Cysto or not?

[diggydog]

So Skye has had a UTI going on a month now with very little improvement. The antibiotics have decreased the amount of blood in her urine but she is still showing blood after 3weeks of cefelaxin and 1 week of another antibiotic. C & S was done first time round with a free catch of urine but I spoke with the vet today and he has suggested that we can try doing a Cysto or go straight to ultra sound or x-ray to check for stones and to see how her bladder looks.

Having never been through this before I am a bit lost and dont want to make the wrong decision for her but at the same time if i don't have to spend loads of money on ultra sound or x-ray then it would make things much easier financially as I need to take time off work to have surgery so watching my money like a hawk just now.

[Joan]

Re: Cysto or not?

Cysto wont show much that your free catch did not show. I have never had one come up with a different bacteria. I have been thru this a bunch as with 5 paraplegics, it is pretty common.

Some vets will do a cysto just by feel, it is pretty straight forward and usually not too expensive at all. You dont need a tranquilizer in most cases, takes a few minutes, and then the fee for the C & S. Some vets want a ultrasound to guide the cysto, this is not neccessary, and if you are paying for the ultrasound anyway, might as well take a look for stones.

Personally if I have been thru the C &S and the recommended antibiotic has not cleared up the UTI, I would spring for an xray. Again, no anaesthesia etc, and here anyway, much cheaper than an ultrasound.

The other option, is another free catch sample for culture and see if there is another different bacteria now. Something like e-coli can mutate in a few days if the antibiotic is not specific enough. If the second culture does not show someting different, the most likely culprit is stones.

In the meantime, the most important thing is to encourage water consumption. Extra water several times a day with something like a pinch of tuna to get them to drink. My pugs weigh about 20 lbs, and I give 1/3 cup tuna-water 4 times daily in addition to free choice water 24/7. Can make a world of difference! Cranberry suppplement is good, as is d-mannose several times daily.

The other culprit on repeated UTIs is dental problems. But my guess is that your dog just did not receive the correct antibiotic, which is not too unusual. Almost any antibiotic will decrease the infection, but only one with a specific action on the present bacteria will eliminate it completely. A lot of times, the antibiotic is not given for a long enough period of time. I like to keep using it till I have 2 wks of clear urine. You can buy urine stix to test for infections at most pharmacies, and that is a lot cheaper than repeated tests at the vets. A lot of times, that is exactly what the vet is using to determine the presence of an infection.

If you cant get urine stix at your pharmacy, you can order them here, about 10 cents each

http://www.biousa.com/multistix--che...est-strip.html

Here is a site with an explanation of the stix interpretation

http://www.vet.uga.edu/VPP/CLERK/Sine/index.php

[k9diabetes]

Re: Cysto or not?

If you can swing it, I would do the ultrasound. It can catch problems that just checking for infection and stones via a catch of urine cannot.

I don't think it matters whether you do free catch or cysto for a sample. The only advantage I can see of a cysto is to check for infection and avoid picking up any bacteria from outside of the body that aren't actually in the bladder so to avoid thinking there is a bladder infection when there isn't.

I suspect that in this case they are more concerned about stones or possibly obstruction or growth or unusual anatomy and it seems like the ultrasound would be the best way to check for all of those.

Natalie

[ozzi]

Re: Cysto or not?

When Ozzi was initially showing signs of lower back pain about 5 or 6 years ago, he had a lumbar spine Xray done, which showed bladder stones. Ultimately he had a cystotomy and had over 100 stones removed. I mention this because the majority of bladder stones and kidney stones are radio-opaque and show up on plain abdominal films, which is much cheaper than an ultrasound. However if the concern is anatomical or possible obstruction, plain films won't show that and an ultrasound would be needed. When you say "cysto" what do you mean? Cystoscopy is using a scope through the urethra to look into the bladder as opposed to a suprapubic aspiration which is sticking a needle in the bladder to get a sterile urine sample. What were the culture and sensitivity results? Were the antibiotics the correct ones for the bacteria that were causing the infection? What does her urine show now...just blood, or white cells and bacteria as well? If the concern is stones, I would start with an abdominal Xray, otherwise I would consider a cystoscopy if the concern is cancer causing the hematuria. I would probably put the ultrasound on hold if you're only doing that to rule out stones since there are cheaper ways to make that diagnosis. Unfortunately you don't know what you're dealing with until you get into it, and I find that often I start with the least invasive (and typically least expensive) means to diagnose, and sometimes that's enough and sometimes you have to do further testing. I think the most important thing you can tell us is what the concern is (persistent infection, stones, or cancer/tumor) that the vet is trying to rule in or out.
Kevin

[diggydog]

Re: Cysto or not?

I think by cysto I mean getting a sterile sample of urine direct from her bladder - the concerns are stones causing a blockage ? not exactly sure but I am sure the vet mentioned wanting to check out her bladder wall for some reason. There was mention of looking for crystals (am guessing not the good jewelry kind ) but to be honest I have been so busy with Alfie I have not done much looking into all that can be involved with this.
I figured get the C&S and a few weeks of antibiotics and she would be fine but its turning into a whole lot more than I expected. Her simple UTI is rapidly becoming something all together more sinister.
The first antibiotic she was on was indicated by the C&S so not exactly sure why its not worked and the next antibiotic has a few more days to run was also indicated by the C&S
She is still a wee monkey and not at all bothered by all the stress its causing me, a few mornings she has only eaten half her food but eats everything the rest of the day.Trying to convince myself now that its nothing serious as I just dont think I could cope without her. She is VERY special to me.

[buddingartist]

Re: Cysto or not?

In the case of my Buddy, they only discovered the stones in the bladder through the ultrasound. The vet said they were small enough that it was possible he would eliminate them naturally. They also saw the sludge in the bile ducts but it was a more comprehensive ultrasound looking at all adrenal glands... therefore more expensive.

Since then, I use the Regent strips that Joan is suggesting and I can catch the UTI very very early. When he started a UTI a while back, I went to the vet immediately and they confirmed it (using the same stix and prescribed Clavaseptin for a little over 2 weeks and it cleared. Now I test Buddy weekly using those stix.

Buddy has never been a big drinker during the day so now, I also follow Joan's suggestion and give him the water and tuna 2-3 times a day and he now considers this as a major treat and loves it. I also added 25mg of bilberry to his morning meal.

Because of both the stones and the sludge in the bile ducts, I know exactly when he needs to go as he starts panting like crazy before and a little while longer after once he has relieved himself (both pee and poop).

Strangely enough, when I went to the vet for something else, the other vet on duty that day said she could feel his stones simply through palpation. (go figure)

Good luck with your little one or your <wee little monkey< as you so tenderly refer to her
Louise

[AlisonandMia]

Re: Cysto or not?

If I were in your position I'd go for some sort of imaging - probably ultrasound. It really does sound like there could be something like a bladder stone in there which would explain the continuing uti symptoms despite the correct antibiotics. The irritation caused by a stone or stones can cause symptoms pretty much identical with a UTI.

Partial blockages by stones can also lead to UTI's because of urine stagnating in the bladder and irritation of the tissues. I wonder if this isn't what happened when she first got a UTI.

UTI's can also sometimes lead to bladder stone formation, I believe.

Alison

[ozzi]

Re: Cysto or not?

I just saw your most recent post, and if the vet wants to check the bladder wall, I suspect s/he wants to use a scope to visualize it. Regarding crystals, there are several types of crystals that can form in the bladder and kidneys (calcium, magnesium, etc.) and ultimately form stones, but they can be seen with a microscope using a urine sample. If I were you, I would get more clarification from the vet about what it is that s/he is exactly looking to do and why. I would also ask more about the urinalysis you had done to see if crystals already showed up, hence the concern about stones. Let us know what happens!
Kevin

[peggy0]

Re: Cysto or not?

I would definately go with the ultra sound. I had one done on tj after treating him for months and it got to the bottom of the situation.

[diggydog]

Re: Cysto or not?

I am going to see the vet on thursday and get him to explain things to me a bit better - or maybe that should be I need to listen more carefully to him and find out exactly whats showing in her urine and also what they are thinking and expect to see from ultra sound or x-ray.
Skye has never been a poorly dog and before all this she was only ever at the vet for an annual check up. All the talk of ultra sound and x ray seems so serious and scary

[peggy0]

Re: Cysto or not?

ultra sound is a very easy test for the doggy. its just a visual of whats going on inside, just like watching baby grow painless

[diggydog]

Re: Cysto or not?

I am booked in for an ultra sound in a couple of weeks - wonder if my doctor will do Skye as well a wee two for one kind of thing!
I have gallstones and need my gallbladder removed, its funny that at the same time as me having this Skye has her own bladder (different kind of bladder but close enough) problems. She is very much my girl

[CarolW]

Re: Cysto or not?

Sometimes it's hard to listen to the vet - when you aren't very clear on just WHAT the vet is talking about! So, you might practise asking questions of yourself first - maybe ask the vet to slow down a bit with the explanations, so you can have time to discover what questions you have to ask about the explanations the vet is giving. This is not an easy task! If you don't know what something means, it can be difficult to formulate your questions!

So, in conversations with the vet, try to notice when meanings are slipping past y0u and you're not understanding, then ask the vet to explain in simple terms. Not all vets are good at doing this! And that's true of very good vets, too.

I'll be here watching, as always!

Mon, 27 Sep 2010 13:54:48 (PDT)

[buddingartist]

Re: Cysto or not?

Diggydog, I don't know the practise where you live, or if you feel up to it, but in our case, my husband was allowed to stay with Buddy throughout the ultrasound procedure, and he was allowed to ask questions. Buddy was calmer having his daddy there with him.

Louise

[diggydog]

Re: Cysto or not?

Well I am getting another C & S done on skye to see if there is anything else that shows up this time round.
I spoke to the vet and handed in another urine sample on saturday.
The vet said he "spun in down" and she is not showing any crystals and also that this time round she doesn't have any white blood cells present - which I take it to mean that she had this previously. She is still showing around the same amount of blood and traces of protein as last time.
The C & S is getting done on a free catch again as I dont feel that a cysto is going to be really any better than the free catch. I am hoping that something different shows up this time round.