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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 24467
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My name is***** am a proud mommy of a 2 year old Yorkshire

Customer Question

Hi my name is***** am a proud mommy of a 2 year old Yorkshire terrier named Peanut, he has had a reoccurring condition that has been happening for the last year. His symptoms include blood in his urine and we have had X-rays urinalysis and culture done but the only thing that has turned up in his test results are translucent crystals. His vet has put him on zeniquin 25mg half tablet once a day and clavaseptin 50 mg twice a day. He has been sleeping a lot. Could these medications or combination of medications have this effect on peanut
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.
Aloha! You're speaking to Dr. Michael Salkin
I'm sorry that your question wasn't answered in a timely manner. Those antibiotics can cause GI distress - inappetence, vomiting and/or diarrhea - and the combination of the two might be particularly distressing for Peanut; hence, his malaise. Can you tell me, please if Peanut intact? His recurrent hematuria yet negative urinalysis and culture suggests prostatitis in the intact male.
Customer: replied 1 year ago.
His vet thought that the blood in the urine could be related to peanut not being neutered so we had him neutered at the age of 1. This has continued on and off for the last year. Do you think it might be related to his diet.
Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for the additional information. No, I don't believe his diet should be incriminated. I would proceed to ultrasound his entire urinary tract including his prostate gland looking for the source of that bleeding. Has this been discussed with you? Bleeding dyscrasias (disorders) such as hemophilia and thrombocytopenia (low blood platelets) need to be considered as well. A complete blood count (CBC) including a platelet count is the initial blood test of choice. Specialized testing for hemophilia and other blood factor deficiencies is available.
Customer: replied 1 year ago.
We are booking an ultrasound for this week, I will mention to his vet about the specific blood work that you have suggested. Have you had any experience with a similar case of this sort? And if yes what was the outcome? Is this something that occurs in his breed?
Expert:  Dr. Michael Salkin replied 1 year ago.
It can be a challenge to track down the cause of such intermittent hematuria. In too many cases we have to settle for a diagnosis of idiopathic (unknown cause) hematuria because we can't find the source for it. Specialty hospitals (please see here for a specialist veterinary internist: www.acvim.org) now have the ability to thread thin scopes/cameras up into the urinary tract of our pets and have been able to find sources of bleeding heretofore impossible to detect. No, I'm not aware of such bleeding associated with Yorkies.
Customer: replied 1 year ago.
Can peanut live a normal life with this ongoing problem?
Expert:  Dr. Michael Salkin replied 1 year ago.
Yes, most do but, of course, this would be predicated upon what's ultimately found as the etiology of his hematuria.
Customer: replied 1 year ago.
Thank you for your time and suggestions. Have a good night.
Expert:  Dr. Michael Salkin replied 1 year ago.
You're quite welcome. I can't set a follow-up in this venue and so would appreciate your returning to our conversation with an update - even after rating - at a time of your choosing.
Customer: replied 1 year ago.
I will. Thanks again.
Expert:  Dr. Michael Salkin replied 1 year ago.
I appreciate it!
Customer: replied 1 year ago.
Dr.michael, in your opinion what would be the best medication for peanut to be on? Since he has only been diagnosed with crystals in his bladder. I searched the medications he has been given and one is apparently for gingivitis.
Expert:  Dr. Michael Salkin replied 1 year ago.
Crystalluria - crystals in the urine - are normally found in dogs. They shouldn't be incriminated in diseases unless they're unusual types of crystals or there is a concomitant urinary tract disorder that explains why there's an excess number of them. I don't see the need for any medications in Peanut at this time. His antibiotics were prescribed in case an infection was present - mainly in the kidney(s) - a pyelonephritis - which at times is unculturable.
Customer: replied 1 year ago.
Peanut had his ultrasound today and the technician found a stone in his bladder he did mention that he could not see a shunt and that peanut had a very small liver. He will need surgery to remove the stone in his bladder because the stone is large. He did suggest a special blood work to see if he in fact has a shunt. Could dogs lead a normal life with out a proper liver shunt?
Expert:  Dr. Michael Salkin replied 1 year ago.
Well...that's certainly a simpler finding than all of the other etiologies we spoke about. A blood test called serum bile acids should be performed. It's quite sensitive for detecting the probability of a shunt. Dogs with shunts tend to progressively worsen and have limited life spans. Shunts aren't always visible with ultrasound imaging and, in fact, microvascular dysplasia - abnormal vasculature within the liver - may be the only vascular abnormality present and that's diagnosed by biopsying the liver rather than ultrasound. When inside his abdomen to remove the stone, the liver and surrounding blood vessels should be examined for a shunt.
Customer: replied 1 year ago.
How complicated is the surgery to remove the bladder stone? I'm feeling anxious for my little peanut.
Expert:  Dr. Michael Salkin replied 1 year ago.
It's one of the simpler and quickest abdominal surgeries but I want a knowledgeable vet to spend time examining the liver and perhaps take a biopsy of it and examine the surrounding vasculature if the serum bile acid blood test is abnormal. If that blood test is normal, his liver is functioning well and so biopsying and checking for a shunt isn't necessary.
Customer: replied 1 year ago.
Thank you
Expert:  Dr. Michael Salkin replied 1 year ago.
You're quite welcome. Keep me posted, please. No need to reply at this time.
Customer: replied 1 year ago.
Dr.Michael, Peanut had his blood work for the bile acids yesterday and we got the results today. His( pre )results was 405 and his ( post ) was 310. His ALP was 183. From my understanding the surgery is complicated and expensive, but my main concern is Peanuts well being. Do you think with liver support medications and a strict diet we can have Peanut healthy again? We are uncertain about the shunt surgery and to be honest we can't really afford it. I forgot to mention that his platelets are also low.
Expert:  Dr. Michael Salkin replied 1 year ago.
Oh my goodness...It's important for you to know that survival statistics for medically managed minimally symptomatic or asymptomatic dogs are no different than dogs undergoing surgical shunt attenuation. However, unligated medically managed dogs have more dramatic responses to small health issues. Please consult with Peanut's vet to have a medical treatment plan drawn up. It will mainly include dietary considerations although medications that increase GI protein tolerance are also likely to be prescribed. A low platelet count needs to be confirmed by hand counting the platelets. Machine counts are often falsely low.
Customer: replied 1 year ago.
Dr. Michael, we have been told that regardless of Peanut having low platelets and a shunt problem he will need to get the stone in his bladder removed, and that the surgery is "inevitable" Is there another way to release the stone from his bladder besides surgery? I know that him humans laser can break up the stones so it can pass through the urinary tract. Is that option available for dogs? We are concerned about the risk of anesthesia and the chance of excessive bleeding because of his low platelets.
Expert:  Dr. Michael Salkin replied 1 year ago.
If the stone is made of struvite, it can be dissolved with a special diet. Unfortunately, struvite uroliths aren't likely in Yorkies and aren't the majority of stones anymore overall. Although the correlation of the type of crystals and type of stone isn't perfect, it would be helpful to know which type of crystal has been seen in his urine. Lithotripsy - shock wave therapy - isn't readily available and risks urethral obstruction by fragments of the stone.
Customer: replied 1 year ago.
Dr. Michael, in your opinion will the bladder stone removal surgery be dangerous for Peanut, because of the low platelets, anesthesia or shunt problem?
Expert:  Dr. Michael Salkin replied 1 year ago.
Peanut will need to be carefully monitored during surgery. A pulse oximeter which measures his oxygen and carbon dioxide saturation, a blood pressure monitor, and an EKG should be in place prior to, during, and following surgery. Progressive practices will monitor in this manner which minimizes the risk to patients. An anesthetic that doesn't need to be metabolized by the liver should be chosen. If a hand count of his platelets confirms severe thrombocytopenia (low blood platelets), either prednisone or vincristine should be considered in an attempt to raise the level prior to surgery. Alternatively, a blood transfusion can be performed just prior to surgery.
Customer: replied 1 year ago.
Dr. Michael, Peanut had his surgery today and it seemed to go okay, however minutes before we were scheduled to pick him up his heart rate elevated and his breathing became fast. We rushed him to a 24 emergency clinic where he is staying. His heart rate has decreased to 60 beats at this time. We are hopeful that he will recover. Do you have any suggestions for a recovery? The vet on call has warned us of possibilities of seizure and heart failure. She said because of his liver problems there could be a chance of him going into a coma. Could you give us your opinion on what should be done?
Expert:  Dr. Michael Salkin replied 1 year ago.
I have to defer to the ER vets who know Peanut's current condition much better than I. They're aware of his pre-exiting conditions. I'll think good thoughts for Peanut. I have to leave my computer early tonight but I promise to reply in the morning if need be. I'll watch for your update as well.