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.

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