Ask the Vet: Challenging UTI's

by Mark Nunez, DVM

© courtesy Chris Abbas via Flickr.com

Dear Dr. Mark:

I have a 6 yr old Shih Tzu who has been sick for six weeks. She was diagnosed with a urinary tract infection and has a history of bladder stones and urinary tract infections. I kept telling my vet that she had no other symptoms (frequent, straining or painful urination). Then her left neck lymph node swelled to a huge, hard knot. The vet said she was trying to fight off infection, but eventually removed it and pathology was benign (it was 60% necrotic). 

The lymph nodes on her tummy swelled, then bleeding occurred again, but only for a day. Further problems included an erosion type sore on belly, then another on eye, and another large neck node. Now she has sores all over her belly. 

Blood work was normal 2 was ago except slight anemia. What is wrong with my dog? I took her to an internal specialist too, have spent $3200 so far, and no diagnosis. She continues to lose weight and get weaker. I am force feeding her every bite she eats.                    --Julia

-------------------------------------------------------

Dear Julia,

If your dog has a bladder stone she will be predisposed to UTI's.  Many times the bacteria live inside of the stone and antibiotics cannot reach that far.  A course of antibiotics will treat an active UTI, but very soon after the course the infection will return.  Removing the stone is the best course of action, no question about it.  

The situation with the lymph nodes is concerning.  I would, at the very least, have more of them aspirated or biopsied.  When any tissue is necrotic it can be difficult to see what is truly going on.  The anemia is also a concern.  There are many causes of anemia and this should be explored further.  

"Normal" bloodwork does not always mean that there is not something very serious going on.  Many times, even in the face of an obvious infection, the white blood cell count will be normal.  This is because we measure cells that are in circulation.  We cannot measure cells that leave circulation in order to fight an infection with in tissue.  The site of infection may be loaded with white cells, but the circulating population can look quite normal.  

I wish I had more insight for you as to what is going on.  I hope someone finds an answer for you and your dog very soon.

Best wishes, Dr. Mark

© courtesy m.n.
Mark Nunez, DVM

Dr. Nunez is a practicing veterinarian while also assisting patients through The Balanced Canine blog and his own online veterinary pharmacy. Have a question for Dr. Mark? Send it to AllThingsDogBlog@gmail.com. You can also follow Mark on Twitter.

Want to read more from Dr. Mark? Try these, or visit his archives: 

Digestion in Senior DogsMore on Dogs and AllergiesDogs and AllergiesDogs Who Eat Bugs