Update: Ruby's UTIs....kidney damage?

Well, it's been four weeks on a strong course of antibiotics and Ruby is still not recovered from her latest UTI. She is still incontinent after exercise, and the last few days has been getting depressed and quiet again.

So, I rang our lovely vet and we have an ultrasound and cystocentesis scheduled for next week. He said that we have to have another look as her last x-ray (that showed no stones) was in November last year, and he wants to do an ultrasound this time to make sure none have developed and also check to see if part of the problem is an ectopic ureter.

He doesn't want these constant infections to start affecting her kidneys, and so I said we'd just had enough of conservative measures and it was time to get to the bottom of things. She may require surgery or long-term medication for her incontinence. At the very least I'm anticipating a complete dietary change (we already acidify her food but I don't think that's enough) and more meds.

I don't like the idea of long-term antibiotics though - I'd rather get to the heart of the problem and fix it.

Not only this, but Chester has been having panic attacks lately, and so we are getting a behavourist in for him as well. I have been working with him but I think it's a case of `doctors shouldn't treat their own families'. I'd like to get someone in who doesn't know him as well as I do to work with me on his anxiety. I think an outside perspective would be helpful.

Will keep you posted on them both!

are they going to culture the urine from the cysto? find out what's growing and what drugs it's sensitive to.

Good luck I hope you finally get to the bottom of this...Keep us updated

Good luck! I hope there is a positive outcome. Do keep us posted!

This has already been done twice, and Ruby's system seems to resist the antibiotics the bugs are supposedly sensitive to. It's her second cystocentesis and her third urinalysis, with different drugs administered each time the results come through, because the previous ones haven't worked so well.

It's kinda baffling to us and the vet, too - hence the ultrasound.

Oh Rubylove, I'm so sorry you're having such a time with your poor baby. This is really baffling. I do hope they get to the bottom of this and that she'll be cured once and for all. Sending you positive vibes that this next diagnositic procedure will give some more thorough information to go off of. Do let us know. (((hugs))) I think too, that it's a good idea to bring someone in to see what's going on with poor Chester. You're really having a lot on your plate.

I hope you can get to the bottom of this soon and get Ruby on the way to good health.

how frustrating

So sorry you have to go through this !! Do keep us posted !!

Good news!

Well, Ruby had her ultrasound today. She was such a good girl - no sedation required, not even for the cystocentesis. She likes to lie on her back (sleeps that way regularly) and so when they'd got her up onto the concave table, she settled very happily in on her back for as long as it took - she probably thought it was like an extended belly rub or something!

Anyway, no stones, no kidney problems, no ectopic ureter - a perfectly healthy, happy, physiologically sound bladder, kidneys and urinary tract.

Good news. BUT... ... ... ...

What is wrong with her then??? It's a relief to find this out but why, why is she still incontinent?? She got up from her bed last night and left a big puddle behind.

We'll wait for the results of the cysto - could just be an extremely stubborn UTI. The other alternatives are post-spay incontinence or a degenerative spinal problem that causes pain after exercise, leading to incontinence. I pray it's not that.

So, I'll update again when we get the cysto results, but in the meantime excellent news for the Rubester Boobster.

If this were my dog, I would keep in mind a couple of things:

Antibiotics kill all bacteria. Some bacteria are necessary for good health. I would consider supplementing with some excellent digestive enzymes if this were my dog.

Acidity in the urine is the enemy of UTIs. If this were my bitch, I would be using cranberry capsules, vitamin C, and natural unfiltered Apple Cider Vinegar (about a teaspoon per meal) in her food and/or water.

Consider spay incontinence. Many spayed bitches will lose some strength and efficiency of the bladder sphincter. Most will tighten up with a low dose of Phenylpropanolamine (PPM) twice a day.

Hope she is all better very soon.

This is why we had the ultrasound - I don't want more antibiotics for her.

Yep, we do Vitamin C and cranberry. Her urinalysis came back after I'd posted my last entry and her alkaline has gone from >9 to 6.5. So that's all working. Yay!
And, yes, her urinalysis was absent of all infection so hormonally induced post-spay incontinence it is. The vet phoned just on 7pm to tell me. She starts on her medication tomorrow. At last - a solution. She'll be on meds for the rest of her life but this is way better than kidney disease or structural abnormality.
Hopefully she will! Now that we know what the cause is

I don't know if this can be given to dogs... but perhaps it's something to look into? I used to get UTIs all the time until I started using D-Mannose. Here is a link about it.
http://www.drpressman.com/Library/D-Mannose.htm

Big hug from Squirt and family. Hope all turns out well in the longrun. hard to wait.

Well, just got back from the vet to pick up Ruby's hormone replacement meds. It's going to cost us just shy of $700 per year for the rest of her life in medication alone, but we opted for this drug rather than the considerably cheaper one, because of her age.

Essentially, Stilbestrol, which has been the drug of choice for many, many years, can cause bone marrow suppression in long-term use. It is considerably more convenient and astronomically cheaper (one dose per week and about $30 per 2 months) but most dogs don't become hormonally incontinent until about middle age, and so the long-term risks of Stilbestrol at that age are much lower. Because Ruby isn't two yet, the vet is unsure of what the risks would be for her if she were on it for up to 12 years. We could do quarterly CBC bloods, but if anything is detected it may be too late to reverse it.

Ephedrine is the other choice but, ah, NO. Not with the high risk of heart conditions as a result of long-term use.

The drug we have gone for (Propalin) is $120 per two months (four times the cost), and needs to be given twice daily - forever - but the side effects and long-term risks are much, much lower. We have been told that if we ever go away or Ruby needs to be looked after by anyone else then it would be perfectly safe to have her on the cheaper, easier-to-use drug for six months if that made things easier for her carers.

The cheaper drug is not dangerous at all - don't get me wrong - but Ruby is the sort of dog where if it can go wrong, it probably will, and we don't want to risk that! We'll still continue to acidify her food, as well.

So, we're just tightening our belts and making sure that she is well - it will be sooooo much nicer for her not to need a bath every second day because she's been lying in her own wee....poor baby. I'm thrilled we've finally got an answer and a solution.

Bless her heart !! Yours too !!!!!!!!!

Oh Rubylove, I'm glad it is this and not something more serious. My Lab, Bonnie had that problem and she wasn't even very old at all, maybe around 6 or so....just the lack of estrogen which is needed to tighten up the sphincter muscle. She took, I think it was Propalin. (It's been a long time) And she took it for maybe 2 or 3 months, maybe a tad longer and I remember running out of the pills and not rushing to get more. Time went by and I continued to procrastinate....no leaking from her. She never took another pill in her 13-1/2 years of life and never had an incontinence problem again. So, with any luck, maybe your dog won't have to be on it forever.