Overdue update on my health

Have you ever noticed when there is a problem in life, every bit of your attention goes to that problem? Have you also noticed as soon as the problem goes away you forget about all that attention? I sure do. This past summer I was plagued with bladder problems. If you didn't know me back then you can read about my travails here and here.

The human took me to five different vets. Five! I was poked, prodded, tested, and forced to do very unpleasant things. I was finally diagnosed with having calcium oxalate stones--a condition that isn't treatable, persistent, and required bladder surgery. Even if I was to have surgery to remove the stones, I was told I would have to be on a bland (unhealthy!) prescription diet for the rest of my life and I would STILL be likely to get the stones again.

The human fired the first three vets--he felt like they were treating him like he was ignorant. One made me have a painful procedure without proper sedation. He fired the fourth vet because despite his vocal statements about not willing to put me on a prescription diet (do you know the main source of animal protein in most prescription foods are things like chicken feathers? Did you know that prescription diets are associated with their own set of health problems?) the vet continued to suggest I go on a prescription diet. That vet also refused to give me proper sedation despite my obvious and extreme display of fear during a procedure.

I was beginning to worry about my human. In rapid succession he fired everyone that met me. I was worried that he was the problem. As it turns out, he wasn't. He finally brought me to a doctor that understood my problem and was able to solve my problem. He also saved me from having surgery that would have cost over $1,800 and had the risk of life-long incontinence. I don't even know for sure at this point if I actually had the condition that I was supposed to get surgery for.

Anyway--that catches you all up to date. I don't think I told you all that I was better. I am. I am much better. The human took me to Dr. Dan's Integrative Pet Hospital. After carefully listening to my human's concerns, after gently examining me, and after some reflection together, Dr. Dan essentially said this is no big deal. He prescribed me a supplement called UT Strength STAT for dogs. This is the same company that makes the wonderful non-toxic non-scary flea and tick be-gone product that also changed my life (thanks Dr. Dan!).

I've not had a single problem with my bladder since then. With one product I went from having a life-long condition that would likely require multiple expensive operations to having no condition (I don't even use the supplement anymore). I thought you might all want to know, since I certainly complained enough about the problem when I was having it.

If any of you reading this have a similar problem, don't run out and order the UT Strength. You need to consult a vet that you trust: what worked for me might not work for you. What is important here, and what is the moral of this story, is take the time to find a vet you trust. Take the time to find a vet that is knowledgeable. If you believe in a holistic approach, by all means take the time to find a vet that is well trained in holistic medicine. Having a vet that speaks your language is what is important here.

In fact, you can ask my cat-brothers that very same question. They were lucky because the human already had a vet that specialized in cats (in fact, he only sees cats). Dr. Carlson at the Cat Doctor was the one initially responsible for getting the human so strident and uppity about pet food. After having two cats die from fatty liver disease the human finally found Dr. Carlson--and heard him say something along the lines of we've been killing cats for years with prescription diets and dry foods that cause problems rather than help prevent them.

My cat brothers, you see, were also having bladder problems. This was before I was born. The way the cats explain it they discovered painful (yet oddly pretty) crystals in their pee. The human stuffed the cats in a box, drove them all the way to New Hampshire, and upon exiting the box they saw Dr. Carlson. After an hour long lecture about how horrible many cat foods are, and being taught the evils of a dry food only diet, and learning a whole lot of other useful stuff... Anyway, the cats say Dr. Carlson said "wet food only" and "mix it with broth until it's like a beef slurpee." The cats have never had crystals again. Never.

Easy as that.

So--go find yourself a good vet. And as for Dr. Carlson and Dr. Dan--I know you both read this blog sometimes--thank you for being smart and thoughtful.

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!

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.

I'm a Super Listener

So I demonstrated to Jason this morning what a super listener I am. He fed me rather late this morning: he was busy blogging and tweeting. There is a routine and I stick to it. First Jason feeds the cats. They are a little complicated to feed. He opens up their canned food, mixes it with chicken broth, and then sings the "It's time to feed the kitties" song. Spot eats on the kitchen table. Iggy eats in the bathroom with the door closed. After many experiments, this is what works best. No one argues, no one steals food that doesn't belong to them, and peace and harmony is generally maintained.

Then I get fed. Part of the routine is that Jason puts my food bowl down and says "leave it." I wait patiently until he says "okay, take it." I usually have to wait anywhere between one and 15 seconds. Well, Jason got distracted this morning. He put my food bowl down and left. I sat waiting for ten minutes. He finally walked by and saw me looking at him with very sad Basset Hound eyes. Jason said "okay, good girl, take it!" I finally got to eat.

Aren't I a good girl?

Making me wait this long bordered on cruel and unusual. Don't be this extreme at home. However, the basic principle is a great idea. Food time is an ideal time for some basic training. I'm motivated--I want my dinner! Anything that happens in the few moments before a meal is a powerful training opportunity and shouldn't be wasted. Doing simple things like always asking me to sit before I eat, or teaching me to "leave it" before I get to eat, lays a foundation for some wonderful skills that can be replicated at times away from the food bowl.

Try it. Just don't walk away and make your puppy wait ten minutes. That's just mean.