Author Topic: Cosmo's latest diet  (Read 1017 times)

Offline Beth

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Re: Cosmo's latest diet
« Reply #15 on: January 17, 2017, 02:31:24 PM »
Great news!  I really respect your mission to find help for him!!
Buddee ( salt/pepper ) 9-5-05 chief couch potato
Teebone ( salt/pepper) 6-9-05 "the boss"
Sunny- (salt/pepper) 7-22-08 AKC GCh and lure coursing CA
Eli (black/silver) 3-21-08-my most loyal companion
Levi (salt/pepper) 6-2-10 born on my birthday!  AKC Grand Champion --handled solely by ME!! (WooHoo)
FeeBee salt/pepper female born 4-14-03  fostered 6-17-13 adopted 7-26-13 sweetest girl EVER
Tiffee female salt/pepper born 7/22/13-on her father Sunny's birthday--tiny maniac 🙄

Offline George

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Cosmo has stones again
« Reply #16 on: July 25, 2017, 06:28:03 PM »
Almost one year ago (8/1/16) Cosmo had his second bladder surgery to remove calcium oxalate stones.  His first surgery was in November 2014. Today he had an exam and bladder x-ray.  Stones are again present.  He also has blood in his urine and a UTI, typical effects of oxalate stones.  As you may recall, we have been feeding Cosmo a special low oxalate diet plus three courses of "soup" each day to increase his fluid intake and dilute his urine.  The pH of his urine was about 7 today and the specific gravity 1.016, both good values, at least theoretically.  We had hoped that a low oxalate diet, plus lots of fluids would prevent the return of stones.  Obviously, none of these measures have helped. 

We do plan to have the stones removed later this summer after the infection is under control.  But what to do then?  Will this become a yearly event?  Even with our efforts to increase his fluid intake, he still spends 8 hours at night with no fluid intake.  Perhaps that is when stones form in the more concentrated urine.  But I am beginning to wonder if stone formation is a metabolic disorder which is unaffected by diet and fluid intake. 

Cosmo, male S&P Miniature Schnauzer, born November 11, 2008

Offline Jacob

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Re: Cosmo's latest diet
« Reply #17 on: July 26, 2017, 07:01:42 AM »
It makes sense that the stones form during sleep, and I also think it has to be some sort of metabolic disorder. Why else would once dog get stones and not another (assuming both dogs are on a decent diet.

During sleep the waste in his body is allowed to settle and without movement, as with a stationary test tube, if there is any particulate it will settle at the bottom. I think it's during this time stones would be most likely to form.

Think of a cement truck. Everything is nice and fluid until the movement stops.

How active is Cosmo these days? If he's stationary for most of the day, that, in theory, would contribute as well.
Frankie, male cream Schnoodle, born August 4, 2016
Sonny, male white Miniature Schnauzer, born December 2, 2016

Offline George

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Re: Cosmo's latest diet
« Reply #18 on: July 29, 2017, 09:08:54 AM »
Jacob.... thanks for your thoughts.  We do a lot to prevent the stones for 12 hours per day, but from 8pm to 8am, we do nothing.  During that period Cosmo is very inactive..... usually asleep.  We have changed his feeding schedule to give fluid late in the day.  Maybe we will go to one meal midday, rather than two.  But I have little hope that will help the current situation.  Another surgery to remove the stones seems ill advised at this point.  It has only been a year since his previous surgery (#2) and the stones will likely return.  Evidently, this is very common in this breed (http://avmajournals.avma.org/doi/pdf/10.2460/javma.246.10.1098).  But if we don't remove them we can expect recurring UTIs which is not good and also the chance of a urinary obstruction. 

George
Cosmo, male S&P Miniature Schnauzer, born November 11, 2008

Offline George

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What's next?
« Reply #19 on: August 12, 2017, 08:29:52 AM »
For those of you with an interest in stone forming schnauzers, here is a recently published (2016) set of guidelines for their treatment and prevention.

https://www.ncbi.nlm.nih.gov/pubmed/27611724   The full article is available (free) at this site.

They recommend lithotripsy rather than surgery to remove stones, but this procedure is not widely available.  And it can only be used in dogs which are able to pass a 8.5Fr catheter into the bladder, which is fairly large.  We contacted UCDavis to see if they could do the procedure, but the person my vet talked to said that Cosmo was too small (he is a relatively large miniature at 26lbs and not overweight).  I have also contacted the University of Minnesota and that is where I got the catheter size requirement.  I'll find out if Cosmo qualifies next week.  This might be a procedure more suited to female schnauzers which have a shorter urethra.  I suspect another surgery is in Cosmo's future.

As for food, we have started him on a diet of Royal Canin Urinary SO (moderate calorie).  We are using a 1:1 blend (by calorie) of the canned and dry.  The dry food is 1/3 the cost of the canned, but it is quite high in sodium and it lacks the moisture that the canned would provide.  But for the latter, we can always give him more "soup," which we are doing.  He seems to like it.  This food does not contain any citrate, so we might add that later to increase his urine pH.

We might also try hydrochlorothiazide which has been shown to decrease urinary excretion of calcium (https://www.ncbi.nlm.nih.gov/pubmed/11393368).  There is some evidence that the metabolic problem in stone forming schnauzers is that they excrete too much calcium in their urine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311896/).  The problem with using hydrochlorothiazide is that the dose is fairly high and there are side effects.  There has only been one study that I can find that demonstrates the possible value of this drug and it is over 15 years old.  That study only used 8 dogs.  It is not possible to adjust the dose, at least for me, since the effect, decreased urinary excretion of calcium, cannot be determined without expensive instrumentation. 

Cosmo seems fine, but I worry about another UTI due to the stones.  The sooner we get rid of them the better.  But I strongly suspect, no matter what we do, we'll be in the same position next year at this time.  Unfortunately, Schnauzers seem to have a reoccurrence rate about 3 times that of other breeds that develop oxalate stones (https://www.ncbi.nlm.nih.gov/pubmed/25932935).
Cosmo, male S&P Miniature Schnauzer, born November 11, 2008

Offline George

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Alternatives to another cystotomy
« Reply #20 on: August 19, 2017, 08:20:12 PM »
As I mentioned previously, Cosmo has had two surgeries to remove calcium oxalate stones.  These have been traditional cystotomy surgeries where the bladder is opened and the stones removed.  I'd like to find a less invasive method of removing the stones since it appears that almost yearly removal procedures may be needed.  We will continue to try various dietary methods and drugs to reduce stone reoccurrence, but I have low expectations given our experience. 

Here is a 2010 review of methods used to remove stones:  https://vetfolio-vetstreet.s3.amazonaws.com/mmah/a4/2e46a77c57412abd92ad1adc7dda78/filePV0610_langston_CE.pdf

Two less invasive procedures seem to have promise.

1.  Lithotripsy.....  In this method, a YAG laser equipped catheter is fed into the bladder via the urethra.  The laser fragments the stones into pieces which can then be removed with a basket or by flushing the bladder.  The limitation of this method is that the minimum size catheter that can be used is an 8.5 French, which might be too large for small dogs, especially males.  However, the vet that performed Cosmo's 2016 surgery used a 12 FR catheter.  See the attached image.  This radiograph was taken after his surgery with the catheter still in his bladder.  This is an interesting image in that it shows that the exit of the bladder to the urethra is at the top of the bladder.  Cosmo's stones have always been at the bottom, although I am sure they move around a bit.  Perhaps this is why urinary obstructions are relatively rare events.

I have found two institutions the perform this procedure (I'm sure there are many more):  the University of Minnesota and UCDavis vet schools.  Both have web pages for this. 

http://www.vetmed.ucdavis.edu/vmth/small_animal/internal_medicine/activities/urinary_disorders_procedures.cfm

https://www.vmc.umn.edu/about-us/specialties-services/urology

2.  Laparoscopy:  For example percutaneous cystolithotomy.  A good illustration of this procedure is shown in the article cited above.  Basically, a small incision is made through the abdominal wall and into the bladder.  A laparoscope is then used to remove the stones.  Since the scope diameter can be larger, there may be no need for a laser to break them up.  This procedure can also be done at both of the clinics listed above.  This is certainly more invasive, but the incision is small relative to that of a typical cystotomy.

What about the cost?  We paid about $800 for the cystostomy last year.  Our local vet did a great job.  I don't have a good estimate as yet, but I suspect both of these alternatives are at least twice as expensive.  But in addition to being less invasive, there is the advantage of having Cosmo's post procedure diet and medical therapy defined by vet school faculty with more specialized clinical experience than most local vets have in this area.  Certainly, the practitioners at the U of M are world class in this area.  Time will tell what course we follow.  Cosmo is doing fine.  No more blood in his urine and the UTI has been resolved. 
Cosmo, male S&P Miniature Schnauzer, born November 11, 2008

Offline Rock

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Re: Cosmo's latest diet
« Reply #21 on: Yesterday at 07:14:19 PM »
Very interesting X-ray.  Thanks.  I've learned many things from this discussion.  I hope Shadow does not need this treatment. But it is very good to know about less invasive procedures are being developed.

My USA home is very near the Iowa State University Vet Med college in Ames, IA.  I know many pioneering Vet care work is done at ISU.  I will inquire if they will handle small animals.   They do handle livestock.

Shadow's neutering incision was closed with medical grade adhesive.  No stitches.  This is very progressive for China, my Vet is very caring and appears to be using new techniques.
Shadow, male Salt & Pepper (mostly Pepper) Miniature Schnauzer, born May 3, 2016