Abnormal Labwork AGAIN! :(

[Ellie May]

Originally Posted by bellasmomok

Yes, the reference is ?-27, but I've been told 25 is really too close to high and that I should give Azodyl (it is a probiotic) to help support her kidneys and bring the BUN down a bit. What do you think about that?? I obviously don't know enough about it, so I'm just trying to filter through all the things I'm being told. I guess the urinalysis will tell me more.

I just got off the phone with the vet, and they said that they prefer to do a free catch first (so there isn't a chance of the results being skewed as far as blood content, since doing a cysto would introduce blood into the sample). They said they will be checking for blood, protein, bilirubin, etc... too, and then will get a specific gravity and look for crystals...they'll also get pH. THEN, if it seems like there is just an overabundance of bacteria, they will ask me to bring her in for a cysto to check for UTI, but if it's just a small amount of bacteria, they "don't worry about it". I'm not sure how this "free-catch" thing is going to go...Bella has a tendency to cut off an not go all the way if she's disrupted by sound/movement/etc... We'll see I guess. Maybe I'll try it a couple of times tonight so she is more used to it.... *sigh

I have heard good things about Azodyl and wouldn't hesitate to give it but you may want to wait until you do the U/A because considering the BUN high is questionable. It would concern me but it may be nothing at all... Either way, it won't hurt to give it as far as I know.

Ellie's vet would only take urine via cysto when sending for culture. Een at Ellie's check-up when she had a U/A, it was taken cysto (my choice). I think either way is okay for most things but with all the cystos Ellie has had (probably at least 3 or 4), I don't think there has ever been an issue with blood... I guess doing it free catch first and then doing a cysto if there is a problem is fair.

[Yorkieluv]

Crystal, same with my vet...They always take it cysto for culture. I usually prefer they do it this way anyway.
I don't think the BUN is considered HIGH, but it is very high normal so should definitely be watched, and in my opinion, support should be given.

[bellasmomok]

After racing Bella round and round the living room and playing lots of fetch and walking her (so she'd be thirsty and drink!), I brought Bella back up to work last night to take another look at her bladder. This time is WAS full!!!! AND, NO STONES!!!! Hooray! I took another look at her kidneys and they were the same.

Afterward, I took her right into my bathroom at work, put a pad down and proceeded to do a test run on catching her urine! It worked!
However, this morning was a whole different story.....I sat with her for over an hour trying to get her to go, and when she did she cut it off as soon as I tried to catch (she only got maybe 1/2 tsp out before she stopped and most of that was on the pad ). So I called the vet and asked if we could just to a cysto and they said to bring her on in....I wanted to do it before she had a chance to pee out that first morning urine!!

I just got the urinalysis results faxed to me, and here they are:
Glucose--Negative
Bilirubin--Negative
Ketone--Negative
Blood--3+ (whatever that means?)
pH--6
Protein--Trace
Urobilinogen--Normal
Nitrite--Negative
Leukocytes--Negative
Specific Gravity--1020

Then it says this:
Sedementation: Positive: Negative:
Bacteria +++
Crystals -
WBC +
RBC +

Immediately, I'm just glad she was negative for crystals!!! Yay! But it looks to me like she has a UTI, so I called to discuss it with Dr. Pitts. I'll have to call back in ~1 hr. because he's out.

Just wanted you to know....I'll let you know when I talk to him...I'm thinking she may need an antibiotic, and I wanted her to get it now instead of in a week when we get back!

[bellasmomok]

We have an appointment on Wed. the 3rd to consult another vet here in town....the vet I'd been using (Dr. Pitts) just wasn't cutting it and neither was his colleague I basically had to drag an interpretation of the urinalysis out of them and then ask for an antibiotic to treat the UTI!!! Then, they gave me a liquid (Clovomax I think??). I tried it on Tuesday afternoon and Wednesday morning, but 2/3 of it ended up on the hair on her face instead of in her mouth where it could do some good. Since we were out of town at that point, I ended up taking her, her lab work results (all of them), and the antibiotic to a local vet and waiting for an hour to be seen. He seemed surprised they would give her a liquid (given her long hair) and gave me a chewable (Baytril) to replace it since I told him how good she was at chewing up her meds. ALREADY her UTI is better, I can tell!! VERY light colored and non-smelling urine...Yay!!

So, the vet I'm consulting on Wed. is a holistic vet. I'm going to ask for a Protein C test that day as well as catch her up on everything so far. I also have an email in to Dr. Wakshlag (Cornell nutritionist) and am eagerly awaiting a response. Hopefully he will be able to help me figure out a home-cooking diet for Bella and consult with the new vet if need be. I'm getting very tired of soaking her kibble in water and then mixing it with yogurt or something so she'll eat it. Plus it makes me sad because I know she doesn't like it very much, and I'm pretty sure she's been getting hungry even with eating all 4 meals a day I upped the amount I've been giving her by just a bit because I can't stand to see her hungry....especially since she is not overweight and still hasn't shown any symptoms.

I'm also hoping I can give Dr. Wakshlag a couple of treat recipes that I've found that he can possibly modify so they will be ok for her, or maybe he can give me a recipe himself that would be good. My baby likes treats, and I'm sad that there doesn't seem to be anything that's ok to give her!!

Thanks everyone for your support, and I hope you all had a wonderful Thanksgiving!!

[Ellie May]

Originally Posted by bellasmomok

We have an appointment on Wed. the 3rd to consult another vet here in town....the vet I'd been using (Dr. Pitts) just wasn't cutting it and neither was his colleague I basically had to drag an interpretation of the urinalysis out of them and then ask for an antibiotic to treat the UTI!!! Then, they gave me a liquid (Clovomax I think??). I tried it on Tuesday afternoon and Wednesday morning, but 2/3 of it ended up on the hair on her face instead of in her mouth where it could do some good. Since we were out of town at that point, I ended up taking her, her lab work results (all of them), and the antibiotic to a local vet and waiting for an hour to be seen. He seemed surprised they would give her a liquid (given her long hair) and gave me a chewable (Baytril) to replace it since I told him how good she was at chewing up her meds. ALREADY her UTI is better, I can tell!! VERY light colored and non-smelling urine...Yay!!

So, the vet I'm consulting on Wed. is a holistic vet. I'm going to ask for a Protein C test that day as well as catch her up on everything so far. I also have an email in to Dr. Wakshlag (Cornell nutritionist) and am eagerly awaiting a response. Hopefully he will be able to help me figure out a home-cooking diet for Bella and consult with the new vet if need be. I'm getting very tired of soaking her kibble in water and then mixing it with yogurt or something so she'll eat it. Plus it makes me sad because I know she doesn't like it very much, and I'm pretty sure she's been getting hungry even with eating all 4 meals a day I upped the amount I've been giving her by just a bit because I can't stand to see her hungry....especially since she is not overweight and still hasn't shown any symptoms.

I'm also hoping I can give Dr. Wakshlag a couple of treat recipes that I've found that he can possibly modify so they will be ok for her, or maybe he can give me a recipe himself that would be good. My baby likes treats, and I'm sad that there doesn't seem to be anything that's ok to give her!!

Thanks everyone for your support, and I hope you all had a wonderful Thanksgiving!!

You had to ask for the UTI to be treated???
I think I'd be finding a different vet also.

[bellasmomok]

Originally Posted by Ellie May

You had to ask for the UTI to be treated???
I think I'd be finding a different vet also.

I know!!!! She had the urinalysis done at 7:30 am, and when I still hadn't been called at noon, I just decided to call myself....vet was out to lunch but they faxed me and would have him call. It told her I would be leaving town around 3:30 (though I didn't actually leave until 4:30), and she said he'd call before that. I tried once more just after 2, but now the vet was out on "an emergency farm call" and they didn't know when he'd be back....after putting me on hold, they said they had just talked to him and he was on the way back and would be there in 10 min. Still hadn't heard anything, so I just stopped by on the way out of town, knowing that the +++ Bacteria and blood meant that she had a UTI (which I didn't want to leave untreated for another WEEK!!!). The vet was still gone, so I asked to speak with the other vet. He was very weird, and I had to say that I thought it looked like she had a UTI. He agreed, so I asked what we needed to do for that. That's when he gave me the antibiotic ($18!!!) The vet that she saw on Wednesday only charged me $2.85 to check her out (feel her bladder), look over all her labwork, and give me the Baytril meds!! (I think he may have felt sorry for me and just charged me for the meds. He made the comment when he saw that it cost me $18 for the other meds that "they sure are proud of their medicine aren't they!" He seemed shocked that they charged so much for it...he has the same meds and uses them, but said a liquid isn't his first choice on a long haired puppy. He was really nice...I liked him a lot!)

I'm so hoping this holistic vet will be a good alternative...I'm not used to a vet like the one I've been seeing. My previous vet (in another town) was always so caring, concerned, and informative! *sigh

[Ellie May]

Originally Posted by bellasmomok

I know!!!! She had the urinalysis done at 7:30 am, and when I still hadn't been called at noon, I just decided to call myself....vet was out to lunch but they faxed me and would have him call. It told her I would be leaving town around 3:30 (though I didn't actually leave until 4:30), and she said he'd call before that. I tried once more just after 2, but now the vet was out on "an emergency farm call" and they didn't know when he'd be back....after putting me on hold, they said they had just talked to him and he was on the way back and would be there in 10 min. Still hadn't heard anything, so I just stopped by on the way out of town, knowing that the +++ Bacteria and blood meant that she had a UTI (which I didn't want to leave untreated for another WEEK!!!). The vet was still gone, so I asked to speak with the other vet. He was very weird, and I had to say that I thought it looked like she had a UTI. He agreed, so I asked what we needed to do for that. That's when he gave me the antibiotic ($18!!!) The vet that she saw on Wednesday only charged me $2.85 to check her out (feel her bladder), look over all her labwork, and give me the Baytril meds!! (I think he may have felt sorry for me and just charged me for the meds. He made the comment when he saw that it cost me $18 for the other meds that "they sure are proud of their medicine aren't they!" He seemed shocked that they charged so much for it...he has the same meds and uses them, but said a liquid isn't his first choice on a long haired puppy. He was really nice...I liked him a lot!)

I'm so hoping this holistic vet will be a good alternative...I'm not used to a vet like the one I've been seeing. My previous vet (in another town) was always so caring, concerned, and informative! *sigh

Lol, it must be nice there in OK.
$18 sounds very reasonable for MI.

[Yorkieluv]

Originally Posted by bellasmomok

Hopefully he will be able to help me figure out a home-cooking diet for Bella and consult with the new vet if need be. I'm getting very tired of soaking her kibble in water and then mixing it with yogurt or something so she'll eat it. Plus it makes me sad because I know she doesn't like it very much, and I'm pretty sure she's been getting hungry even with eating all 4 meals a day I upped the amount I've been giving her by just a bit because I can't stand to see her hungry....especially since she is not overweight and still hasn't shown any symptoms.

I'm also hoping I can give Dr. Wakshlag a couple of treat recipes that I've found that he can possibly modify so they will be ok for her, or maybe he can give me a recipe himself that would be good. My baby likes treats, and I'm sad that there doesn't seem to be anything that's ok to give her!!

Thanks everyone for your support, and I hope you all had a wonderful Thanksgiving!!

I think I've told you this before, but if she's hungry and eating well, I see no reason to restrict the amount she's getting. I would continue with the 4 meals per day of equal quantities, just increase the amount. She should not act hungry. If she does, the amount of calories per day needs to be increased. Does she not like carrots, apples, watermelon, or anything like that?
That is so ridiculous that you had to ask your vet for antibiotics!! I'm glad you switched vets. It seems like the new one listens and is much more cooperative.

[luvfla]

I just have to pop in with this...did you know that improper extraction of blood can lead to skewed results?

[Ladymom]

Originally Posted by luvfla

I just have to pop in with this...did you know that improper extraction of blood can lead to skewed results?

You are absolutely right!

The bile acid test is very reliable but the red blood cells MUST be separated from plasma (the clear part of blood) before they are sent to lab for analysis (centrifuged or spun to allow plasma separation from blood cells). Results can be falsely abnormal if the bile acid samples are lipemic (lots of fat IF the fat is not adequately removed by the laboratory analyzing the sample) or if hemolysis (burst red blood cells, makes the plasma red) occurs. The red color interferes with the color of the end point dye in the bile acid test. A clinician can tell if the sample is hemolyzed when they centrifuge the sample to separate the red blood cells from the plasma. If it is hemolyzed they should collect another sample. Drawing blood with a vacutainer needle into a vacutainer (suction of the tube facilitates the collection) may be too traumatic for some red blood cells augmenting hemolysis. Using a syringe and needle or syringe and butterfly needle appears to collect the best samples. After the blood is collected, the needle should be removed from the syringe and the top removed from the vacutainer so that the blood may be gently transferred to the vial. Results of the bile acid test should state if the samples were lipemic or if hemolysis occurred.

PSVA and MVD Research Summary

[Yorkieluv]

It should say at the bottom of the report if hemolysis occurred. Your vet should have told you if this happened, but I understand that sometimes they don't..

[bellasmomok]

Originally Posted by luvfla

I just have to pop in with this...did you know that improper extraction of blood can lead to skewed results?

Originally Posted by Yorkieluv

It should say at the bottom of the report if hemolysis occurred. Your vet should have told you if this happened, but I understand that sometimes they don't..

Yes, I did know this could happen, but the report did not say it did. I've been worried about that, though........they ought to say that the sample was a good sample or that hemolysis did NOT occur so that you knew it was good. Otherwise, there is no way for you to know!! I'm wondering if I need to repeat the test??? For that reason AND because she had a UTI at the time of the test, which I understand could have also skewed the results. Maybe the UTI is why her BUN was at the high end of normal??
I know her ALT is super high, buuuut the vet I saw out of town said that it is normally quite high in puppies and he wouldn't have been worried about it either if no other numbers were abnormal. I know ALT is commonly very high in human infants too, so it would stand to reason that it would be high in puppies too.......the info I read said that an infant's ALT will start normalizing as he/she approaches 1 yr. of age. Any thoughts on that??

Originally Posted by Yorkieluv

I think I've told you this before, but if she's hungry and eating well, I see no reason to restrict the amount she's getting. I would continue with the 4 meals per day of equal quantities, just increase the amount. She should not act hungry. If she does, the amount of calories per day needs to be increased. Does she not like carrots, apples, watermelon, or anything like that?
That is so ridiculous that you had to ask your vet for antibiotics!! I'm glad you switched vets. It seems like the new one listens and is much more cooperative.

She doesn't like raw carrots, because I tried them before I knew about her liver (did I read somewhere they shouldn't be given raw for liver dogs??).....I don't know yet if she'd like them cooked. She does like watermelon and apple, and also green beans, and I've been giving her snacks of those in between meals when it seems like she's hungry.....it just didn't seem like enough while I was gone. (She also doesn't like her food much.....she shunned it even when it was brand new when normally she thinks a new food is AMAZING!! That has made this diet change even harder since I have to add something to it to get her to eat it, unless she is super hungry--which is just sad to me . I'll be sooo glad when I can talk to a nutritionist and home cook--I really want her to like her food, but I want to make sure it's balanced before I go that route!!) I'm thinking the hunger had to do with being a LOT more active since there were puppies to play with and that she just burned up the calories a lot faster. She has seemed fine today with 25 kibbles per meal (I had started giving 30), but we're back home. Maybe I'll just have to increase when I know she has played extra hard??? (Before all this, she did eat more than usual when she would play hard....)
As for the vet, I did like the one I saw where my family lives, but Bella has an appointment on Wed. to see another vet here in town for a consult. She is an holistic vet, and I've heard really good things about her....I'm hoping she is MUCH better (it would be very hard not to be though!!)

[bellasmomok]

From the "Liver disease" thread:

Originally Posted by Yorkieluv

You are doing this temporarily until you can find out more, right? You will be retesting soon or doing further testing? Correct me if I'm wrong.
Yes, puppies need more protein than adults. Keep in mind appropriate kinds of protein though.
If the dog is doing well at the protein amount that she is eating, you can increase protein gradually every 7-10 days. Just make sure the protein type is appropriate - dairy/vegetarian. And don't add it all in one meal, spread the amount of protein out evenly throughout each meal. These recommendations are for puppies and for adults...

Ok, thanks for the clarification. Yes, I will be doing further testing, but I hadn't thought about this change being temporary.....I had thought that this was her fate since her numbers were abnormal. Is there still a chance that she won't need this forever?? Is there any chance at all that her UTI caused her BUN to be high normal and caused her bile acids to be off (or her BAT was off because she smelled food before her pre--which I'm pretty sure she did--and/or because it was lipemic or hemolyzed??) and that her ALT is off because she is a puppy?? I'd love to have some hope, but I understand if it would be false hope. Maybe I need to have her tests redone?? If so, when? (She is on Baytril for 10 days for her UTI, so her last dose will be on Friday, Dec. 5th. Her urine is already LOT better!! Yay!! I will be doing another ultrasound on her kidneys myself probably Tues. night--so I can see them before her vet appointment on Wed.--I'm hoping to see that the hydronephrosis I saw previously, which is a sign of a UTI, will be resolved! If it isn't, I'll do it once more after her dose is complete just to see.....I'm also wondering if I should do another urinalysis....I guess I'll know if I need to do that if her urine gets darker when she's completed the meds???

[bellasmomok]

I remember reading that "chicken fat" listed as an ingredient is totally different in terms of allergies anyway than chicken or chicken meal. I believe I read someone say that dogs are normally allergic to the protein but that the chicken fat wouldn't cause an allergy if the dog were allergic to chicken. Is that right??

The reason I ask is that I have been wondering if I could boil chicken and then use the "broth" to soak her kibble in instead of just plain water?? I think the water would take on the taste of the chicken and might make it more appealing to her? (I of course wouldn't give her the chicken.)

In addition to apple bits and watermelon, I have been occasionally giving her a cucumber bit.....is cucumber ok? She LOVES it! I didn't think this one would be bad, but I wanted to check. She also loves green beans, so I'm planning to have some of those ready too for a snack. I've talked to someone about oats being high in purines (I think??), so are those a no-no because of her ALT or because of her BUN? She loves dry cereal (I have given her a rice chex before, but they contain sugar, etc... so I'll need to find something else.....maybe a kashi product--they have pretty limited ingredients) so I'd love to be able to have something like that she could have.

Also, is celery bad? I've never tried it, so I don't know if she'd like it, but I know it's basically like eating water for humans, so I wondered if it would be ok to try with her??

[Ellie May]

Originally Posted by bellasmomok

From the "Liver disease" thread:


Ok, thanks for the clarification. Yes, I will be doing further testing, but I hadn't thought about this change being temporary.....I had thought that this was her fate since her numbers were abnormal. Is there still a chance that she won't need this forever?? Is there any chance at all that her UTI caused her BUN to be high normal and caused her bile acids to be off (or her BAT was off because she smelled food before her pre--which I'm pretty sure she did--and/or because it was lipemic or hemolyzed??) and that her ALT is off because she is a puppy?? I'd love to have some hope, but I understand if it would be false hope. Maybe I need to have her tests redone?? If so, when? (She is on Baytril for 10 days for her UTI, so her last dose will be on Friday, Dec. 5th. Her urine is already LOT better!! Yay!! I will be doing another ultrasound on her kidneys myself probably Tues. night--so I can see them before her vet appointment on Wed.--I'm hoping to see that the hydronephrosis I saw previously, which is a sign of a UTI, will be resolved! If it isn't, I'll do it once more after her dose is complete just to see.....I'm also wondering if I should do another urinalysis....I guess I'll know if I need to do that if her urine gets darker when she's completed the meds???

Since there are about a bajillion new cases of liver disease on YT in the last few days, I'm forgetting what testing each Yorkie has had and if their bile acids are very high or only slightly elevated. Because I don't want to keep rereading these threadds, could you give me her BAT results again and the second ALT? Wasn't it like 4? post and ALT 2?? ? I would guess the BUN could be up for that but not sure. It might be worth redueing. If the ALT were to come down and the bile acids were to stay only slightly elevated and she remains asymptomatic, supplementation may not be necessary (I still would but some don't). If the BATs do stay even slightly elevated, I would avoid the foods that could be considered more toxic to her like red meat. I personally also wouldn't want to give NSAIDs and I'd be careful with anesthesia. The ALT being that high, puppy or not, has me wondering though.

As for all of this purine stuff, it may be good to pay attention to it but I just don't with Ellie persay. We mostly watch the protein and still aren't clinical with that because she seems to be okay and nobody involved in her care has been concerned about low purines. This is definately something I'd look into if she because symptomatic.

Is Bella allergic to chicken?
Is that why you are avoiding it or is it because you don't want her liver to have to process it?

I had read that same thing about chicken fat not causing allergy issues but haven't confirmed.