Pandora’s box

January 27, 2013

Bear is a 6-year-old neutered male Miniature Schnauzer. He came to the clinic in September for drinking more and peeing a lot more. He had been preventing his owner from sleeping with all the bathroom breaks in the middle of the night.

And Bear is not nice. He is nice enough to his owner, but he has bitten the hand that feeds. He would not think twice about anybody else‚??s hand.

The possibilities for drinking and peeing more include kidney disease, diabetes, a urinary tract infection, bladder stones, and Cushing‚??s disease.

Bloodwork would determine if Bear had kidney disease or diabetes. He had diabetes.

Since diabetic patients are more likely to have urinary tract infections, a culture of Bear‚??s urine was sent to the lab. To our surprise, he did not have a UTI.

In order to leave no stone unturned, X-rays of Bear‚??s bladder were taken to rule out bladder stones. We had already discovered diabetes, so why keep looking for other issues?

Did I mention that Bear was not nice? He was sedated now. In order to prevent having to sedate him another time, it seemed wise to look for as many things as we could. And it paid off: two stones in the bladder.

Diabetes. Bladder stones. No kidney disease or UTI. Cushing‚??s disease? Still a possibility.

Bear began twice-a-day injections of insulin. He was also placed on a special diet to dissolve the most common type of stones.

With diabetes, insulin drives glucose back into the cells (where it should be) and out of the blood (where it should not be). This, in turn, generally makes the patient less thirsty. As the patient begins to drink less, the patient also begins to pee less.

However, the special diet used to dissolve bladder stones will increase the patient‚??s thirst. Remember: ‚??the solution to pollution is dilution.‚?Ě By drinking more, more water is passed through the urinary tract. Theoretically this should help to ‚??wash out‚?Ě any bacteria and the crystals that may contribute to stone formation.

We had already proven that Bear did not have a urinary tract infection. But stones that do not dissolve can only be removed by surgery. And cultures can be wrong; or simply could miss a ‚??hidden‚?Ě infection. Bear was diabetic, after all.

Bear spent most of the fall still drinking more and peeing more. The drinking seemed to be less than at his original visit in September. But the peeing was still keeping his owner up. Uncontrolled diabetes or special diet?

Now a good veterinarian would have repeated Bear‚??s bladder X-rays around Thanksgiving to see if those stones had dissolved. But Bear‚??s veterinarian has never proclaimed to be that good.

Did I mention Bear was not nice? A trip to the clinic is a big deal. It would require sedation. And sometimes those stones do not dissolve in two months, like they are supposed to (if they read the book, that is). So rather than taking X-rays too soon, it might be best to give the food another few weeks.

Then Christmas came around. And all involved decided that there was a lot on their respective plates. And in order to handle those holiday plates, they would need their fingers. So maybe they should wait until after the first of the year.

Finally, Bear‚??s X-rays were repeated in the first week of January. The stones were still there. And they were still the same size. Nearly three and a half months of a special diet made to dissolve bladder stones and no luck. Surgery was necessary after all.

Since Bear was already sedated for his X-rays, full anesthesia was induced and surgery was performed. Two very sharp, jagged stones were removed from his bladder. The stones were sent to a special lab in Minnesota that will identify what kind of stones they are. That analysis is still pending.

Although not ideal (nothing with Bear is ever ideal), bloodwork drawn after sedation revealed that his diabetes is well-controlled. However, a liver problem is now present.

For the first time in four months, Bear is able to make it through the night. Most nights, anyways. Apparently bladder stones are that irritating.

We are taught to try to give the patient one problem that explains all the signs. However, Bear is a virtual pandora‚??s box of problems. Diabetes. Bladder stones. Liver disease.

Did I mention that Bear was not nice? For three days after his bladder surgery, he was not eating and simply lying around. Bloodwork indicated his diabetes was controlled, a urine sample revealed that he had diabetic ketoacidosis. On Jan. 11, Bear was biting again. God blessed him!

Dr. Adam Ferguson works at Baker Animal Hospital in Cridersville.