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Old September 4th, 2013, 03:14 PM
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BabyJessy BabyJessy is offline
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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".

THIS IS WHAT'S REALLY BOTHERING US: 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.
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Old September 4th, 2013, 07:43 PM
Barkingdog Barkingdog is offline
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If I am correct having a surgery with a yeast infection could be very dangerous if get into the blood system.
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Old September 10th, 2013, 01:28 PM
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Dr Lee Dr Lee is offline
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Hello,

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.
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Old September 10th, 2013, 10:04 PM
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BabyJessy BabyJessy is offline
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It's Aspergillus flavus !

Dr. Lee,

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...

Thanks!
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Old September 11th, 2013, 01:16 AM
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Dr Lee Dr Lee is offline
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Quote:
Originally Posted by BabyJessy View Post

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...
Answers:
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.


PS - if I ever do not answer or anyone wants me to look at a question, please PM (Private Message) me on here. Thanks
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Old September 12th, 2013, 10:01 AM
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BabyJessy BabyJessy is offline
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Aspergillus Flavus

Dr. Lee,

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...

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.

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?

Thanks!

Last edited by BabyJessy; September 12th, 2013 at 03:49 PM. Reason: Added "garlic"...
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