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Good Morning! I have a female bullmastiff rescue girl, about

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Good Morning! I have a female...
Good Morning!
I have a female bullmastiff rescue girl, about 7 years old. Hard to know. She was spayed before I adopted her.
She has a history of eating raisins about 2 months ago. It was quite challenging as on the 2nd day she presented extreme spasms of the upper body as she tried to stand up in bed. I treated her with homeopathics and charcoal and a kidney diet.
Moralla seemed to come through it fine - her kd markers in labs were ion normal range.
2 days ago I observed darkened urine as she peed. I got a ziplock bag ready for the next urination and did a clean collect. Scary, dark red blood, liquid, not clots. The day after, it changed to darker yellow- not even as dark a a severe bile elevated liver patient. Then again last night, the blood returned.
I am an oriental medical doc, homeopathic physician and have some western medical training
Labs from yesterday show low platelets and rbcs. Her gums and eyes are not pale.
The vet wants to treat with combo gentamycin and penicillin. I am VERY concerned about the side effects and potential kidney. liver and even lifet hreatening dangers
Do you have a suggestion?
Dr. Robin Falkov ***@******.***
www.healthfreedomrights.com
I also have a morning news show and would love to interview you!
Submitted: 2 years ago.Category: Dog
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Answered in 22 minutes by:
6/11/2015
Dog Specialist: VetTechErin, Licensed Vet Tech replied 2 years ago
VetTechErin
VetTechErin, Licensed Vet Tech
Category: Dog
Satisfied Customers: 681
Experience: Published author in veterinary medical journals and on the Veterinary Information Network with a focus in toxicology
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Hi there!
My name is ***** ***** I would be happy to help you with your question about your dog.
I just had a few questions for you in regards ***** ***** main concern - the raisin ingestion that occurred happened about eight weeks ago? Was this an ingestion of raw raisins from a box, or ingestion from a cooked/baked product like raisin bread?
Is your main concern the kidney damage that can potentially occur from the raisins coupled with the signs you are seeing in the urine?
Or are you concerned more with the penicillin/gentamicin affect on the kidneys due to her prior raisin exposure?
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Customer reply replied 2 years ago

My main concern is the blood in her urine. She seemed to recover from the raisin episode.

Yes, you are spot on. I have a vet who was outstanding. Something has changed there.

YES- it is concern for gentamycin/penicillin if there was prior kidney damage.

What other antibiotic course of treatment is safer with her brief history?

I may have to go out and continue with you later. I will give you every opportunity to get the info.
Thanks

Dog Specialist: VetTechErin, Licensed Vet Tech replied 2 years ago

Thank you for answering the questions for me!

A little bit more information about grapes and raisins just to get you updated on what you're looking at in regards ***** ***** exposure posing challenges later on down the road:

Currently, there is no known mechanism of action for grapes and raisins in dogs. It seems like the cause of renal damage after exposure may be due to an individual sensitivity in each particular dog, so even some dogs who ingest a lot of raisins or grapes may not show signs. They've been able to rule out pesticides and grape type as possible causes separate from whatever is in the grapes. Raisins tend to be a lot more toxic than grapes, and they tend to have a lower margin of safety. So far, we have not seen instances of -cooked- grapes/raisins causing an issue, but we still treat it with diuresis, as we don't want to take the risk that one day a dog will develop kidney damage from them. Grape juice also does not seem to cause the same issues.

The first thing we start to see is gastrointestinal upset, usually within the first 24-48 hours of ingestion. Dogs will vomit, stop eating, stop drinking, and gradually their kidneys stop successfully concentrating the urine, urination becomes scanty, and then they'll stop urinating altogether. Once kidney damage has developed, these signs can last for several weeks after exposure.

Now, if you had told me that you didn't test her blood until recently and that it was her BUN/Creatinine that was elevated, I would also be concerned about kidney damage due to the raisins. However, with an exposure to grapes and raisins, we see an elevation in those kidney values within a few days (48 hours is the most common time-frame).

But since you ran blood chemistries near to the exposure and again when you started to see blood in the urine and they came back normal, this leads me to believe that she either did not get enough of them to cause a kidney problem, or she is is one of those dogs who is just not as sensitive. Since it has been two months since the exposure (with those normal kidney values), the signs that you are seeing now are unrelated to the grapes.

Blood in the urine is also not super common with grapes and raisins, we tend to see an inability of the kidneys to properly concentrate the urine which eventually leads to urine cessation. This would have been seen within several days of ingestion, and unless she had sustained damage to the kidneys which would have been seen in those blood tests. After a grape/raisin exposure causes an noted elevation to the kidney enzymes, this does not go down on its own and requires 48+ hours of diuresis to get under control.

So it does sound like your vet has settled on a urinary tract infection as the cause of the blood in her urine. This is a VERY distinct possibility, as red blood cells in the urine coupled with bacteria seen via urinalysis is a very strong indicator of a urinary tract infection. Now, we CAN see urinary tract infections that can become more severe and lead to kidney infections. These are usually also treated with antibiotics, but stronger ones.

As UTIs that causes bleeding can cause dips in the RBC and platelet count in dogs, this would match with her blood work far better than renal damage from the raisins as well.

Antibiotics are the number one drug of choice here. If these infections aren't treated with an antibiotic to which they are susceptible, we see a urinary tract infection become a kidney infection, which can very easily lead to sepsis, stones, and other complications.

That being said, Penicillin itself is a very weak antibiotic when it comes to a UTI in dogs. Gentamicin is sometimes used as a "stronger" antibiotic, but may not always be the best "first try" antibiotic for a urinary or kidney infection, especially as there are other drugs that work and have fewer associated side-effects.

So given where you are, I would ask if your vet performed a urinalysis? If so, and bacteria were seen, then antibiotics are absolutely appropriate, though I would discuss your concerns about the gentamicin leading to kidney damage with your vet and ask if there is an alternative (such as Clavamox or Baytril, both of which work really well. Clavamox tends to be something they try first, then move on to Baytril as a more broad-spectrum antibiotic).

Another option would be to have them send of a sterile urine sample to have the bacteria grown and susceptibility tested. This will tell you exactly what you're dealing with and exactly which antibiotic is going to be the most effective.

Similarly, did your vet perform radiographs to check the kidneys and look for stones? These can complicate a urinary tract infection and may need further treatment on top of the antibiotics. Kidney infections are more commonly treated with Baytril, and sometimes stones even need to be surgically removed to prevent continued irritation and recurrent infections.

Hopefully this will get you started on the right track, and has addressed your concerns about the kidneys and the raisins a bit as well. If you have any further follow-up questions, please get back with me via reply!

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Customer reply replied 2 years ago

Hi,

As a physician I am very away of different antibiotic problems. Clavamox has many side effect that raise dangerous and serious concerns.

I will google baytril.

I do not have the necessary info for you advise me. I was NOT told they did not test for the specific bacteria. This is an obvious waste of time and misrepresentation for my girl.

I have to head out. Will wait to till I get the necessary info. There is not much that you can do without that.

Clavamox is another drug for caution. Combing it with Amoxycillin can cause a 50% risk for hospitalization in patients with liver disease, with damage and even death.

Thanks. I will give you that information as soon as I get it.

Dog Specialist: VetTechErin, Licensed Vet Tech replied 2 years ago

The human generic equivalent of Baytril is enrofloxacin, if that helps. There are going to be unappealing possible side-effects in most of the antibiotics that are effective in a urinary tract infection. Some of them are just milder than others.

Clavamox is generally very well tolerated in dogs. When we're giving a drug that comes with a risk of damage to the organs, you can request a chemistry panel before you start any medication to get a good baseline, then repeat it in 48 hours to get a good idea on the trends. The risk of liver issues in a dog on Clavamox is not high (Looking in the usual veterinary literature, I'm not seeing a reference to the impact on the liver as it is primarily metabolized in the kidneys. This may be due to the fact that the ratio of amoxicillin and clavulanic acid in Clavamox is far different for dogs, or humans may have a species sensitivity that dogs do not have. The largest risk for dogs appears to be tummy upset, hypersensitivity, and disruption of the intestinal flora leading to diarrhea).

A dog with no pre-existing liver issues is not likely to have their blood tested at a vet prior to antibiotics unless you specifically request it. You're going to find that many drugs that are used in both veterinary medicine and human medicine react completely differently in animals. It's part of why so many of our medications are toxic to pets.

However, you also want to be sure that you're comfortable giving medication to your pet. Coming from a background of holistic medication, you have a greater understanding of some of the risks that come along with chemical compounds that your vet may not be directly concerned with. In many a case all it will take is you telling your vet about your hesitations with a medication and asking for an alternative. If there is no other alternative, your vet should at least be able to tell you why.

I would be COMPLETELY surprised if your vet did not have a way to test for antibiotic susceptibility. This is something we routinely do when a dog is having issues with kicking a urinary tract infection so that we can identify the bacteria and prescribe the proper antibiotics and hopefully not lead to antibiotic resistances. Usually this is not done in-house, but sent off to a lab. It may not be something they opt to try first, but it should be available when you request it.

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Customer reply replied 2 years ago

Erin

I will be getting the bacterial culture results very soon. I explained to you that I wanted your input on the specific recommendations.

If this ties you up, I am happy to rate you now. Just let me know.

Have a good weekend.

Dog Specialist: VetTechErin, Licensed Vet Tech replied 2 years ago
I am happy to wait until you get the test results back! You can just continue to update here as needed!
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Customer reply replied 2 years ago

Thanks Erin,

Things are very disturbing with the vet. He is someone who had done excellent work in the past.. The office had a turnover of 50%... many difficulties calling them The phones are always busy, replies are not forthcoming..

Bate and switch - I asked for urineanalysis to id the bacteria... He did it in house to only show levels - no id.. Did not get what I wanted to pay for.

I just want you to understand that getting anything done with this vet has become a nightmare. I will be taking my girl for labs to verify her very low platelet count from his office equip.

Always hard to know about in house testing -- how often is the equip calibrated. With something this serious, I need another opinion.

Not much that you can do at this time...

Dog Specialist: VetTechErin, Licensed Vet Tech replied 2 years ago
Absolutely, and it is always a good thing to have a second opinion on any diagnosis. Take as much time as you need to find someone you trust to retest and verify what was found!
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Customer reply replied 2 years ago

Thanks for your help. Sorry it took so look for me to get info from the bacterial culture.

It is Morganella Morganii .. I've done some research about it, but did not know that my session with you would be closed out. Very disappointing. You did not tell me there would be a time limit.

I now have to check on which is the safest and most effective antibiotic in case there is a breakthrough of the infection. I will be collecting urine to be tested on Thursday, for a basic urine analysis .

Dog Specialist: VetTechErin, Licensed Vet Tech replied 2 years ago
There should not be a time limit on these, you can come back at any time to post to your question. The system simply closes them out after a certain amount of time idle. I am working on compiling some information for you, and will post it here for you to read!
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Customer reply replied 2 years ago

Thanks so much Erin. I look forward to your reply.

Smile

Dog Specialist: VetTechErin, Licensed Vet Tech replied 2 years ago
You're very welcome! The bacteria in question (which you can read about on the fact sheet here: http://www.antimicrobe.org/b115.asp) is a gram negative bacteria and would be susceptible to any antibiotic that are most effective against them. This one in particular is actually pretty susceptible to aminoglycoside antibiotics. Aminoglycosides would take you back to the original suggestion of your vet's, which is gentamicin. I know you were concerned about the side effects of gentamicin use due to the possibility of side-effects involving the organs. If you were hesitant to try it (though it is likely to be the most effective against this particular bacteria), you could instead ask your vet to look into Cephalosporins. Cephalosporins are VERY common in vet medication (Cephalexin being one of the most widely used), and they have very low toxicity. Side effects tend to be limited to mild vomiting and diarrhea due to tummy irritation that can be seen with any antibiotic. The other concern would be if your pet was allergic to this particular type of drug (but again, that will be true for almost any antibiotic). They are very similar to penicillins in nature. M. morganii has shown some resistance to the 1st and 2nd generation cephalosporins, which makes it possible that cephalexin or cefazolin would not be as effective, but it is still susceptible to the third and fourth generation cephalosporins. There are several of these approved for use in veterinary medicine such as cefpodoxime or cefepime. If you want to be completely thorough, your vet can do susceptibility testing too. While this tends to be a little bit more expensive, they will be able to determine exactly which medications would be effective against the strain of bacteria that is infecting your girl. If she has one that is susceptible to cephalexin, then it would open the way for the more common, and cheaper antibiotics for use.
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Dog Specialist: VetTechErin, Licensed Vet Tech replied 2 years ago
(Sorry, edited to say that cephalexin would not be as effective due to lack of susceptibility)
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