Violet's Dental - Update: U/a Results Post #83

[greysmom]

Just now getting caught up. {{{{{HUGS}}}}} for you and Violet!

 

[MaryJane]

Thanks all. I just got home about a half an hour ago after picking up Amicar and then Zuri and then finding poop on my bedroom floor that I got to clean up, yay me.

 

Anyway, I reviewed everything with the ER vet before I left and then I got to spend about 30 minutes with Violet. Her mouth is pretty swollen and she was definitely stressed when they brought her in. She had been lounging with the staff in the dental room, but she had to be moved to a cage in the ER side and apparently that freaked her out. But after I left they got more Dexdomitor on board and she was resting quietly when I called for the update.

The good (very good) news is that I took her out to potty when I had her. They had been taking her out, but she wasn't going. She went immediately for me and her urine did not have blood in it!! :yay So I really really hope she is on the mend and I will be able to pick her up in the morning. We discussed whether she still needed to stay overnight and agreed it was the safe thing to do provided they could keep her from getting anxious, but a big part of me really wanted to just bring her home because I know she would be happier here. Anyway, I really don't think this was rhabdo and don't know if we'll ever know what it was. They are going to run a urine culture (tbhounds, she said they have a special culture they can do when ABs have already been given) and we'll see if any bruises pop up tomorrow. I decided to cancel sending urine out to test for myoglobin in light of hte yellow pee since the vet said she would have to do some digging to see where to even send it.

 

One question - how many days after a dental do you typically give Amicar? I went to pick up a 7 day supply and it was $200!!! So I took 2 days worth and I'm going to see if I can get the rest cheaper from Costco tomorrow.

 

 

This is really good news. If you were not seeing blood when she urinated then, chances are that the tech that reported visual blood clots (brown urine) was mistaken or miscommunication occurred. To clarify -- there would not be visible clots at one point and then in the next hour, they disappear. If they are ONLY picking up blood cells in the microscopic, then this would be indicative of irritation and that would be as a likely result of infection.

 

If you have the inclination, can you ask about this "special culture" that can be done once antibiotics are started. I'm up-to-date on most new laboratory methods (even though I haven't been in the field for decades) and I haven't heard of this one. On the other hand, if the antibiotics are not working, the bacteria would grow out but, it would not be a "special culture".

[NeylasMom]

We are home!!! Violet happily scarfed down some food and then promptly curled up next to me on the couch and passed out.

Our discharge was comical, first the dental tech to review our discharge instructions, then the ER tech to review her med schedule and some other restrictions/instructions, then Dr. Stiles (our dentist, aka the "captain" ) to do a final review. He did recommend that we schedule an appointment with an internist to have a full ultrasound done and otherwise try to figure out if there's an underlying issue we haven't identified yet. As long as she's doing well, we will hold off until after the holidays for that (and we'll see what the urine culture results are in a few days). We also have to go into our regular vet tomorrow to recheck CK and AST values and I'm also going to have them do an in-house urinalysis to check for RBC, casts. etc.

 

Jen, I'm sorry to hear about the problems Violet is having. I found this website, while it is discussing hematuria in humans, to be very informative nevertheless.
It says that clots are usually indicative of urological problems, but have they checked for proteinuria to test for glomerular infiltration to help rule out nephrotic issues?

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/evaluation-of-hematuria/#cesec5

Thanks for this, very helpful. When we see the internist I'll take this with me. I will say, the vet told me that when she urinated the blood/clots that it was all at the beginning of her urine stream and then the urine cleared up somewhat by the time she was done, which according to that article points toward a non-renal issue. I don't have the full urinalysis results yet (they sent them out) so I can't answer the other questions yet, although I know there were some casts, but don't know which kind (I thought the non kidney kind because we worry if there are the kidney kind because of rhabdo). As for protein, I discussed briefly with my vet when I called to schedule tomorrow's appt and she said the problem with protein in the urine is that if you have RBCs it could just be from those. Anyway, thanks again - definitely helpful.

 

 

MaryJane, there WERE blood clots along with plenty of frank blood in her urine right after the procedure and then MANY hours later after we had been treating her, there were not. There are still RBCs in her blood, even as of this morning and in the analysis they did yesterday afternoon, there were tons of RBCs in the sediment after they spun the urine down and viewed it on the slide. I confirmed all of this with multiple people, including our vet who witnessed it.

 

As for the culture, I will ask if I talk to them again or if my regular vet can tell from the report. It may be something as simple as they let them know ahead of time that the dog has been on ABs so they look for any miniscule amount of growth, I really don't know.

 

 

Thanks again everyone for the well wishes and all of the helpful input - you guys rock as always!

Edited December 18, 2014 by NeylasMom

[Burpdog]

Glad she is home!

[BootsyCollins]

I understood 5 words in this thread...Violet, blood, urine, and freaking out. So I cant offer opinion or advice. But I CAN offer hugs and support. Love to you both.

[carronstar]

I am so happy that Violet is home, has eaten, and has passed out. Hopefully, it is all clear sailing from here!

[tbhounds]

Glad she's home :-)

[NeylasMom]

So I have the in house urinalysis results in front of me now if any of the medical folk care to comment. Still waiting obviously for the urinalysis results from the sample sent to the lab.

 

So, from the first free catch sample (I'm just noting key stuff):

Urine bloody, cloudy

Spec gravity 1.008

+++ protein

+++ blood

.2/normal urobilinogen

From sediment: RBC TNTC, epithelial cells rare

 

From a later (not sure how much later) cysto sample:

 

WBC 4,630

PLT 143,006

 

Clear dark yellow supersomething (vactant?)

Dark visible pellet

TNTC RBC

4+ protein casts-finely granular

1+ something (anaphous?) background

Rare struvite crystals with a qx about the urine sitting out too long

1+ lysed WBC

1+ extracellular something (cocci??) - confirmed by cytology

Platelets per immersion field: 10-15/HPF

 

I wish I could read the morphology notes better, here's my best translation :

RBC - R___ (rare?) echinocytons. No inclusions or parasites.

WBC - mildly reactive lymphocytes. Otherwise ___ PLTS - ____ !

 

Wish I could read those words before the exclamation point, but I think it's something along the lines of holy ** there are so many platelets.

 

This site was really nice for helping to interpret results. Seems like the fact that the casts are finely granular doesn't point definitely to renal damage and the high protein level is normal for all of the RBCs so basically nothing more helpful than what I already know.

[GreyTzu]

I can't remember, was there blood in her urine?

[tbhounds]

Super something=supernate (fluid after it's be spun off--lacking red, white cells etc---the cells are in the "pellet"))

Anaphous=amorphous material (aka junk)

TNTC= too numerous to count

Struvites (Triple phosphates) can be seen in an old sample--or in a sample with the bacterial infection

Looks like you have a few CBC results mixed in with the urinalysis--WBC, platelets (a which are normal btw)

One thing that is concerning is the urine specific gravity 1.008. That's a very dilute sample esp on a overnight fasted dog. Was Violet already on fluids when the sample was obtained??

[NeylasMom]

Super something=supernate (fluid after it's be spun off--lacking red, white cells etc---the cells are in the "pellet"))

Anaphous=amorphous material (aka junk)

TNTC= too numerous to count

Struvites (Triple phosphates) can be seen in an old sample--or in a sample with the bacterial infection

Looks like you have a few CBC results mixed in with the urinalysis--WBC, platelets (a which are normal btw)

One thing that is concerning is the urine specific gravity 1.008. That's a very dilute sample esp on a overnight fasted dog. Was Violet already on fluids when the sample was obtained??

Thanks. That sample was right after her procedure so she had just been taken off of fluids. Her urine is very concentrated now and has been since I saw her pee at 8 last night, even despite being on fluids all of that time so I think the dilution can be chalked up to the fluids from the procedure (although the fluids after the procedure once she was put back on them haven't caused the same dilution).

Edited December 19, 2014 by NeylasMom