In spite of how revealing ultrasound imaging frequently can be, Bella’s scan was negative for any such obvious issues (ultrasound can detect macroscopic stones, but NOT microscopic crystals). In this case, it was the routine urinalysis that provided the definitive and critical information… showing large numbers of microscopic crystals made up of ammonium magnesium phosphate (AKA “struvite”). Crystals of different mineral and chemical composition have specific visual characteristics which facilitates their rapid identification (microscopically).
When we find such urinary crystals, their mineral or chemical composition are what lead to an understanding not only how they came to exist, but also the potential treatment(s)/remedy options and (therefore) the prognosis going forward.
Crystals (in urine) are the result of the coalescence of minerals if and when the concentration of certain substances become too high for the material(s) to remain in solution…kind of like there being too much salt in water such that it begins to ‘settle out’ on the bottom.
Each individual’s body chemistry is unique, so the risk for each type of crystal forming varies for different people and animals. In addition to underlying metabolic differences, risk profiles include adequate (versus inadequate) water intake and dietary influences – which affect availability of minerals, cholesterol, nitrogen wastes, and even chemicals or medications. All of these variables also affect pH (which in turn ALSO influences how much of each mineral or chemical remains dissolved in the urine).
Bella’s had lots of the struvite crystals, but the data also signaled the presence of bacterial cystitis (“bladder infection”). Irritation – in the form of a million (or more) cuts – mechanical injury from (microscopic) sharp and jagged crystalline edges – lead to bleeding – and bacteria THRIVE on blood!
It is (also) important to remember that a few crystals here or there are unlikely to cause ANY patient problems AND wide variations exist for individual tolerances of such things. Overall though, it seems as though humans develop far more mineral deposits higher up in the urinary system – like the kidneys and ureters, whereas dogs or cats experience more challenges in their urinary bladders!
For this reason, Bella required not just antibiotics, but a diet change as well. In spite of the fact that her new food contained all of the usually necessary urinary acidifiers and mineral balance/restrictions the blood kept returning in her urine. This in spite of her owners faithfully following the rigid guidelines and (standard) treatment advice that was prescribed (and repeatedly revised)!
Weeks (and even months) after Bella had started her diet changes, urinary acidifiers, and conventional antibiotics, the decision was made to resort to “alternative” measures!
By the way, part of the complex issue involving struvite crystals or stones includes the fact that certain bacterial infections often support or cause their formation in the first place, SO antibacterial treatment is absolutely foundational to the success in resolving these problems!
That being said (and done), Bella used the same “calculolytic” (calculus or crystal/stone dissolving) diet(s) which has proven effective on hundreds and thousands of other similar cases. This illustrates perfectly that organized medicine is based on statistics. In spite of the fact that a dietary plan may well be fully effective in effectively resolving cystitis (bladder infection) in the first one hundred or one thousand dogs, the very NEXT dog’s metabolism might well still produce a significant excess of minerals (and therefore the SAME crystals…and subsequent blood in the urine).
These are the sorts of cases that make life “interesting”!
The FIRST thing we did (next) was to fully re-evaluate everything! Sometimes, for instance, when one type of crystal (or stone) is precipitating in the urine at an alkaline pH, acidification of the urine could induce precipitation of a different type of crystal (or stone). Some individuals’ predilection(s) – whether related to dietary (changes) or metabolic fluctuations – are such that urine pH and mineral excretion (by the kidneys of course) vary considerably. Not Bella! She kept right on producing the very same crystals in spite of all the changes and treatments!
To elaborate slightly on stones or “uroliths” – when we sees tones in the urinary tract, the temptation is to presume that the chemical/mineral composition of the/any crystals seen microscopically should reflect (and therefore pre-determine the composition of) any visible stone.
Not so fast! Oftentimes,the “nidus” or interior layers of a stone may be completely different than that of outer layer(s), so (even more) obviously, crystal ‘type’ does not always predict stone composition…even though cats and dogs seem far more constant with regard to their diets (tending to consume more consistently the same food or diet(s) than what humans eat – and not that that is necessarily a bad thing!)
Considering all of the above (which I am determined not to elaborate ANY further on in this setting OR format), we set out to create an herbal formula containing urinary tract disinfecting and anti-inflammatory phytochemicals (herbs) along with pure ammonium chloride (a urinary acidifier). All told we combined 12-15 ingredients (depending upon the batch), and Bella (and her owners) were thereafter relieved to be free from symptoms for the first time in months. Any amount of time lapsing (off of the formula), however – over the past years – has meant an almost immediate recurrence of symptoms… and the resulting angst and inconvenience.
Bella’s owners became so convinced on the benefits of natural medicine that when their other dog began experiencing troubling digestive issues including vomiting and diarrhea, they did not hesitate in insisting we conjure up another herbal formula for her…which also immediately and completely restored her to full health.
This and other case reports can be found at DaactorT.WordPress.com – the blog location for GaylonTeSlaa, DVM, Mammoth Lakes, CA.