Friday, September 04, 2009

Veterinary double talk

I'm so frustrated and upset right now, I just need to vent, so here goes.

Before I left for NY, I took Moxie up to work with me because she had been having intermittant diarrhea and started drinking more water than usual. I just wanted to make sure she was okay before I left town. We saw Dr. S. I like Dr. S because she is very thorough, but she sometimes looks for zebras when its just horses if you know what I mean. Anyway, we ran labwork and a urinalysis, and found out she was Azotemic, had signs of a urinary tract infection, and a low urine specific gravity which along with the azotemia, indicate kidney disease. Dr. S went on VIN (Veterinary Information Network, basically a mecca for all vets to collaborate on cases with a huge searchable database) and printed me out all this info on a disease called Pyelonephritis, which is a chronic kidney infection that leads to damage of the kidneys. This was Moxie's second UTI in as many months, and with the elevated Creatinine levels in her blood, this really seemd like a plausible diagnosis. We sent a sterile sample of her urine to the lab for a bacterial culture and sensitivity.

The next day we saw Dr. W, my regular vet. Just to consult about the bloodwork and see what she thought was going on. She was not as concerned about the azotemia as Dr. S was, and in general was much calmer about all the test results. She wanted a re-check urine specific gravity with a first morning sample and wait on the C&S. So the next morning we rechecked a urine specific gravity and it came back 1.020, which is too low, meaning the kidneys are not concentrating her urine very well. She also wanted me to measure how much water she was drinking in a day, and I did and it averaged 3.5 cups per day, which Dr.W asserted was a normal amount to be drinking.

And so I waited for the results of the C&S.

Results came back on a Saturday, and we saw Dr. J. The results came back "no growth". Dr. J felt like this meant that the bacteria in the urine sample had died before it got to the lab, so she started Moxie on a two week round of Clavamox for a UTI.

I go off to NY for a week and she does great while I'm gone. When I got back I scheduled an ultrasound of Moxie's kidneys and bladder per Dr. W's instructions, and a recheck urinalysis per Dr. S's instructions. The appointment was with Dr. W. The ultrasound was unremarkable. Dr. W feels like her kindeys MAY be polycystic, but she isn't sure so she sent the images out for another opinion from Dr. X, a specialist of some sort. The re-check Urinalysis came back normal, except again for a low specific gravity. The shocker this time was Dr. W didn't want to even look at the rest of the UA, besided the specific gravity, because there was "no growth" on the C&S so there was no infection in the first place.

Huh? This is not what I was told by Dr. J. And if there was no infection, how do you explain all the red and white bloodcells in her urine sediment that Dr. S had found and gone over in detail with me. Dr. W went ahead and checked anyway and said there was nothing in the sediment that made her think infection. I think she was more than a little put out by my questioning her not checking the whole UA, but who do I believe here? Who is right? How am I supposed to know?

So I'm confused. Does she have pyelonephritis? Does she have polycystic kidneys? Does she have kidney disease at all? Why is she still having diarrhea and why is she suddenly drinking at least two to three times as much as she has ever drank before in her ten years of life??? It may be a normal amount of water, but its not normal for her!!! Nothing adds up here. I'm so confused and I don't know who to turn to for answers. I feel like the more I ask people what they think, the more confused I become, and the more I annoy the vets I am working with because I keep questioning things instead of just taking what they say at face value.

So on the one hand I think I need to stick to one vet and one vet only. I've known Dr. W my whole life, she loves Moxie and I know she has her best interest at heart. I also know that Dr. W utilizes VIN and consults with other doctors, so its not like I would be isolating my options to just one doctors opinion. Dr. S is great, but kind of an alarmist. I still don't know if I should be as upset and scared and she made me feel that first night. I think Dr. J just blew me off, because frankly she's a bitch. I won't be consultiing her again thats for sure.

Meanwhile, I'm reading and reading about diet, as thats really the only way to manage kidney disease. Everything I read tells me that the K/D diet she is on is for dogs who are far sicker than she is. The protein is too restricted for a dog in early stages of kidney disease. I found a lot of research to support a home made diet, and found a great list with tools to calculate how much of what to put into her meals each day. Things like protein, phosphorus, calcium, calories, fat, sodium, and potassium are tracked in a fancy spreadsheet. The studies I've read to support that low phosphorus diet with moderate amounts of protein for a dog at this stage of kidney disease are all quite clear and back each other up. For a sampling of what I've read check out These are scientific studies by vet schools and animal nutritionalists.

Anyway I forwarded those links on to Dr.W and she just ignored my email. I think she thinks I'm just some nut. All I really want is what is best for my dog, thats going to give her the best quality of life for as long as possible. Is that really asking so much? I don't feel like I CAN just lay down and accept everything everyone tells me as the gospel truth and absolute best care scenario, because I'm getting so much conflicting information. Its just frustrating. I just needed to rant. Thanks for reading.