Hello all,

I have an 8-year-old male Jack Russell terrier that developed oxalate
bladder stones last summer. The stones were surgically removed and he
was placed on a special diet. 8 months later and the stones returned.
After a 6-hour surgery small stones were once again removed from his
bladder. Unfortunately one stone was logged in his urethra and
couldn't be flushed back in his bladder. This stone was removed 2 days
later, after recovery, again by surgery.

It's been a week now and my Jack is having trouble urinating (no flow,
just drips). An x-ray and urinalysis show no more stones, but my vet
couldn't pass a catheter. My vet suspect's scar tissue is obstructing
the urethra and he wants to put my dog under and try to stitch a
catheter in place for a week in hopes of keeping the urethra open
while it heals. If this doesn't work he is recommending an out of
state surgeon to essentially reroute his urethra so he urinates from
an opening made below his anus. My concerns are these:

1. Is there another approach that would allow us to avoid surgery if
our vet cant pass a catheter?

2. From what I understand, the procedure to reroute his urethra is
most commonly done on cats, not dogs. Is this safe or is there a
better approach?

3. Why didn't our vet tell us about monitoring the ph of our dogs
urine with reagent strips, and using Potassium Citrate Granules to
raise the ph over 6.5? We found this info on the web after his second
surgery and if we would have known this earlier we might have avoided
this reoccurrence.

Any quick advice would be greatly appreciated!

Many thanks,
Jeff Walker

You need to talk to a specialist ASAP. But for now, a catheter has got
to be placed. Your dog's condition is now beyond the scope of the
"family vet" for corrective surgery. It became beyond that scope when
the scar tissue formed.

Diet alone may not be sufficient to totally control bladder stones....
but I'm not sure what additinal measures will be needed.

Jo Wolf
Martinez, Georgia

The word adhesions come to mind.
Where after an operation two areas become like glued together.
It may not be that at all......but it just maybe.
I would get the dog to someone to get it sorted ASAP.
Pat.


"Jeff Walker" wrote in message
om...
Hello all,

I have an 8-year-old male Jack Russell terrier that developed oxalate
bladder stones last summer. The stones were surgically removed and he
was placed on a special diet. 8 months later and the stones returned.
After a 6-hour surgery small stones were once again removed from his
bladder. Unfortunately one stone was logged in his urethra and
couldn't be flushed back in his bladder. This stone was removed 2 days
later, after recovery, again by surgery.

It's been a week now and my Jack is having trouble urinating (no flow,
just drips). An x-ray and urinalysis show no more stones, but my vet
couldn't pass a catheter. My vet suspect's scar tissue is obstructing
the urethra and he wants to put my dog under and try to stitch a
catheter in place for a week in hopes of keeping the urethra open
while it heals. If this doesn't work he is recommending an out of
state surgeon to essentially reroute his urethra so he urinates from
an opening made below his anus. My concerns are these:

1. Is there another approach that would allow us to avoid surgery if
our vet cant pass a catheter?

2. From what I understand, the procedure to reroute his urethra is
most commonly done on cats, not dogs. Is this safe or is there a
better approach?

3. Why didn't our vet tell us about monitoring the ph of our dogs
urine with reagent strips, and using Potassium Citrate Granules to
raise the ph over 6.5? We found this info on the web after his second
surgery and if we would have known this earlier we might have avoided
this reoccurrence.

Any quick advice would be greatly appreciated!

Many thanks,
Jeff Walker

Pat, just for technical clarification....

Adhesions are generally found in the abdominal cavity or in locations
where motion is impeded, such as between two muscles.... both are
scarring. Scarring in the tube that's the urethra can be called either,
but since this appeared so early after surgery, I'd call it scarring
rather than an adhesion. A moot point. The resulting problem is the
same.

I'd have voted to use a silicone coated catheter after removal of that
stone in the urethra, as there was surface tissue damage. Leaving an
indwelling cather for a week or two might have prevented or at least
reduced the problem... but the problem of a secondary bladder infection
and the difficulties of caring for a dog with an indwelling catheter
point out differences between human and veterinary options.

Jo Wolf
Martinez, Georgia

I deeply appreciate the responses. I'm glad to report my vet was able
to pass, and temporarily suture in place a catheter this afternoon. To
your point Jo, my vet's plan is to leave the catheter in place for a
week to 10 days in hopes the urethra will heal in an open position.
I'll gladly take a dog in diapers for a few weeks vs. the alternative.
As I think about his condition and consider all that Ive read, I hope
I can control his stones and not just prolong an inevitable
urethrostomy. In this day of modern medicine, understanding and
controlling calcium oxalate stones seems to be far from an exact
science. –Jeff Walker

(Jo Wolf) wrote in message ...
Pat, just for technical clarification....

Adhesions are generally found in the abdominal cavity or in locations
where motion is impeded, such as between two muscles.... both are
scarring. Scarring in the tube that's the urethra can be called either,
but since this appeared so early after surgery, I'd call it scarring
rather than an adhesion. A moot point. The resulting problem is the
same.

I'd have voted to use a silicone coated catheter after removal of that
stone in the urethra, as there was surface tissue damage. Leaving an
indwelling cather for a week or two might have prevented or at least
reduced the problem... but the problem of a secondary bladder infection
and the difficulties of caring for a dog with an indwelling catheter
point out differences between human and veterinary options.

Jo Wolf
Martinez, Georgia

In article (Jeff Walker) writes:
I deeply appreciate the responses. I'm glad to report my vet was able
to pass, and temporarily suture in place a catheter this afternoon. To
your point Jo, my vet's plan is to leave the catheter in place for a
week to 10 days in hopes the urethra will heal in an open position.
I'll gladly take a dog in diapers for a few weeks vs. the alternative.
As I think about his condition and consider all that Ive read, I hope
I can control his stones and not just prolong an inevitable
urethrostomy. In this day of modern medicine, understanding and
controlling calcium oxalate stones seems to be far from an exact
science. –Jeff Walker

Jeff,

I hope this works for you and yours.

My dog had calcium oxalate uroliths removed. He is now on a
special diet from http://www.petdiets.com/ and we
keep his urine basic with potassium citrate. It
took us a long time to find the right dose.
(I have gone through at least 200 PH strips.)

Too much potassium citrate and he had struvite crystals in
his urine. Too little citrate and he had, again, calcium
oxalate crystals.

If you go to google, hit the groups tab and
search on Dermer bladder, etc. you should
find many of my posts.

Good luck,

--Marshall

Marshall,

Thank you for the advice and sharing your experiences. If I may
please, ask you one question. At what time during the day have you
found it best to test pH? I picked "Spunky" (my Jack Russell), up from
the vet today and his catheter is held in place with tape that is
sutured in place right in front of his penis. The catheter is run up
from his penis to the middle of his chest where it exits. He has a
special white gauze sweater that olds the catheter in place. Its only
been a day and it reeks because of the urine. It seems like there has
to be a better way to manage this urine flow. I going to the store and
Im going to try and rig up something to keep him clean. I have him in
the biggest cage I could find and he's situated where he can be with
us. But he's miserable and it's only the first day. He has a bit of
blood in his urine and the doctor is going to adjust the catheter in
the AM.

I currently have him on canned Purina NF, bottled spring water and 5
grams of Potassium Citrate Granules a day. For the next week to 10
days he's also taking one 22.7 mg Orbax tab a day to fight infection.
He hates the Purina food and I have to mix in a little Gerber baby
food (Chicken and Gravy) to get him to eat it. I'm going to call the
folks at Pet Diets tomorrow. Thanks again for the response.

–Jeff Walker

In article (Jeff Walker) writes:
Marshall,

Thank you for the advice and sharing your experiences. If I may
please, ask you one question. At what time during the day have you
found it best to test pH?

I measured it throughout the day. I found that it was most
acidic in the morning (5:20 AM) and gradually it became
more basic as the day passed. Right now I have it adjusted
so that it is about 6.8 at 5:20 AM and and about 8 at 11 PM.

Calcium uroliths form in acidic urine. (When the stones
were detected Max's morning urine, PH was about 5.6.) As I
adjusted the potassium citrate, I had it at levels that
produced alkaline urine that contained struvite crystals.
Dr. Remillard of PetDiets told me not to panic because it
is the rare dog who has had calcium oxalate stones that
then develops struvite stones (which form in alkaline
urine).

My dog weighs about 18 lbs and the initial dose of potassium
citrate was 500 mg, twice per day. This was much too much.
On the second administration of 500 mg, poor Max vomited and
defecated. The eventual dose that seems to work for him is
just one dose of 35 MG with his last (9:30 PM) evening meal.

In adjusting the amount of potassium citrate you have to
remember that the PH scale is a log scale. So in going from
a PH of 7 to 8 you are increasing alkalinity by a factor of
10. You might, therefore, experiment with changes in dose
by a factor of 1/3 or 1/2. The other issue is hysteresis:
there is a lag between a change and its effect. I found
that about a week would have to pass before Max's urine PH
would stop changing when measured AT A PARTICULAR POINT in
his sleep-wakefulness cycle.

Besides managing urine PH and low oxalate diet, the other
helpful factor is having the dog consume much liquid so
his urine is dilute. We always add water to Max's food: a
sort of brown rice/black-eyed pea mash. And he gets walked
about every 4 or 5 hrs. At night he is walkd at 11:30 PM
and the following morning at 5:30 AM.

For now, you face other problems as detailed below. We all
hope that Spunky will regain the use of his penis. (I
assume that this is still possible.)

I picked "Spunky" (my Jack Russell), up from
the vet today and his catheter is held in place with tape that is
sutured in place right in front of his penis. The catheter is run up
from his penis to the middle of his chest where it exits. He has a
special white gauze sweater that olds the catheter in place. Its only
been a day and it reeks because of the urine. It seems like there has
to be a better way to manage this urine flow. I going to the store and
Im going to try and rig up something to keep him clean. I have him in
the biggest cage I could find and he's situated where he can be with
us. But he's miserable and it's only the first day. He has a bit of
blood in his urine and the doctor is going to adjust the catheter in
the AM.

I currently have him on canned Purina NF, bottled spring water and 5
grams of Potassium Citrate Granules a day.
For the next week to 10
days he's also taking one 22.7 mg Orbax tab a day to fight infection.
He hates the Purina food and I have to mix in a little Gerber baby
food (Chicken and Gravy) to get him to eat it. I'm going to call the
folks at Pet Diets tomorrow. Thanks again for the response.

Do you have a good PH meter or paper indicator strip?

I found Machery-Nagel pH-Fix 4.5-10.0 worked best for me.
I bought a pack of 100 strips he

http://www.wine-testing-supplies.com...ement:phpapers

It is product #361-4004

Or you could just call:

All World Scientific
5515 186th Place SW
Lynnwood, Washington 98037
United States

Phone: 1.800.289.6753

Jeff, please keep us posted and be patient. See if you
and your family can't enjoy the process of caring for Spunky.

Nothing cures like time and love (Laura Nyro),

--Marshall

"Jeff Walker" wrote in message
om...
Marshall,

Thank you for the advice and sharing your experiences. If I may
please, ask you one question. At what time during the day have you
found it best to test pH? I picked "Spunky" (my Jack Russell), up from
the vet today and his catheter is held in place with tape that is
sutured in place right in front of his penis. The catheter is run up
from his penis to the middle of his chest where it exits. He has a
special white gauze sweater that olds the catheter in place. Its only
been a day and it reeks because of the urine. It seems like there has
to be a better way to manage this urine flow. I going to the store and
Im going to try and rig up something to keep him clean. I have him in
the biggest cage I could find and he's situated where he can be with
us. But he's miserable and it's only the first day. He has a bit of
blood in his urine and the doctor is going to adjust the catheter in
the AM.

Hi Jeff,

I would suggest posting this to the newsgroup alt.med.veterinary to see if
the vets there have any suggestions. Is it possible for you to wrap a
diaper around the tip of the drainage tube so the diaper absorbs a majority
of the urine without getting it all over Spunky's skin? Or question the vet
about some kind of drainage bag similar to human leg bag attatched to a
urinary catheter. Of course you would need to keep Spunky from chewing on
it. How do you keep him from chewing on the catheter? Or possibly clamp
the catheter and release it every couple of hours so you can at least
control where the urine goes. Only with a vets OK though. (works fine with
humans, but as a rule, most of the humans don't try to pull out their
tubes.)



I currently have him on canned Purina NF, bottled spring water and 5
grams of Potassium Citrate Granules a day. For the next week to 10
days he's also taking one 22.7 mg Orbax tab a day to fight infection.
He hates the Purina food and I have to mix in a little Gerber baby
food (Chicken and Gravy) to get him to eat it. I'm going to call the
folks at Pet Diets tomorrow. Thanks again for the response.


http://www.merckvetmanual.com/mvm/in.../bc/130413.htm

From reading the Merck vet manual (link above), and reading Marshall's post,
is a 5 gm dose excessive? Maybe they start out with a high dose initially
to dissolve the stones (which you said were gone in the original post if I
recall)??? According to Merck, the dose for prevention of calcium oxalate
stones is 150 mg/kg/day in 2-3 divided doses. How much does Spunky weigh?
a 14-18 pound dog (6-8 kg?) would be on about 1 gm a day... Maybe the
veterinary Merck Manual isn't up on the latest treatments, I don't know for
sure. The Merck manual for humans is great, though.


Good luck and keep us updated!

Shelly





-Jeff Walker

Based on my knowledge of the size of this dog, the sizes of the urinary
leg bags for humans... this would be a management problem right now.
The elastic bandage netting can be purchased by the roll so the "shirt
can be replaced frequently (daily or alternate days).

A small size disposable diaper held in place with regular elastic
bandage might work well... preemie size or next size larger... just
applied flat to his chest/tummy. Cut a couple of old men's tee shirts
(easy to watch, soft, light weight, slightly stretchy)) to hold it in
place and safety pin on top of the back.... might work better than
elastic bandage/vet wrap.

When my Dane had a laminectomy for wobblers, the long incision on the
back of the neck filled with fluid. The vet put in a drain, and I used
ostomy bags, changed daily to collect the nearly liter of fluid that
initially was draining; I could drain the bag a couple of times a day.
If the urinary catheter was cut shorter, an ostomy appliance might be
clipped open wider on the adhesive section to go over the penile shaft
and abdomen, keeping it all in the bag with regular draining. That was
21 years ago.... I don't know what ostomy supplies are out there now...
the model I used then was by Hollister. This arrangement would still
need suppport, but it would be more like a wide belly band. It would be
kinder to the skin.

You might contact area hospitals to see if they have nurses/techs who
specialize in ostomy care or wound management and talk with them for
ideas. One of them might be willing to help you on her free time. I
was a hospital nurse in charge of sterile supplies and special medical
supplies, so knew what was on the market and what had which functions in
those days... The Hollister sales lady was so fascinated when I told
her what I'd done that she came by my place and took photos for her
files.

Jo Wolf
Martinez, Georgia