Author Topic: Cosmo's latest diet  (Read 1363 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!!
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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: August 21, 2017, 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

Offline Walt

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Re: Cosmo's latest diet
« Reply #22 on: September 14, 2017, 06:03:33 PM »
Alaina....

I get the feeling that the vet profession, in general, has a dim view of homemade diets and does not want to encourage their use.  I realize there are some good reasons for this attitude. 

George, I got a real kick out of the above comment.  Over the past five months I have had the opportunity to visit for several vets about diets for dogs.  They don't just have a dim view of homemade diets they are downright hostile to them  :wink:

I have spent the last six months doing research on the raw meat and bones diets for dogs.  After reading tons of information I just dove into the issue and have been feeding Bruno a basic raw meat and bones diet.  I'm an old guy who grew up with dogs, working dogs as well.  They all were on diets of mostly meat scraps and some table scraps.  So, I plowed right in on creating my own recipe for Bruno.

After about five months of trial and error I have come up with a recipe that I think is pretty good.  Over the months, I've gone from feeding whole pieces of meat with bone to grinding the meat and bone.  I've incorporated a wide variety of organ meats to his diet.  And, I have also incorporated some fruit and vegetables as well.  Personally, I am not convinced that fruits/vegetables are absolutely necessary necessary, but I do incorporate them into the recipe.

You mentioned in one of your post here about fruits or vegetables that were good for some reason.  I'm wondering if you could tell me which of the fruits/vegetables were good and why they are beneficial to dogs.  I'm always open to new ideas and information.
Bruno, male B&S Miniature Schnauzer, born June 22, 2016

Offline George

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Re: Cosmo's latest diet
« Reply #23 on: September 14, 2017, 07:33:39 PM »
As I mentioned, we used Pet Diet Designer software to guide us in formulating a diet for Cosmo.  The only vegetables we used in his diet were green peas, cauliflower, and broccoli.  These add surprisingly few calories and not much in the way of nutrients.  The main reason for using them was to add fiber to his diet as well as bulk. 

Cosmo is still on the vet recommended Royal Canin Urinary SO diet (combination of 1/2 calories canned, 1/2 calories dry).  He seems to like it and has maintained his weight over the past six weeks of this diet.  He is regular and his stool well formed.  I don't see any adverse effects.  Since he was shown to have stones again (~August 1) I check his urine weekly for a UTI, blood, pH and specific gravity.  So far everything looks good.  This diet may not help with his stones, but it is certainly easier than making his food as we have been doing for the last couple of years.  And the cost is not that different either.  In addition to his food, we continue to feed him 4 oz of water three times a day.  He also gets water with his food and he drinks some on his own during the day.  Every vet I have talked to about these stones stresses the importance of fluid intake to minimize the risk. 

I'm still in a bit of a quandary as to what to do about Cosmo's current crop of oxalate stones.  As I mentioned in an earlier post, I have been exploring less invasive methods of removing the stones.  That is, less invasive than a cystotomy.  Laser augmented lithotripsy seemed to be the way to go, but that procedure is not widely available.  UCDavis claims to offer it on their website, but after exchanging several emails with a vet there, it appears that is not the case.  The University of Minnesota does offer lithotripsy, but going there would involve an almost 2000 mile trip east. 

I have come to the realization that Cosmo will probably always have stones or will be about to develop them if they have been removed.  I don't think diet is an effective deterrent to stone formation, at least as far as Cosmo is concerned.  I have not seen anything in the veterinary literature to make me think otherwise.  Thus putting off another surgery, even a less invasive one, for their removal and taking a "watchful waiting" approach seems to be the way to go.  As long as he does not develop frequent UTIs and bleeding, I think we will let well enough alone.  I read somewhere that something like 25% of miniature Schnauzers screened had stones, but no symptoms.  Yes, there is a danger of an obstruction, but it is my impression from discussions with our local vet, that obstructions are relatively rare.  I do keep a close eye on his urination so hopefully, if an obstruction does occur, we can get it taken care of quickly. 

So that is where things stand now....watchful waiting. 
Cosmo, male S&P Miniature Schnauzer, born November 11, 2008

Offline Walt

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Re: Cosmo's latest diet
« Reply #24 on: September 15, 2017, 05:18:03 AM »
That is good.  I took it as the vegetables helped to defeat the stones.

I think your comment about the value of the vegetables is the fiber and not nutrients is interesting.  The only reason I added the vegetables to Bruno's diet was to possibly "help provide" a few essential nutrients that Bruno might not otherwise get. 

You do know, "you can lead a horse to water, but you can't make him drink".   :wink: :wink:  That applies to our dogs as well.  We keep a full water bowl for Bruno outside and inside.  His food is probably in the 85% water so when he eats 14 ounces of food he is getting roughly 12 ounces of water.  That equates to about 0.35 liter.   Bruno seldom drinks out of either bowl of water.  I do think that if your dog isn't getting sufficient water then adding some to his food is a good idea.  My only problem with that is to much water causes Bruno's stool to be to soft, bordering on runny. 

I applaud you for all the effort you are putting into taking care of your dog.  The reason I go to all the trouble of preparing Bruno's food is to do the best I can at providing him with the best diet possible.  Because of this thread, I am going to do some more reading on this issue.  It is just another issue in trying to give Bruno all the nutrients he needs without creating any other health problems.

Thanks to you, as now I have another issue to consider.   :grin:

Bruno, male B&S Miniature Schnauzer, born June 22, 2016

Offline Karen Brittan

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Re: Cosmo's latest diet
« Reply #25 on: September 15, 2017, 09:29:26 AM »
And I feed what I consider to be the best-quality kibble because I am not a canine nutritionist and, with all these dogs, it has to be easy to feed and, hopefully, not too expensive. That is Diamond Naturals Chicken and Rice kibble. The proof is in the dogs.... healthy and in great condition... and that includes my two 14-year-old brother and sister from my "cheese litter', Cooper and Brie. 
Britmor Miniature Schnauzers
http://britmorschnauzers.com
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       Pedigree indicates what the animal should be.
 Conformation indicates what the animal appears to be.
  But performance indicates what the animal actually is.
                           -Author Unknown-


Offline George

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Cosmo hates Urinary SO
« Reply #26 on: October 05, 2017, 02:59:52 PM »
Well, Cosmo has decided he doesn't like the RC Urinary SO moderate calorie food.  We started using this food around August 1 on the advice of our local veterinarian when he found that Cosmo had a reoccurrence of oxalate bladder stones.  Cosmo has always been an enthusiastic eater, but about two weeks ago he decided that food was not for him.  We were using a mix of canned and dry.  Given the choice, he MIGHT eat the canned food, but the dry could just as well be a bowl of gravel as far as he was concerned.   So I went back to his homemade recipe (see previous posts).  The only change I made was to use bonemeal as a calcium supplement rather than calcium citrate.  I gave him his first meal of the homemade last night.  I think I actually saw him smile!  Same this morning.  You must admit, he has us well trained!

As I mentioned previously, this diet did nothing to prevent his stones from reoccurring.  It is low oxalate, low calcium, and low protein but still did not prevent them.  And adding calcium citrate, which is recommended by the Fuzzer Diet believers, did not help either.   I'm not sure any diet will prevent stones from developing in Cosmo.  But I am working with a veterinarian nutritionist to see if anything can be done to improve the formula.  She has quite a bit of clinical experience with Schnauzer bladder stones.  Stay tuned.

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

Offline Walt

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Re: Cosmo hates Urinary SO
« Reply #27 on: October 06, 2017, 08:46:56 AM »
Well, Cosmo has decided he doesn't like the RC Urinary SO moderate calorie food.  We started using this food around August 1 on the advice of our local veterinarian when he found that Cosmo had a reoccurrence of oxalate bladder stones.  Cosmo has always been an enthusiastic eater, but about two weeks ago he decided that food was not for him.  We were using a mix of canned and dry.  Given the choice, he MIGHT eat the canned food, but the dry could just as well be a bowl of gravel as far as he was concerned.   So I went back to his homemade recipe (see previous posts).  The only change I made was to use bonemeal as a calcium supplement rather than calcium citrate.  I gave him his first meal of the homemade last night.  I think I actually saw him smile!  Same this morning.  You must admit, he has us well trained!

As I mentioned previously, this diet did nothing to prevent his stones from reoccurring.  It is low oxalate, low calcium, and low protein but still did not prevent them.  And adding calcium citrate, which is recommended by the Fuzzer Diet believers, did not help either.   I'm not sure any diet will prevent stones from developing in Cosmo.  But I am working with a veterinarian nutritionist to see if anything can be done to improve the formula.  She has quite a bit of clinical experience with Schnauzer bladder stones.  Stay tuned.

George

George, stay in there working on the issue and hopefully you will figure it all out.  I have spent the last six months or so working on the recipe that I use for Bruno.  Unlike you, I haven't had a drop of luck in getting any cooperation out of veterinarians.  Most of them just have a closed mind on the subject.  They are just locked into the idea that sub-standard meat and fat along with grains, including rice, that are cooked at temperatures over 250 degrees for a couple of hours makes for great food for a dog.  And, where any vegetables added are cooked to the point to where the nutritional value is mostly destroyed.  As a PhD in a field of science with some relation to nutrition their attitudes on feeding dogs raw meat and bones simply makes no sense.  Especially when the dog foods they sell in their clinics are loaded with junk scraps and grains, including rice which isn't good for dogs. 
Bruno, male B&S Miniature Schnauzer, born June 22, 2016

Offline Walt

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Re: Cosmo's latest diet
« Reply #28 on: October 06, 2017, 02:39:41 PM »
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.

Kidneys don't stop normal function when an animal is at rest or at sleep.  I know of no bodily function that just quit working during sleep.  We continue to breath, the heart continues to beat and blood is continuously flowing and bringing oxygen, water and nutrients to all of our cells.  Digestion continues.  It only makes sense that the kidney continues to function normally.  I know I get up at least two and sometimes three or more times during the night.  There is some relation to sleep and some kidney diseases [google it] but I know of no connection to sleep and stone development in the kidney.  I have had six big stones over the years.  About three weeks ago I had lithotripsey [sp] to break up a 12mm stone in my left kidney.

Bruno, male B&S Miniature Schnauzer, born June 22, 2016

Offline George

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Cosmo's carbs
« Reply #29 on: October 06, 2017, 03:47:48 PM »
One of the challenges in coming up with a diet for a stone forming Schnauzer is that they are also notoriously susceptible to pancreatitis and diabetes.  The usual advice regarding "stone diets"  is to feed a low protein diet, but I have yet to see any data to justify this suggestion.  There are only three sources of calories for any diet... proteins/amino acids, carbohydrates, and fats.  So if I cut back on the protein in Cosmo's diet, it has to be made up for in fats and carbs.  I chose not to use a lot of fats because this may increase the risk of pancreatitis, so I am left with carbs.  Too many carbs can increase the risk of diabetes, but if I keep an eye on his weight and give him plenty of exercises, the risk might be minimized.  His current diet, including his "soup" courses and snacks/treats contains the following per 100 calories:  5.7g protein, 4.0g fat and 10.4g carbs.  By comparison, Royal Canin Urinary SO moderate calorie canned contains per 100 calories: 6.4g protein, 5.4g fat, and 8.2g carbs.  I must admit that the homemade diet combination is a bit arbitrary and that is one thing I want to learn from the veterinary nutritionist... what is a good balance?

The use of rice as a carbohydrate source for Cosmo's diet is driven mainly by the oxalate content of other high carbohydrate foods.  Many grains, especially whole grains, contain a fair amount of oxalate, as do potatoes and sweet potatoes.  Even white rice has some oxalate, but less than most alternatives.

I have had a similar experience in asking nutritional advice from most veterinarians.  I think the problem is that unless they go into nutrition as a specialty, most generalists just don't have much training in this area.  And providing detailed nutritional advice, the sort needed to formulate a homemade food for a pet, is time-consuming and probably not a money-making proposition.  So most advice provided tends to be in generalities and involves recommendations for commercially available foods.  Let's face it, most dogs get along just fine eating some form of "Purina" their entire life.  That is what Cosmo would be eating if it were not for the stones. 



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