Urinary and Bladder Problems

Urinary and Bladder Problems in Dogs
Urine Specific Gravity - considerations when evaluating
Urinary lab testing - monitoring albumin and protein
Urine specific gravity and disease process
Calcium oxalte stones
Jaundice in Border Collie mix - Bilirubin/bile acids
Shar pei urinating irregularly and retaining urine
Retaining urine
Struvite stones, urinary tract infections and pet diets and PH
Urinary tract infections and different urinary stone formations
High ph in urine
Urinary crystals and bladder stones in Corgi
Urate urinary tract stones in Dalmatian
Difficulty urinating - Boxer
Recurrent urinary problems - continued
Urination problem/housebreaking
Urination in crate
Eosinophilic Cystitis
Difficulty Urinating
Urinary control in young dog

also see Prostate
also see Bladder and Bladder Stones
also see Incontinence
also see Kidney
also see Urinary Behavior Problems

Urine Specific Gravity - considerations when evaluating
Question: Dr. Richards--

What would a dog's urine SG that is NOT the first urine of the day have to be before you were concerned, and do other findings such as ph factor into that decision as well? If there is no protein in the urine, how often would you recommend a urine protein/creat reading on a dog with renal aplasia but normal renal values?

Thanks.
Shanna
Answer: Shanna-

There is no truly abnormal value for specific gravity of urine when looking at the results of a single sample. Since one of the functions of the kidneys is to either conserve fluid when necessary or to excrete it when necessary it is possible for the urine specific gravity to vary widely due to completely normal functioning of the kidneys. If I was worried about a specific disease that tended to make urine stay in a particular range for specific gravity then a value in the range might cause me to recheck further samples. I tell my clients whose pets have disorders that I think are affecting specific gravity to bring me as many urine samples as they get over the course of a day, starting from the first one in the morning until the one right before they come to the office. If all of them stay in the range I am worried about then I would proceed with further testing.

I don't worry about the pH when I'm interested in specific gravity testing since it doesn't any effect on specific gravity that I am aware of. There is a relationship between protein levels and specific gravity. Some protein (trace to 1+ reading) is normal in concentrated urine ( > 1.035 generally for dogs) but protein in more dilute urine makes me suspicious. This is especially true as the protein level in the urine increases into higher ranges when the urine is dilute, so a trace reading in very dilute urine would be highly suspicious while a 1+ reading in urine with a specific gravity of 1.030 might just make me retest the protein level in a different sample rather than running a test to quantify the protein loss, which is what the protein/creatinine ratio does. This ratio gives an approximation of the amount of protein that is lost in the urine in a 24 hour period.

Protein/creatinine ratios are not supposed to be a very good way to monitor kidney disease over time because the values vary over the course of the day to some degree and there aren't studies correlating whether changes in the ratio are meaningful in kidney disease. The ratio is useful in determining if protein loss in the urine is significant when there is some question of this -- which is usually the case when there is increased protein in a concentrated urine sample. Once it is established there is a disease that causes protein leakage into the urine I don't see any further need to run this test.

The best currently available test to monitor for kidney disease early is probably the measurement of microalbuminemia. Albumin is a protein that has many functions in the plasma and the body tries to preserve it. There is a test kit for this from Heska Laboratories and several commercial labs offer this service, as well. Albumin is spilled into the urine in microscopic amounts before protein levels are measurable, so it is possible to catch kidney diseases that result in protein loss earlier when routinely testing for microalbuminuria. This is also a non-specific test in many ways, though. Albumin spills into the urine due to inflammatory diseases (possibly from anywhere in the body), glomerulonephritis and amyloidosis. It is important to note that this test is only useful for dogs who start out with no measurable protein in their urine -- if you can measure protein this test doesn't serve a useful purpose as you already know a problem exists.

I hope I haven't been too confusing in this note. If you need clarifications please feel free to ask for them.

Mike Richards, DVM
02/05/2007

Urinary lab testing - monitoring albumin and protein
Question: Dear Dr Richards,

I have been a subscriber for almost a year now, and find your information very
helpful. I have a 2 year old neutered Bull Terrier, and kidney problems are quite common in this breed, so I have been monitoring his urine at home for about 1 year now. In July 2001, he had surgery to remove undescended testicles. At that time his blood results
showed a BUN of 20 mg/dl and Creat of 1.2 mg/dl. His urine
showed a moderate amount of inflammatory cells and trace amount of bacteria, and
suspected a urinary tract infection, they also found fine granular casts in it. They said these are usually seen when there is injury to a part of the kidney called the tubules. However, since he is not having trouble concentrating his urine and the blood tests they used to monitor kidney function were not elevated, they said to monitor. I did have another
urine culture done within several months, and no casts were seen. I had his
blood checked again in 9/01 and BUN was 19 mg/dl, Creat was 1.2 and BUN/Creat ratio was 16.
I am able to monitor his urine on my own, and have been recording specific
gravity , protein(mg/dl) and also microalbumin/creat ratio(this test is specific
for low levels of albumin) always using a first morning void. At first, I was
seeing trace to 30mg/dl levels of protein, and microalbumin/creat results were
always normal. Within the last several months, I have seen intermittent
proteins of 100 mg/dl and several microalbumin results of 150mg/L(which I
understand is the definition of proteinuria) creat results of 300 mg/dl and ratio was
abnormal on several occasions.
I asked my vet to do a urine protein/creat ratio, this was done in 4/02,, and
the ratio was 0.1, normal. I forgot to mention that his specific gravity
results have always been >=1.030.
My vet does not seem concerned by the 150 mg/L microalbumin results
specifically, and the abnormal microalb/creat ratios that I have been getting ,
and has pretty much dismissed them with the normal result from the protein/creat ratio we just got. What do you think, I would hate to miss an early diagnosis of kidney problems.

thanks alot
sincerely, julie

Answer: Julie-

There is a new test for microalbuminuria in dogs ( E.R.D.-Screen by Heska) that may make veterinarians more aware of the potential benefits of monitoring albumin levels in the urine. At the present time there is some question about the meaning of various albumin levels in the urine. Hopefully this problem will be resolved in the near future, too.

At the present time the "worry points" for protein and albumin levels in the urine are reported to be:

Urine protein level of 2+ or more in dilute urine (SG 1.010 - 1.025 ish) should prompt monitoring of urine protein levels.

Urine protein/creatinine ratio of > 1.0 (so less than 1.0 is considered normal, although most dogs have urine protein/creatinine ratios of less than 0.5).

Microalbuminuria is considered to be present in dogs when the urine albumin level is between 10 and 300mg/dl ( I am pretty sure I converted this correctly, the value in Dr. Grauer's review "Diagnostic Testing Offers Early Detection of Renal Disease", in an April supplement to DVM Magazine was 1.0 to 30.0mg/dl ). However, this is a definition based on experiences in human medicine and it is unclear at this time how well they will relate to predicting canine renal failure. However, Dr. Grauer believes that it will work out to be an accurate early warning test for progressive renal failure based on his research. In a colony of soft-coated Wheaton terriers with familial kidney disease that he maintains, microalbuminuria shows up as long as two years prior to the onset of proteinuria. (from the Heska supplement to the March 2002 Compendium on Continuing Education).

So, with this in mind, I think that it is best to consider the possibility that your dog is at risk for later development of kidney disease, based on your findings so far. However, this is new territory for veterinarians and I am not absolutely certain that I am interpreting the numbers correctly. This, along with the fact that isn't a definitive answer to the meaning of microalbuminuria in dogs at this present time, makes it reasonable to consider the possibility that the lab values really will turn out to be nothing to worry about over the long run.

It would be reasonable to try to be certain that there is not an inflammatory or infectious process going on that is being missed. Microalbuminuria consistently occurs in dogs with heartworm disease, is present with pyelonephritis, inflammatory bowel disease, cancer and other conditions that continually disturb the immune system. Ultrasound examination of the kidneys to help rule out some forms of kidney disease might also be reasonable, especially since there were inflammatory cells and bacteria in his urine. A culture and sensitivity test run on urine extracted directly from his bladder (cystocentesis) would probably also be justified given the past history. The odds are probably good that these tests would not reveal a specific problem but that is the nature of testing. If your vet doesn't want to pursue this further given the otherwise normal lab work so far but it continues to worry you, it is reasonable to ask for referral to an internal medicine specialist for a second opinion. It does appear that intervention to control hypertension, elimination of any sources of chronic excessive immune stimulation and the use of enalapril (Enacard Rx) all can help slow the progression of kidney disease in some patients.

If your vet subscribes to DVM Magazine and/or the Compendium, these supplements are recent enough that he or she may still have them. Calling Heska for information on their new test would probably be a good way to get some of this same information, as well.

Personally, I hope your vet is right and this all turns out to be unnecessary worry -- but I really do think it is reasonable to go ahead with a search for potential sources of albuminuria and to keep track of the situation as you have been. I am not sure if the Heska test would be more accurate for microalbuminuria in a dog than the method of testing you have available to you but it might also be worth trying this test to see if it agrees with your findings so far.

Good luck with this.

Mike Richards, DVM
5/26/2002

Urine specific gravity and disease process

Question: Dear Dr. Mike:
Thanks again for another prompt response. Kori's urinalysis results
came back normal except for the Sp. Gr. was 1.015. With this result, the
facial paralysis, excessive drinking of water, and slight balance issues, does
any other possible cause come to mind? I am taking her back tomorrow for a
follow up appointment. Thanks again for your suggestions and
information.
Lori
Answer: Lori-
There are several recognized ranges of urine specific gravity that can
be helpful in determining if a disease is present and what the disease
might be.
Urine in the range from 1.008 to 1.012 is considered to be isothenuric,
or approximately the same specific gravity as the serum that filters
through the kidney (the glomerular filtrate). This means that the kidneys are
not concentrating the urine, nor are they diluting it. Since the only way to
be sure that the kidneys are able to perform these functions is to have
urine samples outside the isothenuric range, it is important to get serial
urine samples to see if this happening when a urine sample falls in the
isothenuric range. Consistently isothenuric urine may indicate that
kidney failure is present and can be seen with hormonal disorders in some
cases.
Urine in the range below 1.008 in specific gravity indicates that the
kidneys are diluting the urine. This happens with disorders like
diabetes insipidus. It is an indication that the kidneys can function, since they
are actually making the urine dilute, though.
In dogs, urine specific gravity above 1.030 indicates that the kidneys
are able to adequately concentrate urine and values above this level are
reassuring, due to this. Specific gravity ranges between 1.012 and 1.030
are indicative of some kidney function but are not high enough to say
that the kidneys are functioning fully.
There is a broad range of urine specific gravity that can be found in
any individual urine sample. It is not at all uncommon for the specific
gravity to be low when a dog is drinking normally and the sample is taken during
the day. Dogs tend to be urinating more frequently during the daytime
and there isn't much need for the body to concentrate urine. If the first
urination of the morning, which should be more concentrated, falls into
the lower ranges of specific gravity there is more reason to be suspicious
of a problem.
So at this point I think you have to look at this sample as being
unhelpful in ruling in or out any of the possible disorders that affect urine.
However, it is a good indication of the need to continue to monitor
urine specific gravity until it can be determined that samples are going to
stay in this range or until a sample is concentrated enough to indicate you
can stop worrying or dilute enough to make it necessary to look for problems
that cause urine dilution.
Balance problems in conjunction with facial paralysis are a stronger
indication of a problem affecting the inner ear than facial paralysis
alone.
Mike Richards, DVM
10/29/2001

Calcium oxalate stones
Question: Dear Doctor,
I have a female Japanese Chin, eight years old, 15 pounds (large for
the breed but not overweight). She has a collapsing trachea, a heart
murmur, and her heart is enlarged. Of most immediate concern, though, she has
calcium oxalate bladder stones. We discovered the stones because one
has almost totally blocked her urethra so she had a great deal of
difficulty urinating.
She had unsuccessful surgery on June 29; some stones were removed but
some remain, and her urethra is still partially blocked. I understand that
the stones cannot be dissolved by diet or medication. She is not a
candidate for urohydropropulsion, and I don't care to subject her to more
surgery since it would probably be no more successful than the first.
We have changed her diet, and plan to start her on calcium citrate, to
prevent more stones forming, or existing stones enlarging. However,
my main concern at the moment is the one stone that is partially blocking
her urethra. If that stone shifts even slightly her bladder will be
totally blocked and we will have an emergency.
I understand that sonic shock wave treatment can disintegrate existing
stones, but I haven't been able yet to locate a treatment source
within reasonable driving distance of my home (central Alabama), nor do I
know any details.
Please tell me if you would recommend the shock wave treatment, and
any details you may have. I am especially interested in the success rate
because I don't care to put the dog through an extremely painful (and
undoubtedly expensive) treatment with little chance of success.
I would also appreciate any other comments and suggestions you may
have.
Thanks in advance, Wayne
Answer: Wayne-
You are correct that calcium oxalate stones are not easily dissolved
through dietary means, as struvite stones sometimes are. So usually it
is necessary to remove these stones. It is supposed to be possible to
remove many stones through voiding urohydropropulsion but surgical removal is
probably still the most common method of removing these stones.
The University of Tennessee has a lithotripter that they use on dogs
and they are reporting good success with this procedure. Purdue University
is the only other place that I know of that is doing this procedure, but
there may be others, as this sort of thing changes frequently. In addition,
there are some people around the country who are experimenting with laser
fragmentation of bladder stones but I don't know where they are, as
this was just mentioned as a possibility in a seminar we attended on lower
urinary tract disease this spring. I know that the Virginia-Maryland
Regional College of Veterinary Medicine (Blacksburg, VA) has done the
laser procedure on horses but I haven't seen anything about small animals
that I can remember.
At the seminar we attended, Dr. Osborne from the University of
Minnesota showed some pretty amazing slides of stones they had managed to
retrieve through voiding urohydropropulsion, but if this has been tried by
someone who is good at it and it didn't work, then this may not be an option.
Also, in some cases it is just obvious that a particular stone is too large
to be removed in this manner, so if that is the case then it isn't an option,
either. There is an article in the September 1, 1993 issue of the AVMA
Journal with good diagrams of this procedure and I think it is covered
in one of the Clinics of North America issues, too.
Your vet should be able to arrange a referral to the University of
Tennessee if that isn't too far to go.
Mike Richards, DVM
8/23/2001

Jaundice in Border CollieX - bilirubin/bile acid levels
Question: Dear Dr Richards,
Please advise me. Over the past two months I have noticed on occasion that
10 year old border collie x looked very slightly jaundiced. I then look
again and his collar looks absolutely fine and I'm left feeling that I
imagined it. I work as a student vet nurse and two weeks ago, as I was
leaving work, I again thought my dog looked as though he had the 'merest
hint of yellow'. All of my colleagues have assured me that his colour is
fine but I decided to catheterise him and obtain a urine sample. A quick
dipstick test confirmed that the bilirubin levels were moderate to high (all
other parameters were fine), his urine was very yellow + slightly cloudy but
as our refractometer is inaccurate I was unable to take a specific gravity.
I then carried out a microscope sample (then sample was not spun down as we
have no centrifuge) which revealed a number of mucus threads. By the
following morning numerous bilirubin crystals had formed under the
coverslip.I sought the opinion of the vet but he is a new graduate and was
not certain (he thought the crystals were probably parasites). Although my
dog is not showing any clinical signs (other than the disputed 'hint of
yellow'!) I was worried and decided to take my dog to a veterinary hospital
and seek the advice of a more experienced vet. The clinical examination
revealed nothing but he agreed to carry out a blood test for my own piece of
mind. Unfortunately the results have done anything but. The results were as
follows:
Haematology - all normal
Biochemistry - Total bilirubin - within normal parameters
- Partial bilirubin - 3 (norm: 1-2)
- Bile acids - 15 (norm: 0 - 5)
I have been advised that 'something is going on in the liver but at this
stage we don't know what' and, provided no clinical signs develop before,
I'm to take him back for retesting in one month.
What concerns me is: why should the bilirubin levels be normal in a serum
sample yet 5 days earlier they were moderate-to-high in the urine sample?
I'm assuming he must have fluctuating levels of bilirubin, but the vet
rejected this and said that it was probably a problem with the urine
testing. However, I tested the urine 3 times and the result was the same.
Also, doesn't the presence of so many bilirubin crystals confirm the results
of the dipstick? I suggested carrying out serial urine testing, but this was
rejected as un-necessary. What do you think? Should I be worrying as much as
I am? What tests should I be asking for?
Answer: Louise-
It is important to remember that in male dogs it is normal for there to be
detectable bilirubin in the urine, especially if the urine is concentrated.
The levels should be low to moderate, though. I find myself looking at
border collies, shelties, collies and schnauzers and wondering about
whether or not they are icteric (jaundiced) more often than I have this
feeling in other breeds, so perhaps you will find that you have the same
problem over time. Most of the time when I check blood or urine values for
causes of icterus I find out that the dogs don't have this problem. Once in
a while, though, they do have a detectable problem.
If there is a problem with persistent rises in bilirubin levels in the
urine (bilirubinuria) then there are two major causes of this problem,
internal bleeding and liver disease. Both of these can cause bilirubin to
increase in the urine. These are the two major causes of bilirubin rises in
the serum (bilirubinemia) as well. So the thing to do is to look for a
problem with one of these conditions. The first thing we try to determine
is whether there is a bleeding problem, so we check for anemia, platelet
numbers and signs of rbc damage on blood smears. If there is no evidence of
a bleeding problem, then we look for liver disease or for something that
might cause blockage of the bile ducts outside of the liver. A bile acid
test is a good way to determine if there is a liver problem but the bile
acid level would be normal for a sample taken within a few hours of a meal
(the test is supposed to be a fasting test but many times that is not the
case). If the other liver values were normal, I would not be too worried
about liver disease.
I don't see any reason not to monitor the bilirubin levels in the urine. It
is easy to do and if you can figure out a way to test for specific gravity
at the same time as bilirubin, you could determine whether or not the
problem only occurs in concentrated urine, which would be normal for a male
dog. I don't think that you can tell much by bilirubin crystal formation in
a urine sample that has sat for a while. There are too many changes in
urine when it sits for a while for a sample to be much value to you if it
is not reasonably fresh.
It is easy to worry too much about our own pets. Sometimes I feel sorry for
my pets because I test them much more frequently and often more extensively
than I test most of my client's pets. It is a hazard of life for a pet
owned by someone who is trained to look for problems!
Mike Richards, DVM
2/19/2001

Sharpei urinating irregularly and retaining urine
Question: Dear Dr. Richards:
Our Sharpei, about five years old, seems very irregular in its urination,
and it will not urinate or defecate close to home (say less than one
block).
Given the weather (deep freeze, blizzards, etc), the dog may urinate once
in 24 hours, and at times, once in 48 hours. No unusual signs or symptoms
have been noted.
However, other dog owners have indicated that the urine retention could
cause a urinary tract infection.
Is such a specific risk significant??? What has been your expeience???
Thank you for your attention.
Howard

Answer: Howard-
I think that urine retention is not the ideal situation. It probably does
predispose dogs to urinary tract infections, although I actually can't find
much supporting evidence for this theory.
Based on your description of the situation it seems more likely that the
urine retention is behavioral rather than medical in origin. In this
situation, if the dog does not have incontinence, the increased risk of
urinary tract infection is probably not very high but it probably would be
higher than the risk in a dog that does not retain urine. Despite that, if
you can think of some way to encourage urination it would be a good idea to
do so. Trying to encourage urination at a regular spot, even if it has to
be a couple of blocks from home, would be a good idea. Some dogs can be
taught to urinate when asked to, if you practice a command, like "go pee"
when your dog does urinate and then give him or her a small treat, you
might find that you are able to encourage regular urination.
I hope that this helps some.
Mike Richards, DVM
12/28/2000
Michal Response: If your Sharpei is male - you might try just jaming stick upright in the snow about a block or so from home. Sometimes dogs can't find the usual uprights they urinate on and a stick in the deep snow helps. Can't hurt.

Retaining urine
Question: Dear Dr. Mike,
I am a subscriber. For the couple of months, Maude (5-year-old epileptic
Australian shepherd) has been retaining urine for up to 18 hours at a time.
This usually starts in early to late afternoon, then she doesn't urinate
before bedtime, only to wake me up at 5:00 a.m. or so.
She had a urinary tract infection last December (when she wanted to run out
to urinate day and night), so this is like the total opposite. This year, as
last year, the infection source is e-coli (confirmed via transabdominal
cystocentesis, I believe it's called). Last year, her vet put her on Ditrim;
this year, her neurologist offered to run the test, and has her on
Sulfamethoxazole/TMP SS. She's only been on the medication for a couple of
days, so it's probably too soon to tell anything, but I haven't seen any
improvement. I might also add that her neurologist TRIED to get a urine
sample two months ago, but we ended up with a pee-in-the-cup sample. It did
show an infection, which was treated with Cephalexin, but apparently the
infection has recurred, or never cleared up.
She doesn't seem ill or out of sorts. She's currently taking 500 mg. of
KBr/BID and 60 mg. of Pb/BID. She's been seizure-free since May 18 (after
cluster seizures of at least three every 21-24 days from November-May).
I know that incontinence is often a problem with epi dogs but wonder if
retention signifies anything and warrants further testing. She was also
hospitalized in October 1999 for pancreatitis, but I doubt that this is
relevant. Just thought I'd mention it.
Thanks for your insights. Linda
Answer: Linda-
Ditrim (Rx) and sulfamethoxazole/trimethoprim SS are approximately the same
medication (or possibly the same medication - I can't remember if the sulfa
portion is the same or not).    It is not unusual for the same medication
to be used more than one time for bacterial cystitis, if the bacterial
culture and sensitivity results indicate it is still likely to work.
It is unusual for cystitis to cause urine retention. As you found on the
last episode, it usually causes an increased urge to urinate, resulting in
frequent attempts to urinate that often produce only small amounts of
urine. There are always going to be some patients that don't have the
typical signs for an illness, though.
Urine culture results can sometimes be misleading. E. coli and other normal
bacterial inhabitants of the body can be found when doing urine cultures.
Counting the colonies on a bacterial culture plate can give an indication
of whether the bacteria is a contaminant. Low colony count numbers are more
likely to be the result of contaminating bacteria. This is sort of
judgment call and it is possible that your vet, or the neurologist, have
taken this into account already.
There are two reasons that bacterial urinary tract infections recur. The
first one is that they were never cured in the first place. This happens
when antibiotics are not used long enough, or an inappropriate antibiotic
is chosen and the pet can not clear the infection on its own. The second
reason is that there is an underlying cause for the cystitis that wasn't
addressed when the first infection was treated. If this is the case, the
neurologist may be the best person to be addressing the problem, because
neurologic problems cause a lot of the cases of urine retention and
bacterial infections related to urine retention. It can take some time to
work through this type of problem, so you may have to make several attempts
at diagnosis or treatment before a way to cure or manage the problem is found.
I can not find any indication that phenobarbital or potassium bromide, or
the combination of the two, causes urine retention. It still wouldn't
surprise me if they had some effect on this situation, though.
I have to admit that I don't think you are going to see improvement in the
urinary retention as the result of antibiotic therapy. I think that you are
going to have to find a separate cause for that problem and appropriate
treatment for it. My inclination would be to refer a patient to a
neurologist who had this problem, so you are already working with the right
specialist, at least for the initial attempts.
Good luck with this.
Mike Richards, DVM
12/27/2000

Struvite stones, chronic urinary tract infections/pet diets and PH
Question: Dr. R--
Thank you for the thorough explanation. It makes alittle more sense now. However, mine is more cooincidental because two of the three dogs kept increasing in ph and develop struvites. My current vet sounds more like you, not as concerned but, I came to him after many attempts of trying to figure out why they kept getting sick.
My aussie, Abby, 18mos., is the most sensitive one. It sounds like the next step is to see if something else is going on other than her "butt tuck". Interestingly enough, Abby does seem to hold her bladder much longer than I would like her to. She's always been that way though. She's getting better about going, but it may also be that she is getting another uti because her ph was up again last week. I'll take her back in tomorrow to check her status. Then, we proceed to Plan B from there.
Further, does this means that you don't see any direct relationship to food relative to higher ph? My other questions relating are:
1-    Is there any relationship to a higher protein content in food relative to the ph?
          The food CD has a lower protein content but, it has the other "junk" that the nutritionists say
to avoid.
2-    Is it more prudent to feed CD to keep her ph down rather than feed her a more nutritious
food with ammonil supplements?
3-    Best case scenario obviously would be to find the ultimate cause, which I will continue
searching for.
4-    If ph doesn't cause struvite stones, what does?
I hope this helps explain my problems with my sweet babies. Thanks for your help and explanations.
Margal
Answer: Margal-
I am not sure of the exact effect of excessive protein on urine pH. In general, I would guess that it
usually causes more acidity in the urine because the major protein breakdown product is uric acid.
However, there may also be a higher level of ammonia in the urine due to the protein breakdown and
this could get much higher if there are bacteria in the bladder capable of urea breakdown which
would produce ammonia in the urine. So my guess is that it usually causes acidity in the urine to have
excessive protein but that in some circumstances excessive protein can lead to basic urine. This is just
my interpretation of the situation, because I couldn't find a clear explanation of the effect of protein
on urine pH in the books that I have on hand.
I am somewhat at a loss in advising you about the second part of your question. In my opinion, c/d
(tm) is a nutritionally complete food and therefore there is no reason to look for a more nutritionally
complete food. Now, whether or not it is the correct food in this situation is much more debatable. I
don't think a reasonable person can argue that the commercial pet foods generally support life and
they contain the ingredients known to be necessary to sustain life and that many pets live long and
healthy lives while fed these foods. People making these arguments are ignoring a huge number of
pets doing very well. Sure there are pets that do better on one diet than on another, but there is not
one diet available commercially, or through home production, that is optimum for each and every pet
alive at the present time.
Are the commercial diets like c/d (tm) optimal? That is much harder to figure out, especially for diets
that are made to manipulate normal physiologic processes, like serum and urine pH maintenance.
There are patients that do better on diets that acidify urine. There is very little concrete evidence to
show that keeping urine pH low actually decreases the risk of urinary tract infection, though. There is
pretty good evidence that doing this reduces the incidence of struvite bladder stone formation but it
increases the likelihood of formation of other bladder stones. We almost never use or recommend
use of c/d (tm) diet in our practice, for dogs, and we have managed to control most cases of
recurrent urinary tract infections without long term use of c/d. We do not routinely use urinary
acidifiers in pill or powder form, in dogs, either. The only exceptions in our practice are patients who
we have obtained a bladder stone from, had it analyzed and it was determined to be struvite.
I just have to ask, who are the nutritionists referring to "junk" in the food that you are referring to? If
there are references from actual nutritionists, not just people claiming to have nutritional knowledge
without having data to back their claims, that specifically refute the use of certain ingredients in pet
foods, I would really like to have copies of the references or directions to where I can find them.
Struvite stones used to be referred to as "infection stones" in pets. The great majority of struvite
stones occur due to the presence of bacteria in the urine. Finding the reason that the pet's normal
resistance to bacterial infection is compromised and fixing that problem, if possible, is the best long
term solution to controlling recurrent struvite bladder stones -- and also recurring bladder infections.
In pets in which this is not possible, manipulating the pH of the urine is a reasonable second choice.
Most veterinary general practitioners lack the expertise or are not able to devote the time and effort
necessary to discover the underlying causes of chronic bacterial infections. This is a situation in which
it is really helpful to live near a veterinary school that has a faculty member interested in this problem
or a veterinary internal medicine specialist in private practice, with similar interests. Your veterinarian
may be the exception to this rule, especially since it may have been a really good move to try to
eliminate problems with vaginal anatomy that may have been contributing to the problem and
recognizing that urine retention may be contributing to the problem is also good.
There are some good explanations of chronic urinary tract infections available. The newest "Kirk's
Current Veterinary Therapy (XIII)" has some good information and the book "Small Animal Clinical
Nutrition, 4th. edition", also has some good information on bladder stone formation and dietary
influences. Your vet might have one of these texts and I'm sure there are others with good
explanations, as well.
Mike Richards, DVM
9/12/2000

Urinary tract infections in Aussie and different urinary stone formations
Question: Dr. R--
The high ph levels lead to contiual UTIs. My aussie had what I call a "butt tuck" to give her more air
circulation to help prevent the build up of bacteria. I don't recall the proper vet name for it, but, she had too
much excess skin between her anus and her vagina keeping a fold over which was harboring bacteria. It made a huge difference, for awhile.
She and the other two continue running high which without the ammonil to address the acidic factor
and grows, we then have other UTIs or as the vets tell me, will or can lead to other complication;
crystals, etc., which they have had on previous occassions. I'm also seeing more additives in vet
catalogs for acidifiers, which leads me to believe there are more and more cases continuing and
growing in numbers. My aussie has a much lower tolerance of feeling ill when her ph runs up. She
acts nasty when she feels bad.
I hope this helps. I wonder why you aren't concerned with the ph running high 7-8-9. This doesn't mean
anything to you?
I'm very curious for as many ideas and perspectives that I can get. I'm still in search of the "right"
vet for me since my favorite vet moved out of state awhile back. I keep finding too many problems at every turn. Much of my research has had to be on my own because the vets here don't know anything but to put them on
CD or keep them on ammonil.
Thank you for your help.
Margal
Margal-
I don't worry very much about urine pH in dogs or cats that do not have recurrent problems with
bladder infections (cystitis) or with stone formation in the bladder or urinary tract. There are a
number of possible crystal types and stone compositions and they respond differently to urine pH.
Struvite stones and calcium phosphate stones are less likely to form in acid urine, but calcium oxalate
stones are much more likely to form in acid urine, so manipulation of the urine pH can lead to
problems that did not previously exist in a patient.
Sometimes, when it is hard to tell if a bladder infection is present, the pH of the urine can help in the
diagnostic process, since bladder infections are more common in urine with a pH of 8 or greater.
However, this is not a sure sign of problems.
In all honesty, I think that you have the order of events wrong. I think that it is more likely that
persistent urinary tract infection is leading to increased pH in the urine. If this is the case, it is
important to look for other things that might lead to persistent urinary tract infections.
In dogs, persistent urinary tract infections sometimes occur when a difficult bacterial infection is not
treated long enough with antibiotics or has found a protected spot in the urinary tract where it is hard
for antibiotics to reach it. In this case, there really isn't a time when the dog is free from infection, so
the urinary tract infection is persistent, not recurrent. In this situation, identifying the bacteria through
culturing the urine and then testing to see which antibiotic will work against it and using it long enough
should work to stop the problem. It may take two or three months of antibiotics in some cases,
though.
More commonly, the problem is due to recurrent urinary tract infection that is occurring because
there is something wrong with the normal mechanisms that prevent urinary tract infection. This can be
a problem with anatomical abnormalities of structures like the vulva or prepuce that allow urine
pooling or urine retention. Internal portions of the urinary tract that are not working properly, such as
a misplaced ureter, can also contribute to this type of problem. It can occur when dogs are unable to
fully empty their bladder due to neurologic problems or painful conditions. It can occur when immune
system disorders or hormonal diseases such as hyperadrenocorticism or diabetes. Crystal formation
in the urine as a contributing cause doesn't seem to be as common in dogs as it is in cats but it can
still contribute. Some types of crystals are more common in acidic urine and some types more
common in basic urine. It can be very difficult to identify the exact problem in these situations but
sometimes it is possible to identify and treat an underlying problem.
This is one situation in which it really can help to refer a patient to a veterinary school or internal
medicine specialist. Most general practices can do most of the work-up, with some effort, but they
don't do it often enough to be really experienced at identifying the more subtle problems.
The demand for a health product is based on perception of value, not actual value, unfortunately. An
example of this is lamb and rice dog food. For some time, when dogs had skin problems,
veterinarians put them on a lamb and rice diet. This wasn't done because there was some direct
benefit of lamb for skin disease or even skin health, it was done because lamb was not a common
ingredient in dog food in the past and vets were trying to figure out if a dog might have a food allergy.
Putting it on a protein source it had not eaten before, in this case lamb, was a good way to figure that
out. Over time, people began to make the association that dogs with skin disease were put on lamb
and rice food without understanding why and they began to demand lamb and rice food from sources
other than their vet. So lamb and rice foods appeared everywhere. If urinary acidifiers are being
promoted as beneficial to urinary health, the same sort of mistake is occurring. Urinary acidifiers have
a place in the treatment of specific urinary tract disorders. They are harmful when given to dogs in
which other specific urinary tract disorders exist. For most pets they are probably neither helpful nor
harmful but it isn't a good idea to count on that.
I hope that this explains my initial question as to why urinary acidification would be necessary for
three dogs. While it doesn't seem unlikely that one dog out of three might need this therapy, it
seemed unusual to me that there would be a situation three out of three dogs in a household would
benefit from urinary acidification medications.
Mike Richards, DVM
9/7/2000

High ph in urine
Question: I'm a dog lover from childhood. I continue to learn with my dogs and try to do better by them
all the time. This means learning as much information as I can to make their lives better and
healthier. The more I learn about the commercial dog foods on the market, the more interest I
have in the more natural foods. I'm not industrious enough or have the time to cook for them, so I
lean towards the "natural" foods on the market. My problem is that all three of my dogs continue
to have high ph in their urine. No one seems to know what really causes this specifically. I'm
hoping you have some insight. When I put them on CD, their ph levels out. The CD has several
ingredients that all the natualists or holistic vets say to avoid. In lieu of a definitive answer, which is better,
having the dogs on a good nutritious diet and supplement with acidifiers (ammonil) or have them stay
on CD forever with the negative ingredients and less beneficial nutrients?
I'm at a total loss for an answer. I hope you can help send me in a positive direction. The dogs are not kin.
I have 2 Samoyeds and an Australian Shepherd mix. I've also researched the avenue of
filtered water as a culprit to the ph to no avail.
I greatly appreciate any ideas you have to offer. I look forward to hearing from you soon.
Thanks.
Margal

Answer: Margal-
I think that I would be able to help you more if I understood why you are worried about the pH
of the dog's urine.
Mike Richards, DVM
9/6/2000

Urate urinary tract stones in Dalmatian
Question: Dear Dr. Mike,
I have a question with a complex and lengthy history concerning my 3 1/2
year old Dalmatian, Mr. Bojangles. I will try to keep it as brief and
informative as possible.
August 1998- Mr. Bojangles shivers some during day and awakens in the
evening only able to sit and yelping in pain. We took him to an emergency clinic
where they did blood tests, x-rays and I think a urine test. His bowels
were backed up and he had a high white blood cell count. The vet concludes the
dog has psychological and/or allergy problems and "nothing" is really wrong. He
gave Bojangles a prednisone shot, and 2 weeks prescription of an ulcer
medicine (I believe SMZ-TP?) and antibiotic(sulphrocate and a home made
modify diet of chicken, rice and eggs for a month.
August/September/October 1999- Mr. Bojangles seems to be feeling
uncomfortable after a full year of good health.   He cannot go up and down stairs well. I
began home made diet of rice, turkey and eggs. Bojangles does not get worst
but doesn't get better. Took him to vet and the vet says because he is a
Dal sounds like hook worm even though they are not common in our area and he has
not been in a hook worm area. Bojangles seems to feel okay the next two
days and then starts getting worst. We were given an additional worm medication
because the vet feels it has to be worms and so with the two worm
medicines he will be fine. Bojangles gets worst and my husband asks vet why we are not
using an antibiotic like last year. Sulphrocate is prescribed. Bojangles
goes into a severe yelping episode. Vet prescribes Rimadyl (without
informing me on anything except it is an anti inflammatory) and Bojangles responds to
Rimadyl. When prescription over with, Bojangles gets worst. Vet then
wants to prescribe three Rimadyl tablets daily and after using your sites and other I
questioned how Bo's health was going to be monitored and why no tests or
have been done. Vet has blood test done and we are told everything is normal,
white blood cell count is slightly elevated but nothing significant.
Bojangles goes into excruciating pain and starts holding left front leg up.
Vet says it is a spinal disc problem and we need to go to surgeon. Surgeon
looks at Bojangles and says she feels before pursuing disc problem, we
should do stone testing. Urinalysis, Urine culture, ultrasound and x-rays taken
and show nothing at all. Bojangles is still taking a maintenance dose of
Rimadyl through this because it was all I had to offer him to keep him from pain.
Bojangles begins to shiver and surgeon/internist at referral clinic feel it
must be arthritis. Joint taps done and results are negative. Bojangles
begins pain episode and internist says she is able to pin point spinal pain
spot just below Bojangles shoulder blade (and says palpitation on kidneys
never had a pain response). Bojangles through all this continues to have no
neurological deficits, can shake his head and no head posture or holding
problems and does the "praying position." They do another urinalysis and
all is negative. Surgeon feels must be cancer tumors then in the front left
leg.
I take Bojangles to a specialist for a bone scan and bone scan is completely
normal. Surgeon/Internist say then it has to be a disc or nerve problem.
VERY RELUCTANTLY I allow Bojangles to have a myelogram be completed.
Myelogram is negative but the CSF shows inflammation (White cell count
somewhere between 14 and 28 since had blood contamination). Put on
cephalexin. CSF culture grows nothing until 4th or 5th day and it could
be a bacteria but they feel it is most likely a contaminate. Titers are done and
all are negative. Internist says he has auto immune meningitis then and
after one and half days after last Rimadyl tablet and four days after myelogram,
prescribes 60 mg of prednisone daily with an ulcer medication and taken
off of cephalexin. Bojangles responds to the prednisone within 6 hours and acts
like our playful dog again, appetite, water consumption and urine producing all
increased.. Four days later, Bojangles becomes sluggish. Internist says
just muscle fatigue from steroids. Sixth day, Bojangles still sluggish, not
moving well, does not want to eat and still continued high water consumption and
urine production. Seventh day, Bojangles throws up food he ate Friday night
and is hospitalized. Tests ran and Bo's BUN is 171 and creatinine 6.0 and
Bojangles has gone from a 58 lb dog to 50.4 lbs. Next day after one day of
dieresis BUN 170 creatinine 7.4. In ultrasound one of his kidneys is
dilated. Second Day, we are told everything is stable (no change) but
kidney still dilated and dog very uncomfortable and urine test comes back
negative. Bojangles continues to produce over 500 ml of urine every four hours and now
weighs 48 lbs. Third day internist says ureter tube has been dilating the
last few days and they now (after four days) can see a stone causing
complete blockage of the one kidney, BUN is at 161 and creatinine is 9.4. Even
though they say he is a bad surgery candidate, I have surgery done on Bojangles and
he has six stones and puss removed from kidney and ureter tube on left side
and begins to pass urine immediately and right side and bladder have no
obstructions or problems found. Now five days after surgery Bojangles BUN
and creatinine significantly dropped each day and is at a BUN of 49 and
creatinine of 2.4. The stone analysis shows the kidney (not bladder) stones are uric
acid stones and we are still awaiting the tissue sample tests to come back
and the urine cultures before diereses started are still negative.
This leads to my question:
Was Bojangles problem all along the stones? Even though blood, urine and
urine culture were always negative until now? He had a positive CSF?
What should I be doing about the right kidney? It was passing urine fine
but Bojangles was still in renal failure and there seems to be no answers or
information why this kidney seems to be in failure?
I have been told by the vets that his kidney condition may be difficult to
maintain or pin point and still might have to put him down. Are there tests
available to tell me if this was just an insult to both of the kidneys by
the stones and/or mylegram, anesthesia, rimadyl and/or prednisone and if
repair is possible for Bojangles' kidneys?
I know I can put him on a modified diet and medication for the uric acid but
don't know that I can believe it is just stones since the pain yelps had
always been associated with movement, never had positive tests for stones or
urinary infection the entire two plus months until now? Finances are
starting to become a concern since the last few months have cost over $14,000 to
date.
Any insight, hope or enlightenment you can provide will be immensely
appreciated and used to keep our best friend, true fighter and love our
lives, Mr. Bojangles with us.
S. and B.
Answer: S.
Urate urinary tract stones are very common in dalmatians. I think that they
are the cause of difficult to pinpoint pain fairly frequently in this breed
and it wouldn't surprise me too much if the urate stones were the cause of
the pain seen. It is obviously difficult to ask our patients about specific
pains but my friends who have had kidney stones describe referred pain
(pain felt in other places) and definitely sometimes have pain associated
with certain positions or certain ways they move.
The worst part of the history you provide is that the first surgeon thought
of these stones and even tested for them -- and sometimes they are hard to
find so they can be looked for and missed even though a good effort was
made to find them. So it is hard to tell if the stones weren't there then
(they form pretty quickly, so that is also possible) or if they were but
just didn't show up in testing.
It is possible for dogs to have more than one problem and it is possible
for a problem like kidney stones to cause enough pain to produce other
problems --- I have a friend who used to get really good muscle spasms in
his back when straining to pass kidney stones. He described the situation
as something akin to double hell.
I'd be really hopeful for the right kidney if the ureter is patent (if
urine can flow through it) postsurgically. Kidneys can recover from pretty
significant damage, at least to an acceptable level of function. If
secondary infection is a continuing problem that lowers the probability of
recovery but your vets are probably doing their best to monitor both of
these things. In a worst case scenario that kidney could be removed and the
other one can provide enough filtration for a normal lifestyle, just like
in people.
It is easy to get side tracked when looking for pain in a pet since it
isn't possible to ask them questions. You have been extraordinarily
dedicated to Mr. Bojangles and that may have resulted in finding the
solution to the problem at this point. I sure hope so.
Mike Richards, DVM
11/6/99
p.s. -- just in case this becomes important in the future, smz-tmp is the
antibiotic (Bactrim, Tribrissen, Ditrim Rx) and sucralfate is for ulcers. A
minor point, but a mix-up could be a problem so I thought I should point
that out.

Difficulty urinating - Boxer
Q: Dear Dr. Mike,
I have a 4 year old, 65 lb. male boxer who was neutered at 4 months of age
due to undecided testes. We travel allot due to my husband's work and
currently live in Bosnia-Herzegovina.
Five weeks ago, Samson showed difficulty when urinating. He would get
unusually uncomfortable when he had to "go out" and then when we took him
out, would take a full 5 minutes to vacate his bladder. Standing there,
sometimes only drops would come out, then a trickle, light stream, drops,
etc. These symptoms are sporadic, sometimes happening several times a day,
sometimes not at all for several days. Since we had just traveled on a
longer plane journey (18 hours with no toilet relief as he's crate trained),
I decided to observe and make sure he was getting plenty of water and time
outside.
Five days ago, I noticed a thick, yellow discharge from his penis (after
exercising) which I've never seen from him before. I took him to the vet
(who speaks no English, I speak no Bosnian). He said Samson was fine (i.e.:
no temp. no lumps, no enlarged areas, no infection) but gave him an
injection of antibiotics. The next day, symptoms grew slightly worse, I took
him back and asked for two more days of injections (which he complied with,
giving them every other day) in case there was an infection. He said Samson
might have "crystals" in his bladder, put him on some herbal tea (no other
water allowed) which I finally managed to get him to drink, making him
urinate approximately every 30 minutes all day long. The ingredients of the
tea are listed below. I have since stopped giving the tea (even though it
contains many healing properties for the urinary tract) and have changed
back to water since he drinks this more frequently and I feel it's more
importent for Sam to have continuous water than sporadic tea.
The discharge is gone but the trouble urinating is still present along with
more frequent urination (needing to go out every 1-2 hours) and the other
night, just after a 30 minute walk, where he vacated his bladder twice, came
inside, lay down and leaked urine. He also, "lost control" going out to
urinate on the stairs, 2 days ago.
After looking information up on the Internet, called and asked if the vet
could do a urinalysis and/or x-rays to determine if and what kind of stones
are present. He does not have the facilities. Samson has an appointment
tomorrow to go to another vet who is supposed to be very good, speaks
English and is as I write, searching the city for an infant size catheter.
There are no x-ray facilities in Bosnia for animals.
Other than this problem, Samson is healthy, active, has a shiny coat, clear
eyes, alert beautiful.
Here are my questions:

1) If a urinalysis determines that there are "calcium" stones, is surgery
the only solution?
2) If a urinalysis shows "crystals" (or anything other than calcium) how can
we be assured that any diet or medication will dissolve them, or whether
they are too big to dissolve without an x-ray? (There are x-ray facilities
in Croatia, 6 hours away and I can drive there if recommended)
3) What medications do you recommend if they are the dissolvable type?
4) If the dissolvable type, have you found cranberry extract to be
effective? If so, in what dosage?
5) Samson's diet, while not consistently the same has always been the best
quality I could provide while living in the US (Science Diet) Africa,
(homemade diet similar to below) and Bosnia (homemade food as described
below). Do you have any recommendations to alter his diet to prevent this
from recurring?
6) Any other thoughts that might help Samson's situation?
Thank you so much for your consideration and reply. It's exciting living in
different countries but sometimes, medically challenging.
Best regards,
Laura

SAMSON'S DIET: Once a day in morning....
16 oz lean cooked beef
24 oz cooked millet or barley
12 oz raw green leafy vegetables or squash (usually spinach)
2 heaping teaspoons "Peak Condition" (ingredients listed below)

In the evening....
A snack of one hard boiled egg, or cup of yogurt or homemade dog biscuit
(made of corn flour, beef broth and sunflower oil)

INGREDIENTS OF "PEAK CONDITION": (Per 4 heaping teaspoons)

INGREDIENTS: Pro-Carb™ (complex carbohydrates from glucose polymers),
ProGest™ protein mix (enzymatically digested chicken, poultry liver, brewers
yeast, whole egg.) Poultry fat (preserved with Natrox), pure yucca, MCT’s,
Flax oil, Creatine monohydrate, R-Aginine, L-Histidine, L-Isoleucine,
L-Tyrosine, L-Threonine, L-Tryptophan, L-Valine, Ascorbic acid, Mixed
Tocopherols, Electrolytes, Vitamins ( A, D, E, K, Thiamin (B1), Riboflavin
(B2), Panothenic acid, Niacin, Pyridoxine (B6), Folic, Biotin, B12, Choline
Inosiol, P.A. Benzoin acid, C), Minerals (Calcium, Phosphorus, Potassium,
Sodium, Chloride, Magnesium, Iron, Copper, Manganese, Zinc, Iodine,
selenium, Chromium, boron, Vanadium). Nature Min™ (over 40 trace minerals as
naturally occurring in Colloidal Polysicates), Omega 3, 6 fatty aids (from 0
fish body oils).
Nutritional Info. per 4 heaping tespoons:
Vitamins:
A 250 iu
C 26 mg (Calcium Ascorbate)
D 250 iu
E 25 iu
K 1.4 mg
Thiamin (B1) .70 mg
Riboflavin
Pantothenic Acid 7 mg
niacin 15 mg
Pyridioxine (B6) .75 mg
Folic Acid .125 mg
B-12 .00125
Choline 85 mg
Inositol .255 mg
F.A.B.A. .25 mg
Minerals:
Calcium 500 mg
Phisphorusa 400 mg
Potassium 375 mg
Sodium 35 mg
Chloride58 mg
Magnesium 300 mg
Iron 3 mg
Copper 55 mg
Maganese .58 mg
Zinc 2.4 mg
Iodine .04 mg
Selenium .004 mg
Boron .000005 mg
Chronium 5 mcg
Amino Acids
L-Arginine 484 mg
L-histidine 366 mg
L-Isoleucine 736 mg
L- Leucine 1256 mg
L-Lysine 1776 mg
L-Methionine
L-Cistine 514 mg
L-Phenlyalanine
L-Tyrosine 483 mg
L-Threonine 514 mg
L-Tryptophan 161 mg
L-valine 895 mg
Nutritional Yield:
Calories: 144
Protein: 6.58 gram
Fat: 6.58 gram
Carbohydrate: 13.16 gram
Fiber: .56 gram
Ash: .56 gram
Moisture: .56 gram
Ingredients of Tea:
Achillea millefolium
Agropyrum repens
Arctostophylos uva ursi
Betula alba
Equisetum arvense
Mayidis stigma
Malva silvestris
Ononis spinosa
Plantago maj. lanc. med.
Prunus avium
Rosa canina
Thymus serpillum
Urtica dioica

A: Laura-
It is going to be very hard to make a diagnosis of your boxer's condition
without the availability of X-rays. The thick yellow discharge is probably
smegma, which is a normal lubricating fluid produced in male dogs. It looks
a lot like pus exuding from the prepuce. It doesn't always leak from the
prepuce and the amount produced seems to vary a lot from dog to dog. It is
not at all unusual for an owner to notice it for the first time when a dog
is mature. There is a possibility of an infection when there is an exudate
from the prepuce but your vet is probably right that this is not a problem
if a physical exam is otherwise normal.
The other signs do point strongly towards bladder or urethral stones.
Sometimes it is possible to palpate bladder stones and less frequently
urethral stones on a physical exam. Sometimes vets don't try to do this
because it is also possible to feel imaginary stones when there is hard
stool in the colon or to get the impression that a stone may be present
when there is gas in the intestine (the movement of the gas on palpation
can feel a lot like grating from small bladder stones, even though that
sounds strange). I still like to palpate for stones, though. Sometimes they
are so obvious on palpation that X-rays are almost unnecessary.
The only bladder stones that dissolve readily, in my experience, are
struvite stones but there are protocols for dissolving other types of
stones. Struvite is the most common type of stone found in the lower
urinary tract of dogs (somewhere around 50 to 60% of urinary stones are
struvite in dogs) so it is a strong candidate. The only way to know for
sure what type of stone is present is to have it analyzed. The stones are
very stable, so it is possible to mail them to a laboratory capable of
doing this if you find that stones are present and they must be surgically
removed.
The signs that you are seeing are suggestive of lower urinary tract
disease. This would include cystitis (bladder infection), prostatitis
(unlikely in a neutered male dog but still possible), anatomical defects
(unlikely to show up this late), uroliths (stones in the bladder or
urethra) and cancers of the lower urinary tract (somewhat unlikely at
Samson's age).
Cystitis is the most common cause of lower urinary tract disease but
usually will respond to antibiotic therapy. In resistant cases, urine
culture, including antibiotic sensitivity testing, can be very useful for
helping to choose an appropriate antibiotic. It is best to use a urine
sample drawn directly from the bladder with a needle and syringe if
possible but that may not an option in your situation.
Uroliths (stones) are the second most likely problem and with chronicity
they become the most likely problem. Most stones are visible on radiographs
but they can be hard to find in some instances even when they are actually
visible on the film and there are stones that are not visible by X-ray
examination.
The only really reliable way to determine stone composition is to remove a
stone (or find one that is passed by the dog) and to have it analyzed. For
this reason, I tend to prefer surgical removal rather than dietary
dissolution of stones as the treatment for the first instance of stones.
The argument can be made that if the stone dissolves with a dietary trial
analysis isn't necessary and I am not a die-hard in my decision making. If
the pet owner really wants to avoid surgery I will try s/d diet from Hill's
to see if it will dissolve the stones. It is necessary to have the option
of X-raying the patient to determine if the diet totally dissolves the
stones, since the diet should not be used more than a two or three months.
In a situation in which X-rays were not available I suppose that carefully
monitoring clinical signs may be sufficient evidence of success, though. I
am spoiled by the availability of a reliable diet for dissolving struvite
stones and have not tried cranberry juice or other options. I honestly can
not say whether or not they would work, although acidification of the urine
is part of the reason the diet works.
Catheterization of the bladder is a useful diagnostic tool, too. If a
catheter can not be passed from the tip of the penis to the bladder, it is
good evidence for a stone in the urethra. Male dogs often have stones that
are trapped at the point that the os penis starts (a bone that is present
in the penis of male dogs). This is about 6 to 8 inches into the penis. It
is helpful to use a stiff catheter when attempting to catheterize the dog
because it is possible to feel the catheter grating against the stone when
it is somewhat stiff. It is a long way from the tip of a boxer's penis to
the urinary bladder (about 12 to 15 inches, I would guess) so a long
catheter is necessary to be sure that the whole urethra is clear. This is
important because large stones may lodge at any point in the urethra, not
just at the area of the os penis.
I know that you would probably prefer to avoid surgery but in circumstances
in which X-rays are not available and there are strong clinical signs of
persistent difficulty urinating, I think that exploratory surgery is a
reasonable option. I would try to be certain that the surgeon had an
appropriate catheter that could be passed through the penis during surgery,
though. It is entirely possible to find bladder stones and remove them only
to discover that there is still a problem because of a stone lodged in the
urethra of a male dog. It is imperative to be as certain as possible that
no stone is lodged in the urethra during surgery to remove urinary stones
from a male dog.
I am not an herbalist and really can not evaluate the use of the herbal
tea. I would tend to opt for increased water consumption if the tea causes
a decrease, though.
The diet you are feeding appears to be reasonable as long as it isn't
making Samson overweight. I am also not a nutritionist so that is not an
expert opinion.
I hope this helps some. Please do not hesitate to write again as
developments occur in the diagnosis and treatment of Sampson's condition.
Mike Richards, DVM
11/1/99

Urinary Tract infection - canine - continued Border Collie
Q: Dr. Richards...
This is a follow-up to a message I sent in February, regarding Joe, a 11 ½
year old border collie with an intractable urinary tract infection. We've
gleaned a bit more info, but haven't identified the problem.
new info:
contrast urethragram shows an enlarged area along the urethral tube, about
at the level of the prostate.
cells collected from that area appear "altered", but cancer not
conclusively identified.
bacteria and other goodies are still having their way with my poor dog, as
seen ijn urine sample collected within last two weeks or so.
My veterinarian is referring me to a veterinary college, either Davis or
Col. State, but unfortunately the urologist at Col. State is unavailable
until early May.
Questions:
This is a neutered dog; however, some of his symptoms are so close to
prostate problems that I hate to dismiss that, and in a phone consult the
vet at Col. State told me vet that a prostate problem is certainly not
impossible. He also indicated that their could be a hidden kidney problem.
Are there any lab tests, as in human men, that would provide a clue about
the prostate?
Could the swelling or enlargement of the urethral tube be related to a
prostate problem, cancerous or not?
Do you know of any reason not to try some of the popular (for human) herbal
remedies assocaited with these problems (cranberry capsules (sprinkled on
his food), saw palmetto (prostate problems in humans), acidoplilus
cultures)?
Do you know of any reason not to consult another vet locally? I feel
discouraged at the thought of traveling 500 to 700 miles with a dog with an
unidentified problem; on the other hand I wouldn't want to offend my
current vet, who I like very much and who is quite competent. So far we're
into the $800-$900 range, with no diagnosis! Yicks!
thanks so much for your advice.
Kate

A: Kate-
Neutering dogs does not affect the odds of developing prostate cancer much,
but it may be a little more common in neutered dogs than in intact dogs,
based on recent studies. Neutering virtually eliminates benign prostate
hypertrophy, which can cause difficulty urinating and other problems but it
doesn't affect cancer much. It is also possible for dogs to develop cancer
in the bladder or urethra. In an neutered male dog there isn't much of a
differential diagnosis for lumps in the prostate region, unfortunately.
Cancer is by far the most likely problem when this occurs.
I am not aware of any tests for dogs for prostate cancer, as exist for
humans. This issue has been studied (Journal of Veterinary Internal
Medicine, May/June 1995) and the tests (PSA) used in humans did not work in
dogs.
I think that it would be worthwhile to go to the veterinary school in Ft.
Collins even if the urologist won't be there. The clinical pathologists,
radiology staff and other services that are likely to be needed will be
there and there will be internal medicine specialists who can help. You
might ask your vet about this. If there is a local vet who is good at
ultrasonagraphy it would be reasonable to see him or her for a second
opinion. If not, it would probably be better to go to the vet school.
I don't know of any reason not to use saw palmetto, cranberry or acidophilus
cultures. As far as I know saw palmetto is the only one of these three
treatments that I have seen recommended for prostate disease, though.
Good luck with this.
Mike Richards, DVM
03/24/1999
Joe..Update

Thanks for your feedback. Since we might be closer to a resolution, I
thought I'd bring you up to date. All the vets involved agree that this is
an unusual case, but perhaps so because it's not a problem commonly looked
for in male dogs.
A local vet did have the appropriate endoscope, and was able to look
closely at the urethra, prostate and bladder. The urethra and prostate
appeared fine, but there were several areas within the bladder that were
actively bleeding. He collected some tissue samples from these areas, and
the pathologist ruled out cancer, and identified a idiopathic interstitial
cystitus. Apparently not uncommon in cats, but not well known in male dogs.
So the remaining question is how to treat it, which these gentlemen are
researching. We'll also get another urine sample (needle aspiration) and do
both an aerobic and anaerobic culture, since there's still lots of bacteria
in there.
No feedback necessary.... I just thought it might be helpful to you to
include the diagnosis in your postings, in case someone else ever runs into
a similar situation. If they come up with an appropriate mediacation, I
will let you know.
thanks, Kate
4/5/99

Recurrent bladder infections - Canine
Q: Hi Dr. Mike,
       I wrote to you last Dec. 20th with a question about Kas's urinating in his
crate. After about 10 days on Amox. he did finally stop. Repeat urinalysis
2wks after end of regime was fine. Last week he again started urinating in
crate at night. Urine was very foul smelling and again showed an infection.
Ph was 8.5. We did Xray to check for bladder stones, but none was seen. Vet
was surprised about the large size of his colon. Background is this is a
14mth male GSD with EPI, on Viokase. His weight is now just about right for
him. His stools are usually very soft but formed. I say usually because he
is currently having very loose ones with occ. mucus. I'm hoping this is
due to the Amox. The vet did put him on Flagyl- 3x's qd for 1wk. He also is back
on Amoxicillin 500mg q 12hr.
       Sorry this is so long. My questions are, why is he having all these
bladder infections, and what about the megacolon? He is finished the flagyl,
should we repeat X-ray? Should I use an acidifer for his urine, or give him
Vit.C?
       Thank you for any help. We really love this guy, and it is frustrating that
just when we think things are under control a new problem comes up, or an old
one continues to cause difficulty. If he has to remain on antibiotics is
there one that does not cause gastric upset, if that is what is causing it
now.
THANKS, Laurene
A: Laurene-
I can't find any relationship in database searches between pancreatic
insufficiency and megacolon. I also can't find any relationship using
searches for EPI and recurrent cystitis. However, there was one article
that suggested that dogs with EPI did a lot better if they were given Vit.
B12 injections once a month to every six weeks and I saw an article on
humans that said oral Vitamin B12 given daily was also effective in
reducing clinical signs of EPI (mostly diarrhea). I can't say it will help
ward off megacolon or help keep the cystitis from returning but it seems
like an inexpensive thing to try to help further improve your dog's condition.
There is a lot of information on German shepherds developing small
intestinal bacterial overgrowth associated with EPI. They also seem to
develop this problem without EPI -- an article on this is "Characterization
of naturally developing small intestinal bacterial overgrowth in 16 German
Shepherd Dogs" by Willard, et al in the April 15th 1994 AVMA Journal.
I think it would be worth repeating the X-ray, just to see if the problem
still seems to be there. I would be really hesitant to try to control the
cystitis using dietary changes in a dog with pancreatic insufficiency that
is doing OK on its present diet. It just seems too easy to make bigger
problems.
I would have to treat the cystitis and EPI as separate problems. I am
really hoping that the megacolon is just an X-ray anomaly and not a real
problem. If it continues to show up on X-rays some plan for dealing with it
may have to be developed, though.
I wish I could help more. I will continue to think about this and to look
for answers for you when researching similar problems.
Mike Richards, DVM
3/5/99

Urination problem/ Housebreaking - German Shepherd puppy
Q: Dr. Mike,
     I have a 1yr.old German Shepard puppy that still urinates
occasionally in the house and also in his crate. He is only in his crate at night , usually
10pm to 6:30am. He is in our bedroom and does not make any noise to warn us
he has to go out. I need to give you some background info. Kastor was
diagnosed with pancreatic insufficiency when he was about 9mths. old. During
the time it took us to get his diarrhea to stop I needed to get up to let him
out once or twice a night. He was also drinking alot of water. He is now
doing O.K. on Viokase powder and Hills I/D. He had a bladder infection also
at about 10mths. During the time before the antibiotics started working he
had frequent accidents. Did he just get used to urinating where he
sleeps, or could he have more physical problems? Should I take in another urine sample?
Any ideas?
Thanks,
Laurene

A: Laurene-
There is a pretty good chance that he just never had a chance to get
totally housebroken due to the many problems so far. Medical problems are
possible, though. It is best to try to eliminate this possibility first and
then work on behavioral problems once it seems reasonably clear that there
are no medical problems.
A good physical examination, checking a blood chemistry panel, a complete
blood cell count and a urinalysis often provides sufficient information to
determine if a medical problem seems likely. Given his other problems, it
is possible that all of this lab work has been done recently enough that it
can be reviewed for this problem, too. Of the lab work, the urinalysis may
be the most important and would be reasonable to repeat if necessary.
If the problem is behavioral it may be necessary to take the view that
housebreaking hasn't been accomplished and to start the process again. The
only major difference between normal housebreaking and your situation is
the urination or defecation in the crate. Dogs will sometimes develop a
preference for certain areas or certain "substrates" - substances that the
dog likes to eliminate on. If you use newspaper to line the crate he may
have decided that it is OK to eliminate on paper. If that is the case then
it may help to use a different crate (perhaps one that has a grate so that
he is not in contact with paper) or to confine him to a small area rather
than in a crate.
If your dog seems to be distressed by being crated and therefore separated
from you it may be necessary to treat for separation anxiety as well as for
the housebreaking problems. If he only eliminates in the house when you are
not present, this is a stronger possibility, especially if he is
destructive in any way while you are gone.
To review housebreaking in difficult cases:
Do not attempt to punish a dog for eliminating in the house. If you catch
the dog "in the act" STARTLE it (sharp "NO", something else sufficient to
make it stop urinating or defecating but not to make it really frightened)
and then immediately take the dog outside to the general area you want
elimination to occur in.
Praise the dog when it does urinate or defecate outside. Helping your dog
understand what you expect by praising "good" behavior helps a great deal.
Set aside some time to pay strict attention to housebreaking. Make it the
number one priority of a weekend or something like that. Keep track of
where your dog is and what it is doing until you can catch him in the act
of eliminating in the house so that you can let him know it isn't OK. Take
the time to catch him eliminating outside so you can let him know that is
OK. If you can't find the time to pay total attention to housebreaking
consider attaching a leash to your belt so that your dog has to stay close
to you, to increase your chances of catching him eliminating in the house.
Clean any areas (including the crate) with a good odor eliminating product
like Nature's Miracle, or Canine Odor Eliminator.
Be patient but persistent. Eventually almost all dogs (but not quite all)
can be housebroken.
Hope this helps.
Mike Richards, DVM

Urination problem - continued

Q: Hi Dr. Mike,
Thank you for your recent response to this problem. To refresh your
mind, this is concerning a 1yr.old Ger. Shep. with EPI. who has been
urinating in house and crate.   I have some new info. I did take in a urine sample for
U/A. He had lots of WBC's, occ. RBC's, mod. amt. of bld, Ph. normal, tiny
amt protein.   He was started on Clavamox 500mg bid. He has been on this for
7 days so far. There has been no improvement in his nocturnal urinating in
his crate. I'm fairly certain he either does this in his sleep, or has such
urgency that he can not ask to go out. I have moved his crate next to my bed
and he does not make any noise. I called our Vet. yesterday and she
suggested we try Phenylpropanolamine HCL 75mg q 12 hrs. I started this last
evening. I made sure Kastor emptied his badder at 10pm. Kas made some noises at 1am,
when I let him out in the back yard. Not sure if he urinated or just chased
creatures. I woke up at 5:45 to a very wet and smelly dog and crate!   Now
that you know more than you ever wanted to about Kastor's elimination, my
question is what do you think is going on? He has not urinated in the house
lately, but he has me trained to make sure he goes out freq. He did mess his
crate yesterday when I went out for about 3hrs. Could any of this be related
to his EPI? Does he have some kidney disease going on? Is he unable to
concentrate urine? I don't believe he drinks excessive water. Any tests you
would suggest? I admit to getting very worn out. Where should I go from
here? Thanks for listening and any help you can give.
Laurene

A: Laurene-
I am pretty sure that your vet would have told you if Kas was not
concentrating his urine because testing for specific gravity is a pretty
standard part of a urinalysis. The ability to concentrate urine is a good
sign that the kidneys are functioning, at least at the time the tested
urine was produced.
When I responded to you the first time I did not consider the possibility
that Kas may have developed diabetes mellitus, which sometimes occurs in
conjunction with exocrine pancreatic insufficiency (EPI). However, glucose
should show up in the urine if he is diabetic and that was not reported,
either.
I did some research online and in reference texts and I did find a
reference to polyuria (increased urination) occurring with EPI, without
concurrent diabetes mellitus, in Dr. Morgan's book "Handbook of Small
Animal Practice". No treatment for this condition was given in the text and
I could not find any reference to treatment for this online, either. I did
not expect to find an easy cure because this condition is hard to treat
without correcting the underlying problem and you are already doing what
you can for that. Therefore, I think that your vet's approach is as good as
any to start with. While phenylpropanolamine is most effective for
incontinence it may provide enough extra bladder control to allow Kas to
make it through the night. If he does urinate when he is asleep it is more
likely that incontinence if part of the problem so perhaps this will be a
successful approach.
If this doesn't work, I think you may have to make plans for methods of
living with this problem, such as a crate with a rack and absorbent pads
under it like the ones used for human patients who are unable to get out of
bed or who suffer from uncontrolled incontinence.
Usually when there is polyuria (too much urine production), there is also
polydipsia (too much drinking) but it is notoriously difficult to correlate
these two conditions in many patients. Lots of pet owners report one
condition without the other.
I wish that I had more to offer. I hope that the approach your vet has
already proposed will work.
Mike Richards, DVM

Eosinophilic Cystitis - Rottie
Q: Dr. Mike, I have a 9yr old Rottweiler who just had Eosinophilic Cystitis. If you have any
information on that too I would appreciate it. But now she is drinking tons of water and urinating
everywhere. I mean it's large amounts. Do you have any ideas? Tina
P.S. She had a mass surgically removed which was what they said
was the Eosinophilic cystitis.
A: TMJ- Eosinophilic cystitis has been reported in cats, humans and other primates. I see no
reason why it would not also occur in dogs but have not found a reference to it. It is usually
treated with corticosteroids adminstered directly into the bladder or systemically (as in injections
or pills). I don't think the underlying causes have been worked out but viral infections, allergies
and immune mediated disease have been mentioned in the literature as possible underlying causes.
Since I couldn't find any references to this disease in dogs, I can't tell you what to expect or how
successful treatment might be.
Mike Richards, DVM

Difficulty Urinating
Q: I HAVE A 14 YR. OLD COCKAPOO THAT HAS BEEN PUT ON 1 MG. OF D.E.S.
FOR INCONTINENCE. LATELY SHE HAS BEEN TRYING TO URINATE AND HER
LEGS GIVE OUT PRACTICALLY BEFORE SHE IS DONE...THERE IS NOT THAT
MUCH VOLUME OF URINE COMING OUT. MY VET TOOK A URINALYSIS AND
SAID THERE WAS PROTEIN IN IT. SINCE SHE IS HAVING A HARD TIME PEEING,
I THOUGHT PERHAPS WE COULD CUT THAT DOSAGE DOWN...(WE GIVE IT
ONCE A WEEK) THIS OF COURSE DOES NOT TAKE OUT THE PROTEIN...THE
VET ASKED US IF WE WANTED TO PERFORM ANOTHER TEST (I DON'T KNOW
WHICH, BUT IT COSTS $42.00) AND WE'VE ALREADY SPENT $125.00 SO FAR.
WE DON'T HAVE A LOT OF MONEY, BUT WANT TO DO THE BEST FOR OUR PET.
COULD THIS REALLY BE THE ONSET OF KIDNEY FAILURE THAT I HAVE HEARD
IS PREVALENT IN POODLE TYPES?
THANK YOU FOR HAVING SUCH A WONDERFUL WEB SITE!
A: I have not seen muscular weakness or changes in the volume of urine produced as a result
of the use of diethylstilbestrol (D.E.S.), so my first suspicion would be that something else is going
on at this time.
Kidney failure usually causes an increase in drinking and urine output early in the disease process.
Later it can lead to a decrease in urine output but most dogs are clearly ill at that point.
If she is trying to urinate more frequently than she normally does and is producing small amounts
of urine when she does urinate, then cystitis is a strong possibility. I am not sure what tests your
vet would want to run to rule in or rule out other diseases but it is not uncommon for vets to want
to do urinalyses or urine cultures in this situation. X-rays to rule out bladder stones are also commonly
recommended. Cystitis is treatable and your dog will feel a lot better if she has this condition and it is treated.
The muscular weakness is also likely to be the result of another problem. There are a great number of
possibilities in this case. Please let your vet know that this is happening as well. Causes of this such as
arthritis and spinal disc problems can be treated if they are present.
Most vets will work with you to keep costs reasonable if you ask. It is best to explain that you are
dedicated to working through the problem but that you just need to do it from as practical an
approach as is possible.
Good luck with this.
Mike Richards, DVM

Urinary control problems and earliest age to neuter a dog
Q: Doc, perhaps you could tell me; (1) what is the absolute earliest age a Black Lab should be neutered?
(2) is there a veterinary standard age of maturity a dog should reach before he is neutered?
(3) can neutering cause a dog to have poor bladder control?
(4) will my dog outgrow this problem (he's about five months old and house broken,...... until he gets excited)?
thanks a bunch.
A: There is not a lot of data on the effects of spaying dogs and cats at younger ages than the "traditional"
6 months that has actually been published, at least that I am aware of. There are reports of two or three
places studying the effects of early spay and neuter at the present time and I have seen references to data
from these studies but am not aware of published data. I am only aware of one study of long term effects
of spaying and neuter dogs at 7 months of age that followed the dogs for their entire lifetime. In this study,
there were no problems attributable to spaying or neutering at this age other than a slight increase in the
likelihood of estrogen dependent incontinence in female dogs. A lot of vets are spaying pets at 4 months
of age pretty routinely now and humane organizations have been spaying animals in their care as early as 8
weeks for several years. Soon, there will be enough of these early spay and neuter patients and they will be old enough to figure out if there are long term effects. At present, no one is reporting any problems as far as I can tell.
So, to answer your questions. I don't know what the earliest age for safe neutering is. I only know that it is
safe at 6 months or older. I believe the veterinarians reporting that they are having no problems with neutering as young as 8 weeks of age, but I can't support their claims with objective studies. Personally, if there was a strong need to neuter younger, such as exists at humane societies, I would have no qualms about it. I wouldn't neuter my own pet prior to five or six months of age, though.
I am not aware of problems with male dogs neutered young developing urinary incontinence. I have not seen any increase in the incidence of male dogs that are neutered over male dogs that are not neutered. I don't think that neutering your dog will make a urinary control problem worse.
There are two causes of incontinence that may explain your puppy's "problem". The first is submissive urination. Puppies that have very submissive personalities tend to urinate small amounts when greeting people or when someone makes sudden movements or assumes a dominant position, even inadvertently. These puppies are generally showing other submissive signs, such as head down postures or rolling over. It can help to just ignore these puppies at first and let them get used to your presence in the house prior to greeting them. Many dogs will outgrow this behavior but some do not. For some dogs, treatment with anti-anxiety medications or phenylpropanolamine can be helpful. Unfortunately, not all dogs will respond to medical therapy or behavioral therapy for this condition. Strategically placed throw rugs or plastic runners are the next line of defense since the behavior often occurs at predictable times and places.
Some puppies can not control urination when they are very excited. They just get so worked up that
they leak urine. Most puppies will outgrow this problem, too (at least based on the ones we see).
Some dogs don't, though. We have some success treating these dogs with phenylpropanolamine.
It seems to give them just enough control to get them through the excitement. It doesn't always work,
though. I have never tried any other therapy for this condition. I think this is because I practice in a
rural area and it is easy for my clients to adjust to making these dogs "outside dogs" and living with
the problem. If there is an animal behaviorist in your area, your vet may be able to refer you to him
or her for help with this problem.
In any case, I don't think neutering will help or hurt with either one of these behaviors.
Hopefully, he'll outgrow whatever problem is bothering him.
Mike Richards, DVM

Last edited 02/06/07

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