Friday, August 20, 2010


This evening's walk was rather interesting. First we were in a big field. I found a stick that the human promptly conscripted into use as a training tool. I was on a 12 foot long leash and he'd ask me to sit and stay. He was so mean. He dangled the stick at me. He threw the stick off into the distance. He walked in a 12 foot circle around me. The whole time he expected me to sit in once place. Talk about difficult! I wanted that stick. The human was using the Premack principle again: if one wants to perform a given activity play with the stick) one will perform a less desirable activity (sit/stay) in order to get at the more desirable activity.

While we were doing this an older couple came up and talked to Jason. They whispered in his ear that there is a neighbor nearby that doesn't like dogs off leashes (he somehow must have missed the 12 foot leash) and that the neighbor takes pictures of dogs without leashes and their humans and turns it into the police.

That's not very nice. I wonder how we might use the Premack principle on that neighbor?

After some time spent doing that, we practiced some loose leash walking in preparation of my upcoming evaluation to be a therapy dog for the Delta Society. As an added bonus, we got to practice walking on a loose leash past other dogs. In my therapy dog test I'll have to pass by a "neutral" dog. We'll assume that dog isn't going to lunge at us or otherwise try to engage with us. While we were out on the road we got chased after a shar-pei that had escaped from his house and then two pit bulls who were very eager to play with me. How'd the human keep me focused on loose leash walking?

The Premack principle of course. That stick, with all it's magical powers, immediately appeared in front of my nose. The human said "watch me" and I did--and watched the stick, and watched him, and watched the stick some more.... It also helped that after a couple of the "watch me" commands little tasty bites of food appeared right in front of my nose too.

So let's break this down: the human used rewards (the food) when I kept my attention focused on him and not the other dogs. He also layered on top of that the Premack principle: playing with the stick is a super desirable reward for me. I'm willing to forego playing with other dogs (sometimes) if there is the promise of some sticks in my near future.

Here is a clip from a couple of days ago. We were at a local tennis court practicing down/stay. Rather than using a stick we used my favorite rope toy. By the time the human took the video I was already exhausted so I had to debate awhile whether staying down was more enjoyable than running for the rope.

Try out the Premack principle with your dog. You'll be surprised at how quickly you'll see things change.

Saturday, August 14, 2010

These Pesky Stones

So the human had a consultation with Rebecca Remillard Ph.D., DVM at Angell Medical Center. I'm glad he did: surgery is postponed. Here is the basic information: it's useful for any of you out there you might be coping with bladder stones.

Way back when this all started, the vet tried to get a urine sample but wasn't able to. Because I had all the signs of a UTI, I was put on an antibiotic. This was the first error. Had a urine sample been taken and cultured we might have already solved my problem. Dr. Remillard shared that if a culture of my urine grew staph, it would have been indicative of struvite stones. This could likely be solved through a nutritional intervention. An alternative culprit could be urate stones. These can be solve through nutritional interventions as well. Lastly, the initial diagnosis of calcium oxalate stones might still be correct. These cannot be solved through nutritional interventions.

Or, can calcium oxalate stones be remedied through diet?

In the May 2010 edition of the Whole Dog Journal featured an article on the diagnosis, treatment, and prevention of calcium oxalate kidney and bladder stones. It reviewed some anecdotal evidence that these types of stones can indeed be successfully treated by nutritional interventions. The diet focus on increasing water consumption, raising urinary pH a bit, feeding a diet low in oxalates, and various vitamin supplements.

Here are two highlights that were particularly interesting in the article:

  • Standard treatment from many vets for stones of all sorts are prescription diets that among other things, restrict protein, calcium, and phosphorus. The article mentioned research published in 2002 by the American Journal of Veterinary Research. It showed that canned food diets low in protein, calcium and phosphorus and have the highest amount of carbohydrates were associated with an increased risk of calcium oxalate crystals. Whoops. No prescription diets for me!
  • The American Journal of Clinical Nutrition and The Journal of the American College of Nutrition, among others, have published research four more than 40 years demonstrating that patients with long-standing, recurrent calcium oxalate kidney stones receiving supplements including magnesium oxide with or without vitamin B6 for five or more years demonstrate stone formation falling by more than 90 percent.
After consulting with my vet, we've decided on a different treatment plan that doesn't involve surgery right now. I'm finishing up my course of treatment with Baytril. After that, we are going to carefully watch any symptoms that develop. The small risk is that I'll get an obstruction which would be a medical emergency. Assuming that doesn't happen, 14 days after I stop the antibiotic I'll have a urinalysis to see where I am. Assuming that doesn't show anything significant we'll repeat the urinalysis again 30 days after I completed the course of antibiotics. If that shows signs of staph, I'll have my diet altered to treat struvite crystals. If there is no staph, we'll re-evaluate and go for plan B. Not sure what plan B is yet.

Okay, that's not exactly true. The human took the cats to the Cat Doctor of Bedford and Nashua this past Friday. Dr. Carlson was informative as always. He suggested that I talk to my vet about having a cystoscopy. They would use a special instrument to peek inside my bladder, see what is there, and remove a stone for analysis. Something worth discussing!

Sunday, August 8, 2010

Calcium Oxalate. Say what?

For those of you who are regular visitors on my Facebook fan page, you know that I've been plagued by ongoing urinary tract problems for the better part of the last month. It's not been pretty. I used to love going to the vet--I walked in fearlessly and enjoyed all the attention. Now I'm digging my paws into the ground when I am outside the front door of the vet's office and once inside, I stand by the door with my nose against the doorjamb hoping that I can somehow escape.

I've had urinalysis done twice, two ultra sounds, x-rays, and blood work. Though it's not definitive, it is looking like I might have calcium oxalate stones in my bladder. These little stones roll around inside irritating the tender lining of my bladder and, well, it's uncomfortable.

The human first noticed all these problems four weeks ago. Almost overnight, I started needing to stop and pee five or more times on an hour walk. This is very unlike me--I usually once going once or twice. The vet first diagnosed it as a UTI. I tried a course of amoxicillin. That didn't do much. I was then put on Rimadyl as I finished the course of antibiotics. Little did I know there were a whole host of side effects with Rimadyl. Let's just say while I wasn't peeing a lot because of the stones, I was going outside a whole lot to do some other stuff. I promptly went off the Rimadyl and we got a second opinion from another vet.

A urinalysis, by the way, did not indicate that there were any bacteria. There also weren't any evidence of stones, either. My pH was a bit off, and there was blood in my urine. Both are problems. An ultra sound suggested that there might be stones in my bladder.

My second doctor (whom I'm very fond of, are you reading this Dr. A?) at Linwood Animal Hospital tried me on a second course of antibiotics. This time I tried Baytril. After a week there wasn't a significant change. The human had me pee into a cup (this must have been fun to watch) and I was back into the vet. Much to my horror I spent the morning at the vet. They shaved my belly and did x-rays and an ultra sound. The x-rays showed the outline of stones and the ultra sound confirmed it. The urinalysis shows no bacteria and traces of calcium oxalate.

This however is unclear: the human consulted Dr. Google and found clear evidence that when urine samples are refrigerated or more than 30 minutes old tend to precipitate calcium oxalate regardless of the presence of stones. The human tells his patients that Dr. Google is no substitute for the advice of an actual living doctor. The human needs to remember his own advice.

Dr. A's best recommendation is to have bladder surgery. They will open up my bladder, clean out all the stones, send them out for analysis, and close me back up. This however doesn't sound very pleasant. The human is investigating plan B.

The human is having a nutritional consult with Dr. Rebecca Remillard at MSPCA Angell. That might turn up a few options. We're also having a consult with Dr. Dan Cirnigliaro who is a local vet with a holistic outlook. That might turn some other stuff up too.

The human tried to see if there were less invasive options available to treat the stones (there certainly a whole host of possibilities in humans!). This was a disappointing adventure. Being wary of rising medical costs, the human was willing to pay for a consult as long as he knew there were other options potentially available. Despite being willing to pay for a telephone consultation to find out specifically if there were other options available for treating bladder stones, both Foster Hospital for Small Animals at Tufts Veterinary school and MSPCA Angell both declined to answer the question or put the human in touch with someone who could answer the question. The only way to find out about less invasive options is to schedule an appointment (at a rather significant expense) and travel to both hospitals. Great if there are other options. Not so great if the answer is the only treatment is surgery.

Of course, no one can suggest treatment just from a brief phone call--that makes sense. Every dog is different and every situation is unique. It just seems that a simple question (are there a variety of interventions available) deserves a simple answer.

Our friendly dog coach Maureen Ross provided a couple recent editions of The Whole Dog Journal. There was an excellent article in the May 2010 edition called "Stoned Again: Diagnosing, treating, and preventing calcium oxalate stones in dogs." The article reviewed some of the latest research and in particular, talked about the work done by Leslie Bean in bringing together some of the latest information about calcium oxalate stones in dogs. The article has given some hope that there are specific dietary interventions that can prevent the reoccurrence of the stones (which are pesky, and tend to come back within three years). The article also gave a bit of hope that it's possible for dietary intervention to resolve the problem without surgery.

Much more research is needed. For the time being I'm scheduled for surgery at the end of the month. The human is going to keep asking questions until he hears answers that he likes. If he doesn't hear answers that he likes--well that means something. It means that surgery is the best option.

Wednesday, August 4, 2010