PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on May 16, 2023 16:17:40 GMT -7
Curtis so glad to hear the infection is really underway with the recurrent UTI's and how much better Moet feels!! When there are reoccurring UTI's, sending the urine out to a lab to be grown (cultivated) over the course of several days is the only way to identify the strain so it matches up with the right antibiotic. And to also know if the specific culprit strain of bacteria has been wiped out with the antibiotic course. "One to two weeks after the course of antibiotics is completed, take another Urine Culture and Sensitivity Test to make sure the UTI is completely cleared up." ==> dodgerslist.com/2020/06/09/recurrent-uti/A follow up Urine Culture would be something to consider.
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Post by Curtis & Moet on Jun 3, 2023 21:02:34 GMT -7
Another update on Moet. The first couple weeks the improvement with Clindamycin was great, but this week we're starting to find her diaper full of pee again, and a couple times expressing her started seeing more puss towards the end. Urine itself is still clear though. We still have about a week of Clindamycin left but may have to talk to the vet about continuing with one of the others that the culture showed was effective.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jun 4, 2023 9:13:33 GMT -7
Curtis, sorry to hear UTI related issues continuing with the appearance of puss/mucus in the urine and not holding urine. Let us know what your vet's thoughts are to get the best handle on infection. Recurrent UTIs can happen possibly to some of these reasons: --- The antibiotic dose and length of use were not correct --- A clone of the original bacterium with a different requirement to kill it is needed. --- A reinfected bladder may mean an altogether different bacterium is involved. There is a short path for bacteria from the outside to travel into the female bladder. -- The original bladder infection was due to multiple bacteria strains. One or more strains may not have been a match for the selected antibiotic and bacteria survived to multiply.
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Post by Curtis & Moet on Jun 5, 2023 16:28:46 GMT -7
Just talked to our vet and we are switching Moet from Clindamycin to Chloramphenicol tomorrow for 2+ weeks. He said it's not uncommon for dogs with this staph bacteria to develop resistance quickly to Clindamycin. After that we're left with just 2 other options from the sensitivity test - Nitrofurantoin and Amikacin.
Moet's pyoderma caused by the staph is still recovering. We think the Chlorhex 4% shampoo is doing the most there, but obviously the antibiotic systemically is helping that too if it's the same bacteria (which is likely of course).
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Post by Romy & Frankie on Jun 6, 2023 13:46:56 GMT -7
I hope that the change to Chloramphenicol will provide relief to you and Moet.
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Post by Curtis & Moet on Jun 7, 2023 7:03:06 GMT -7
Well good news already. After just one dose yesterday evening, Moet's diaper was back to being almost completely dry this morning after 8 hours overnight, and her urine was more clear too. This is the fastest response we've seen from any antibiotic, so hoping that this one will do the trick! Dosing is 1.5 pills 3x's per day for 2 weeks, so more consistent dosing throughout the day might also help.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 10-11lbs approx 12 y.o. ] Chloramphenicol as of 6/6 ?mgs 3x/day for 14 days]
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jun 7, 2023 7:17:06 GMT -7
Curtis, what a relief to see this antibiotic quickly have an effect!
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Post by Curtis & Moet on Jun 25, 2023 8:54:18 GMT -7
Another update - we finished Chloramphenicol on Tues and are already seeing signs of UTI again unfortunately (diaper full of dark urine that smells fishy). We think that these signs were starting up again before she finished the antibiotic though.
We have left our vet a message to call first thing tomorrow to figure out the next plan. Pretty disappointing that yet another antibiotic appeared it was working well and then stops. We are down to 2 left on the sensitivity test which showed effective against the staph. Nitrofurantoin and Amikacin. I'm not sure if they will want to see her again or just prescribe one of these.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jun 26, 2023 10:06:29 GMT -7
Curtis, I'm so sorry to hear evidence of bacteria still existing. Let us know what your vet thinks if possible a new strain developed not affected by that antibioic or what? What are his thoughts if a urine culture may be the only way to know what bacteria exists currently.
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Post by Curtis & Moet on Jun 26, 2023 19:22:06 GMT -7
Spoke with our vet again this evening. He's certainly being as helpful as he can, but said we are definitely starting to get limited on treatment options, unfortunately. He has not had to deal with a bad bacteria like this many times. Suspects that it's MRSP still at this point. He prescribed ✙ Nitrofurantoin 25mg 3x's a day for 5 days, but I'm having problems trying to get it. It's not something they carry, and human doses at all the pharmacies I got ahold of before they closed are 100/50mg capsules, so I get to call around to compounding places in the morning to try and see if someone can do it for us. Being a capsule is apparently the main problem from a friend who worked in the compounding industry. If Nitrofurantoin doesn't work we will try Amikacin injections once a day for three weeks, however he warned that there are potential issues with kidney damage unless we keep her very well hydrated. If somehow that also doesn't work he said the only options left are to retry the others from the culture sensitivity test, and/or get another culture to see if there is any change in the sensitivity. The real last option would be contacting specialty treatment centers for people that contract MRSA (methicillin resistant staph aureus, vs psuedointermedius) to see if they would allow her to get on a treatment plan with them somehow, however he said that many of those places do not like to consider treatments for animals since they are already dealing with life/death situations for people. I asked about a multi-antibiotic treatment plan as well, but he recommended against that saying it can actually make things worse. We are certainly getting very concerned at this point as we run out of treatment options. I always feared that some kind of complication related to her bladder/kidneys from the paralysis would end up causing some dangerous situation like this. We will certainly do another culture soon if no progress with Nitrofurantoin or Amikacin (or even sooner), and I think we will consider contacting A&M University if neither of these work to see if there is any way for them to help. I've been doing a lot of reading tonight about this and wanted to share some links for anyone curious: Good explanation of reading culture and MICs: www.tldrpharmacy.com/content/what-every-pharmacist-should-know-about-antimicrobial-susceptibility-testingSummary of MRSP: www.medvetforpets.com/methicillin-resistant-staphylococcus-pseudintermedius-mrsp-dogs-cats/Comparison of drug treatments: agriculture.vic.gov.au/__data/assets/pdf_file/0010/605764/AGVIC_A5_SmallAnimals_Flipbook.pdfLarge study of treatments of MRSP: ohiostate.pressbooks.pub/osuvmcabxuse/chapter/abx_nitrofurantoin-companion/Others: www.frontiersin.org/articles/10.3389/fvets.2022.867784/fullfiles.brief.vet/migration/article/39851/top-urinary-tract--prostate-antibiotics-39851-article.pdf
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jun 27, 2023 7:43:41 GMT -7
Curtis, thank you for sharing your readings. These recurrent UTIs are definitely complicated things. Hope you are successful in getting the Nitrofuration compounded for Moet.
It does appear your vet is hinting perhaps a consult with a specialist would be something to consider? The last urine culture/sensitivity was done end of April 2023. Because of the importance in timely treatments ...just throwing out this idea: Could the bacteria landscape have evolved or changed, making the April 2023 culture less valid for selecting the right antibiotic today? Is sooner than later the time to consider getting a referral to A&M specialist?
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Post by Curtis & Moet on Jun 27, 2023 18:46:12 GMT -7
Luckily I was able to pickup Nitrofurantoin this morning. I left a message with the vet's office this morning asking about doing another culture before starting her on it, but they have been very busy lately and I did not hear back in time, so decided to go ahead and start her on the med this evening to avoid further delay. It should work very quickly (within 4hrs), and from studies I read last night it has a low chance of resistance to MRSP (1.8% in a 1100-1200 sample study, compared to 18% for Chloramphenicol and 35% for Clindamycin), so keeping fingers crossed that this one will finally work. The last 2 meds were ~2 weeks each, so this one will be much faster, and hopefully we'll be able to schedule another culture for early the week of July 10th (our vet wanted 1 week with no antibiotics before a culture last time).
Yes, we suspect that the culture results will change a bit and show intermediate or resistance levels for Clindamycin and Chloramphenicol, or at least still sensitive but with higher MIC values, however the vet recommended moving forward still with one of the other antibiotics that showed sensitive from the report. Collection was 5/3.
I do have confidence in our vet, but yes, if somehow Nitrofurantoin also doesn't work, then we are going to reach out to a specialist that can concentrate on her whole case more closely, especially considering that we would be down to only Amikacin from the original culture. I've already started trying to get some recommendations.
As my cousin (a cardiologist) always says, "you are your best advocate", so that's why I've been trying to read up as much as I can on this bug and how to work with the vet(s) for the best treatment. He's also checking with some microbiology contacts for input as well.
Appreciate all of your responses and encouragement, Paula.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jun 27, 2023 19:44:53 GMT -7
Curtis, you are Moet's best advocate! Love how you are boning up on this topic and being proactive. Miracles of miracles, may the Nitrofurantoin be the answer for Moet.
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Post by Curtis & Moet on Jul 9, 2023 17:06:56 GMT -7
Another update. We did 6 days of Nitrofurantoin, completed on Monday, but then on Friday morning we started getting a lot of urine and some mucus in her diaper again, and some coagulated blood towards the end of expressing one time. We promptly took her back to the vet that afternoon where they decided to start her back on another ~5 days of Nitrofurantoin, and we're reaching out to two specialists in the morning to figure out which one is the best fit going forward. Our normal Dr. at the vet wasn't available Friday afternoon so we saw another Dr. which was good as a second opinion. We ran a liver/kidney blood panel and luckily all looks good there, so this Dr. thinks the blood was related to inflammation in the lower urinary tract, not from infection in kidneys. She also said that the last time they had to refer to a specialist for recurring UTIs like this, the specialist indicated that for dogs it's not necessarily guaranteed that the infection will go up into kidney's and cause damage (at least not quickly). Obviously that isn't changing our plans for treatment though.
Moet is acting completely fine, thankfully. It has been almost 48hr since we started the antibiotic again. No more mucus, and urine when expressing is clear, however we're still finding urine in her diaper changing even every 3-4hr.
I'll report back after talking with the specialists tomorrow.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jul 10, 2023 12:58:18 GMT -7
Curtis, good to hear Moet is feeling normal. I can imagine this is worrisome to you. Hoping the specialist will have a path to follow in getting rid of this infection.
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Post by Curtis & Moet on Jul 14, 2023 6:19:43 GMT -7
We just finished the additional 5 days of Nitrofuratoin last night but have had full diapers most of the time and mucus in her urine periodically when expressing the past couple days (especially at the very end of expressing when trying to fully empty). Yet another antibiotic failure, unfortunately. [MED LIST/HISTORY- Moderator's Note. Please do not edit 10-11lbs approx 12 y.o. ] Chloramphenicol as of 6/6 ?mgs 3x/day for 14 days Nitrofuration as of 6/27: ?mg ?x/day for 17 days ✙Carprofen 12.5mg 2x/day ]
We are scheduled to meet with an Internal Medicine vet on Thursday but might get worked in sooner. The appointment is for 60-90 minutes, so glad to get plenty of time with him to go over everything thoroughly.
Starting Moet on an ✙anti-inflammatory until then to try and prevent recurrence of blood in urine since she will need to be off antibiotics for the visit with the specialist, and obviously this one isn't working either anyway. Most likely doing an abdominal sonogram to look for potential root causes of this (such as a colovesical fistula possibly), and also doing further labs and another culture.
Moet is still acting totally normal at least.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jul 14, 2023 8:41:02 GMT -7
Curtis, appreciate your taking tine to educate us on the progress of this recurrent UTI. Good news is a Thurs appt with an Internal Medicine specialist. Fingers crossed an experienced specialist's detective work for the root cause for bladder infection paired with a new culture will produce the correct therapy to get rid of the UTI. Which anti-inflammatory is being used? So glad to with all this going on, Moet remains her usual self.
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Post by Curtis & Moet on Jul 16, 2023 21:47:41 GMT -7
They prescribed Carprofen 12.5mg every 12 hours. Changing Moet this morning we found redish mucus again, and when expressing a lot of mucus came out, and some urine that clearly looked red with blood, ugh . Notified the specialty vet in case somehow that gets her in faster.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jul 17, 2023 7:05:45 GMT -7
Curtis, not what you want to see for sure. Hope you have success getting her in for faster attention with red blood in urine.
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Post by Curtis & Moet on Jul 20, 2023 9:48:29 GMT -7
Back from our appointment. Dr. Rolfe at VCA was great. They did an ultrasound and found that her bladder wall is pretty thick on the lower part (asymmetrically) due to the infection, inflammation, and gravity keeping the infection on that part most likely. The imaging is smooth, so they do not suspect cancerous - also I would agree since antibiotics have obviously stopped all symptoms previously, and that wouldn't have happened if it was bladder cancer.
Dr. Rolfe commended us highly on how well we've taken care of Moet for 7 years in her condition. They are attached to a surgery center that does back surgeries which ends up with some patients paralyzed like her, and said that most don't have this good of an outcome for this long, and that she is doing exceptionally well except for this infection.
They are running another culture with a wider panel of antibiotics. Most likely going to start her on Amikacin next week after those results are in, unless the culture shows additional antibiotics that the bacteria is susceptible to which would be better. He said that he has seen great results with Amikacin in other similar resistant UTI infections. He also wants to put her on Pronin or Incurin to stop incontinence, which he believes is making it harder to fight the infection. We are also going to start her on several supplements to help try and return the bladder to normal function in general while on the next antibiotic. We use D-mannose on her food occasionally already (which helps prevent bacteria from attaching to lining of urinary tract), but he also has recommended:
1. Crananidin --inhibits the ability of microorganisms to adhere to the epithelial cells that line the urinary tract (over the counterl internet --i.e. Chewy.com, use label dose) 2. Denamarin --decrease oxidant injury (available from a veterinarian, use label dose) 3. Probiotics (some options --Forti-flora, Proviable, VSL#3 (vsI3.com), VetVisbiome) --promote healthy bacteria (primarily in the GI tract) (use label dose) 4. Omega 3 fatty acid supplement (~60-100 mg/kg, 400-500 mg for Moet, of combined DHAI EPA daily)-anti-inflammatory 5. Glucosamine/ chondroitin sulfate --Dasuquin/ Cosequin --helps nourish and strengthen the urinary tract lining.(label dose) 6. D-mannose by Pure Encapsulations --help prevent bacterial adhesion. The dose for D-mannose is 1/8 scoop (or 1/16 tsp) to 1/4 scoop (1/8 tsp) 2 to 3 times a day 7. Vitamin C (ascorbic acid) --helps to acidify urine, making the bladder a less inviting environment for harmful bacteria to colonize (canine multi-vitamin, label dose)
I'll report back next week when we get the new culture results and what we're going to move forward with, but we'll start these supplements as soon as we can get them.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jul 20, 2023 10:39:37 GMT -7
Curtis it is wonderful recognition by a specialist to confirm the excellent attention to detail and care for Moet you've provided all these years! Unfortunate a resistant infection befell Moet. May help be on it way soon to beat it with Dr. Rolfe's help.
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Post by Curtis & Moet on Jul 24, 2023 13:28:25 GMT -7
Good news. We just got the culture results back and it's a different strain that is more treatable now. Proteus mirabilis. It appears we may have gotten lucky that one of the antibiotics did knock out the MRSP. No need for the wider panel of antibiotics on the culture. I noticed that the smell of her urine has changed recently (mentioned above) where it is more "salmon skin sitting in the trash for 2 days" type of smell, which we weren't getting around the time of the last culture, so it does make sense that we are dealing with a different bacteria now producing different smells. From googling, Proteus mirabilis is specifically known for fishier smells.
"Recommend the following specific treatment -- 1. Standard dosing of enrofloxacin or marbofloxacin for 14 days 2. Recheck urine culture in 12-14 days (BEFORE the antibiotics are completed), then again 7 days aftercompletion of the antibiotics"
We are still getting blood in her diaper and urine even with anti-inflammatory meds, but not every time at least. Hard to tell if any improvement yet. We finally think we have her taking all of the supplements regularly. She is a very picky eater and unless we find something she REALLY likes, she will pick a pill out of a treat haha. So now we are doing small bits of watermelon with a pill/supplement inside, at least until she stops liking that! Peanut butter used to work, but she got tired of it, haha.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jul 24, 2023 16:24:08 GMT -7
Curtis, a fortunate break to deal with a much less resistant bacteria strain! Moet has the best parents, the way you care for her is exemplary! Thanks for the good news! It would be good to have a recommendation for our Vet Directory with Moet's recurrent UTI issue at some point in time. Bad UTIs are not too common, however, they do crop up from time to time on the Forum. This way a member can read your travels down this road over on Moet's thread. And read your comment with the service provided in the directory. Here is the Directory: dodgerslist.boards.net/board/13/member-reported-surgery-costs-recommendations State: Hospital/Boarded Internal Medicine DVM: Address: Cost: Comments about recurrent UTI treatment:
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Post by Curtis & Moet on Jul 24, 2023 17:21:54 GMT -7
Thanks - yes, we are doing all we can for her. Dr. Blonien (one of her main Dr's) said that Dr. Rolfe was ecstatic to see that it wasn't the resistant MRSP on the culture. Personally I'm not 100% confident that it's gone, and I suspect that's why he wants another culture while she's finishing up the new antibiotic (because then the culture will have the current infection suppressed and any others may be visible), but at least we have a much more treatable infection to concentrate on for now. Also, if somehow the staph is still there in upcoming cultures, Amikacin was shown to treat both MRSP and Proteus as well, so it might be a good next step. Dr. Rolfe said that he has had great success with Amikacin in the past as well. No problem on the recommendation site. Happy to fill that out once we get past all of this (hopefully soon!). So as of now she is on: - Marbofloxacin (Zenaquin) again now with 25mg daily (previous treatments were only a half pill - 12.5mg daily). - Carprofen anti-inflammatory to try and reduce bleeding - Pronin to try to help with incontinence - Omega 3 (max strength, 270mg EPA, 180mg DHA) www.amazon.com/gp/product/B00UB50G3K/ref=ppx_yo_dt_b_asin_title_o01_s00?ie=UTF8&psc=1- Multivitamin (Glucosamine, Chondroitin, Vitamin C, Probiotics as the main ones aiming for) www.amazon.com/gp/product/B09HJ9ZGQZ/ref=ppx_yo_dt_b_asin_title_o01_s01?ie=UTF8&psc=1- Crananidin www.amazon.com/gp/product/B0077CYK6E/ref=ppx_yo_dt_b_asin_title_o02_s00?ie=UTF8&psc=1- d-Mannose
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Post by Curtis & Moet on Jul 26, 2023 11:27:43 GMT -7
Another update. After only 2 doses of Zenaquin, we have seen a dramatic improvement. Barely any leakage into Moet's diaper. Fishy smell in urine has gone away. Looks like she still has a little bit of blood in urine when expressing, but we suspect that will go away with a bit more time as the bladder wall heals from the Proteus infection. After reading about this bacteria, I found that it is known for causing wounds due to it's swarming motality, which very well could be something like a bleeding ulcer in her bladder wall. Anti-inflammatories and healing of that should take care of the blood, we hope.
Watermelon continues to be the key to giving her meds, haha.
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Post by Romy & Frankie on Jul 26, 2023 13:05:15 GMT -7
Good news that the new antibiotic is helping Moet.
I think I will try watermelon next time I have to give my dog pills.
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Post by Curtis & Moet on Jul 27, 2023 13:47:36 GMT -7
Even more good news. Signs of her UTI are pretty much gone already! We're keeping meds/supplements going and have the next 2 cultures scheduled. Will report back in a couple weeks after we get those results!
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Post by Romy & Frankie on Jul 27, 2023 13:52:55 GMT -7
So happy to hear this!
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Post by Curtis & Moet on Aug 7, 2023 10:33:40 GMT -7
Just back from the $490 Cystocentesis (very pricey going through the specialist... but she is our "kid", so oh well.). Should hear results in a couple of days. We're stopping Carprofen and done with the 2 week round of Zeniquin as of last night. Expecting to have to do another culture next week after the Zeniquin is out of her system completely. Culture today while on Zeniquin was to be sure that with the Proteus at bay, there isn't another bacterial that the previous culture couldn't even pickup because the Proteus counts were so high.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 10-11lbs approx 12 y.o. ]
Started having some vomiting and diarrhea Fri/Sat, and loose stool yesterday/today. Took her off of most of the supplements except D-mannose and went with a probiotic only. Hoping that her GI tract improves without the antibiotic or anti-inflammatory. We'll slowly get her back on the other supplements when GI tract is recovered.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Aug 7, 2023 14:09:17 GMT -7
We've got our fingers crossed for good culture report and GI issues quickly gone. Thank you for the update.
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