Symptoms worsen after vet visit. Where to go from here?

[orion3003]

We went to the vet a few months ago for a suspected uti. She was drinking a bit more than usual and peeing more often on walks. It wasn’t anything too dramatic but just a small notice. There was 1 day she kept asking to go out which prompted the vet visit.

Urinalysis found suspected bacteria & we were given antibiotics. She toke them for 4 days until the urine culture came back negative in which I stopped. The vet said it was probably not a uti then. During this visit we also did a blood test and x rays but everything was normal except high bilirubin.

We went back to do another blood test a week or two ago and it’s a different doctor this time (but the same clinic) who is going over the last visit. He mentions something the other vet didn’t which is my dogs urine has a pH of 9 which could indicate a uti. I opted not to do another urinalysis or urine culture because of what the other vet said and just process with blood work. It came back normal. Bilirubin levels were within range.

These past few days, the drinking water has increased where it’s so noticeable. Few months ago even though I noticed a bit of an increase in intake of water, her pee was still yellow as usual. She generally doesn’t drink that much water anyways. Now it’s like light yellow to clear. And she’s peeing way more often on walks. She’s also gained a few pounds which the 2nd vet noticed. That may or may not be related to the uti symptoms but still something I wanted to mention.

Idk what to do/ go from here because it seems the vet can’t really figure out what’s going on and blood tests look normal.

 

[brennanskates]

@orion3003 I'd suggest getting back to the vet and letting them know that something still isn't right.. if they are unable to offer further diagnostics or help, then ask for a referral to an internal medicine specialist.

 

[fausto1973]

@orion3003 Lots of drinking and subsequently peeing can be a neurological issue as well. My 3 yr old started doing this and was eventually diagnosed with a brain tumor

 

[orion3003]

@fausto1973 Oh my, how did they eventually diagnose this?

 

[fausto1973]

@orion3003 Lots and lots of tests to rule other possibilities finally ending with an MRI to check her brain after exhausting every other applicable test. The whole process took a few weeks. Her other symptoms weren’t quite the same as your pup’s so I doubt it’s something that serious, but I just wanted to let you know it definitely has the potential to be very serious.

 

[honoringintimates]

@orion3003 CVT - best thing to do is get a culture and sensitivity sent out to a lab. Urine run in house is subject to much more error than being run at a lab. She may have had an infection and you need to know what drugs it is susceptible to.

Whatever is happening with the urine there is something wrong. The increased drinking and peeing is secondary to organ damage. Perhaps she has an endocrine disorder. Best bet is to see an internal medicine specialist at an ER/specialty hospital. They manage multiple diseases in patients and can advise the best. A slightly high tbil isn't terribly helpful.

 

[orion3003]

@honoringintimates How would we find an internal medicine specialist?

 

[honoringintimates]

@orion3003 google, or call local ER/referral hospitals. These are the next level of hospital that GPs send complicated cases to for 24hr management or higher level medicine. IM docs specialize in diagnosing and managing more complicated disorders/concurrent disorders.

 

[orion3003]

@honoringintimates I believe the urine culture was done in a lab. It toke a few days to get the results and it came back negative

 

[honoringintimates]

@orion3003 Yeah, it can change though. Ongoing urinary issues would warrant another culture. You don't just throw antibiotics at urinary issues, that can cause resistance. A culture takes a sample of urine and it is plated on a growth medium like agar with antibiotic samples. The places where the bugs don't grow indicates the antibiotics that work on your pet.

 

[orion3003]

@honoringintimates Can I just do a urine culture or is the urinalysis also necessary? I spent quite a bit on the last two vet visits with no answers and am trying to spend only if necessary.

Do I also have to redo the bloodwork? She’s already done it twice now.

 

[honoringintimates]

@orion3003 They can send it to a lab, they have to for the culture. Usually adding on the UA isn't terribly expensive, but it is important to be sure she is on the correct antibiotics. A pH of 9 is concerning, that is going to lead to an angry bladder. She may need a urinary diet that lowers the pH of urine.

Still, consulting IM is the best way to go. She will need repeat bloodwork and urine as things can change within days. They need current diagnostics to be able to diagnose.

 

[orion3003]

@honoringintimates I’m not sure I’ll be able to afford going to a er/internal specialist. Prices are usually higher because it’s an emergency place. With the symptoms getting worse, is it worth it to just go back to vet and retest? And possibly just do an ultrasound?

Edit: we went back and saw the 2nd vet again and he called for just bloodwork and urinalysis. Apparently this time it’s a more comprehensive blood panel and being sent to a lab instead of being run in-clinic. I had asked to also do a urine culture, not sure how helpful it is since the vet didn’t call for it

 

[honoringintimates]

@orion3003 Unfortunately your GP isn't trained in doing full diagnostic ultrasounds, that is an IM thing. You don't have to commit to doing more that the ultrasound right away, this isn't life threatening. You can get a consult and AUS for probably $500. It will take a day or so for them to go over all the info and make a report, then they can advise you what to do next. If they are too expensive they can consult with your primary vet and tell them what to do next so you don't have to have it done at the specialty hospital.

I know the repeat bloods and urine are annoying and expensive, but they can change on a daily basis.

Look into Care Credit. It is a credit card for human and veterinary healthcare. If you spend more than $250 on a transaction you can get six months no interest and most all vets take it. Just be sure you can pay it off in the six months or they jack up the interest rate and charge it retroactively.

 

[orion3003]

@honoringintimates They did mention the ultrasound was to be done by a specialist but they don’t seem to be pushing for that right now. I was thinking about asking for a referral to an IM if the vet still can’t figure out what’s going on. Would they look at her most recent bloodwork and urinalysis results so we wouldn’t have to rerun everything again?

Edit: bloodwork and urinalysis came back normal except high urine ph again and some crystals present. Based on the results he said her internal organs seemed fine. He just recommended trying a rx diet out first and then if her symptoms don’t resolve, we can do an ultrasound. Do you still think I should just consult an IM or try out the diet?

 

[honoringintimates]

@orion3003 You could go either way. It's certainly not wrong to do the urinary diet with that urine pH. It could be something as simple as a sterile cystitis because of the urine pH. It will take quite a while for the diet to work though, just be aware of that. That would certainly be the more money conscious way to go about it.

You could also start with just a consult with an IM doc. Have all your records sent from your primary and they will do an exam and go over all the labwork and make suggestions. That way you can budget if they feel ultrasound or testing is warranted, and maybe the diet will help in the meantime.

 

[orion3003]

@honoringintimates Thanks so much for answering my questions. So it seems I never got the urine culture results that I paid for and upon contacting them, the vet now recommends antibiotics after relooking at the results. I’m slightly confused because there was no bacteria present so why the use of antibiotics?

The owner of the clinic contacted me after contacting idexx and they said the agent didn’t do the urine culture test because there was no bacteria found from the urine samples. Do you think I could ask for a refund?

 

[monocle]

@orion3003 My dog has been going through almost the exact same issues. What ended up helping or how was this resolved?