them sometimes. Then DH bought a large crate. She's fine in the crate during the day. This morning, I knelt down in there (she wasn't inside at the time) to spread her chenille blankie around and make it comfy for her, and it occurred to me... it stinks in here. Feel around the blanket, and yes, wet. Sniff, yes, urine. That explains why she's been reticent to go in the crate since yesterday.

 

Also yesterday she had an accident on the rug outside the crate, but it was very strange. I was tossing treats around on the carpet - a silly game I play with them. Feeding the chickens. She was sniffing around the room looking for any she might have missed, and Ajax followed me back into the kitchen as I put the bag of treats away. I was out of the room for only 2 or 3 minutes, walked back in and there's a wet spot on the rug where I was tossing treats.

 

What in the world... So despite being a good girl and asking to be let out when she feels the need (and getting two walks a day also), this was so very sudden. If she's got such a sudden, uncontrollable urge to go that she lets loose just where she happened to be, doesn't that just scream UTI?

[robinw]

Oh yes, it can be missed, and missed numerous times. Loca had one forever and the results kept coming up negative. There is another test that Loca had that finally allowed her to be diagnosed, but I don't remember what it's called. Somebody here will know

[Guest giantsfan]

When we initially got Winnie, she was having accidents that couldn't be easily attributed to not being trained. Although the urine sample we had tested didn't conclusively indicate an UTI, the vet still thought it would be wise to give her a course of antibiotics and voila, the mysterious potty accidents ceased.

[Guest sweetpea]

Not my story or experience, but I know a hound who failed every UTI diagnostic (meaning nothing showed up on the tests)

and yet, when he was dosed with anti-biotics, his accidents disappeared. This happened a number of times until

finally he was put on a long term regimen of high power antibiotics.

 

So the answer to your question is yes.

 

Good luck,

Buzzy

[Riverhound]

Yup. Joe had one around Christmas a year ago. Nothing showed up on tests, but we had a miserable dog who needed to pee all the time. The vet gave me a combo of two antibiotics for 2 1/2 weeks. We noticed a difference right away, and he's been fine since. When Brees started to act like she might have one, I skipped the testing and when straight for drugs. She was fine a couple days later -- except that she learned that barking and whining gets you let outside to chase critters at night!

[greyhead]

Shane had one for six months that escaped detection, until it finally showed as E. coli. It took months of antibiotics to "clear," but even then he had a leakage problem. He seems to have an issue with his kidneys after all that, and the only way we've been able to almost eliminate the leakage entirely is by putting him on a medium protein kidney diet (Royal Canin Renal). Whenever we try to put him on a different food, the leakage increases big time, so Royal Canin it is.

 

I should also mention that he tested positive both for Babesia, for which he was treated two years ago when all this started, and for Lyme, for which he's about to start treatment. Have you tested for TBD's? They can mess with the kidneys and lead to problems like this.

[MaryJane]

While a UTI could cause what you are describing there are also other things that can do. If she is allergic to a food sometimes they will drink more and as a result, pee more. If she is getting too much protein for her system she might need more water to eliminate it and hence, pee more.

 

Did they culture her urine or just check under a microscope - if they never cultured then you want to get a sterile urine (clean her first) first catch preferably and have them culture it. At the same time you should also get a regular urinalysis done and get the values for protein (s/b negative) and the specific gravity.

[Guest BlueCrab]

When we initially got Winnie, she was having accidents that couldn't be easily attributed to not being trained. Although the urine sample we had tested didn't conclusively indicate an UTI, the vet still thought it would be wise to give her a course of antibiotics and voila, the mysterious potty accidents ceased.

 

Same experience we had when we adopted Leyland: frequent accidents that could not be diagnosed despite numerous tests. Course of antibiotics cleared it up.

[jetcitywoman]

Thank you everyone. Yes, she's been tested for tbd, and shows borderline for rocky mountain spotted fever. Both dogs do, but it's so low borderline that the vet said he wasn't worried about that. I don't remember if her urinalysis was cultured or not, so I'll ask for that. About the only thing I'm sure she has NOT had down was a course of antibiotics just in case. You'd think they'd try that before sending us to the $peciali$t for an ultrasound, but... Grrr.

 

Another thing we did was a fluid intake test - measuring the amount of water she drank for 24 hours. The vet said a dog her size should drink 7-8 cups of water a day on average. She drank 5. So she's not drinking excessively.

[GeorgeofNE]

Not my story or experience, but I know a hound who failed every UTI diagnostic (meaning nothing showed up on the tests)

and yet, when he was dosed with anti-biotics, his accidents disappeared. This happened a number of times until

finally he was put on a long term regimen of high power antibiotics.

 

So the answer to your question is yes.

 

Good luck,

Buzzy

 

I'm just guessing that Buzzy is referring to my dog.

 

It did indeed SEEM as if long term antibiotics "cured" his persistent pee problem. In retrospect, his peeing stopped when he was put on an NSAID for aches and pains.

 

When he started his peeing again two years later, I put him back on antibiotics, thinking that they had been the answer. Only after a very depressing 10 or 11 months of failure did I realize that his pee problem started up again almost the day my new vet changed his NSAID dose from 50 mg. to 35 mg.

 

Since we returned him to 50 mg., he has not had a single accident.

 

I cannot tell you how much money I have spent trying to figure out WHY. At this point, I don't care why. I'm just happy he can now hold it! Use of NSAIDs on a regular basis requires regular monitoring of the blood to make sure the liver function isn't being compromised, but I'm more than happy to deal with that versus having my dog in a belly band every day.

 

He has never had a single thing found in his urine--no blood, crystals, bacteria. His specific gravity is normal every time. He had an ultrasound. His bladder and all other organs are normal, and in the proper places. There is NOTHING wrong--but when the vet told me it was behavioral, I just knew she was wrong, and I insisted we continue to try different things. It was really quite an accident that we found the answer was an NSAID.

 

Disclaimer: there is no reason to believe this would help anyone else's dog. This is just my experience.

[jetcitywoman]

That does sound a bit like Capri, though. She also had pain problems that were never truly diagnosed last summer but ultimately looked like arthritis, and has been "cured" with daily Dasiquin doses. Was George diagnosed with any inflammatory disease like arthritis, or is the NSAID purely to help the urination problem? If Capri's issue comes back after a course of antibiotics, I may come back to you for some details of George's lab results so my vet can compare. But we'll see how it goes.

[Batmom]

The Rocky Mountain SF titer isn't significant -- that's an acute disease, not a chronic one like some TBDs. Meaning if dog has it, dog is sick. Titer shows prior exposure, which is pretty common.

 

How often does she go out during the day? If someone is home here, mine will usually want to go out every @ 4 hours.

 

An ultrasound can be worthwhile. Dog could have stones or another issue that you wouldn't see just on urinalysis or on x-ray (some stones visible, some not).

[GeorgeofNE]

That does sound a bit like Capri, though. She also had pain problems that were never truly diagnosed last summer but ultimately looked like arthritis, and has been "cured" with daily Dasiquin doses. Was George diagnosed with any inflammatory disease like arthritis, or is the NSAID purely to help the urination problem? If Capri's issue comes back after a course of antibiotics, I may come back to you for some details of George's lab results so my vet can compare. But we'll see how it goes.

 

George has a PROBABLE diagnosis of LS. Prior to this (trip to a specialist) the vet put him on the NSAID because he was having some trouble getting up the stairs. He now also takes Gabapentin (100 mg) once a day. I give him the 50 mg Deramaxx in the morning with his breakfast, and the Gabapentin at night. Since starting this regime, I have noticed he is SIGNIFICANTLY less grumpy. He has bad days, and on those days he gets a Tramadol.

 

There is nothing to share in terms of lab results. As I said, they are all normal (well, normal Greyhound--although his creatinine is a little high, even for a Greyhound, but since it is always high, and nothing else is off, Dr. Couto said it is safe to assume it's George normal!). Normal ultra sound. Normal everything.

 

Positive response to the manual test for LS. Suspicious spinal x-rays showing a narrowing of his spinal column in the lower lumbar region.

[jetcitywoman]

Interesting, George still sounds a bit like Capri's situation. All of her tests were negative also. The only thing we could find that might contribute to the pain symptoms was that MRI of her spine showed a small bulge between one of her cervical vertebrae. So we switched to harness and only use her collars as decoration (and to hold her tags). And the dasuquin which seems to have made the pain go away. They did also prescribe tramadol for her, and we used it for a few weeks to get her under control but I didn't want to give her pain meds for an unknown issue for the rest of her life. The Dasuquin has been a better alternative for that.

 

Batmom, you missed the part where I mentioned she was ultrasounded - no stones, crystals or tumors. Her potty schedule is like this:

 

First thing after waking up in the morning (about 6:30am) - backyard

walk after breakfast, about 7:30 - 8:00

lunch break in the backyard, around 11:30 - 1:00

whoever gets home from work first offers a backyard break, around 5:30

evening walk, around 5:30 - 6:30

dinner and toothbrush time (and sometimes she asks to be let out in the middle of this, which is okay)

backyard after toothbrushing (if she didn't go ten minutes ago)

last backyard break before bed, around 9:00 or 10:00

[jetcitywoman]

Well, we saw the vet again this morning and discussed all the treatment to date and how the problem continues. The vet mentioned that one of the previous urinalysis was a culture and nothing grew, so that's one thing I wasn't sure of. Her urine was clean again with a microscope check. It was a bit dilute, and I think it's been that way for a while. We'll try to take in a first-morning sample so they can check the concentration. We came home with an rx of incontinence medication - phenylpropanolamine. We'll try that and if it doesn't help then we can try anti-biotics.

 

I'm still sure it's not a behavior problem and this morning was more proof. Capri got her usual long morning walk, followed by breakfast, and then a couple hours rest before the vet. She peed before getting in the car, and seemed to want to pee when we got there (15 minute drive), but I didn't want her empty if they needed another urine sample, so I tried not to let her go. In the waiting room she started out fine as usual, but then started whining and pulling toward the door, and her complaints gradually increased in volume. She's not usually nervous at the vet, but I figured it was either that or because we left Ajax at home, or she had to pee again. The vet tech came out to the lobby to ask some preliminary questions and Capri finally squatted and peed right there in the lobby. So, answer: she HAD to go and I was not listening to her. (My bad!) After the 15 minutes with the doctor, she was starting to stress again, so I took her outside and she peed again.

 

So there's definitely feelings of urgency - when she has to go, she HAS to go. And she does try to tell me when she has to go. The question remains, why so frequently.

Edited June 2, 2012 by jetcitywoman

[greyhead]

How was the pee situation when she was on the tramadol?

 

(I'm personally curious about this whole situation, as Shane's pee problem seems to have disappeared entirely with tramadol and methocarbamol. Not saying that has anything to do with you or Capri.)

[jetcitywoman]

I don't think the pee issue had started at that point. It seemed to start a few weeks after we got her pain symptoms under control. We asked the vet if it could be a reaction to the dasuquin, and he said no.

[greyhead]

Interesting. Given our experience, I'd be tempted to try the tramadol again for two or three days just to see what happened. But our dog didn't do well on Proin, so I'm biased. And I'm not making any recommendations to you, just sharing experience.

 

Speaking of Proin, did your vet not want to try DES instead? It seems to work for many females, and it's not dangerous as far as I know.

[jetcitywoman]

What is DES? Is that the estrogen based incontinence med? She mentioned that and said she doesn't like to use it because of the estrogen side effects - bone problems. She felt that this one was safer.

[greyhead]

I don't know a lot about long-term DES side effects, but I don't think it's ever fatal. For some dogs, Proin has been fatal. If you do an archive search here, you'll find more info about it.

[JJNg]

I'm wondering...why incontinence meds at all? Is she really incontinent (ie. involuntarily dripping/leaking urine) or is she having voluntary accidents due to an increased need to urinate? It seems that none of the accidents at home have been witnessed, but the recent one at the vet clinic was definitely voluntary. The increased urgency to pee is more consistent with a UTI or inflammation of the bladder (similar to interstitial cystitis in people). Incontinence due to a weak sphincter, which is the only condition that would respond to Proin or DES, does not cause increased urgency to pee.

 

I've also seen dogs who become incontinent due to a bladder infection. So even if the urinalysis/culture are clean, I often still try a course of antibiotics before starting incontinence meds. As previously mentioned, both Proin and DES have the potential for serious side effects, while antibiotics don't. And antibiotics treat a simple condition (infection) that can be resolved, while a diagonsis of incontinence is often one that requires lifelong management. IMO, it makes more sense to try to rule out the problem that may be temporary and has a better chance of being completely cleared.

 

Another thought...is the Dasuquin you're using the one with MSM or not? I know of someone who has had more than one greyhound have urinary accidents when they were given MSM, and the problem stopped when she stopped the supplement.

 

On the issue of dogs who stop having accidents when on pain meds or anti-inflammatories - a couple possible theories... When pain is not adequately controlled, they may be reluctant to posture to urinate as often as they need to, so when they reach the point they can't hold it anymore and happen to be inside, they'll have an accident. Or, I suspect that some dogs do get a condition similar to interstitial cystitis. Since this is a painful, inflammatory condition, it often responds to drugs that address these signs.

[jetcitywoman]

She's definitely having voluntary accidents because of an increased urgency. She never leaks or has accidents in her sleep, which the vet said is the clear sign of incontinence. However, she also has no blood, white blood cells or bacteria in her urine and a culture didn't grow anything, which kind of rules out UTI. The only thing that steered the vet slightly more toward incontinence is that Capri is 8 years old. It seemed like a logical argument.

 

We discussed both treatments and decided to try one first, then the other. The vet did leave it up to me to pick which one we tried first, and I kind of tossed a coin. The incontinence med is definitely not the long-term solution, it's more just to try it and see it not work to rule out incontinence. We're going to give it to Capri only for two weeks.

 

I'll have to look up the ingredients in Dasuquin. Are there two formulas for it, since it's a brand name for cosiquin?

[JJNg]

I guess I don't really understand the logic of using her age to suspect incontinence when she isn't showing any of the clinical signs...

 

Dasuquin and Cosequin are different brand name products made by the same company. There are 2 formulas of Dasuquin - the regular Dasuquin, and Dasuquin with MSM. It should be clearly indicated in the name of the product on the label.

[Batmom]

I'm wondering...why incontinence meds at all? Is she really incontinent (ie. involuntarily dripping/leaking urine) or is she having voluntary accidents due to an increased need to urinate? It seems that none of the accidents at home have been witnessed, but the recent one at the vet clinic was definitely voluntary. The increased urgency to pee is more consistent with a UTI or inflammation of the bladder (similar to interstitial cystitis in people). Incontinence due to a weak sphincter, which is the only condition that would respond to Proin or DES, does not cause increased urgency to pee.

 

I've also seen dogs who become incontinent due to a bladder infection. So even if the urinalysis/culture are clean, I often still try a course of antibiotics before starting incontinence meds. As previously mentioned, both Proin and DES have the potential for serious side effects, while antibiotics don't.

 

I would agree with all the above. I've had two dogs now whose excess urination problems didn't respond to antibiotics but did respond to a food change, so it is well worth eliminating any supplements or other food additives and then considering a sort of elimination diet to see if that helps.

 

IMHO Proin is a bad idea if you haven't had a blood pressure check. I know many dogs get along well with it, but some have severe problems even at small doses. So I would be cautious with that.

[jetcitywoman]

Okay, I hear what you guys are saying. Regarding the food additives and a comment about too much protein in the diet possibly causing excess urination... what about bully sticks? Could that be the cause of it? The reason I ask is that last summer when this started, we stopped giving her all other additives like prozyme. The only thing she gets now in addition to her kibble is bully sticks, and those only about twice a week. The vet didn't think they would cause any problem. On the other hand, so far you guys sound a lot more knowledgeable about such things then my vet does!

 

Plus, it's interesting, just in general... like human doctors, it seems like the last things the vets ever consider is a diet change! Do they (like human doctors) get bare-bones education in nutrition in vet school?

Edited June 5, 2012 by jetcitywoman