Business Fantasy : Billy's Bladder Stones Did Not Remain Silent

By Dr. Jonathan Mitelman, DVM and Barbara Kelly

It has been several months since we shared an update about dachshund Billy. As you might recall, Billy suffers from skin allergies, medication and food intolerances and IBD. The following account will catch you up on what’s been happening with Billy since our last chapter.

Barbara: Milestone events always evoke thoughts and reflection; where we came from, where we are now, and where we expect to be in the future.

Billy celebrated his 10th birthday in August.

He is just starting to get his "frosty face” as his snout turns gray, so he will fit in well with his human family in that regard.

Despite his ongoing health concerns, Billy continues to be spirited, loyal and active. For this we are grateful.

The home-cooked diet of beef and oatmeal, supplemented with daily amounts of a canned vet formula venison and rice, has produced good results. Except for a couple of small tummy upsets his IBD has been under control.

His skin has been calm as a result of his once- to twice-weekly medicated baths and he is calmer through the day, sleeping well at night. His quality of life has been on the high end.

But, and there always seems to be a but, those bladderstones we discovered about a year ago have not remained silent.

Dr. Mitelman: The clues started with an unexpected wetting of the bed, something Billy had not done for some months. And then the family reported Billy seemed to be confused, couldn't find his driveway on a couple occasions, had tripped on the stairs, and gone to the bedroom instead of the kitchen when it was feeding time.

I was asked if he could he be having issues with his eyesight.

Next came the large puddle of urine in the kitchen. This was not typical of Billy.

It was time to investigate.

Barbara: Dr. Mitelman often says, "Billy shows us everything, yet tells us nothing." This wasn't the first time I found myself wishing that Billy could talk.

When we take him to the clinic, Billy's tail is wagging and his energy level is high. At home, as in the case with many pets, we see the signs and changes in behavior.

It was time to let the diagnostic procedures do the "talking" for Billy.

Dr. Mitelman: Barbara brought Billy in for a full physical exam, blood work, urinalysis and ultrasound. We needed to check his eye sight and investigate whether his confusion was linked to diminished vision or cognitive impairment.

We knew that Billy has cataracts in both eyes.

The right eye, previously assessed with optic nerve hypoplasia, was completely blind. The left eye still has vision, but is becoming cloudier. But this was not likely the cause of his confusion.

The ultrasound showed stones in his bladder, slightly larger than when last checked.

A still u/s image of Billy's bladder showing sediment material (bright white pile),
consistent with small stones, about 2 mm high.

There were irregularities in the bladder wall, not present in previous ultrasounds.

There were no visible abnormalities in the other organs.

Billy's blood work came back indicating elevated liver values.

The early urinalysis showed infection and the cultures confirmed this. Billy was put on amoxil, an antibiotic that he has always tolerated well.

Barbara: The next couple of weeks were stressful for us.

I felt we had more questions than answers. If the stones in Billy's bladder were growing, it was likely he would need another surgery. Especially since those stones were holding bacteria that caused repeated UTI's.

If we leave them, there is also the risk of blockage. In this case, the surgery could become an emergency, not an option. But with his liver values inexplicably elevated, would he be more at risk?

We are faced with decisions that are not easily made.

Dr. Mitelman: Billy responded well to the round of amoxil but needs to stay on this course of treatment for another 4-6 weeks. A recent ultrasound showed the bladder wall looks smooth again, indicating inflammation was the source of the irregularities on the previous one.

The liver values have returned to normal, except alkaline phosphatase. Although it is usually the last enzyme to fall back down to the normal range, its persistence in Billy’s case is believed to be due to cholestasis (slow bile drainage from the liver), due in turn to his IBD.

The bladder stones will need to come out, the question is when.

The procedure will be done laparoscopically and a liver biopsy will be taken. We will send the stones for analysis.

Barbara: With Dr. Mitelman's advice we have taken some steps to helping Billy with his cloudy vision. It has been as simple as providing increased lighting to certain areas of our home. But we continue to see indications that point to cognitive issues.

For those of you who question the need for diagnostics such as blood work, urinalysis, x-rays and ultrasound, as I admit our family once did, Billy's case is an example of their importance.

Everything fits together in this complicated puzzle that is our dog. The information the diagnostics provides allow us to make decisions that are better for Billy and more comfortable for us.

Even so, we are still left with questions.

We will share our investigation into this and our soon to be made decisions around the treatment options for his bladder stones in our next update.

Business Fantasy

Monday, October 8, 2012

Billy's Bladder Stones Did Not Remain Silent

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