***3331. The female, not spayed Silkie Terrier had seen many vets for urinary tract infection without cure

Challenging case. Recurring urinary tract infection in a female not spayed dog.

Dec 27, 2017. TP 46126

A 2nd challenging case of recurring urinary tract infection and treated by several vets. I had one such case many years ago (lady in red case). See below.


Dec 2017 Case.  SILKIE TERRIER F, NOT SPAYED, 9 YEARS OLD. Born 2008.

Dog came in today Dec 29, 2017
Strong smelly urine again in this 9-year-old female, not spayed dog. Heat period stopped around FEb 2015 for 1.5 years. False pregnancy presented and milk seen in Dec 2017 examination.


History
2010.  At 2-year-old, consulted Vet 1for UTI, cured for 1-2 years.
2012.  At 4-year-old, strong smelly urine. Saw Vet 2 4-5X and Vet 3 for 1X
   X-rays - no urinary stones by one of the vets

Aug 15, 2015  lst consultation at Toa Payoh Vets.
7 years old  female not spayed. smelly urine
The young lady consulted me. Smelly urine plus blood and pus for the past few years and treated by several vets. After treatment, will be ok for a while. Then smelly urine again.
Palpation - pain + in letf kidney area. Bladder mass 2 cm x 2 cm.
Vulval area was hyperpigmented black due to long-standing licking.
False pregnancy seen with milk present. Urine pH 8. SG 1.0, Protein 3+.

I advised spay as the bacteria from womb infection goes into the bladder due to the dog licking her vulva frequently (evidence from black skin pigmentation). The lady did not want to spay her dog. 
Bought canine k/d x 1 small bag.

Sep 18, 2015. Strong smelly urine. Seen 3 vets. Treatment. I advised Canine C/D diet and spay.
Nov 30, 2015 and Feb 4, 2016.  Buys canine k/d

Apr 27, 2016. No more smelly urine for past 7 months. since first visit unlike other vets - smelly urine after 2-3 months.
Advised urine test and X-rays but owner did not want to do the tests.

July 27, 2016   dysuria, haematuria
Sep 7, 2016      dysuria, haematuria, stranguria
May 28, 2017      Buys canine C/D x 1 bag 17.6 lbs.
Sep 16, 2017   recurrent UTI. Declined tests. Wants medication only.
Dec 29, 2017   recurrent UTI. blood and urine test.

X-Rays by Vet 1 before Aug 2015. Said to be normal. No urinary stones.


BLOOD TESTS
 1.  Aug 16, 2015.  Glucose less than 0.1  (3.9 - 6)

kidneys normal
haematology normal

2.  Dec 29, 2017.  
kidneys normal
haematology normal


URINE TESTS
 1.  Aug 16, 2015.  pH 9. SG 1.035. Nitrite positive. Protein 4+. Blood trace
                         WBC 9 +ve, RBC 0, Epithelial cells 0, bacteria Nil,
Crystals Amorphous phosphate 3+, triple phosphate +
Possible haemolysis of RBC in urine

2.  July 27, 2016.  pH 6. SG 1.017. Nitrite positive. Protein 2+. Blood 4+
                         WBC over 900 +ve, RBC 127 +ve, Epithelial cells 5, bacteria +
Possible haemolysis of RBC in urine

3.  Dec 29, 2017.  pH 9. SG 1.022. Nitrite negative. Protein 2+. Blood 3+
                         WBC 75 +ve, RBC 55 +ve, Epithelial cells 0, bacteria 3+

                        Advised spay and X-ray but owner felt the dog might die under anaesthesia during spay. No more porridge water and treats. Strictly Canine C/D.



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SEP 2011 CASE  STUDY - SIMILAR TO 2017 CASE
This Sep 2011 case shows a female spayed corgi with recurrent UTI with a happy outcome after consulting so many vets.

The 2017 case - the old dog was not spayed. The owner did not give canine K/D or C/D solely and did give treats. The urine was alkaline instead of acidic at the latest time of examination in Dec 29, 2017. 

Friday, December 9, 2011

767. No more smelly urine after the end of antibiotics for an old corgi

A HAPPY LADY IN RED CAME TO THE SURGERY

A fair lady in red sheath dress, with black eyeliner suddenly came into the waiting room and waved at me from the outside. My consultation room's door has a glass window on the top half and so I could see who was coming into the waiting area. This lady, in her prime at around early 30s, looked quite familiar and since she waved to me, she must have met me. 

 I had to stop the meeting which had taken over 30 minutes as I guess my assistants had enough of my reiterations of things to do, government and legal processes to be complied with and records to be written meticulously. Reminders to staff appear to be part of a manager's job and it is a role I rather not be involved in. But I was the licensee and the ultimate responsibility of any clientele complaint, investigation and litigation is with the licensee.

I said hi to the lady in red. Fairness and bright red always demand attention. The lady in red said: "Do you remember the Corgi? I am coming for the S/D diet."

"I am sorry I can't recognise you," I said. "But I do remember Oreo. She had seen a few vets and always passed smelly urine after a course of antibiotics. For at least 2 years or so. Is she OK now?" I had thought of following up but had not done so and now one month had flown by. Just like that.

"Well," the lady beamed. "She is no longer passing smelly urine after one month of treatment. Your medication has been taken and is no more. Her urine is clearer. Best of all, I don't have any smelly urine in the apartment after the end of antibiotics as in the past."

"How many times does Oreo pee and how much does she drink per day?" I asked. "Did you measure the amount of water she drinks a day?" It was difficult for her to answer precisely as she did not take note. She said: "I can't measure the amount because Oreo drinks only fresh water and so the bowl of left over water has to be replaced."

I was surprised that her female spayed dog peed all over the apartment at such an old age. "An adult dog usually pees twice a day, in most cases," I said. "The fault lies with the owner if she pees many times a day," I said. "The owner has no properly house-training the dog as a puppy." This frankness was not good bedside manners.

"Well, I did," she said. "She would hold her urine and then let go a lot." She spread her arms wide. "Is it common for dogs to pass a vast amount of urine every day"

"A dog would pass a lot of urine in the morning for one time," I said. "But not several times. Your dog has been withholding the urine until she can't stand it anymore. You must be beating her up when she had peed all over the apartment when she was younger," I said. "Holding urine leads to bladder infection and the smelly urine that the various vets you consulted before could not cure. Your dog is not fully cured yet. It is only one month.

"You need 3 months of S/D diet to know whether she will be free of urinary tract infection as the S/D diet acidifies the urine and prevents bacteria forming struvite sand in the bladder, leading to bad smelly urine. No other food, dog treats or any other pills."

"My dog loves apples," she said. "Can I give her apples? She looks at me appealingly for apples when I eat one."

"It is best not to," I said. "You had suffered over 2 years of this problem of smelly urine after antibiotics after seeing a vet. Now, her urine is not smelly without antibiotics. Why take risks? Let her urinary tract system stabilise over 3 months of eating S/D diet and drinking plain water. Then you may give her apples."

As regards whether the Corgi was harshly disciplined when she was younger, the lady in red said: "Yes, she got spanked when she peed everywhere." the lady said. "This may be why she withholds her urine till the last moment and urinated a very large puddle of urine onto the floor. What do you suggest I do now?"

At first I advised confinement and removing the urine smell in the floor apartments using white vinegar + water at 1 part to 3 parts water.

As she was moving to a new apartment away from Woodlands soon, I advised: "Complete confinement for 24 hours in a room, with a baby gate, for 4-6 weeks. Newspapers with her urine smell on one side and bed on the other. Confinement is the key to success. Let the dog out when you are at home and pick her up when she is about to pee on the floor and put her into the confined area. Say in a firm tone 'Pee here.' Give a treat if she does that or a praise. Persevere. Old dogs can learn new tricks too especially when you start from a new house."

This case of recurrent UTI seems to be successful but urine monitoring per month should be done. I gave her a urine collection bottle and asked her to know volume of water drank per 24 hours. I hope the new apartment will be free of dog urine smells as friends can smell it but owners who live there will not smell it as their noses are used to it.

Will wait and see. The "living happily ever after" story has not concluded but it seems that there is a good clinical outcome of my recommendations and that is what the lady in red wanted and what all owners whose pets have long suffering diseases demanded. 

UPDATE IN DEC 31, 2017
I have not seen Oreo since writing this Dec 2011 case study. I presume the lady had gone to a nearby vet to purchase the Hill's urinary diet S/D or C/D. It is very common for Singapore owners not to provide feedback or return to the vet if the urinary tract infection is resolved.  








PREVIOUS REPORT
Written in Oct 31, 2011 (>1 month ago), Recurrent UTI in an old Corgi is at:
http://www.sinpets.com/dogs/20111044blood-urine-recurs-over10times-old-corgi-female-toapayohvets.htm

The blog has brief version:
http://2010vets.blogspot.com/2011/10/717-recurrent-uti-in-old-corgi-is-hard.html


THE WEBSITE FOR THIS FOLLOW UP REPORT WRITTEN DEC 10, 2011 IS AT:
http://www.sinpets.com/F6/20111210recurrent-urinary-tract-infection-old-female-spayed-corgi-singapore-toapayohvets.htm