Sunday, July 24, 2016

To Pee or Not To Pee, That Is the Question

"Buddy" the Bassett's Urinary Bladder Stone X-ray

                               Urology,  or the study of urinary tract health,  is a topic near and dear to my heart. My Welsh Corgi, "Bunny," enjoyed good health until she developed chronic kidney disease at the age of twelve.  During our nine month journey with Bunny's kidney failure, she taught me a lot about  treating  patients with her condition.  While I do not enjoy diagnosing kidney failure in pets, managing this condition gives me the opportunity to  utilize both my experience and  training to improve the quality of life for patients that face this terminal disease.

                                Besides managing kidney failure patients, another enjoyable area of urology for me is correcting urinary incontinence in pets.  Surprisingly, this condition is quite common, especially in dogs. One of the best ways for a dog to get its parents' attention is to literally wet the bed. An incompetent bladder sphincter is usually the culprit. With a little help from oral sphincter control medication or hormone replacement therapy, a pet's leaky plumbing can be readily treated so Fido will be invited back into the bed again.

                                Perhaps the most fun and satisfying area of veterinary urology is diagnosis and treatment of bladder and urethral stones. While urinary stones are not fun for the patient, seeing the "treasures" that  grow inside an animal's urinary tract can be quite amazing. "Buddy," the Basset Hound, reminded me of this recently when I surgically retrieved over 140 stones from his bladder, varying in size from millimeters to the size of a plum. His diagnosis was actually made by feeling the grating "bean bag" that was his urinary bladder during his physical examination.

                                Dogs and cats get a variety of urinary stone types, the two most common being struvite (magnesium ammonium phosphate) and calcium oxalate stones. Urates are the third most frequent stone type, and similar to oxalates, are usually genetic in origin. Struvite stones, on the other hand, are unique in that they are formed secondary to bacterial infections of the urinary tract, and may be treated surgically or by feeding diets designed to dissolve them (Hill's Prescription Canine or Feline s/d or Feline c/d). 

                                Once  urinary stones have been removed, analyzed and identified, veterinarians will prescribe an appropriate dry diet with added water or a canned formula to help prevent stone re-occurrence. Feeding the recommended diet exclusively is essential!

                                Unfortunately,  urinary stones can become a life-threatening emergency if they become lodged in the narrow outflow tube of the bladder or "urethra."  In addition, in male dogs, the urethra is very long and makes a "U-turn" at the back end of the dog's body  before it reaches the tip of the penis. This bend in the urethra is a likely site for stones to get hung up, and is difficult to reach during stone removal attempts.

                                Please be aware that if your dog strains to urinate and no urine is produced, it is experiencing great discomfort associated with either obstruction of the urethra, an over-distended bladder or bleeding and inflammation of the lining of the urinary tract. Likewise, cats that are frequenting the litter pan more than usual, standing or lying in the litter pan for extended periods, or urinating blood are in distress! If your cat or dog experiences any of the above symptoms, please seek immediate advice from your veterinarian.

                                Finally and sadly, cancers also occur in the urinary tract of pets.  The most common urinary cancer is transitional cell carcinoma of the bladder or urethra. These tumors are initially difficult to detect and their symptoms may mimic a urinary tract infection. For this reason, it is important to do regular urine testing, especially for senior pets, to provide early diagnosis, when cancers are most treatable.

                                Prostate cancer in un-neutered male dogs is yet another concern.  This cancer may cause difficult to treat urethral obstruction and is preventable with routine neutering at an early age. Both urinary and prostatic cancers are treated and palliated with oral chemotherapy drugs that are also non-steroidal anti-inflammatory medications, including  piroxicam and meloxicam. 

                                Lastly, don't wait for "Tommy" or "Toto" to have to make the decision "to pee or not to pee" inappropriately. Ask  your veterinarian to perform blood wellness testing for kidney health on your pet regularly because, as always, an ounce of prevention is worth a pound of cure! 
By Dr. Bonnie Jones

Dr. Bonnie Jones is co-owner of Delphos Animal Hospital which she operates with her husband, John H. Jones, DVM .  She was valedictorian and Outstanding Senior Clinician of The Ohio State University College of Veterinary Medicine Class of 1985. 


The Moments That Matter


Dr. D. O. Jones deworming a sheep

            "Do you remember me?" asked the lady as I examined her new puppy. I must admit, I was at a bit of a loss. She was nice looking, with a pleasant smile, and sparkling blue eyes, but I really had no recollection.
            "You came to my house about eight years ago and put my old Boxer to sleep."
            That did jostle a brain switch. "Did you bring him here a few weeks before, wanting a second opinion?" I replied. She nodded in agreement.
            "I do remember. I wrote a column about you!"
            The column, "Laughter is the Best Veterinary Medicine," told of my feeble attempt at humor to help this woman with the sad situation she found herself in. Her dog, an ancient Boxer, had been having some difficulty getting around, and she was feeling pressure from others to have him euthanized.
            I could tell as soon as I entered the exam room she was quite upset- the already huge pile of tissues was a good indication. Yet, through her tears, she made it very clear that she didn't want any more testing or medications, she only wanted a second opinion. So after examining the dog, I gave her one.
            "I think your dog looks pretty good...but, you're too emotional."
            This comment was followed by what I described as "pin drop silence for a very uncomfortable eight or nine seconds." Fortunately, she finally did laugh at my joke. Although the laughter temporarily lightened the mood in the room, it was still dampened by the sadness.
            Following a quick reminisce of this moment, and of the euthanasia call to her house, which was much sadder, I realized why I didn't recognize her. I had never seen her happy before. But she was happy now. She had a new Boxer puppy. Who wouldn't be happy with one of those?
            When I excused myself to check on the puppy's stool results, I actually printed a copy of the column. She had never read it. I didn't use her or her dog's name in the column, and figured she likely wouldn't see it anyway, so I didn't seek her approval to publish it, like I usually do.
            After I handed the column to her, she put it in her purse, smiled shyly, and said she'd read it once she got home. Upon my return from really checking on the sample, I found her with the  puppy on her lap, the column in one hand, and a tissue in the other. The tears were back, but this time she said they were happy tears. And she was right. As I've become somewhat of an expert on her tears, there was quite a distinct difference. Apparently, puppies have a way of brightening our lives, and making even sad memories more tolerable.  
            I suppose most of us who become veterinarians do so because of a love for animals, though some may aspire to the profession because they like the science or medicine aspect of it. I wanted to be a  veterinarian, not only to help people with their animals, but to also have a career full of memorable moments like this one with the lady and her puppy - a simple interaction between two people that defines and bonds us as humans.        
            This trait I probably garnered from my dad. He was a people person. He was also a veterinarian. For over thirty-five years he taught at Ohio State, and had a rapport with his students few other professors could match. I feel blessed to have had him as one of my teachers. Sadly, he developed lymphoma during my senior year of veterinary school and died five months before graduation.
            One thing I learned from his death, is how precious those special moments can be. During the last few weeks of his life, I was able to visit with him often, listen to his stories, and learn his philosophy about life, including hearing about his unwritten book, "Don't Rock the Boat." More than thirty years later, these truly are the moments that matter the most. This may be the most important lesson he ever taught me.
            Many thanks to all of you, and of course your animals, for providing so many wonderful moments and memories over the years. And thank you, Astro's mom, for giving me one more. Happy Father's Day.
By Dr. John H. Jones

Trust Them To Be Dogs...

I was driving home from vet school late one Saturday night and, after three hours in the car and only ten miles from home, as I drove through a sharp curve, something was suddenly in front of me. It was fawn in color so I thought coyote immediately, but I realized it was a dog. I stopped short and the dog ran off. I pulled over in the nearest driveway and got out hurrying to the nearest farm house to see if they were missing a dog. They weren’t and had no clue whose dog it might be that had dashed in front of my car.
I wandered down the side of the road in the dark with a cell phone that was almost dead in a dress suit with no jacket, looking for the dog in the freezing cold. It took some searching, but I finally found the dog, which turned out to be a young Mastiff standing over another dog that was clearly injured. The other dog growled at me as I approached threatening to bite, so I backed off and called 911 to send a sheriff. I managed to get a leash off one of my two dogs, who were both in my car, and a collar to put on the dog that wasn’t injured to prevent her from running back into the road. It turns out the dogs hadn’t strayed far from their home and the sheriff came quickly, but not before their owner arrived.
Their owner was heartbroken of course to see her dog had been hit by a car and kept saying her dogs didn’t leave the yard normally. The sheriff arrived and we got the dog into her car and off to the veterinarian.
The owner’s words — they normally don’t leave the yard — kept running through my head. Unfortunately, that night they did and crossed a dark highway at the wrong moment and someone hit one of them. The situation reminded me of an article I read once about dog training and doing it safely. It discussed how even the best trained dogs can go tearing across a parking lot after a squirrel if off-leash at the park or in the right situation could behave in a manner that could threaten their lives. That is the truth. Dogs can get distracted and momentarily forget training. At the wrong moment, that can cost a dog its life. 
I love my two dogs and we do train regularly in obedience as well as other disciplines several of which involve working off a leash. Most of the times my girls are great, responding to my cues to come when asked. When I visited family not long ago my girls came along and whenever they needed to go out I would put them on leashes and go out into the yard. My family was amazed that my dogs that I show and compete with needed leashes. I told them it wasn't that they aren't trained, it is that I trust them to be a dog. I trust them to leap at the sight of the squirrel and maybe momentarily forget there is a road between them and said squirrel. I trust them to see someone running down the road that they want to visit. I trust them to be what they are, dogs, and as their owner I need to do what I can to keep them safe.
By Dr. Jill Dentel