What to Expect When You Go To The Vet for a Dog With Urinary Tract Infections: (Of course, your vet may do things differently)
History: Dogs with urinary tract problems are usually brought into clinics because they are urinating in the house, squatting to pee excessively, often with very little urine produced. Sometimes a little blood in seen in the urine.
Exam: Most of the time exam findings are unremarkable, but nonetheless, your vet will go over your pet from head to toe looking for fever, pain, discharges, and look for additional or associated problems. Remember that problems often come in multiples. A good history is also a part of a good exam. Your vet will want to know about duration, past urinary tract problems, diet, and any medications your pet is taking. For middle aged and older male dogs, your vet will palpate the prostate gland.
Effort in getting a good diagnosis: Like so many things in life, you and your vet will now need to decide how much money and effort you're willing to spend in getting quality results. Whether to treat the symptoms and slap the patient on antibiotics that are likely to work or whether to spend a little effort on getting a firmer diagnosis. Mostly, this means doing a good diagnostic work up:
Urinalysis: This fairly inexpensive test confirms whether we do indeed have a urinary tract problem. Sometimes dogs urinate in the house for behavioral reasons. Urine testing tells us if there is blood in the urine, gross infection, sugar (associated with diabetes), casts (associated with kidney disease), crystals (associated with bladder stones, hydration, and diet factors), urine pH (diet), ketones (protien losing diseases) urine concentration (kidney function) and bilirubin (associated with liver, gall bladder, and systemic diseases). This test is routinely done at most clinics for the obvious reason that we learn so much for so little money. Expect your vet to do this informative test as part of his or her diagnostic work up and also as a follow up test after treatment.
Urine Culture: This test has a few problems and is often skipped, especially at first, but is often done if initial treatment fails. The problems are moderate expense, a delay in getting results for 1-2 weeks, and the frustration of getting inaccurate results. Still, with careful effort in getting a good, non-contaminated sample and a little wait, we learn 2 valuable pieces of information: Which bacteria or combination of bacteria is causing the problem and which antibiotic therapy is most likely to work. This is especially valuable information if previous treatment(s) have been unsuccessful.
Blood Work: A blood chemistry panel and complete blood count is one of our most basic tools in evaluating a patient's overall health in both human and veterinary medicine. Remember that urine is waste expelled from the body and a urinary tract problem may really be just secondary to something bad going on "UPSTREAM" such as metabolic diseases (diabetes, adrenal gland diseases, thyroid problems, liver and digestive problems), kidney diseases, infections of the blood, cardio-vascular diseases, toxins, or organ damage due to parasites, adverse side effects of drugs, and so forth.
These routine blood tests alert us to the presence of all of the above diseases to some degree. I highly recommend routine blood work as part of your pet's diagnostic workup.
For example, your vet may offer as a second choice some screening tests for blood sugar, creatinine, and Blood Urea Nitrogen (BUN) that at least help rule out the the more common diseases associated with urinary tract problems which are diabetes and kidney disease.
Radiographs: This is straight forward. Some bladder infections and other problems are due to damaged urethral and bladder tissue caused by bladder stones. Radiographs usually let us know whether or not there are any stones present and if so, whether or not surgery is likely to be needed for removal. I certainly recommend radiographs for patients with repeat infections or if it's obvious that it really hurts for the patient to urinate, or if there are a lot of cyrstals in the urine sample.
Other imaging techniques: Up until recently, most general practioners didn't have ultra sound machines available. Most, including me still don't. But they are getting to be more common and there are times when ultra sound or MRI's are superior to radiographs. As the expense goes down, don't be surprised that these techniques will be recommended more and more.
Treatment Choices
Your vet will probably recommend some combination of the following:
Antibiotics: Infection, whether all by itself, or in combination with other problems such as stones, diabetes, kidney disease etc is the most common finding in dogs with urinary tract problems. Your vet will choose which antibiotic and the duration of antibiotic treatment based on some combination of experience, budget, patient tolerance, convenience to the owner, and test results.
pH Modifyers: Often changing the pH of the urine will help speed up the resolution of an infection and more importantly prevent future crystals, stones, and infection. pH modification is usually done with prescription diets and or medications such as dLMethionine or cranberry extract.
Mucosal Protectants: These medications are somewhat controversial on how helpful they are, but glucosamine, Durlactin, pyridium, and urinary antispasmotic tablets containing methylene blue dyes (safe?) are all sometimes used for either their coating-soothing properties or anti-inflammatory properties.
Pain and Anti-inflammatory Medications including Steroids: Short term steroids are great for reducing inflammation and bleeding and are also good at stimulating thirst and therefore drinking and voiding; helping to "flush" out the sediments and crud of bladder infections. BUT, steroids can also suppress the immune system, reduce sphincter control, and cause a host of other potential problems. Some vets refuse to use them for routine cases, others do, but for only a short period. Alternatives include Atopica, Durlactin, diazepam, phenobarbital, and/or non-steroidal pain medications such as Rimadyl.
Stress Management: It's become quite apparent in Feline medicine that stress is often the root cause of so called bladder infections. It may be that this is also true with our canine patients. So your vet, in some situations, may suggest a trial of prozac or other similar medications
