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UTI has returned?

Species: Dog
Breed: Pharaoh Hound Shar P
Age: 11-15 years
We are currently living abroad in Kazakhstan. Vet care here is not what we are used to in the States. It looks like my dog has a complicated UTI. There really isn’t anywhere I can get a culture done here. I gave her a two week course of clavamox which I could get over the counter here. The pharmacist was basically rolling on the floor laughing that I would buy drugs for my dog. Most dogs are treated quite differently here, more as livestock that live outside.
Our dog is 44lbs sight-hound mix, 12 year old female, and I was only able to get adult sized human pills that I broke in half. Basically she got 300mg twice a day. I didn’t have any peanut butter so I put it in cheese. I know you can’t do cipro and cheese but I didn’t see anything about cheese and clavamox online.
She was straining and peeing blood at first. The straining and visible blood went away after 3 days. She was also wetting the bed at night. This went away after the third day as well. I just stopped day 14 on Thursday. Things seemed good, but she wet the bed again this morning (three days later). This looks like relapse.
This could be old age, but that symptoms improved with drugs and then started again when drugs were discontinued worries me.
Again, I can’t get her vet care we are on our own here. Do you have any recommendations? I also brought cranberry supplements from the States for me to Kazakhstan.
I worry about making her symptoms work if I create resistance, but if do nothing she will surely get worse on her own. Should I start a second course of Clavamox, or try a different drug?
I was reading that sometimes if you do a course and knock it out in complicated cases the dog will stay on a maintenance dose of 1/3 daily dose at night but not to do this with an active infection. There really isn’t away to get a culture done unless I can find someone at the University we are at in the biology department with some experience. So far the only person I asked said he doesn’t think anyone here does that kind of work.


Online vet, Dr. Marie

Dr. Marie replied:

This is a tough question for me to answer. I can't legally make a diagnosis or give you direct medical advice online. So, I will give you my thoughts on what could be going on here.

There are not many UTIs that will not respond to Clavamox. (And yes, it's ok to give Clavamox with cheese.) I am concerned that there may be something else going on. Yes, a resistant infection is possible, but it would be unusual for the infection to come back again after just 3 days.

The first thing I thought of when you described your situation was that there could be bladder stones present. I don't know how you will deal with these without having access to a good vet, however. There are different types of bladder stones. Some are treated by giving special food to help break down the stones and other types of stones can only be cured by having surgery to remove them. If this were my case I would be doing a urinalysis and also an xray to look for stones.

In an older dog I get worried about other causes of blood in the urine such as a tumor in the bladder or reproductive tract. These are difficult to diagnose even with good medical practices.

Is she spayed? An infection in the uterus can look very similar to a UTI although there is usually not much straining, so this is less likely. A uterine infection (pyometra) is a life threatening condition and requires surgery.

The cranberry supplements are not likely to help and actually could do some harm. Humans with a UTI take cranberry because it reduces the ability for E. Coli bacteria to attach to the bladder wall. But most dog UTIs are not E.Coli. Also, the cranberries acidify the urine. If this is a calcium oxalate stone then you are actually contributing to stone growth by giving the cranberry.

It is certainly possible that she just needs a longer course of Clavamox. There is no harm in doing so. But I am concerned that there could be either stones or a tumor of some sort.

I really feel for people in situations like this where you are in a country with poor veterinary care. I wish I could do more for you!

I hope things improve soon!

Dr. Marie.



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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

She is a rescue. The shelter said that she was spayed and has never had a period as far as I know, so even though I can't see a surgery scar I assume that she does not have a uterus.

Thanks for letting me know about the cranberry. My friend in the biology department also brought his dogs, and he mentioned that Cipro would kill both gram positive and gram negative.

I was worried about giving Cipro to her because of joint issues. She does not have any. It is more a fear I have. I took levaquin once and I never have felt so much pain from an adverse effect. Antibiotics in this family make me nervous personally. I realize that I am quite different from my dog though.

I understand that you can not legally diagnose over the internet. Would it be harmful or riskier to give a course of cipro instead of clavamox? They have 500mg pills available over the counter that are scored and I can break in half. I know with Cipro I shouldn't use dairy to give the pill.

Sadie has had a UTI before so when I saw the straining to pee I thought of that. When we lived in Michigan a few years ago she had an infection that needed two courses of clavamox to clear up. I remember getting urinalysis done after about a week and the vet saying it look like quite a bit of bacteria was still alive.

If it gets much worse we might have to go to get help. My friend in biology who brought one dog, also adopted another here and got her spayed in Astana. The vet did poor stitches and the dog got an infection from the surgery so I am worried that with differing expectations and non-western training that a vet visit may do more harm than good. Another friend went to a different vet with a rescued cat and told some horror stories. I keep waiting to here about care that sounds reliable and more familiar to us. It isn't expensive to see a vet here. I think many offices would be able to do an xray and basic analyses. Complicated bloodwork has to be sent out of the country. Another friend brought a cat and wanted to then take her to England. I guess she needed some toxoplasmosis screen and had to send blood on dry ice to Germany.

Are their basic care sort of tests if we go see a local vet you would recommend asking about?

Thanks again for your time with this.
Christina


Online vet, Dr. Marie

Dr. Marie replied:

I haven't used much cipro in dogs. It is a fluoroquinolone and we have one for dogs called Baytril that I use more commonly. But, cipro does usually tend to be tolerated well. However, I'm hesitant on advising you on which antibiotic would be better just because of legal issues. I think that an extra 2 weeks of Clavamox is likely what I would be doing...but then I would also be doing a urinalysis and a culture and an xray to help me support that decision.

If you can get an xray done then it is usually very easy to see bladder stones. Also, a urinalysis should be able to be done without sending urine away to a lab. Those two tests will tell you an awful lot.



Customer reply:

Dear Dr. Marie

We last spoke in February about Sadie. After the second antibiotic course she seemed to get better and no longer had any accidents in bed.

I am thinking I am going to have to take her to the vet in town which I have heard very negative things about. It is the best of the bunch. I have a student who will go with me to translate, and I am hoping to know what tests to ask for.

Her incontinence has returned. No blood or urgency like last time though. I am hoping that it is just old age, but now am thinking I need to get her tested for diabetes maybe.

She maintains a very slim figure like most sight hounds. Lately her appetite has been decreased. She gets two cups of kibble a day and unfortunately there aren't many high quality kibbles here. I have found some royal canine off and on, but it's distribution is spotty, now she gets pedigree which is pretty low quality. Before moving to KZ she was on a grain free diet. About two days a week now she turns up her nose at breakfast unless we put a vitamin or other goody in the bowl. She will always eat at dinner though. Because we have a second dog, if she doesn't want to eat within a few minutes we pick up her bowl because he will finish it off.

I don't notice any excessive thirst, and her pee output seems the same. She often squats on concrete so it looks like a lot to me. I am not sure what is normal. She goes out 4X a day. No problems going poop. My husband is in charge of refilling the water bowl,and it is shared between the two dogs. Pretty much gets refilled about 3 times a day -- Morning, after work, and sometimes at night. I would say the bowl holds between 1.5 and 2 liters, and there are two dogs.

The problem -- at night now we have begun to find wet spots again in bed. What is strange is that they don't appear yellow or smell like pee. Really it looks like someone has just spilled a lot of water. My husband is wondering if it is even pee, or just drool. The spots are too big to be drool I think and appear to always be under where she lays and not her head.

Also, her legs seem to be getting weaker and more shaky. We only notice this when she squats, walking there are no problems.

The vet in Astana does not have appointments and you have to wait a very long time for care.

What tests should I ask for. I don't think they will culture the urine -- they rarely do it for humans going in with UTIs here -- my friend went to the hospital last week and almost had an appendectomy for a bladder infection, so you can see why I am worried about vet care if this is the standard of human care.

I know a lot of biologists on campus here, and one has diabetes, maybe I can try to get a glucose test for Sadie from him.... do you have any thoughts or reassurances at all? Thanks for any advice.

Christina


Online vet, Dr. Marie

Dr. Marie replied:

Sorry to hear that Sadie is still not feeling 100%

Regarding diabetes, if your first vet was able to do any in house testing on the urine they have probably already tested for diabetes. One of the most simple tests that we do on urine is to use a urine stick that shows us a number of things including whether or not there is glucose in the urine. There is always glucose in the urine of a diabetic dog.

When you mentioned that she is leaking urine where she sleeps it makes it sound like she could have USMI. You can read about that here: USMI in dogs. However USMI is something that doesn't make dogs feel unwell at all. If her appetite is reduced then there could be something else going on.

Sometimes a dog with USMI will have increased symptoms when there is something else going on in the body that causes her to produce more urine such as a kidney problem. However, again, a kidney problem is usually something that would show up on initial urine tests as the specific gravity of the urine would be a very specific amount.

From what you have described, it may be that the "lack of appetite" is not really a lack of appetite but maybe just disinterest in her morning food.

If this were my case I would be repeating a basic urinalysis and also doing basic bloodwork to look at her liver and kidney enzymes. Regarding a culture, her current symptoms don't seem indicative of a UTI as she is not straining or having any blood. So, if this were my case I would hold off on this.

If the urine and blood tests show nothing wrong then I would consider that she could have USMI. You can read about treatments for that in the Dr. Marie



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.