Blood In Urine After Dental

[Guest OPointyDog]

So our crazy destructo-dog Mika managed to destroy one of his own teeth on Monday night - he was chewing on a nylabone and I heard the tooth snap. Checked his mouth and sure enough, there's no tooth and 2 roots sticking out and a ton of blood. Called the vet and we got him on pain meds (Rimadyl, as he cannot tolerate opiates) and then got him in for an appointment on Tuesday. Antibiotic started on Tuesday (injection of Convenia, since it doesn't seem to cause GI upset for him, and he is the KING of diarrhea...). Our vet agreed to get him in for dental surgery Wednesday, and they did all the pre-op bloodwork. Everything looked good.

 

The dental and extraction went well, and he came out of anesthesia well, but then apparently started urinating blood everywhere once he was awake. Continued to have blood in the urine for the next few hours, and the extraction area was also bleeding heavily. I arrived to pick him up, and he had just peed again and they caught the urine and the blood content had dropped off quite a bit. We found a local pharmacy that had some Amacar in stock, and I started him on that last night. We discontinued the Rimadyl.

 

This morning, I caught the first urine of the day, and it's still a dark golden orangy brown. I took it in for urinalysis and haven't heard the results yet. The extraction site had a little blood oozing, but it wasn't too bad.

 

Mika is 6 years old, male. His major other health problem is suspected IBD, which is controlled with a prescription food (Purina DCO). He was groggy last night, but this morning was his usual crazy self - doing zoomies in the living room with a stolen couch cushion because I took all the toys away.... (He eats soft ones and can't have chew toys because of the dental). Appetite normal for him, which is that he can eat anything at any time.

 

Anybody got any ideas about what could be going on with the blood in the urine? We don't think UTI since there were no signs of infection in the blood or urine. Stress from being at the vet all day?

 

 

[JohnF]

Stress very likely and possible handling to get on and off the table causing bruising. Report it to the vet anyway.

Edited October 30, 2014 by JohnF

[3greytjoys]

Just my experiences that the surgery, and/or Rimadyl is enough to cause excessive bleeding in some dogs. (Bleeding can be a side effect of Rimadyl.) Adding the Amicar (aka: Aminocaproic Acid), and removal of Rimadyl should begin to reduce excessive bleeding soon. If not, let your vet know. Hopefully, others will respond too.

[3greytjoys]

I wonder if the continued urine discoloration is a combination of the anesthesia + other medications + old blood.

Any idea if he swallowed the broken tooth? If so, he's probably already passed it by now, but might be worth watching for it in his stool.

[Blaidd49]

I agree that the Rimadyl might well be the cause. Hope his recovery is uneventful from here on.

[tbhounds]

Did he do a lot of shaking?? Was his recovery unremarkable? I would be concerned about rhabdo.

[Guest OPointyDog]

Yes, the vet did mention that he was shaking before the surgery, which was weird, because I've never seen him do that before. Otherwise his recovery was unremarkable.

 

He does not appear to be in any pain or distress, is eating, drinking and behaving normally. Frequency and volume of urination is normal for him. Is there still a danger of kidney damage, even with no other symptoms? Should I have him checked again? It's now been about 30 hours since the surgery.

Edited October 31, 2014 by OPointyDog

[4My2Greys]

Sounds like it very likely was rhabdomylosis. If he hasn't received any fluid therapy to flush the toxins there is danger of kidney damage. The longer the time between onset and fluid therapy the greater the damage to the kidneys.

[Guest OPointyDog]

He had an IV during surgery - would that be enough to help with the flush of toxins? What is involved in fluid therapy?

 

I just checked, and the urine is still darker than normal, though not as dark as this morning. Palpated all the major muscle groups, and no soreness that I can tell.

 

Is this one of those times I should put him in the car and go to the E-vet tonight (an hour away)? Or call the local vet first thing in the morning?

 

I have been giving him more fluids than normal - his food is soaked in water because of the dental.

[4My2Greys]

Sorry for not responding sooner I had gone to sleep., I wouldn't wait if I suspected rhabdamylosis. You might want to quickly read through the thread that Neylasmom posted about Violet's experience with rhabdo.

 

http://forum.greytalk.com/index.php/topic/301058-violet-rhabdomyolysis-update-vet-recheck-183/page-1

[Guest OPointyDog]

Thanks everyone for the responses. We have an appointment at our regular vet in a couple hours - so far normal temp, no sign of muscular pain. He is eating, drinking, peeing and behaving normally. I did a catch of urine this morning, and it's still darker than normal but not as dark as yesterday. When I called the vet this morning they gave me the results of the urine test from yesterday, and said that they suspected a UTI, but I also know that rhabdo can be misdiagnosed as a UTI in some cases. I don't think it's a UTI. I suspect we are the only greyhounds in the practice, so they probably have never seen a case before.

 

He's not a nervous dog - he's very calm and outgoing and rides well in the car, etc. I am wondering if the fasting and maybe dehydration leading up to the stress of the dental surgery on Wednesday led to a mild episode of rhabdo?

 

If anyone has any suggestions of what I should ask the vet to look for, I'll take the suggestions along to our appt. Unfortunately the vet we always see isn't in on Fridays, but the others are all very good. (One, in fact, studied with Dr. Couto at OSU so may know something about this.)

[NeylasMom]

Make sure they spin down the urine so they can determine if the discoloration is from RBC or from myoglobin. Determining whether it's blood or myoglobin is key to diagnosing rhabdo. If it's myoglobin, you have your answer. Don't take no for an answer on doing this. If you read through my thread, you'll see that I was initially very suspicious of rhabdo and the vet was doing everything possible to convince me otherwise. We almost walked out not knowing that's what it was, but at the last minute I pressured him to tell me if there was anything else we could do to rule out heat-related issues and that's when he said he could spin down the urine (DUH!) and figured out it was myoglobin.

 

If it is rhabdo, you'll want to look for casts in the urine (an early indicator of kidney damage) and do bloodwork to check renal values. Hope this isn't what you're dealing with, but if it is, the fact that he's acting normal is a good sign that it's not a hyperacute case.

 

ETA: Oh, make sure to check CK level as well.

Edited October 31, 2014 by NeylasMom

[Guest OPointyDog]

Thanks very much for the suggestions - I will take them with me. I did read through Violet's thread and there was a lot of good info in there. I'm sorry you had to go through all that but was glad to see the good outcome! I do think we're probably dealing with a much milder case if that's what it is - he really hasn't shown any discomfort and doesn't have an elevated temperature. This morning he seems a little subdued, but not alarmingly so. We're almost 48 hours out now from surgery and he seems pretty normal.

 

Our vet called me on his day off a bit ago to check in on Mika - turns out that the vet is quite familiar with rhabdo and had considered it, but with no muscle cramping or pain, thought it didn't quite match previous cases he'd seen. Mika was treated aggressively during the surgery and after with IV fluids, so that also was reassuring. We had a long talk about things to do differently for the next dental, too.

 

We'll see another vet in the practice in a few hours - to check Mika's urine and the extraction site in his mouth needs to be checked - they'll do a physical exam, too. If we find anything, they can run his bloodwork, too. I'll probably have them do sub-Q fluids, just as a precaution, no mater what we find.

[NeylasMom]

Let us know as soon as you know anything please!

 

I will add this. If there's one thing I've learned, it's never to rule out anything simply because it doesn't present in the way it's presented in other (especially non-greyhound) cases, especially for something unusual/rare like rhabdo. It just makes more sense to do the tests so you know one way or the other, particularly when it's something as simple as spinning down some urine (ie. won't cost the owner much time/money).

 

Anyway, your situation may very well not be rhabdo and I realize this is moot since you're following up on these things anyway, just more a general statement for others who may face this sort of thing.

[NeylasMom]

Any updates?

[Guest OPointyDog]

Good news overall! A bit of an unclear diagnosis, though. The vet we saw today has previously worked with racehorses, so was familiar with the various unconventional ways that rhabdo can present itself and knew what to look for. No myoglobin in Mika's urine today - just some RBC. The vet chatted with the tech who spun his urine yesterday, though, and the tech remembered that it didn't separate well, so she suspects that he probably had myoglobin in his urine yesterday. She also palpated his muscles and found that he was a bit sore and having small spasms in his back leg muscles. So she thinks that he had a mild case of rhabdo, but it's not really definitive.

 

She ran a full blood panel - CK and clotting profile are still pending, but all the other values were within normal range, so at this point it looks like no sign of damage. Assuming he continues to improve, we'll repeat the bloodwork in a week.

 

He also had a bruise on the inside of his thigh - no explanation for that. He is on Amacar, so hopefully that will keep it from spreading. And we aren't sure why he had RBC in his blood (yesterday there were also a few WBC, but none today). The RBC quantity in the urine had dropped off a lot from Wed-Thurs-Fri, so that was also good.

 

So he got fluids (IV and then sub-Q) to continue to support his recovery. Given that everything else is improving and his bloodwork was good, we'll just keep watching him. The vet will call me tomorrow with recommendations for supplements or vitamins that might help support his recovery. He's already on an antibiotic for the dental, so if there were a UTI brewing hopefully that will help.

 

Tonight he's been pretty restless - I think part of it is the trick-or-treat kids, so hopefully he'll settle down now that's done. We're also putting him out a lot to encourage him to pee.

 

So here's hoping the improvement continues.

[NeylasMom]

Poor guy, hope he's back to normal soon. How frustrating to not have easy answers. Is he on anything for pain? If not, you might want to consider some Tramadol for a few days. Also, if you're operating on the rhabdo assumption, I suspect you'll want to restrict strenuous exercise for some time. Obviously we had a worse case, but Violet was restricted to walks for 8 weeks (gah!).

[Guest OPointyDog]

Unfortunately he's one of those dogs who gets really, really frantic on tramadol and other opiates. We used it once after a dental, and he spent the entire night frantically racing around the house barking at things that weren't there. I wish we could put him on something for pain, especially after the dental extraction, but there's not good choices at this point - the NSAIDs aren't good for the bleeding/kidney problems, and the opiates make him crazy. I feel terrible thinking about the pain, but keeping him calm is pretty important at this point.

 

Yes, the vet said to restrict him to short leash walks for the next few weeks. He almost never runs in the yard, so keeping him from running won't be too hard. But we walk a lot. He's one of those super-busy dogs, so I use long walks to tire him out. Plus I had to take all his toys away (he eats the soft ones and can't have any hard ones now with the dental extraction). It's going to be a long few weeks.

 

He did finally crash on his bed - hoping he's resting comfortably.

 

Thanks for the good wishes - it means a lot.

 

Here he is. He is a complete nutcase but we love him.

 

 

Edited November 1, 2014 by OPointyDog

[NeylasMom]

Yeah, the Tramadol's probably not a good idea then.

 

And oh my gosh, he is so handsome. Violet wants to know if he wants to be her rhabdo BF.

[Guest OPointyDog]

Ha! Mika wants to be everyone's BF, and I'm sure he and Violet would get along splendidly and could share a lot of stories.

[Batmom]

FWIW, if there comes a time when you need pain control and don't have other options -- One of my dogs who had a similar response to tramadol did OK with it if I gave the full dose over 2-3 hours. 25mg first, then another 25 an hour later, etc.

[Guest OPointyDog]

Thanks, Batmom, I'll keep that in mind in case we need it.

 

He seems tired today, but was moving well on the morning walk, so I hope the pain is subsiding for him. He may be tired due to the long vet visit and trick-or-treaters that took away from his naptime yesterday. Plus we had to go out last night a few times to pee.

 

I forgot to mention that they did do an ultrasound of his bladder and prostate yesterday to make sure things looked OK due to the RBC in his urine, and the findings there were normal.

 

Today the sub-Q fluids are absorbed. He's still peeing a lot, but his urine seems improved in terms of color. The bruise on his thigh is also clearing.

Edited November 1, 2014 by OPointyDog

[Guest OPointyDog]

Follow-up to say that the CK and clotting profiles came back normal. The bruise on his belly is nearly gone, and the urinalysis values are back to normal. So far looks like no lasting damage and he's made a full recovery.

 

Now we just have to try to keep him fairly calm for the next week or so!

 

Thanks everyone for your help!