bleeding penis

[palomaespecial]

Hello vets/fellow dog parents. My dog's penis was dripping blood last feb 1 so I immediately rushed him to the vet. Vet ordered for cbc, blood chem, urinalysis, pcr test and ultrasound (linked below).

significant findings:

CBC - high eosinophil, low mcv & mch

blood chem - high globulin, low amylase & alkp

urinalysis - s.gravity 1.005 , albumin +1 , pus cells 35-45/hpf , rbc 6-14/hpf , bacteria many , amorphous urates moderate

pcr test - positive in ehrlichia

ultrasound - no stones in urinary bladder , few prostatic cysts in prostate. [LINK:

https://imgur.com/a/7NscwYo

]

We were sent home with a prescription of the ff:

--- hemostan 500mg/day for bleeding - 7 days

--- doxycycline 100mg/day for ehrlichia and uti - 2 months

---finasteride (for humans) 2.5mg/day for prostatic cysts - 1 month

I was told neutering would be best but we have to clear his ehrlichia first which could take months. I asked if the bleeding was caused by the prostate but vet said no, it could be because of a urethral wound but he is unsure because urethra wasn't visualized in ultrasound. And that to come back for a follow up labwork. That day was really overwhelming emotionally and financially.

bleeding lasted for 9 days after consultation, peeing became frequent and number of potty time reduced to twice/day. I've been googling and researching but all point to prostate problems.

They scheduled us for a for a follow up check up and repeat blood test next week (Mar 7), I wanna know more about his ultrasound results from other vets here before going in so I could ask the right questions.

--- is the whole prostate visualized in the ultrasound? I don't know where it starts and ends.

--- I'm guessing his prostate is enlarged, kindly educate me. And how enlarged? Pressing on the bladder?

--- I also don't know which are cysts and not cysts. It's like staring into an optical illusion.

--- can ultrasound verify if it's benign prostatic hyperplasia and not prostatic cancer?

--- also, please tell me if I'm forgetting something that needs to be tested by his vet or important questions I'm forgetting to ask his vet.

I'll really appreciate any enlightenment. Thank you.

edit:

* Species: canine

* Age: 8 y /o

* Sex/Neuter status: male / intact

* Breed: chow chow

* Body weight: 17.5kg

* clinical signs: bleeding penis, losing weight

* location : southeast asia

LINK to urinalysis, cbc and blood chem

https://imgur.com/a/Qw3grcJ

https://imgur.com/a/wKXZGuS

[ addtl ultrasound pics ]

 

[honoringintimates]

@palomaespecial Vet tech - what breed/age/ neutered or not/age when neutered if applicable. Conditions, meds?

 

[palomaespecial]

@honoringintimates hi, thank you for replying. I edited my post to include more details I hope you could take a peek.

 

[ck23]

@palomaespecial Vet tech here as well. At my clinic where we stay very up to date on the latest treatments, unless the CBC is showing abnormalities directly related to ehrlichia - low RBC's, low platelets etc, we don't actually treat and just monitor for clinical changes as this can often lay subclinical for a very long time, similar to Lyme disease. Instead we monitor CBC every 6 months - 1 year for changes.
We also specialize in reproduction and in terms of prostate abnormalities we have historically sent out prostatic fluid cultures and urine cultures to determine if an infection is present and if so what kind to decide on appropriate antibiotic use.
The ultrasound image isn't very high quality so it's difficult to comment based on this one image alone. I don't necessarily see a cyst (this would show up as hypoechoic or a dark/black area) but there is a hyperechoic area and it's hard to say if that's prostate or not.
I'd recommend posting in the veterinary advice subreddit with specific values for the blood abnormalities (how high is the albumin etc, without knowing values it's impossible to comment) and a complete sigalment (age,breed, etc).
Please also verify if the urine SG is truly 1.005 because that is extremely low and doesn't make sense with the amount of debris and material noted in the UA.
I hope you find an answer soon! One last thing is I feel your dog could benefit from some anti-inflammatory or other pain management because I'm sure whatever's causing the bleeding doesn't feel nice.

 

[palomaespecial]

@ck23 I can't thank you enough for replying on my post, I've been wrecking my brain trying to figure out what to do. Vets here in our country usually practice alone and they do everything from extraction to ultrasound and interpretations, we don't have vet techs here or vet specialists which makes it really frustrating when trying to get to the bottom of my dog's issue as their explanation is always so vague. I'll edit my post to include everything. I feel guilty for not realizing my dog's bleeding could be painful for him, thank you for mentioning that.

 

[honoringintimates]

@palomaespecial Yeah I'm sorry I should have directed you to r/askvet. Prostate is always suspect in an older intact male. But the urine SG of 1.005 is weird. That doens't make sense with all the cellular component that was found on microscopic exam. Maybe it was a SG of the liquid component of a spun sample? That's not a thing I've ever come across but it could be a thing. The increased protein and low SG of the urine make me think kidney issues, but the SDMA/BUN/Crea are normal so perhaps it is an early kidney injury or nephritis of some sort. Neutering when he is healthy is a good idea to encourage the prostate to shrink, but you have to figure out what is happening here first. r/AskVet has loads of veterinarians, might get better answers there. Good luck.

 

[palomaespecial]

@honoringintimates Hi! I did post on r/askvet first before posting here, no responses yet though. What would be a good additional lab work to check on kidneys? Is an ultrasound of the kidneys a good diagnostic test?

 

[honoringintimates]

@palomaespecial Yeah it seems to take a few days to get a response over there. If the kidney values were normal, then you probably don't need an ultrasound. If you want to do all the things then sure. Maybe it could be a UTI and prostatitis. See how the meds go.