I took Maisy in for a just-being-super-cautious bladder ultrasound on Monday. It’s been six months since her huge bladder stones (and subsequent removal). Since that time, all of her UAs have come back great, and she continues to be on the prescription diet to help prevent a recurrence, so I figured it would be a pretty quick and easy appointment.
It’s like I don’t even know my own dog.
Of course she has bladder stones. Five or six, actually. All small enough to pass, but still. Wasn’t the diet supposed to prevent this? Yes, it should have, but… well, we’ve cheated. Oh, sure, her main meals have been the prescription diet, but she has still gotten the occasional bully stick and we definitely feed her off our plates… The vet didn’t think that would be enough to cause stone formation, but that’s what I’m going with because the alternative is more frustrating.
See, there are two main types of stones: struvite and calcium oxalate. Struvites can be dissolved by diet and are therefore the better kind to have. This is what Maisy had last fall. Calcium oxalate, on the other hand, have to be removed surgically. We don’t know which kind Maisy has now, so I’m going with the diet-needs-to-be-stricter theory.
The plan right now is to switch from the stone-prevention diet to the stone-dissolution diet and then do a recheck ultrasound in 6-8 weeks. If the stones go away, we’re all good. If they don’t… well, we’ll figure it out then. The good news is that the stone-dissolution diet can also be used for maintenance. The bad news is that every. single. dissolution diet on the market has eggs in them. Maisy is allergic to eggs. But hey, she’s already on steroids, so hopefully that will prevent any allergy issues.
Fingers crossed! On all fronts!
Showing posts with label bladder stones. Show all posts
Showing posts with label bladder stones. Show all posts
Thursday, March 6, 2014
I believe my response to the vet would be an inappropriate post title
Thursday, October 24, 2013
Hindsight
I’m amazed at how well Maisy is doing… and feeling bad because it’s (now) obvious that Maisy was not feeling well for quite awhile. Over the summer she became hesitant to jump in the car. Since she didn’t seem to have trouble getting on the furniture or the bed, I thought maybe she was getting carsick. Nope. She’s now bouncing into the car, even running to it hopefully at other times. Well okay then!
I’d also forgotten how much ENERGY this dog has. She’s been a nutcase (in a good way): having evening zoomies again, playing with the cat, even playing with obnoxious adolescent chi-mixes. Although she had never stopped playing ball, she’s redoubled (retripled? requadrupled?) her ball-bringing efforts. It’s getting a bit obnoxious, honestly.
Not that I’m complaining! I’m so thrilled to see her feeling so well! She clearly feels better than before she got sick. Yay steroids! I’m so relieved she hasn’t had any negative behavioral side effects with them.
Bladder-health-wise, Maisy had a urinalysis on Saturday. I had at done at 3 weeks, which was a bit early (she needs them every 4 to 6 weeks for awhile), but counting is hard. Or something. I’m not sure how I did that.
At any rate, it makes the results THAT MUCH MORE exciting as they came back pretty good. Ideally, she should have a urine pH of less than 6.5 and a specific gravity (USG) of less than 1.020. Maisy’s pH was 6.5 on the dot and she had NO crystals! Yay! Her USG was high: 1.050, which means that her urine was more concentrated than we want. We did do the test first thing in the morning, so it had probably been 10-12 hours since she had peed last, but either way, I need to encourage fluid intake. Which is so hard with this dog.
We will continue to check her urine every 4 to 6 weeks for six months (when she is due for an ultrasound to confirm there are no stones). The vet- our regular practice vet, not from the hospital- and I discussed other preventative things we could do; she agreed that while effective, the prescription diet is nasty, so in a few months I’ll be consulting with a nutritionist to get a raw/home cooked diet formulated for her. The vet also recommended probiotics and a cranberry supplement (which I already started Maisy on).
Any suggestions for increasing fluid intake? I’ve tried broths (usually but not always successful) and adding water to her kibble (I don’t like doing that because I prefer to put her kibble in food toys, but I guess maybe I need to). I want to try drink mixes or even just sugar added to the water. Girlfriend has a sweet tooth like woah. What am I missing? I'd love to hear some other ideas!
Thursday, October 17, 2013
A Week of Good News!
Both Maisy and I received great news this week! (Finally. Last month was hard.)
Maisy's Health
Maisy had a follow-up appointment with the neurologist at the U of MN on Monday. He saw her during her first hospitalization for immune-mediated inflammatory disease of the spinal cord. Although Maisy really, really, really did not want to enter the vet clinic at the U (and really, who can blame her?), she was a good dog for her exam. Perhaps a bit more drama-queen-y than usual, but she didn't try to bite anyone, so I'm calling it a success.
The neurologist was pleased with her quick recovery and said that I could treat her the way I normally do- no activity restrictions! She does tire a bit easier now, but that's largely because she isn't in the same condition as she was before all this. She will continue on daily steroids (down from twice a day) for three weeks, and then will take 5mg of prednisone every other day for 4-5 months.
Maisy has had no appreciable side effects from the steroids. Some dogs get thirstier (and thus need to pee more); this hasn't happened with Maisy. Some dogs will have behavioral effects (heck, I get incredibly grumpy when I'm on high doses of steroids), but Maisy hasn't. If anything, she's friendlier. About the only thing I've noticed is that she wants to lick my face more than usual. I have no idea if that's related or not, and while it's annoying, it's also manageable. The only side effect that might yet show up is muscle wasting. I hope we don't get that!
Of course, Maisy had two issues last month, the other being her bladder stones. She is still on her very restricted diet, and she will need regular UAs and other monitoring. However, this is a highly manageable condition, if expensive. I now have three jobs. It sucks, but what can I do?
Crystal Thompson, CPDT-KA
That's right! I got my exam results back this week (hey, I took the professional dog training exam the first day Maisy was sick, remember?), and I passed. I am now officially a CPDT-KA. I am thrilled to report that I got a 97% on it! Yay me!
All in all, it's been a great week. Hopefully things continue going this well!
Maisy's Health
 |
| Maisy on her 7th birthday earlier this month. |
The neurologist was pleased with her quick recovery and said that I could treat her the way I normally do- no activity restrictions! She does tire a bit easier now, but that's largely because she isn't in the same condition as she was before all this. She will continue on daily steroids (down from twice a day) for three weeks, and then will take 5mg of prednisone every other day for 4-5 months.
Maisy has had no appreciable side effects from the steroids. Some dogs get thirstier (and thus need to pee more); this hasn't happened with Maisy. Some dogs will have behavioral effects (heck, I get incredibly grumpy when I'm on high doses of steroids), but Maisy hasn't. If anything, she's friendlier. About the only thing I've noticed is that she wants to lick my face more than usual. I have no idea if that's related or not, and while it's annoying, it's also manageable. The only side effect that might yet show up is muscle wasting. I hope we don't get that!
Of course, Maisy had two issues last month, the other being her bladder stones. She is still on her very restricted diet, and she will need regular UAs and other monitoring. However, this is a highly manageable condition, if expensive. I now have three jobs. It sucks, but what can I do?
Crystal Thompson, CPDT-KA
That's right! I got my exam results back this week (hey, I took the professional dog training exam the first day Maisy was sick, remember?), and I passed. I am now officially a CPDT-KA. I am thrilled to report that I got a 97% on it! Yay me!
 |
| Wait. I missed one on learning theory? |
All in all, it's been a great week. Hopefully things continue going this well!
Tuesday, October 8, 2013
Hopeful for a Full Recovery
Cross your fingers, knock on some wood, put a rabbit foot on your key chain… anything to prevent me from jinxing things here, because I think Maisy might have a full recovery.
As you know, September was a hard month for us. First she landed in the ICU for what turned out to be immune-mediated inflammation of the spinal cord. Then, just as she was starting to recover, she ended up back in the ICU with some pretty bad bladder stones (and a very uncomfortable procedure to remove them). It’s been almost two weeks, though, and over the weekend Maisy started showing signs of being herself again.
She has more energy and stamina again. She’s enjoying her (short, for potty breaks only) walks again instead of plodding behind me like we’re on a death march. She’s even asking for longer walks. Her coordination seems to have returned as well. She’s not tripping over her own feet when going up the stairs anymore.
Her enthusiastic naughtiness is back, too. She’s bringing me tennis balls whenever I’m… well, awake, really! Last night she shoved open the bathroom door and insisted on sitting on my lap while I was in there. She’s joyfully nipping at my heels and running circles around me in the morning.
And, instead of sleeping in the other room or at the far side of the bed, she’s back to sleeping pressed up to me, and last night she slept in my arms for at least half an hour. Oh, I missed that! Perhaps of everything, I missed that the most.
I’m optimistic that she will have a full recovery. Visions of hiking trips and dog shows have returned, and I’ve begun making plans again.
Of course, that isn’t assured. Last night we did the first reduction in her steroid dose. She had been on 7.5mg twice a day, and now it will be 5mg twice a day for a week or so. We’ll see how (if) that changes things. She sees the neurologist next week, and I assume that we’ll discuss steroid use then. Worst case scenario (I think/hope!) is that she’ll be on them for the rest of her life. Since they don’t seem to be affecting her behaviorally, that’s just fine. After all, I take steroids twice a day, too.
The bladder stones actually seem to be the bigger issue at this point. She’s on a prescription diet that I hate, but that I also have confidence in. I’ve had a hard time not giving her little extras; she’s not supposed to have any treats at all. I have always shared everything I eat with her. I wasn’t able to do it cold turkey, but I’ve really cut back, and each day it’s a bit easier. I still plan to consult with a nutritionist at some point.
She will also need pretty regular monitoring, at least for a while. The U of MN Urolith Center actually has a lot of good info on it, with recommendations on how often to test and what parameters to look for. She will need a follow up urinalysis every 4-6 weeks until the specific gravity is less than 1.020, the pH is 6.5 or ungder, and there are no crystals. After that, follow up UAs should happen every 3-9 months. They also recommend either x-rays or ultrasounds every 6-9 months to evaluate for stones. Since none of the billion x-rays Maisy had last month showed any stones, I’ve decided to do ultrasounds.
For now, though, I’m just going to enjoy having my dog back.
As you know, September was a hard month for us. First she landed in the ICU for what turned out to be immune-mediated inflammation of the spinal cord. Then, just as she was starting to recover, she ended up back in the ICU with some pretty bad bladder stones (and a very uncomfortable procedure to remove them). It’s been almost two weeks, though, and over the weekend Maisy started showing signs of being herself again.
She has more energy and stamina again. She’s enjoying her (short, for potty breaks only) walks again instead of plodding behind me like we’re on a death march. She’s even asking for longer walks. Her coordination seems to have returned as well. She’s not tripping over her own feet when going up the stairs anymore.
Her enthusiastic naughtiness is back, too. She’s bringing me tennis balls whenever I’m… well, awake, really! Last night she shoved open the bathroom door and insisted on sitting on my lap while I was in there. She’s joyfully nipping at my heels and running circles around me in the morning.
And, instead of sleeping in the other room or at the far side of the bed, she’s back to sleeping pressed up to me, and last night she slept in my arms for at least half an hour. Oh, I missed that! Perhaps of everything, I missed that the most.
I’m optimistic that she will have a full recovery. Visions of hiking trips and dog shows have returned, and I’ve begun making plans again.
Of course, that isn’t assured. Last night we did the first reduction in her steroid dose. She had been on 7.5mg twice a day, and now it will be 5mg twice a day for a week or so. We’ll see how (if) that changes things. She sees the neurologist next week, and I assume that we’ll discuss steroid use then. Worst case scenario (I think/hope!) is that she’ll be on them for the rest of her life. Since they don’t seem to be affecting her behaviorally, that’s just fine. After all, I take steroids twice a day, too.
The bladder stones actually seem to be the bigger issue at this point. She’s on a prescription diet that I hate, but that I also have confidence in. I’ve had a hard time not giving her little extras; she’s not supposed to have any treats at all. I have always shared everything I eat with her. I wasn’t able to do it cold turkey, but I’ve really cut back, and each day it’s a bit easier. I still plan to consult with a nutritionist at some point.
She will also need pretty regular monitoring, at least for a while. The U of MN Urolith Center actually has a lot of good info on it, with recommendations on how often to test and what parameters to look for. She will need a follow up urinalysis every 4-6 weeks until the specific gravity is less than 1.020, the pH is 6.5 or ungder, and there are no crystals. After that, follow up UAs should happen every 3-9 months. They also recommend either x-rays or ultrasounds every 6-9 months to evaluate for stones. Since none of the billion x-rays Maisy had last month showed any stones, I’ve decided to do ultrasounds.
For now, though, I’m just going to enjoy having my dog back.
Saturday, September 28, 2013
Maisy's Home! (Again)
On Wednesday afternoon, we got the results of Maisy's spinal tap and adjusted her medications. One of the things we did was increase her steroid dose. I was warned that one of the side effects would be an increased need to urinate, so when she asked to go out frequently on Thursday morning, I didn't think much of it. But on Thursday afternoon, we noticed that she wasn't actually going every time she squatted. Then she started to squat every thirty seconds, no matter where she was (including in the house, and she is very well housetrained).
I took her to the ER, where an x-ray showed that her bladder was huge, indicating a blockage. They weren't sure what was blocking her since they didn't see any stones, but did a therapeutic cysto (they stuck a needle through her abdomen and into her bladder in order to remove the urine that way). Yesterday they did an abdominal ultrasound and found several small and one large stone (approximately 7mm, which is about the size of a pinky fingernail, I think).
A lithotripsy was performed. This is a non-surgical procedure where they put a small video camera up her vagina and then used a laser to break up the stones. Then they did a combination of stone basketing (not really sure what this is- Dr. Google isn't very helpful!) and urohydropropulsion (a urinary flushing technique) to remove the smaller bits.
Lab analysis showed that the stones were struvite, which is the best kind a dog can have. Struvites are usually the result of an infection, especially staph infections. As you may remember, Maisy was found to have a UTI caused by staph when she was in the ICU a few weeks ago.
Originally, they planned to keep Maisy overnight, but she recovered from the anesthesia quickly and they felt she would be “more comfortable” at home. When I picked her up, I found out what that meant- apparently any time someone came near her, she would snap at them. She was brought out to me in an e-collar with bright red stickers on it that said “CAUTION: MAY BITE.” Poor Maisy. I really don't blame her (I would feel bitey, too!). Oddly, on her discharge paperwork, they said “She is a very sweet girl and we really enjoyed working with her.” Ha.
The plan going forward: She will continue the steroid treatment for the inflammatory disease of her spinal cord, and we're adding in antibiotics for a couple weeks and pain meds as needed. She was also sent home on a prescription diet and orders to follow it strictly. Maybe it was just trigger stacking, but this was the first time I actually cried throughout all of Maisy's health woes this month. And oh, how I sobbed on the phone with friends. I didn't realize how important it is to me to be able to share junk food with her.
Anyway, Maisy is home and doing well, or at least, as well as she can considering the circumstances. She's very, very tired, but when she's awake she's happy and playful. I am so glad she's here with me. I have no idea what the future looks like, and only a small idea of how it might change, but she's here, and for that I am grateful.
Finally, I just wanted to answer some of the questions I've been getting:
Is this related to the inflammatory disease of her spinal cord?
It's highly unlikely. More than likely, it's just some seriously bad luck. The thing is, Maisy has had recurrent UTIs her entire life (including a previous scare a few years back), so this was bound to happen at some point.
Why didn't they catch this when she was in the ICU before?
I don't know, but I don't think it's because they missed something. They did all the diagnostics they should have. She had two UAs/UCs, and a ton of x-rays. The x-rays she had on Thursday night didn't show the stones, either.
Have you considered a raw diet/supplements?
Maisy was actually on a raw diet before all this started and we used supplements (cranberry, fish oil, and probiotics, mostly, although we'd run out a few months back and I hadn't gotten around to starting them again because money has been tight). When things settle down in a few months (and I have the money again), I'm going to schedule an appointment with the nutritionist at the U to discuss diet again. Although I believe in the prescription diets, I also hate them. I don't think there's any actual meat in the one Maisy's on.
Speaking of money...
Have I mentioned how grateful I am for all of you? To date, I have spent $6,957.77 on Maisy's health care this month alone. There will be more bills to come (neither issue is resolved at this point), but hopefully they will be smaller. I have received $4,444.03 in donations, so I only have to pay $2,513.74 out of pocket. This is still more than what's in my emergency savings, so I'm in the market for a third job. Even so, I cannot even express how thankful I am for everyone who has supported Maisy and I in the past month. I'm not sure what I would have done without your financial assistance.
If you're local, please consider signing up for one of my reactive dog classes to help me pay the bills! I also do private lessons. Email me for more info about either one. I have a class starting next Friday for easily distracted sport dogs and/or mildly reactive dogs that isn't full yet!
I also make and sell quilts and weighted blankets. The weighted blankets are great for people with sensory processing disorder (also autism, insomnia, anxiety, etc.). The shipping for quilts isn't bad, but for the weighted blankets, it gets expensive. Email me for info and pricing.
I took her to the ER, where an x-ray showed that her bladder was huge, indicating a blockage. They weren't sure what was blocking her since they didn't see any stones, but did a therapeutic cysto (they stuck a needle through her abdomen and into her bladder in order to remove the urine that way). Yesterday they did an abdominal ultrasound and found several small and one large stone (approximately 7mm, which is about the size of a pinky fingernail, I think).
A lithotripsy was performed. This is a non-surgical procedure where they put a small video camera up her vagina and then used a laser to break up the stones. Then they did a combination of stone basketing (not really sure what this is- Dr. Google isn't very helpful!) and urohydropropulsion (a urinary flushing technique) to remove the smaller bits.
Lab analysis showed that the stones were struvite, which is the best kind a dog can have. Struvites are usually the result of an infection, especially staph infections. As you may remember, Maisy was found to have a UTI caused by staph when she was in the ICU a few weeks ago.
Originally, they planned to keep Maisy overnight, but she recovered from the anesthesia quickly and they felt she would be “more comfortable” at home. When I picked her up, I found out what that meant- apparently any time someone came near her, she would snap at them. She was brought out to me in an e-collar with bright red stickers on it that said “CAUTION: MAY BITE.” Poor Maisy. I really don't blame her (I would feel bitey, too!). Oddly, on her discharge paperwork, they said “She is a very sweet girl and we really enjoyed working with her.” Ha.
The plan going forward: She will continue the steroid treatment for the inflammatory disease of her spinal cord, and we're adding in antibiotics for a couple weeks and pain meds as needed. She was also sent home on a prescription diet and orders to follow it strictly. Maybe it was just trigger stacking, but this was the first time I actually cried throughout all of Maisy's health woes this month. And oh, how I sobbed on the phone with friends. I didn't realize how important it is to me to be able to share junk food with her.
Anyway, Maisy is home and doing well, or at least, as well as she can considering the circumstances. She's very, very tired, but when she's awake she's happy and playful. I am so glad she's here with me. I have no idea what the future looks like, and only a small idea of how it might change, but she's here, and for that I am grateful.
Finally, I just wanted to answer some of the questions I've been getting:
Is this related to the inflammatory disease of her spinal cord?
It's highly unlikely. More than likely, it's just some seriously bad luck. The thing is, Maisy has had recurrent UTIs her entire life (including a previous scare a few years back), so this was bound to happen at some point.
Why didn't they catch this when she was in the ICU before?
I don't know, but I don't think it's because they missed something. They did all the diagnostics they should have. She had two UAs/UCs, and a ton of x-rays. The x-rays she had on Thursday night didn't show the stones, either.
Have you considered a raw diet/supplements?
Maisy was actually on a raw diet before all this started and we used supplements (cranberry, fish oil, and probiotics, mostly, although we'd run out a few months back and I hadn't gotten around to starting them again because money has been tight). When things settle down in a few months (and I have the money again), I'm going to schedule an appointment with the nutritionist at the U to discuss diet again. Although I believe in the prescription diets, I also hate them. I don't think there's any actual meat in the one Maisy's on.
Speaking of money...
Have I mentioned how grateful I am for all of you? To date, I have spent $6,957.77 on Maisy's health care this month alone. There will be more bills to come (neither issue is resolved at this point), but hopefully they will be smaller. I have received $4,444.03 in donations, so I only have to pay $2,513.74 out of pocket. This is still more than what's in my emergency savings, so I'm in the market for a third job. Even so, I cannot even express how thankful I am for everyone who has supported Maisy and I in the past month. I'm not sure what I would have done without your financial assistance.
If you're local, please consider signing up for one of my reactive dog classes to help me pay the bills! I also do private lessons. Email me for more info about either one. I have a class starting next Friday for easily distracted sport dogs and/or mildly reactive dogs that isn't full yet!
I also make and sell quilts and weighted blankets. The weighted blankets are great for people with sensory processing disorder (also autism, insomnia, anxiety, etc.). The shipping for quilts isn't bad, but for the weighted blankets, it gets expensive. Email me for info and pricing.
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