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Dr. Laura Devlin, DVM, DABVP
Dr. Laura Devlin, DVM, DABVP, Small Animal Veterinarian
Category: Dog
Satisfied Customers: 1752
Experience:  DABVP, Specialist in Canine and Feline Medicine, Veterinarian since 2000
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I have spent hundreds on Buddy a 7 year old mini dach with

Resolved Question:

I have spent hundreds on Buddy a 7 year old mini dach with zero results. Buddy was first seen about 2 months ago for blood in his urine and a test for uti was done without a culture. It came back negative for uti but positive for the blood, ph of 5.5 he was placed on amoxicillin for 2 weeks, I then subsequently did a complex xray and ultrasound which yielded normal results with a slight change in the kidneys but no ascertainable reason. Following all of that a urine test was done with a culture and this time found infection - he was treated for a week with Batril and still has symptoms ( I have not had him retested but from his marking I know he still has the same issues). I also have tested his urine white blood cells with an human urine strip as I have done before and it shows positive. The vet has recommended Royal Canin for uti's but that doesn't appear especially nutritious and is extremely costly. It is past 2 weeks since he finished his Baytril. The vet wants him to get another voided culture. From the literature it looks like voided is not very accurate. Before I spend hundreds more on a non productive course for him I thought I would seek any advice you might have. Here are some of the comments regarding my questions from the vet: Buddy's urine concentration was normal both assays, cant tell more about the kidney condition without a biopsy which I do not recommend, creatnine and bun was normal in january Sounds like we need a case summary to date: We have diagnosed Buddy with nephritis and discussed how the changes in the kidney can be a source of recurrent infection. We performed one urine culture which was positive, so we put buddy on a course of antibiotics and recommended retesting the urine w/culture 3-5 days after the antibiotics were complete to see if they sucessfully treated the infection. We discussed that we may need to put him on urinary s/o diet and possibly do pulse antibiotics every 6-8 weeks. We have ruled out stones and tumors in the bladder and the prostate as of February 2013. So the next step is the urine culture and urinalysis recheck. I think this is very helpful in determing how susceptible the infection is to the prescribed antibiotics. And at this point, if you haven't already, I do think a prescription diet like Royal Canin Urinary S/o is indicated. I was going to wait and see if the culture-targeted antibiotics fixed the problem before having you switch diets but if you cannot do the recheck and he is still having symptoms, I would definately switch him to this diet. __________________________________________________________________ Is there a way for me to upload the result of his tests?


 


Also he is neutered.  I wonder if you had success adding d-mannose to a uti pup's diet?


 


Also just got this clarification from the vet:


"both urinalysis, ph values, crystal counts, etc and all are normal"


 

Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Laura Devlin, DVM, DABVP replied 1 year ago.
I am Dr. Devlin and I am a Board Certified Specialist in Canine and Feline Practice.

Thank you for your question about Bud and for the comprehensive information you have provided about his case. That's very helpful as I try to work through the particulars of his condition.

I'm very sorry Bud has this medical issue and from your description, it sounds as though he is still having symptoms.

Your veterinarian appears to be on the right track with treatment thus far. In dachsunds, urinary tract stones are a frequent cause of recurring symptoms, so an ultrasound and x-rays are recommended for recurring cases or cases that did not respond well to treatment.

I have a few questions about his case:

I'm unclear on the diagnosis of nephritis - how was this diagnosed? with a normal lab panel for the blood work it seems unclear. Based on the ultrasound results?

After the culture was positive, I am a little unclear about the history. Was he only treated with a week of baytril? do you have the culture results as far as what antibiotics the bacteria was susceptible to?

Is Bud neutered?

It is correct for recurring infections to treat for 6-8 weeks ( I know this might sound excessive) and then to follow up with a culture 5-7 days after the antibiotics are done to see if the treatment cleared the infection.

If you can let me know the additional information it would be helpful. You can copy and paste the test results in if your vet can email them? There is no quick and easy way to upload a document, unfortunately.

I'll be offline for about 1.5 hours starting in about 10 minutes but then will be back online.
I'll try my best to help you and Bud.
Laura Devlin

Customer: replied 1 year ago.

Hi Dr. Devlin,


 


Yes the Budster is neutered. He is adorable too!


The order of treatment was:


1. After my seeing blood in his urine, an ordinary urine test done at vet. It came back neg for uti but positive for blood. On Amoxicillin for two weeks.


2. Comprehensive xray done showing normal results.


3. Comprehensive ultrasound showing normal results with slight kidney changes.


4. Urine culture showing uti - prescribed Baytril for one week.


5. Still marking and home urine test showing white blood cells9 human test so not sure how accurate)


 


I would love to email you the reports so you could make an easier more accurate assessment if possible. I cannot post them here as they are not formatting correctly at all. Can you send me your email please?


 


I'm really not sure about putting him on Royal Canin either.


 

Expert:  Dr. Laura Devlin, DVM, DABVP replied 1 year ago.
Oh, I bet he is adorable! He sounds like a special little one.

The lab work would be helpful. Unfortunately we are not allowed to give out our email addresses and the JA site will block out any email or phone numbers. :(

Could you post any abnormal results? That might be helpful.

I'm not sure about the royal canin at this point - that doesn't sound like it will address the primary problem since no stones were noted. The leukocyte (white cells) doesn't read accurately in dogs and cats and we ignore that value on both human and pet urine dipsticks.

The best course, although expensive, would be to have a urine culture repeated. You are correct, this does need to be obtained on a sterile sample, preferable obtained with an ultrasound. Can your vet do this? I'd be a little concerned if they can not, and there is too much risk of contamination to culture from a free catch sample.

Thanks and I'll wait to hear back from you. I'll be back after 3:30 EST.
Laura
Customer: replied 1 year ago.

I agree re the Royal Canin from what I researched for the same reasons, but would like to know what alternate diet to put him on if any - he is currently on Merrick Whole Earth Farms Senior dry which is excellent food. But maybe has too much protein?

 

Bud just had an ultrasound and it was normal.

 

Yes the vet does want to repeat the culture and this is what she proposed just now (and all of which is expensive so want to make sure before I take these steps) and it sounds like she wants to do voided sample again:

 

"

all urinary collection methods have pros/cons. we often get urine via cystocentesis for urinary cultures, occasionally via a sterile urinary catheter. We use free catch to better evaluate whether or not blood in the urine is a real finding, as cystocentesis or urinary catheter passage can contaminate urine w/blood.
buddy has good renal function, w/recurrent blood in the urine and possibly infection (we need the recheck to know) ; and the portion of the urinary tract we can examine did not indicate tumors in the kidneys or bladder, and no stones in the blader, possibly small stones in the kidneys or scar tissue.
the next step is to repeat the u/a and culture asap. I can also refer you to a specialist if you like. I doubt anything you are able to read on the internet will impart enough understanding of his relatively minor condition to be helpful. I understand the need to research things that are confusing, believe me I do the same thing but we can get even more confused trying to understand the spattering of info on the internet. Instead of doing a tech apt, why don't you schedule a recheck exam and see if we can answer any further questions you may have?"

 

Thank you Dr, Devlin!!

 

 

Customer: replied 1 year ago.

I am going to copy and paste the test but please note they may not format correctly.


Patient Info: Hospital: Lab:
Name: Buddy Species: Canine Reported: 01/19/13 08:01
Antech ID: 120419 Received: 01/19/13

Accession No.
ATAA23256895
Pet Name
Buddy
Test Results Adult Reference Range L Normal H
Chemistry Panel
Total Protein 6.1 5.0-7.4 g/dL
Albumin 3.2 2.7-4.4 g/dL
Globulin 2.9 1.6-3.6 g/dL
A/G Ratio 1.1 0.8-2.0 Ratio
AST (SGOT) 22 15-66 U/L
ALT (SGPT) 26 12-118 U/L
Alk Phosphatase 68 5-131 U/L
GGTP <5 1-12 U/L
Total Bilirubin 0.1 0.1-0.3 mg/dL
Direct Bilirubin 0.0 0.0-0.3 mg/dL
Indirect Bilirubin 0.1 0-0.2 mg/dL
Urea Nitrogen 13 6-31 mg/dL
Creatinine 0.7 0.5-1.6 mg/dL
BUN/Creatinine Ratio 19 4-27 Ratio
Phosphorus 3.3 2.5-6.0 mg/dL
Glucose 87 70-138 mg/dL
Calcium 9.5 8.9-11.4 mg/dL
Sodium 149 139-154 mEq/L
Potassium 4.5 3.6-5.5 mEq/L
Na/K Ratio 33
Chloride 114 102-120 mEq/L
Bicarbonate 18 15-25 mEq/L
Anion Gap 22 8-25 mEq/L
Calculated Osmolality 295 277-311 mOsm/L
Cholesterol 197 92-324 mg/dL
Triglycerides 45 29-291 mg/dL
Amylase(NNN) NNN-NNNNU/L
Lipase 158 77-695 U/L
Page 1 of 3


Accession No.
ATAA23256895
Pet Name
Buddy
Test Results Adult Reference Range L Normal H
CPK 91 59-895 U/L
Comment
Accession No.
ATAA23256895
Pet Name
Buddy
Test Results Adult Reference Range L Normal H
CPK 91 59-895 U/L
Comment
Hemolysis 1+ No significant interference.

Magnesium
Magnesium 1.7 1.5-2.5 mEq/L
Complete Blood Count
WBC 11.0 4.0-15.5 103/µL
RBC 8.07 4.8-9.3 106/µL
Hemoglobin 17.4 12.1-20.3 g/dL
Hematocrit 52.6 36-60 %
MCV 65 58-79 fL
MCH 21.6 19-28 pg
MCHC 33.1 30-38 g/dL
Platelet Count 342 170-400 103/µL
Platelet EST Adequate Adequate
Neutrophils 8250 75 2060-10600 /uL
Bands 0 0 0-300 /uL
Lymphocytes 1870 17(NNN) NNN-NNNN/uL
Monocytes 660 6 0-840 /uL
Eosinophils 220 2 0-1200 /uL
Basophils 0 0 0-150 /uL
Heartworm Antigen ELISA
Occult Heartworm Antigen
Negative
There were no measurable amounts of adult female heartworm antigen in this sample. Adult Dirofilaria immitis antigens will not
be detected for 5 to 7 months following exposure to early larval stages.
T4
T4 1.9 0.8-3.5 ug/dL
Note new Canine reference range
Urinalysis
Collection Method
Differential Absolute %
Not stated

Color Yellow
Appearance Cloudy *Clear
Specific Gravity 1.020 1.015-1.050
Page 2 of 3


Accession No.
ATAA23256895

Pet Name
Buddy
Test Results Adult Reference Range L Normal H
pH 5.5 5.5-7.0
Protein Negative Neg
Glucose Negative Neg
Ketone Negative Neg
Bilirubin Negative Neg To 1+
Blood 2+ Neg HIGH
WBC 0-1 0-3 HPF
RBC 11-20 0-3 HPF HIGH
Casts None Seen LPF
Ca Oxalate Dihydrate
Crystals
0-1 HPF
Bacteria None Seen None HPF
Squamous Epithelia 0-1 0-3 HPF
Accession No.
ATAA23256895

Pet Name
Buddy
Test Results Adult Reference Range L Normal H
pH 5.5 5.5-7.0
Protein Negative Neg
Glucose Negative Neg
Ketone Negative Neg
Bilirubin Negative Neg To 1+
Blood 2+ Neg HIGH
WBC 0-1 0-3 HPF
RBC 11-20 0-3 HPF HIGH
Casts None Seen LPF
Ca Oxalate Dihydrate
Crystals
0-1 HPF
Bacteria None Seen None HPF
Squamous Epithelia 0-1 0-3 HPF
Page 3 of
Page 3 ofPage 3 of 3
33
__________________________________________________


Patient Info: Hospital: Lab:
Name: Buddy Species: Canine ANTECH Diagnostics
Chart No:23999 Breed: Dachshund Reported: 02/08/13 03:51
Antech ID: 120419 Received: 02/08/13

Accession No.
ATAA23506085
Doctor
Pet Name
Buddy
Test Results Adult Reference Range L Normal H
Urinalysis
Collection Method
Natural Voiding

Color Yellow
Appearance Clear *Clear
Specific Gravity 1.017 1.015-1.050
pH 5.5 5.5-7.0
Protein Negative Neg
Glucose Negative Neg
Ketone Negative Neg
Bilirubin Negative Neg To 1+
Blood 1+ Neg HIGH
Result verified.

WBC 0-1 0-3 HPF
RBC 4-10 0-3 HPF HIGH
Casts None Seen LPF
Ca Oxalate Dihydrate
Crystals
0-1 HPF
Bacteria None Seen None HPF
Epithelial Cells None Seen HPF
Page 1 of
Page 1 ofPage 1 of 1
11


_________________________________________________


Buddy (23999)
Canine Dachshund 7 Yrs. 4 Mos. Neutered Male 12.2 pounds (1/18/2013)
Weight: 12.2 pounds (1/18/2013) Temperature:

Subjective: ph for abd scan. wants urine culture if normal abd scan. p is doing better at home. ec

Objective: bar,

abd scan: bladder thin walled and filled w/anechoic fluid as is wnl, urethra may be slt. distended and
uniform appearing prostate gland is noted measuring 1.4cm x 0.8cm. Both kidneys exhibit mild to mod
changes in echo appearance consisting of decreased renal corticomedullary distinction, hyperechoic
flecks in renal pelvic diverticuli consistent w/fat or fibrous tissue, and acoustic shadowing from the renal
pelvis. Both kidneys are normal in size. Both kidneys have normal function as determined by laboratory
analysis. The spleen is uniform and normal echogenicity, hyperechoic to liver and renal cortex. The liver
and gall bladder appear wnl, the l. adrenal measures looks slt. plump and measures 1.7 x 0.7cm at the
high end of reported normals. The r. adrenal also looks slt plump and measures wnl of 1.1cm x 0.54cm.

urine culture pending

Assessment: recurrent hematuria, no stones or bladder masses evident, need to review normal prostate
sizes in neutered dogs to be sure the prominent prostate in this pet is not abnormal. There are no
cushings specific symptoms so I would make note plump adrenals and pursue if symptoms develop. The
mild/mod changes seen in the kidneys represent a non-specific nephritis and could be the source of the
hematuria noted on u/a. Since kidney function is wnl, no further workup is indicated other then evaluation
of kidney function every 6-12 months. rccd u/a every 6-12 months to monitor hematuria as well. may need
to recheck these findings in 1-3 months to see if static, then recheck annually is suggested

Plan: abd scan, urine culture

Client Education: will send full report within 48-72 hrs

ADDENDUM on 2/27/2013 at 23:58:18
prostate gland is wnl as reported normal size in neutered males ranges from 0.55 to 1.5 cm. jlc

Invoice Items
Status Date Item (ID) Qty Amount
Recommended 2/18/2013 Ultrasound Abdominal Exam <25lb (11936)
Recommended 2/18/2013 Culture & Sensitivity, Aerobic, UGA

_________________________________________________


 


Report Date ATHENS DIAGNOSTIC LABORATORY Page 1 of 2

02/26/2013

COLLEGE OF VETERINARY MEDICINE

UNIVERSITY OF GEORGIA

ATHENS, GA 30602

Species: CANINE
Breed: DACHSHUND


BACTERIOLOGY RESULTS
Aerobic Culture
1 SPECIMEN Urine
AEROBIC CULTURE Enterobacter spp.
COMMENTS This organism possesses an inducible beta lactamase and may become resistant to allthird generation cephalosporins and aztreonam. Monitoring during and after therapy isrecommended. Isolates resistant to third generation cephalosporins or aztreonamgenerally remain susceptible to carbapenems.
2 AEROBIC CULTURE Escherichia coli
3 AEROBIC CULTURE Enterococcus spp.
COMMENTS Enterococcus- Cephalosporins, Aminoglycosides, Clindamycin, Methicillin ( or Oxacillin ) &
Trimethoprim-sulfamethoxazole may appear active "in vitro" but are not effective clinically,
and isolates should not be reported as susceptible. Therefore, these antibiotics are NOT
included in this susceptibility panel which may appear very short.
Combination therapy: Resistance to High-Level Gentamicin indicates that there will be nosynergy between amipicillin, penicillin or vancomycin and any aminoglycoside.
COMMENTS Colony count >100,000 cfu/mL for all isolates
GRAM STAIN Gram negative bacilli, Gram positive bacilli, and Gram positive cocci seen on direct smearof urine
COMMENTS Unable to isolate Gram positive bacilli observed on urine Gram stain
REPORTED BY Sarah Quattlebaum; Lab Tech II
REPORT DATE 02/26/2013

Antibiotic Susceptibility Pattern

1 2 3
AMIKACIN S S
AMOX/ CLAV R S R
AMPICILLIN R I R
CEFOVECIN (3RD GEN) S S
CEFPODOXIME (3RD GEN) S S
CEPHALOTHIN (1ST GEN) R R
DOXYCYCLINE S S R
ENROFLOXACIN S S R
GENTAMICIN S S
GENTAMICIN 120 MCG S
NITROFURANTOIN I S
ORBIFLOXACIN S S R

Accession Number: A13-26128 Final Report


Report Date ATHENS DIAGNOSTIC LABORATORY Page 2 of 2
02/26/2013 COLLEGE OF VETERINARY MEDICINE
UNIVERSITY OF GEORGIA
BACTERIOLOGY RESULTS

1 2 3
PENICILLIN S
TETRACYCLINE S S R
TICARCILLIN S S
TOBRAMYCIN S S
TRIMETHOPRIM/SULFA S S

This is an "in vitro" test that may not reflect clinical outcome.






__________________________________________________


 


Report Date ATHENS DIAGNOSTIC LABORATORY Page 1 of 2

02/26/2013

COLLEGE OF VETERINARY MEDICINE

UNIVERSITY OF GEORGIA

ATHENS, GA 30602
ROSWELL, GA 30076 Received: 02/21/2013 Finalized: 02/26/2013

Species: CANINE
Breed: DACHSHUND

Sex: MALE NEUTER Age: 7Y
Animal ID: BUDDY

Specimen: SEE SPECIMEN ID

BACTERIOLOGY RESULTS
Aerobic Culture
1 SPECIMEN Urine
AEROBIC CULTURE Enterobacter spp.
COMMENTS This organism possesses an inducible beta lactamase and may become resistant to allthird generation cephalosporins and aztreonam. Monitoring during and after therapy isrecommended. Isolates resistant to third generation cephalosporins or aztreonamgenerally remain susceptible to carbapenems.
2 AEROBIC CULTURE Escherichia coli
3 AEROBIC CULTURE Enterococcus spp.
COMMENTS Enterococcus- Cephalosporins, Aminoglycosides, Clindamycin, Methicillin ( or Oxacillin ) &
Trimethoprim-sulfamethoxazole may appear active "in vitro" but are not effective clinically,
and isolates should not be reported as susceptible. Therefore, these antibiotics are NOT
included in this susceptibility panel which may appear very short.
Combination therapy: Resistance to High-Level Gentamicin indicates that there will be nosynergy between amipicillin, penicillin or vancomycin and any aminoglycoside.
COMMENTS Colony count >100,000 cfu/mL for all isolates
GRAM STAIN Gram negative bacilli, Gram positive bacilli, and Gram positive cocci seen on direct smearof urine
COMMENTS Unable to isolate Gram positive bacilli observed on urine Gram stain
REPORTED BY Sarah Quattlebaum; Lab Tech II
REPORT DATE 02/26/2013

Antibiotic Susceptibility Pattern

1 2 3
AMIKACIN S S
AMOX/ CLAV R S R
AMPICILLIN R I R
CEFOVECIN (3RD GEN) S S
CEFPODOXIME (3RD GEN) S S
CEPHALOTHIN (1ST GEN) R R
DOXYCYCLINE S S R
ENROFLOXACIN S S R
GENTAMICIN S S
GENTAMICIN 120 MCG S
NITROFURANTOIN I S
ORBIFLOXACIN S S R

Final Report


Report Date ATHENS DIAGNOSTIC LABORATORY Page 2 of 2
02/26/2013 COLLEGE OF VETERINARY MEDICINE
UNIVERSITY OF GEORGIA
ATHENS, GA 30602

BACTERIOLOGY RESULTS

1 2 3
PENICILLIN S
TETRACYCLINE S S R
TICARCILLIN S S
TOBRAMYCIN S S
TRIMETHOPRIM/SULFA S S

This is an "in vitro" test that may not reflect clinical outcome.

Accession Number: Final Report


_________________________________________________

Buddy (23999)
Canine Dachshund 7 Yrs. 4 Mos. Neutered Male 12.2 pounds (1/18/2013)
Weight: 12.2 pounds (1/18/2013) Temperature:

Subjective: ph for abd scan. wants urine culture if normal abd scan. p is doing better at home. ec

Objective: bar,

abd scan: bladder thin walled and filled w/anechoic fluid as is wnl, urethra may be slt. distended and
uniform appearing prostate gland is noted measuring 1.4cm x 0.8cm. Both kidneys exhibit mild to mod
changes in echo appearance consisting of decreased renal corticomedullary distinction, hyperechoic
flecks in renal pelvic diverticuli consistent w/fat or fibrous tissue, and acoustic shadowing from the renal
pelvis. Both kidneys are normal in size. Both kidneys have normal function as determined by laboratory
analysis. The spleen is uniform and normal echogenicity, hyperechoic to liver and renal cortex. The liver
and gall bladder appear wnl, the l. adrenal measures looks slt. plump and measures 1.7 x 0.7cm at the
high end of reported normals. The r. adrenal also looks slt plump and measures wnl of 1.1cm x 0.54cm.

urine culture pending

Assessment: recurrent hematuria, no stones or bladder masses evident, need to review normal prostate
sizes in neutered dogs to be sure the prominent prostate in this pet is not abnormal. There are no
cushings specific symptoms so I would make note plump adrenals and pursue if symptoms develop. The
mild/mod changes seen in the kidneys represent a non-specific nephritis and could be the source of the
hematuria noted on u/a. Since kidney function is wnl, no further workup is indicated other then evaluation
of kidney function every 6-12 months. rccd u/a every 6-12 months to monitor hematuria as well. may need
to recheck these findings in 1-3 months to see if static, then recheck annually is suggested

Plan: abd scan, urine culture

Client Education: will send full report within 48-72 hrs

ADDENDUM on 2/27/2013 at 23:58:18
prostate gland is wnl as reported normal size in neutered males ranges from 0.55 to 1.5 cm. jlc

Invoice Items
Status Date Item (ID) Qty Amount
Recommended 2/18/2013 Ultrasound Abdominal Exam <25lb (11936)
Recommended 2/18/2013 Culture & Sensitivity, Aerobic, UGA








Expert:  Dr. Laura Devlin, DVM, DABVP replied 1 year ago.
Thank you for the lab results and I did receive the ones sent to the lap of love site.

I've reviewed everything you've sent and I think your are doing a very good job with Bud.

I see from the culture/sensitivity panel that you sent that Bud was diagnosed with three different bacteria. This a definite concern. The enterococcus is a bacteria that tends to develop after treatment with antibiotics and we can have some cases that are quite difficult to treat.

I have a few concerns thus far with Bud's case that I want to share with you. I'm not managing his case and your vet definitely will have the best knowledge about his case and condition. With that said:

1.) There was no evidence of infection on the initial urinalysis, only the presence of blood. Was this sample a free catch or was it a cysto or catheter sample? That might help identify the sources of the blood.

2.) I do not recommend using a catheter to obtain a urine sample in a dog. Even with the most careful technique there is the risk of introducing a bacterial infection as the catheter passes through the outer skin. With all of the bacteria present in the hospital and the resistant bacteria we are seeing now a days, this is a definite concern. I recommend a cystocentesis sample using an ultrasound to guide the needle. This is safe and shown to be comfortable for our patients, especially with a belly rub or other distraction at the same time. Does you vet use an ultrasound to guide the needle? It can also be safely done in slender dogs with a full bladder without an ultrasound - so if they don't have one they may still be able to safely obtain one. If Buddy is overweight, then I would recommend the ultrasound method.

3.) I've reviewed the culture results - and notice that bacteria #3 is resistant to baytril, which I believe is the antibiotic that was used. The enterococcus likely wouldn't respond to this antibiotic and another would be needed.

4.) At this point, it would be best to obtain another culture if it's been at least 5 days since antibiotics were discontinued. Then, based on this new panel, I would select the appropriate antibiotic and treat for at least 6 weeks. I would not recommend the higher strength baytril (for shorter time) as I have seen bacteria not respond to this treatment. A culture could be repeated 3 weeks in and then 5-7 days after the end of treatment. This would be a little more expensive, but certainly a thorough approach.

5.) The culture sample should be obtained by cysto - not a free catch. Perhaps your vet could refer you to another hospital to acquire the sample if they do not have an ultrasound? The pricing for the culture was very reasonable from your vet and here in town would generally cost $95-140 for a culture.

6.) Pulse antibiotics moving forward "just in case" would not be recommended.

I hope this helps. I definitely do not want to step on any toes, and would take use this information as a tool to help manage Buddy's case. Please let me know how things go and best luck with your sweet little one.
Laura
Dr. Laura Devlin, DVM, DABVP, Small Animal Veterinarian
Category: Dog
Satisfied Customers: 1752
Experience: DABVP, Specialist in Canine and Feline Medicine, Veterinarian since 2000
Dr. Laura Devlin, DVM, DABVP and 7 other Dog Specialists are ready to help you
Customer: replied 1 year ago.

The tests both were from free catch not cysto and they apparently are recommending free catch again (maybe because of lower cost) and apparently they do cysto via catheter. Is it worth doing another free catch or is it worthless? I am considering doing that v. the catheter if they don't offer ultrasound.(They are the only somewhat affordable vet in town and with not working and in rescue with pups I am caring for at the moment - finances have to be considered.)


 


Please also comment on his diet - can I keep him on Merrick Whole Earth for Seniors or what do you recommend?


 


Do you think Dmanose is useful?


 


What is causing his infections?


 


Given his types of bacteria found what would you have recommended for treatment (antiobiotics and or anything else) since you didn't like the Baytril or Amoxicillin for all he had?


 


If it comes back positive for the same strains again and/or blood do you recommend a pulse therapy or course of X ( fill in the x) antibiotics and for how long?


 


Yes I am definitely paying you after your answer to this last questions with a bonus and would like to follow up with another new session if and when he gets his next tests back ( if I decide the free catch is worth doing for culture)


 


Thank you Dr!!

Expert:  Dr. Laura Devlin, DVM, DABVP replied 1 year ago.
You're welcome! I'm going to copy and paste:

The tests both were from free catch not cysto and they apparently are recommending free catch again (maybe because of lower cost) and apparently they do cysto via catheter. Is it worth doing another free catch or is it worthless? I am considering doing that v. the catheter if they don't offer ultrasound.(They are the only somewhat affordable vet in town and with not working and in rescue with pups I am caring for at the moment - finances have to be considered.)


I would NOT culture on a free catch. If you think about the male dog, that urine has to pass through the long outflow tract then out through the skin of the prepuce - and no matter how you clean the outside, it will not be a clean sample. Not worth running because you don't know if the infection is real or not. It may just be a contaminant.

If a free catch we don't know if there ever was a real urinary tract infection.

And if a catheter was passed, it could have caused an infection. Does this make sense?

 


Please also comment on his diet - can I keep him on Merrick Whole Earth for Seniors or what do you recommend?

I wouldn't change his diet at this time. That is a good diet and there is no indication that a change is necessary.


 


Do you think Dmanose is useful?

It probably wouldn't hurt but your money would be better spent on getting a cysto culture and going that route. There isn't enough evidence with our canines to know that it is beneficial.


 


What is causing his infections?

It's uncertain. At this point since it was a free catch this could all be contamination! There may be infection given the symptoms you are seeing at home - so we need a good sample to verify this.

 


Given his types of bacteria found what would you have recommended for treatment (antiobiotics and or anything else) since you didn't like the Baytril or Amoxicillin for all he had?


It's not that I didn't like it - it's that the culture is run partly to tell you what antibiotic will work on the infection. The bacteria was resistant to Baytril so that wasn't a good choice. When the culture is repeated it will tell you what is present and what antibiotic will be best.


If it comes back positive for the same strains again and/or blood do you recommend a pulse therapy or course of X ( fill in the x) antibiotics and for how long?

I do not recommend pulse therapy. This is a bad idea. Treat for 6-8 weeks as I outlined earlier - with the follow up cultures.

 


Yes I am definitely paying you after your answer to this last questions with a bonus and would like to follow up with another new session if and when he gets his next tests back ( if I decide the free catch is worth doing for culture)

Thank you! I have a number of repeat clients - I only take a few new questions periodically because of my other work committments - and I enjoy the follow up and being able to help. I know this can be frustrating but hang in there!

And remember - I know your budget is limited - but cheap veterinary care isn't necessarily good - and good care isn't always cheap. Sometimes you save money but doing things the right way the first time - does this make sense? I think you are having good intution on the problem and hopefully you can get it all figured out for him. Pleae keep me posted!

Oh - and a cysto is different then a catheter. A cysto uses a tiny needle that goes through the belly. Like when an amniocentesis is done on a pregnant woman? It sounds terrible but it's very tiny and they really don't mind when it's done right! Less of a pain then trimming nails! A catheter is passed up the penis and into the bladder.
Laura
Customer: replied 1 year ago.

I am paying you now but hope you can clarify this please.


"It's not that I didn't like it - it's that the culture is run partly to tell you what antibiotic will work on the infection. The bacteria was resistant to Baytril so that wasn't a good choice. When the culture is repeated it will tell you what is present and what antibiotic will be best."


So what was the good/right choice - what did the last test indicate was the right choice of antibiotic?? I guess that is one of main questions.


 


Thanks again and I am paying right now. :)

Expert:  Dr. Laura Devlin, DVM, DABVP replied 1 year ago.
Thank you so much for the payment and the bonus.

If you look at the culture results - it shows a list of antibiotics to use. The Enterococcus Bacteria is resistant to the baytril that your veterinarian used:
AMIKACIN S S
AMOX/ CLAV R S R
AMPICILLIN R I R
CEFOVECIN (3RD GEN) S S
CEFPODOXIME (3RD GEN) S S
CEPHALOTHIN (1ST GEN) R R
DOXYCYCLINE S S R
ENROFLOXACIN S S R
GENTAMICIN S S
GENTAMICIN 120 MCG S
NITROFURANTOIN I S
ORBIFLOXACIN S S R

Any "R" means resistant. if you go back to the longer report and carefully read it, it will be a little more clear. There are three "bugs" and the first two are sensitive to the baytril, but the third is resistant.

There is still hope that maybe these were from the free catch sample and not really growing in his urinary tract - so a new culture is definitely needed on a STERILE sample straight from the bladder and not through a free catch or catheter.

Thanks again.
Laura
Customer: replied 1 year ago.

So of those listed which one would you use to treat all three? Last question I promise. :) ( I did see the report but NONE of the antibiotics showed three S's and some just showed blanks too instead of an S or R so am confused about which is the right one to treat all three bugs)

Expert:  Dr. Laura Devlin, DVM, DABVP replied 1 year ago.
It's ok! I wouldn't use any right now - I don't know if these results are valid because of the way in which they were obtained, and the pattern might be different now after the baytril.

Once you have your new report back I would use those.

Hope that helps and keep me posted on little Buddy. :)
Customer: replied 1 year ago.

Just to help me in understanding how to read these tests which one would you have used assuming he really did have all three - in other words what from these choices would you have used to treat all three other than Baytril?( and there was another page of choices I am posting here not sure you saw.


 


So what would you use or have used when there are not three SSS's?) I just want to know which drug since none seem to treat all three or would you use a combo and of which ones on the list?? ( This will help me greatly and I apologize for asking)


 


AMPICILLIN R I R
CEFOVECIN (3RD GEN) S S
CEFPODOXIME (3RD GEN) S S
CEPHALOTHIN (1ST GEN) R R
DOXYCYCLINE S S R
ENROFLOXACIN S S R
GENTAMICIN S S
GENTAMICIN 120 MCG S
NITROFURANTOIN I S
ORBIFLOXACIN S S R


1 2 3
PENICILLIN S
TETRACYCLINE S S R
TICARCILLIN S S
TOBRAMYCIN S S
TRIMETHOPRIM/SULFA S S

Expert:  Dr. Laura Devlin, DVM, DABVP replied 1 year ago.
Not sure, would probably have called the bacteriology lab had this been a sterile sample. Sometimes enterococcus goes away on its own and we don't treat - but regardless I wouldn't use this panel and at this point should focus on the next results.
Customer: replied 1 year ago.

Gotcha and makes sense. I will see if you are available to read the results and sign up for another session when I figure out from which vet I can get a good sterile sample! Thanks again for all your help Doctor.

Expert:  Dr. Laura Devlin, DVM, DABVP replied 1 year ago.
You're welcome and thank you so much. Best luck with him.
Laura
Customer: replied 1 year ago.

I tried to write a follow up on a new form so you would get paid again but it doesn't look it got to you? If you got it you can answer back on that re the update I received from the doctor.

 

" my apologies for the time crunch today and my short, potentially confusing responses. I confirmed that the single culture we did on buddy we did via cystocentesis via ultrasound guidance.

the culture was obtained via cysto on the day of the scan, prior u/a were voided samples to be more accurate about actual
presence of blood
the baytril was chosen because 2 of 3 isolates WERE sensitive to baytril and it gets good penetration into urine
the THIRD isolate was resistant to EVERYTHING except an injectable antibiotic called gentomycin, he would have to be
hospitalized, on fluids, w/iv catheter to give this antibiotic safely. Sometimes in vitro sensitivities do not correlate well with
invivo sensitivities thus my decision based on the very mild presentation was to do no harm and treat the two isolates
sensitive to baytril
the most important thing to do is recheck the urine and the urine culture asap"

Expert:  Dr. Laura Devlin, DVM, DABVP replied 1 year ago.
Thank you!

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