Question for a vet: Should we allow sx with yeast in urine?
Sorry it's kind of long, but it's been long for us too!
The dog dislocated a hip 6 weeks ago; after liver enzymes were found to be in the 200s so many tests were done including ultrasound but the only major problem found was yeast in the urine which is considered a UTI but no bacteria, only yeast. Specialist in internal medicine says anti-fungal therapy for several weeks before any surgery but I've read this stuff often doesn't work, and our regular vet doesn't think it would be very good for her liver right now and we agree. I am treating her naturally - she has always had a yeast issue (skin) but no vet seemed to be able to provide much help so I got her on Nzymes products and she's been well under control for many years. Since I found out about the yeast in the urine a week ago I've been giving her probiotics twice a day and add apple cider vinegar to her water; I've also doubled up the Nzymes as they tell us to do in times of "need".
[B]THIS IS WHAT'S REALLY BOTHERING US:[/B] They mentioned in the report that if we do an orthopedic surgery now before the infection (yeast) is under control then the risk of complications are much larger. Is that true? And what would be the risks?
We have already fooled around for 6 weeks with $2000 of tests that were negative except for the urine culture with yeast only. We just want this operation done and have a dog that can walk properly! She is presently crippled with a dislocated hip and sometimes is in some obvious pain. We have a day scheduled for the surgery next week but this specialist is causing us a lot of anxiety - is it true that she could have "important" complications because of the yeast in her urine or are they just hoping for more business from us in the form of diagnostic tests?
I should mention that this is one of those vet hospitals where we went only for an ultrasound but they keep calling us with more and more suggestions of potential problems (they want a new test for diabetes even though 2 blood tests in the past month were normal; they want another urine test by means of expensive ultrasound-guided cystocenthesis - over $200 the last time; they want a test for Cushings even though she is healthy and radiant and has no symptoms; etc, etc). Perhaps they are trained to look at every single potential problem but our money is running out and the operation she needs isn't even done yet! She'll also need physio (more $$). We adore our dog but we are wondering what is truly necessary and what is exaggerated. Thank goodness our regular vet has told us that a Cushings test could be in a few months (or next year) if we want but it wouldn't affect the operation since she has no obvious symptoms. And the yeast doesn't seem to bother her as much as it bothers them;today they even mentioned they are afraid it could up into the kidneys and that they want a negative urine culture before the surgery (that could take months!!!). I haven't had her opinion on that yet.
We are confused, exhausted with all this, and don't know what to do. Are they purposely scaring us and trying to take us for a ride? We wonder what the real risks would be of doing the FHO surgery with some yeast in the urine. We would appreciate another vet's opinion. We would like to know the truth.
If I am correct having a surgery with a yeast infection could be very dangerous if get into the blood system.
I am sorry to hear about the challenges and frustrations that you are going through.
While bacterial urinary tract infections (UTI) are quite common, yeast UTIs are highly uncommon. While Candida species can infect the urinary tract, it is unlikely unless there is concurrent disease or immune compromise of some sort. The risk of yeast entering the blood stream and translocating into a systemic or new local infection is even more rare without concurrent disease.
There are a couple possibilities that I would be considering:
1) There is a true yeast UTI. If this is the case, then the further tests that your veterinarian is recommending may be worthwhile to rule out concurrent diseases. Antifungals like fluconazole can work quite well. In humans with candida UTIs, fluconazole has been reported to work as well as amphotericin. Fluconazole is a lot safer of course than amphotericin. Of course, if severe liver issues are present, then fluconazole may not be suitable. Both long and short term fluconazole use is typically well tolerated by most healthy dogs.
2) The yeast was a spurious finding. Retesting of the urine from a cystocentesis (direct sampling from the bladder) might be worthwhile.
Regardless, the last thing that anyone would ever want is to proceed with a major orthopedic procedure and then have a complication. Urine cultures are typically standard before this type of surgery and it is standard to follow up any abnormal results. Again, yeast UTIs are very uncommon in dogs and may often be associated with underlying disease. Whether this is an extremely rare isolated yeast UTI, an uncommon yeast UTI with underlying disease or immune compromise, or a spurious laboratory finding, a methodical and careful workup is recommended.
Best wishes and I hope this helps. :pawprint:
It's Aspergillus flavus !
Thanks for your info, however I wish I would have known the strain before posting; we just found out it's aspergillus flavus - 30,000 colonies. So no, it's not a true UTI, it's a discovery of a fungus in the urine culture.
Jessy has no signs of being immunocompromised and this has been repeated to us numerous times by numerous vet pros we've seen in the last 7 weeks. She's in good spirits, eating well, and looks great.
When it gets very humid (as it was in July) she tends to develop what appears to be a slight vaginitis; however this year she also had dislocated her hip and was sitting and laying a lot which, I think, aggravated the situation and she developed this vaginitis which I am still trying to get rid of.
One vet's theory is that possibly the A. flavus climbed up the urethra and showed up in the urine since A. flavus is a known climber! This was actually my first idea too, but the zealous internist wants thoracic x-rays, complete cytology exam, and much more, even though the dog is very healthy and has never had any respiratory troubles nor have any lesions been seen on the abdominal ultrasound. I am thinking that perhaps these tests may be unnecessary. We have already done so many...(6-panel blood, 12-panel blood, urine test and culture by cystocentesis, abdominal x-ray, abdominal ultrasound, bile acid test (twice), and the list goes on.
I read some medical articles recently that say fluconazole doesn't work on aspergillus flavus; the anti-fungals that could work are very hard on the liver. It's not an easy situation and I've read systemic issues are basically considered fatal, regardless of the treatment. But if there is no real reason to believe that this is systemic (I'm starting to think it's almost impossible), perhaps we should just keep her on the natural and healthy path we've followed thus far with Nzymes products and maybe add some colostrum as someone recommended because it can help eliminate fungus in the bladder (and many other benefits) if that's the case and it's not dangerous. Once I see the vaginitis has disappeared then I suppose it would be a good time for a new urine culture and hopefully the hip surgery.
We have heard, however, that a new urine culture may still grow A. flavus but that this still doesn't indicate a systemic issue. Do you know why that would be so? There was no explanation.
And if you have any ideas on how to get rid of this stubborn vaginitis, please let me know!
Oh and lastly, would a low-grade Cushings diagnosis mean the dog is immunocompromised even though her health seems fine? She has yet to be tested...
1) ...the anti-fungals that could work are very hard on the liver. It's not an easy situation and I've read systemic issues are basically considered fatal, regardless of the treatment.
2) We have heard, however, that a new urine culture may still grow A. flavus but that this still doesn't indicate a systemic issue. Do you know why that would be so? There was no explanation.
3) And if you have any ideas on how to get rid of this stubborn vaginitis, please let me know!
4) Oh and lastly, would a low-grade Cushings diagnosis mean the dog is immunocompromised even though her health seems fine? She has yet to be tested...[/QUOTE]
1) there are two types of medications that are given systemically for fungal infections. Medications that inhibit growth and allow the body to fight the infection, ie fluconazole, etc and those that kill the fungus, ie amphotericin. For dogs, the first group is very safe and the second category is not safe for dogs. So yes, you are correct.
2) Urine cultures, regardless of what it finds are not considered "systemic" as it only indicates an infection within the urinary system. For an infection to be systemic, you need either a positive blood culture or multifocal positive cultures of the same organism in various locations in the body.
3) I am sure your research and vet has covered it but here are some basic ideas I tell my clients. If all of was covered, let me know and I will dig deeper. Some things that will help: a) weight loss. If there is obesity, the fat covers the vulva, allows urine and moisture to build up and changes the temperature of the area, b) keeping the area dry, c) cleaning the vulva with Malaseb swabs or alternatively white vinegar. I would do this every time she urinates and as often as possible, d) keeping her bedding and where she lays down very clean and dry, and e) potentially shaving the area if there is a lot of hair. When chronic vaginitis is present, the hair will start to keep in moisture and infection. These are some common recommendations.
4) Cushing's disease is hyperadrenocorticism. Keeping it simple: The gland of your body that produces steroids becomes functionally overactive. This can be the equivalent of giving large doses of prednisone. So, the short answer is yes. The longer answer, is that all things can be relative so not necessarily. Sorry - that this isn't as clear as we would like.
I hope this helps. I am not sure if I answered all of your questions. Please let me know. :pawprint:
PS - if I ever do not answer or anyone wants me to look at a question, please PM (Private Message) me on here. Thanks
Our own vet seems to now be thinking that the internist us scaring us unnecessarily with the threat of a systemic A. Flavus issue. She checked Jessy's thoracic xrays from a month ago when liver xrays were taken and the lungs are also showing up quite clearly; she says there are absolutely no lesions so this is great news since this fungus fancies the lungs (and the ultrasound didn't show any abdominal lesion). She told me today that she's spoken to 2 specialists and they are baffled. From the beginning we suspected it was due to the vaginitis climbing up; and then I read articles explaining that yes, this is the way that this fungus climbs - like a vine. So after Fluconazole for 5 days and no improvement in the look of it (still a bit swollen and yeasty looking) we decided to just stop it and go back to my Nzymes, probiotics, and we'll add colostrum. I was happy you explained the different function of Fluconazole and in that new light I can see how it might be helpful but I have been told that I shouldn't use the Nzymes (etc) while using the Fluconazole because there could be some interaction. Also, I was encouraged when I read yesterday that Nzymes Ox-E Drops (sodium chlorite) are extremely safe and often used in reservoirs and municipal water facilities because it KILLS Aspergillus flavus! We have been using these in Jessy 's drinking water for 5 years now but we are supposed to add a bit more if we see trouble (like the vaginitis) but we didn't...
[I]By the way, there are many brands of digestive enzymes, probiotics, and sodium chlorite drops so we are not trying to do marketing for this particular company; it's just that it was easy to get a "kit" already put together, but other brands could work just as well.[/I]
Yes we are keeping her super-clean, especially after every potty outing. She isn't overweight anymore (she lost 30% of her initial weight in one year) but she has folds that hang down and I have to push up to clean the area well. I have used apple cider vinegar and water but is there a reason why you recommend white? I have now purchased a vaginal cream that contains probiotics (and garlic!) and have applied that.
I would very much appreciate having your opinion - what do you suspect and what course would you recommend this situation?
I'm sorry you are having this trouble and I'm sorry I have no experience or suggestions to offer. But I wonder if I can help lighten your mood with a little joke? Every time I see this title I think you are asking if your dog can have sex. :)
Poor poochie girl Jessy. I hope it gets all cleared up for her and you.
Wish it was sex and not surgery....and potentially life-threatening fungus....sheesh! :cry:
But we're keeping positive, so thanks for the laugh!
PM'd answer for you :)
I'm not a huge fan of the Nzymes products, wondering if you are having success with them?
What breed of dog do you have?
About 5 years ago, when Jessy (Pom/Lhasa) was about 4, we started seeing major skin problems. The vets only talked about allergies and Prednisone and antibiotics, which I knew were just a "band-aid" and the Prednisone could hurt her. So off I went in search of natural aids...at one point it was so bad that she wasn't sleeping, we weren't sleeping, she was depressed and had large red collarettes all over her abdomen and had lost all the fur underneath and was not even eating (and she's normally a dog with a great appetite). I actually had to feed her in my hand. I was at wits end and decided I'd try the whole Nzymes product kit for "yeast" (yeast was seen on a skin scraping of hers). I know it's just digestive enzymes, Ox-E drops (sodium chlorite - not "chloride") in her water, black walnut oil and olive leaf extract to kill yeast, plus the treats which are vitamins (A, C, E, etc) and a gradual change of food (at the time it was to the Nzymes-recommended old Eagle Pack, no longer available). I don't know what did the change but the dog completely turned around in a matter of weeks. After 2 months she was radiant. I also gave her pep talks, daily massages, lots of love, etc. Something worked. But there are so many stories of success of their website - our story is there too, and I'm not lying so I'm sure many others are also not lying.
For now, though, with this new Aspergillus flavus problem, I've cut out the Bac Pac powder because it does contain "safe" aspergillus (a different strain) as a digestive aid but I've read that dogs with a sensitivity to aspergillus mold might be better off avoiding anything that contains it in any form. I am also wondering if perhaps the black walnut/olive leaf tincture might have had some aspergillus (it's a fungus that enjoys walnut trees) so I am abstaining from that too, just in case. She's getting probiotics, colostrum, virgin coco oil, minced garlic, etc - she's good. I still give her the Nzymes treats for the antioxidants/vitamins and the sodium chlorite drops which kill aspergillus flavus. I'm doing my best with the limited information I have because A. flavus in a urine culture with no sign of systemic infection is an issue most vets haven't seen, especially in a dog that doesn't seem immunocompromised. The first place it attacks is the lungs (lesions) but her lung xrays look good, her abdominal organs look good (ultrasound). It's really odd.
I may be repeating myself (sorry) but a few vets have suggested what first came to me: her vaginitis is probably aspergillus, not candida (it happens) and it climbed, and then showed up in the urine culture. I feel that if I can get rid of the vaginitis (and it's looking better everyday) then we can go for another urine culture and let's hope we killed that fungus!!! Lord knows I'm trying my best. Maybe some will criticize me for not going with Itraconazole (strong anti-fungal med) which is the only medical suggestion we had thus far, but I know what this stuff can do to her liver and I've read many (MANY) medical articles that explain how systemic aspergillus flavus cannot be successfully "cured". Many dogs have taken the Itraconazole for 2 years (with its side effects) , then stopped and the fungus returned. It's not an answer. There is no right treatment, it seems. So I'm doing my ultimate best and I hope it'll work. 5 years ago we had success and she was extremely sick; right now she looks great and seems to feel great apart from her limited use of the dislocated leg. Let's win again!!! :thumbs up
i am so sorry for your troubles w/ Jessy i have a 111/2 yr old pom my baby girl kizzy she has congestive heart failure & cushings disease
in cushings im sure youve looked up info but lots of panting , alot of water intake & lots of urinating hair changes sm x falls out the get a pot belly appearance they get weak in the back end heat in tolerant & weight gain a few more symptoms kizzy was cushinoid long b4 congestive heart failure cropped up
& now having both diseases & on lasix even more panting , more water intake & more urinating so i was already used to excessive amounts in these 3 areas
but she is doing well rt now but my beloved vet will not treat her for cushings afraid it may kill her with the congestive heart disease
if your dog is not diabetic & is not drinking alot of water & panting & going more often to urinate then id doubt the possibility of cushings ??? the symptoms r pretty distinct & i think you should get you a new vet to do surgery ect they r taking you for a major ride ???
& i wld not feel comfortable with them i hope if you want their is another option how did she dislocate her hip ?? how much does she weigh ??
how did she lose 30 % of her weight ?? my girl needs to lose wt she is a full blood pom 19.5 lb because of cushings & low tyhroid & congestive heart failure
i am in texas i carry her because her bk end is too weak she stands to poop only sm x urinate but usually she lays down lifts tail
also i have to wash her belly , legs & tail & vulva to wash urine off its hard to keep clean & keep dry any suggestions to prevent sores
wen she poops i have to give her a lower half bath every time a big mess
she is happy though rides in stroller eats well
i wish you & jessy alot of luck plus any suggestions for me let me no please for kizzy & her lower half keeping clean dry & any great products & any suggestions for yeast in ears thanks
First and foremost, if you don't already have a Yahoo email I would suggest that you sign up for one and join the support group for canine Cushings disease at: [url]http://groups.yahoo.com/neo/groups/CanineCushings-AutoimmuneCare/info[/url] . These people all have dogs with Cushings and they have been through the medications, the problems - everything. They will be able to help you with Kizzy much better than I ever could.
That being said, I am so sorry to hear about your problems with Kizzy; she is lucky to have you. I know what it's like to have to clean up a fluffy Pom after every pee and poop - especially when Jessy first dislocated her hip and couldn't stand very well she would get messy all over herself. The problem is that the more we wash them in water, the more there is humidity and with this humidity comes skin problems so make sure she is quite dry if you wash or rinse her skin (I sometimes use the blowdryer on the cool, low setting but she hates it). I found that to clean up after a pee, it's better to use either white vinegar with water (half and half) that I keep in a spray bottle or a jar and just put some on a paper towel to dab the fur along her legs where the urine has leaked. The vinegar gets rid of the urine smell in the fur, too. As for the vulva, the same mix is good but I go to Costco and buy those cotton pads for cheap and by the box! These are the cotton pads that women use to remove eye make-up, etc. They're gentle on her "lady parts". Just make sure you dilute the vinegar with water, 50/50, because otherwise it could pinch. This can also sometimes be enough to get rid of any sores.
And for the messy bum, I think I'd bring her to a good groomer (or do this yourself): have them just cut or shave a little off her behind - a nice even trim so that the fur is easier to clean. They once did a special "sanitary trim" around her anus so there was also less soiling of her fur - it worked great and you can't see the shorter hair under those fluffy Pom tails anyway. If you have a groomer do this, I would suggest you stay with the dog because she will need you to support her under her belly as they trim. I am also afraid of leaving my dog with groomers - we read of bad things happening sometimes so it's better to be careful.
But if there is still some mess happening after "Number 2", I'd try to just get it off the fur and not go down to the skin with the vinegar/water or some gentle soap/water (unless you have to). Like I said before, the more humidity that hits the skin, the more potential there is for sores...that's how it is with Jessy anyway. Her skin doesn't like too much water and especially soap. I use Buddy Boo Buddy Wash by Cloud Star when I have to, I rinse really well, and I finish with a vinegar and water rinse (no need to rinse off the vinegar/water). The company also makes a nice "spritz" that smells like lavender and sometimes I spray it on a paper towel with some water and use it to freshen up her fur around her bum and lady parts, too.
I have another possible solution for you - you can make a sling from a piece of towel or other fabric (like a long, wide belt) and have it under her belly when she does her duties and this way you can hold her up and there will be less mess on her fur. But not all dogs will do their duties with a sling under their belly - maybe Kizzy will? It's worth a try and could solve your problems.
For her ears - does she have an ear infection or is it really yeast? Jessy never had yeast or fungus in the ears (thank goodness - ONE THING she never had) but once she had an infection and the vet prescribed Surolan drops that cleared it up in no time. These are anti-yeast but you'd have to see the vet for that. They also had us rinsing her ear with a vinegar/water solution, letting it dry out, and then we put in the Surolan drops. These drops are also great for little sores on the skin but they do contain cortisone so you don't want to use too much or for too long (just a few days usually gets rid of the problem). I prefer natural meds but these drops have often been a lifesaver !
If your dog has yeast issues, you could try a good refrigerated probiotic (1/3 capsule maybe 2 or 3 times a day - so it ends up being almost a whole capsule per day), and order the Ox-E drops from Nzymes for her water (or you could put a few drops of apple cider vinegar in Kizzy's water bowl), and the Nzymes Antioxidant Treats are good too - they are vitamins A, C, and E (I think) plus a little selenium for the thyroid. A nice oil for dogs called Ascenta (or they may be other brands in the USA) is also really good - just follow directions on the bottle. These simple things made a big difference for Jessy. And make sure you don't give tap water - I bought a Brita to filter the water for us and for the dog.
Jessy has always been a "hot" dog, so sometimes there is panting and she has always preferred cool places to sleep but her water consumption is normal, no pot belly, but she does have the excess fat between the shoulders even though she's now at a healthy weight. I am not in a rush to get the special blood test done for Cushings because even if she has it, it's not a big deal with her or we've been dealing with some light symptoms all these years. I won't be giving her medication she doesn't need. We have seen a few vets lately and the one we trust the most has said that if Jessy does have Cushings, it's not "full blown" so we can just treat little problems as they come up. She is very smart and very reasonable so we are going with her advice.
How did we have her lose weight (30%) in one year? Well, we took that good vet's advice and started slowly diminshing her dried food portion because that's where the calories are, and we started giving her the same brand's canned food to compensate - the canned food has a lot of water so they feel full but there are less calories. We also gave her a little bit of steamed vegetables, mashed up, like broccoli and green beans and some carrots because there aren't many calories but they make the dog feel full (I didn't want Jessy to starve!). We actually counted the kibble to make sure she wasn't getting too much because sometimes our eyes are not very reliable! We also cut out a lot of treats - we were giving her good stuff like the dried chicken or duck breast pieces as snacks, but maybe too often. We now only give her maybe 3 tiny pieces a day because the dog doesn't really see the size - it's the thought that counts! And just with the food changes she lost the weight. She started off at almost 18 pounds and she's now a healthy 12.5 (she not a tiny Pom). The vets are all very happy....
Food quality is very important and there are some recommended foods on the Nzymes website that are good for dogs with yeast problems. You might want to go see if any of the names are brands you know or already use. If you change, you have to go slowly (you probably know that, but just in case...).
As for problems with heat, we got air conditioning for the dog 3 years ago !!! Ok, it was for us too - the summers here in Canada are getting extremely humid - but the dog is much happier and often doesn't even want to venture outside away from her a/c when it's really hot and humid. Her skin is better since we got the unit installed.
And how did Jessy dislocate a hip? Well, she has hip dysplasia (like many dogs) and she saw a wasp, did a little twisty jump, and she dislocated the hip....it can happen quite suddenly in dogs with hip dysplasia.
I hope I answered all your questions and I really hope you join that Cushings forum where I know you will get good advice for Kizzy.
Take care and bless you for all you are doing for your little dog! :thumbs up
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