|
|
Post by Curtis & Moet on Jan 20, 2024 10:22:11 GMT -7
Talked to Dr. Blonien [1/20/2024] yesterday about the MRSP skin infection again, and I also did a bunch of research as well. Chlorhexidine baths should be able to resolve the infection without the need to take oral antibiotics for it specifically since it is just a superficial infection. We are going to bathe her every day for a couple weeks until it's clearly taking care of the infected spots, and then we are just going to need to bathe her more often (1-2x/week) with Chlorhexidine shampoo to prevent future outbreaks. Luckily MRSP and other bacteria have no resistance (yet) to Chlorhexidine, so it is a very good treatment for skin infections that you can do continually.
We'll have to get a conditioner to keep her skin from drying out with all the bathing though, and Dr. B recommended omega3 supplements to help her skin too. Since she is on antibiotics for the proteus UTI full-time now, that's essentially making her immune suppressed, so possibly why this infection and pyoderma flares up, but also likely since she has to wear a diaper and the area under there is more likely to get a skin infection anyway.
I also have a new theory about Moet's UTIs in general. I highly suspect now that the first cysto culture done in May last year was contaminated with MRSP from the skin on her belly and that MRSP was not the main bacteria infecting her bladder causing her UTI at the time. She had pyoderma like she does now and we were not treating it properly with Chlorhexidine shampoo yet (we thought it was fungal). It's still possible that MRSP was in the urine too of course, and won out on the culture growth plates at that time, but I believe that the resistant proteus mirabilis we're fighting now was likely the main UTI problem from the start. This would explain why previous antibiotics like Chloramphenicol and Nitrofurantoin in May-July weren't helping her UTI, but her skin infection went away quicker than expected even without bathing as much as we are doing now. If you recall, we were very concerned that her UTI wasn't getting better and it seemed the MRSP was becoming resistant to each antibiotic very quickly and we were running out of options to treat her UTI. When we found proteus on the culture in later July and began treating that bacteria with different antibiotics (since it was susceptible to different ones than the MRSP), it makes sense why her UTI symptoms went away quickly. We were previously treating the UTI for the wrong bacteria.
So in the end, I think Proteus Mirabilis is really what we've been battling, and it's just a very difficult bug to beat with Moet's condition.
She is continuing to have frequent soft stool, which is difficult for us to get only when expressing her, which is not helping her situation of avoiding extra bacteria around her urethra and potentially stopping the UTIs. Besides adding pumpkin to her food, is there anything you recommend? When she had a bad GI episode a couple months ago with runny stool, we had to switch to chicken/rice/pumpkin for a week or so, however I read that we want to minimize the amount of vegetables in her diet to keep her urine pH lower (more acidic) because the bacteria in her bladder won't flourish as much in acidic environments (the whole reason "urinary treatment" diet foods are more acidic).
|
|
PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Jan 20, 2024 12:22:11 GMT -7
Curtis, your analysis seems to fit: antibiotic was treating the wrong bladder bacteria, but the right bacteria on the skin!
This is the way pumpkin (high fiber) works in general. I don't know if Moet's situation make things different. Or if 1 teaspoon a day would make her urine less acidic.
Plain pureed canned pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation.
NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe.
--To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin 1x a day.
-- To firm up the stool add 1 teaspoon plain canned pureed pumpkin 1x a day to kibble. (Give a teaspoon of pumpkin for every 10 pounds of body weight)
Bananas with bright yellow skins, a very few brown speckles contain electrolytes and other nutrients. Diarrhea tends to deplete these nutrients. By eating bananas, some of those nutrients are restored. Green bananas are hard to digest.
NOTE: Rice is complex carbohydrate that tends to ferment in the dog's colon, causing unfortable gas. In addition rice often passes right through the dog's GI tract exiting totally undigested. Whereas pumpkin or sweet potato is nutrient rich plus high in fiber. Dogs can absorb/digest its nutrients from the fiber.
Vitamin E has been considered an anti-inflammatory agent in the skin. If you have Vit E capsules at home, you could break open the gel capsule to use as topical lubricant on her skin for specific areas that need extra moisture protection. Check with your vet on this idea.
|
|
|
|
Post by Curtis & Moet on Jan 20, 2024 22:46:49 GMT -7
Thanks for the info on pumpkin, rice, and vitamin E. We'll lower the amount of pumpkin we are doing to about 1.5 teaspoons a day to firm up, and just keep that going consistently for a week or two to see if it makes a difference.
|
|
|
|
Post by Curtis & Moet on Feb 27, 2024 11:28:27 GMT -7
Quick update on Moet. We had to take her to the ER a week ago in the middle of the night after she vomited about 10 times in one day. We think the Cipro upsets her stomach and have been trying to make sure she has food with it, but suddenly it got worse and she couldn't keep any food down on a day without the Cipro, and eventually was vomiting up mostly just water pretty shortly after drinking and also had diarrhea. They had to give her an anti-nausea shot to stop the vomiting.
After some bloodwork it turned out that she had pancreatitis, with Amylase and Lipase levels about 3x's the upper limit. She is still on Metronidazole for the GI issues, and we finished up Sucralfate for little specs of red we saw in both vomit and diarrhea, and Pro Pectalin Gel to help firm up stool.
She's doing better now, but a few days ago I think I figured out that we may have caused this with too many omega 3 supplements (high fat). The ER doctors said it's almost always food related when pancreatitis hits, and she has a good diet most of the time otherwise, but we were giving her a whole omega 3 supplement with around 300mg of omega3's when the directions said 1/2 for under 15lb. Plus her daily multi-vitamin also had 100mg of omega3's too.
So, goes to show, too many supplements can also cause some pretty bad problems and have to be careful.
With this resolving, we will watch to see how her UTI recovers (it seemed to get better while the pancreatitis was around). The ER vet said he recommended doing another culture since the last was Aug/Sept, and we might consider changing antibiotics to see if she handles something else better.
|
|
|
|
Post by Romy & Frankie on Feb 27, 2024 14:44:44 GMT -7
Pancreatitis now! You both have been through so much.
Best wishes for a quick recovery from the pancreatitis and an effective treatment for the reoccurring UTI with minimal side effects.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Feb 27, 2024 17:57:03 GMT -7
Curtis, good to hear quickly blood lab revealed the problem and things are on the mend with the pancreatitis. Hope to hear Moet remains on a good path of UTI control with next culture.
Good point you make and thanks for reminding us all. There are no safe meds or supplements. The safety is in using them correctly. It is the dose (amount) that can turn a healing thing into a poison. Such as benign water even can be a poison to the body if too much.
|
|
|
|
Post by Curtis & Moet on Mar 1, 2024 11:22:45 GMT -7
Yes, for sure. Nothing like a $1k ER visit to figure out we were overdosing her on the omegas, ha. We are taking a short break from all supplements for another week or so probably to let her get balanced back.
Called yesterday to figure out schedule for next culture and will report back results once that is all done.
|
|
|
|
Post by Romy & Frankie on Mar 1, 2024 13:58:51 GMT -7
Fingers crossed that the culture will show no evidence of bacteria.
|
|
|
|
Post by Curtis & Moet on Mar 1, 2024 14:26:21 GMT -7
Fingers crossed that the culture will show no evidence of bacteria. We're pretty sure it will because we are still seeing signs of UTI (some cloudy urine on day her Cipro is due, and frequent urine in diaper before we can express her), but starting to think about switching off Cipro to something else possibly based on culture. |
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Mar 2, 2024 8:33:26 GMT -7
Curtis, Moet has the best mom and dad. Your love and devotion to her care is awesome with this trying UTI circumstance.
|
|
|
|
Post by Curtis & Moet on Mar 17, 2024 21:43:00 GMT -7
Well we took her last weekend to try and get another culture, but timing was off to have enough urine in her bladder, and she peed at the vet on the table, so not enough left to get via needle. So we will try again soon and report back with results.
|
|
|
|
Post by Curtis & Moet on Apr 12, 2024 21:35:46 GMT -7
We finally got the culture done [4/6] last Sat and received the results today. Yet another new bacteria, Enterococcus faecium. It is susceptible only to Nitrofurantoin (MIC 32), and Chloramphenicol (MIC 8). I sent a message to Dr. B to see if we should switch off of Cipro to Chloramphenicol immediately, and will hopefully hear back tomorrow. It is pretty concerning that the culture only shows 2 antibiotics that work for this (and none Intermediate), and the Nitro doesn't appear to work that well with a rather high MIC (though I've learned that you really can't compare MICs between different antibiotics like this, but who knows).
Reading into this bacteria, it is natural in GI tract and healthy pets can be carriers of these resistant versions. It doesn't seem as "bad" of a bacteria as the others because her symptoms aren't horrible. We're finding urine her her diaper rather consistently, but no obvious blood, and mucus/pus in her urine isn't as bad either (but is certainly still happening). Dr. B said under microscope he could see red blood cells despite not seeing red blood in urine with naked eye like we've been able to in the past. I suspect these red blood cells are due to the inflammation of her bladder related to these infections.
Report:
Isolate 1: Enterococcus faecium - >100,000 CFU per ml
For Amoxicillin susceptible isolates, treatment with Amoxicillin, Ampicillin or Penicillin is recommended. Other antibiotics to which the isolate is susceptible should be considered as secondary options reserved for the treatment of Amoxicillin-resistant isolates. Although Fluoroquinolones MAY be effective in treating Enterococcal infections, in vitro susceptibility does NOT consistently predict clinical efficacy. Vancomycin should be reserved for the treatment of serious systemic infections and is NOT recommended for treatment of simple urinary tract infections. Trimethoprim/Sulfa, Clindamycin, Gentamicin and all Cephalosporins (including Cefovecin and Cefpodoxime), are NOT reported due to lack of correlation of in-vitro testing with clinical effectiveness and are not recommended for the treatment of Enterococcal infections.
Isolate 1 MIC
Amoxicillin-Clavulanic Acid R >=32
Enrofloxacin R >=4
Marbofloxacin R >=4
Doxycycline R
Nitrofurantoin S 32
Chloramphenicol S 8
Amoxicillin R
Ciprofloxacin R
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Apr 13, 2024 8:13:01 GMT -7
Curtis, your reporting your journey with resistant UTI bacteria is both enlightening and so frustrating.
May Moet's UTI symptoms remain as manageable as you report until such time Chloramphenicol (fingers crossed) can annihilate the Enterococcus.
|
|
|
|
Post by Curtis & Moet on Apr 16, 2024 20:47:22 GMT -7
Good news. As in the past after a culture and start of a new antibiotic, we've seen quite a change 36-48hr since starting Chloramphenicol. Her diaper is almost completely dry between changes now and we're expressing lots of clear urine.
We're having some BIG difficulties getting her to take pills recently though. All of the tricks end up not working with her after a short time. I think these pills are bitter. She nibbles the edges of treats and sniffs out everything really well trying to find pills. We're having to switch up the types of treats we use every few days. Currently on small pieces of rotisserie chicken. Very picky!
Also, we learned how dangerous some of these antibiotics can be after asking the vet about possibly breaking the pill up into a powder to give in liquid via syringe. Chloramphenicol is banned in the US for human use because it was found in rare cases to cause fatal anemia and even leukemia when used decades ago. Scary stuff. We're having to be very careful with these pills since she needs 1.5 every 8 hours, which requires cutting one and spreading powder from it.
|
|
|
|
Post by Romy & Frankie on Apr 17, 2024 13:09:54 GMT -7
I am happy to hear that the Chloramphenicol is helping Moet. You both have had a long, long journey with the persistent UTI's
Scary how dangerous some meds can be.
When you have to cut a pill in half, it can seem even more bitter because the coating has been disrupted. The best luck I have had was with peanut butter and or cream cheese. You may have already tried these. I had to make sure I gave her these treats without a pill fairly regularly, otherwise she would be suspicious from the start.
|
|
|
|
Post by Curtis & Moet on Apr 20, 2024 12:43:03 GMT -7
Yes, these pills are coated and cutting definitely doesn't help. Having to be most careful when cutting the pills to avoid any powder left anywhere.
Moet has decided she doesn't like peanut butter anymore, haha. She had to take so many pills with it, that she correlates it with meds now. Whipped cream cheese worked a couple months ago, but we're holding off on that for now. We're using small bits of rotisserie chicken ok still for now. We have 1 more week of this antibiotic and then need to figure out if we should do another culture immediately or wait a bit.
One other thing to mention is that her staph skin issues seem to be getting better. From reading about Chloramphenicol, it appears that it is used to treat MRSP infections sometimes, so I bet that it is susceptible in this case too. Hopefully a 2 for 1 treatment here! We will certainly keep chlorhexidine baths going for pretty much the rest of her life to avoid these skin issues.
The last thing we're continuing to battle is her constant/aggressive licking of front paws. We're trying some new 2% chlorhexidine/2% Miconazole wipes that seem to be helping, and switched to a shampoo of the same type too. It's been almost 4 months she has had to wear a cone to prevent licking now. We're ready for her to have that off!
|
|
|
|
Post by Romy & Frankie on Apr 20, 2024 14:27:29 GMT -7
I am glad to hear that Moet's skin issues are improving and hope that the new wipes and shampoo will stop her from excessively liking her paws.
You both have been through so much. Fingers crossed that you are beginning to get past that and through to the other side.
|
|
|
|
Post by Curtis & Moet on Apr 28, 2024 20:14:27 GMT -7
Like a merry-go-round, we finished Chloramphenicol yesterday and already have a fish-like smell from her urine, exactly like happened in June according to the history here.
Instead of going straight on Nitrofurantoin like we did last time, we're going to go ahead and ask for another culture tomorrow when talking to the vet again.
Reviewing our culture history last year, we didn't get one immediately and went straight on Nitrofurantoin thinking that the Chloramphenicol didn't work, but we think it has worked against the Enterococcus faecium and it's a different bacteria which produces the trimethylamine that smells like fish. We'd rather just pay for yet another culture to identify what this is and knock it specifically out instead of guessing and causing any more resistance to antibiotics possibly.
Wish we could buy a 10 pack of cultures at a discount to save on this. $360 each is not fun.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Apr 29, 2024 10:15:57 GMT -7
Glad to hear your reviewing the history on this thread has allowed you to make an educated and wise decision. This recurrent UTI is an expensive issue for sure.
|
|
|
|
Post by Curtis & Moet on May 7, 2024 10:09:50 GMT -7
Culture results back and we have Proteus Mirabilis again. This time it's susceptible to 6 different antibiotics luckily. Cipro and and Marbofloxacin being two of the best. We already had Cipro at home since we were doing it every other day for a few months as a prophylactic, but she puked 4-5 times about 2 hours after I gave it to her, so we're switching to Zeniquin again (Marbofloxacin). This is a much smaller pill which we will have better luck getting her to take, and she hasn't had issues with vomiting it historically. I expect that we'll see improvement pretty quickly, but of course the question is going to be for how long.
We leave for Africa next week for 2 weeks, so my father will be watching her and hopefully she doesn't have any issues with all of this while we're gone. That's our constant worry now when traveling.
|
|
|
|
Post by Romy & Frankie on May 7, 2024 13:05:39 GMT -7
So sorry that the UTI issues continue. Both of you have had so much to deal with.
I hope that the Zeniquin will give her some long term relief.
|
|
|
|
Post by Curtis & Moet on May 8, 2024 14:23:43 GMT -7
Good news that we're already seeing a big change with her bladder after one dose at dinner last night. No leakage into her diaper, and urine is quite a bit clearer. Now if only we could keep it this way for a while! We're on Zeniquin for 3 weeks.
|
|
|
|
Post by Romy & Frankie on May 8, 2024 14:28:31 GMT -7
So happy to hear the good news! I hope the Zeniquin can keep the bacteria at bay for a long while.
|
|
|
|
Post by Curtis & Moet on Jun 21, 2024 12:14:02 GMT -7
Just wanted to give another update on Moet. We got her into a vet dermatologist the end of May, who suspects that many of her skin and toe issues are food allergy related, but also bacteria/yeast. We're doing a food trial on only Hydrolyzed Protein diet (which is non-allergenic) for about 2mo, and also started her on an antihistamine and back on ✙Cefpodoxime antibiotic that she has been on before. Also an antibiotic for her ears as well as a wash. They did an in-office cytology test from cells from her abdomen and toes separately and found coccus bacteria and fungus as well, and so far her skin is looking much better! She had a lot of redness and "ooze" around her belly where her diaper was, and this has totally cleared that and the dark skin there too. So some good progress, but she is still licking her toes non-stop if we take her cone off, which is really annoying.
As far as UTIs, we think she has a mild one because her diaper is mostly full of urine when we go to change her (an obvious sign to us), but being on cefpodoxime for the skin issue doesn't really let us try and culture/treat that right now. It doesn't seem like a bad UTI at least, since no obvious signs of blood or bad smell. We will do another culture in a couple weeks probably once she's been done with this skin antibiotic for a week. It's also possible that this cefpodoxime is helping keep the UTI at bay a bit, so we'll see what happens after that is finished too.
|
|
|
|
Post by Romy & Frankie on Jun 21, 2024 13:30:07 GMT -7
I am happy to hear that Moet's skin is doing much better and the cause of the issues may have been discovered.
Cefpodoxime is used to treat some UTIs so, depending on the strain of bacteria, may be helping with the UTI somewhat.
|
|
|
|
Post by Curtis & Moet on Jul 31, 2024 9:47:53 GMT -7
We had another culture done 1.5 weeks ago and got the results back Monday. Proteus mirabilis again, but this time another one as well, Enterococcus faecalis. Naturally the susceptibility to antibiotics for both of these is slightly different, but we are going back on Zeniquin again, which the proteus is susceptible to, and the enterococcus is intermedia susceptible to. Researching the enterococcus faecalis, it sounds like a natural GI bug that has gotten into her bladder from stool.
The new food trial she has been on has caused her to have much more frequent but smaller bowel movements, so it has been really hard for us to keep her diaper as clean. We are hopefully wrapping up this food allergy trial here in a few weeks and then can go back to food that she only has 1-2 bowel movements a day from, which we also have a better chance of expressing too.
We'll report back if her UTI signs improve quickly. Luckily this time it is really just the smell of her urine, and diaper being full before we can express her. It has also been very difficult to express her in general, really having to work the spots of her bladder multiple times to try and empty it.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Jul 31, 2024 11:22:34 GMT -7
Curtis, I have great admiration for your conscientious dedication to the on-going recurrent UTI. You have had to become quite an expert in researching things every step of the way to be part of the discussion and the treatments. Thank you for sharing so much valuable information here on the Forum. Best of wishes for the allergy trial to reveal useful information.
|
|
|
|
Post by Romy & Frankie on Jul 31, 2024 13:21:13 GMT -7
You both have already dealt with so much. I hope the Zeniquin will do the trick and your little girl will have some relief from these frequent UTI's
|
|
|
|
Post by Curtis & Moet on Sept 21, 2024 9:26:32 GMT -7
A quick update since it has been a couple months now. Moet is still on Zeniquin but has had some UTI symptoms pretty much the whole time (urine in diaper, and mucus at the end of expressing sometimes). We had another culture done on Wed while she is on Zeniquin to see if we can pickup the Enterococcus faecalis or something else still that the Zeniquin isn't working for.
Her skin issues are still doing much better, and we finally have had her out of a cone and not obsessively licking her toes for about a month now since she started on a steroid/antihistamine combo called Temaril-P. We started on a stronger dose and are titrating down to see how low we can go and still keep her from licking.
We hope to finish her food allergy trial very soon.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Sept 21, 2024 10:24:11 GMT -7
Curtis, good news about her skin issues so greatly improved and in much better comfort without need of the cone while waiting for the end of the food allergy trial.
Appreciate the time and details you provide to update us. Having this wealth of information may be helpful for another member dealing with recurrent UTIs and even allergy.
|
|
