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  Discussion on The rule out game, uti?
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New Member:
Dorene

Posted on Tuesday, Oct 10, 2006 - 12:50 pm:

I have a 4yr old Haflinger that we are playing the rule out game with. His symptoms started with explosive diarrhea. Abdominal discomfort, frequent urinating, dull personality. We have taken care of the diarrhea, He did a week of no grass, smz’s and probias .His manure came back neg and we 2x strongid. He is now a week off everything and we are going into the 3rd week still having these symptoms: (1)Frequent small amounts of urination. Urine is thick and brownish as if end of urinating. (2) Stays in urine stance for a while.
(3)Abdominal discomfort, seems like behind flank area. (4) no spunk, ears back if asked to canter. His appetite is fine and he is in great physical shape. Not too fat and was doing great endurance wise. My daughter uses him for pleasure and gymkhana events he is an all around wonderful little Denis the Menace.
First round of labs showed Slightly anemic (28), wb a little low, liver and kidney normal. Now our 2nd rounds of bloods 2wks after first. Show liver&kidney normal, wb normal, rb a bit low, crystals do show up in urine.
We are going to treat him for 6 weeks with smz for a uti. Other diseases my vet is considering are ulcers, belly button abscess, tumor, cushings and lymes.
Most just don’t jive because of his age, appetite and fitness. Im concerned with the long uti treatment if its not that am I waiting to long to treat anything else that we might be missing. We do need to economically approach this. Yet I do not want to jeopardize him in anyway.. Any advice and suggestions are welcome.
Moderator:
DrO

Posted on Tuesday, Oct 10, 2006 - 7:13 pm:

Hello DB,
The depression suggests the horse is recovering from a serious bout of colitis, though the ongoing urinary system signs are not consistent.

Hmmmm....the way to diagnose UTI is finding blood and WBC in the urine, has a complete urinalysis been done? The article Diseases of Horses » Urinary System » Normal Urination in Horses explains procedures and results. This has to be done before antibiotics are started however. Since the UTI can be secondary to stones, the urinary system also needs to be examined by ultrasound.

Also to consider is that colic unrelated to the urinary system can cause urination like posturing so until the urinary system is ruled in as the cause you cannot rule out this possibility.
DrO
New Member:
Dorene

Posted on Wednesday, Oct 11, 2006 - 11:23 am:

Thanks Dr. O, I spoke with my vet last night. He also shows much concern so we are Ultra Sounding Westlee tomorrow. I read up on the colitis and the urinary system and Westlee just doesn’t meet the criteria fully. The ua was done on Fri at that time he was off the smz’s for one week. My vet explained it as,Westlee’s score is a high normal on the full analysis. Westlee behaved really well for the internal exam and everything seemed clean. The vet’s biggest concern is the urine would be normal if that was the ending element of the catch. He was there when I got the sample and it was the very beginning. Westlee’s stall has been saturated by the AM, He is still eating, drinking and not showing any signs of stressing. Yet you can tell he is very uncomfortable. When the farrier was shoeing his hind end yesterday he gave us a real hard time. A friend talked to me about a horse where the bladder was full of sediment that it almost rupture. I hope the Ultra Sound tells us what’s going on. If you have anything for us to zero in on,or questions I should ask my vet please let me know.
Moderator:
DrO

Posted on Thursday, Oct 12, 2006 - 6:31 am:

If they all had the exact same symptoms for each disease medicine would be easy. Unfortunately for any one disease every horse is a little different. At this point zeroing in on a predefined disease is exactly what you do not want to do. Instead keep an open mind to all possibilities and then use objective findings to rule them in or out. This is the only way to be sure you don't miss something.
DrO
New Member:
Dorene

Posted on Sunday, Oct 15, 2006 - 10:42 pm:

Dr. O,
Westlee had his ultra sound on Fri. My Vet is consulting with some of your associates.
Hypotonic Bladder or Primary Bladder Dysfunction. Westlee’s bladder was 75% sediment. No stones of any kind were present.
My understanding is he is one of the youngest geldings to earn this Dx. We are backing off rich hay, trying to lower calcium & potassium levels. Lowering PH and increasing chlorides. Im also having a chiro come check for any injuries that might be making it uncomfortable for him to empty his bladder. He also had a large amount of sand in his manure we are treating that with psyllium. I have many concerns pulling out the calcium and Phos.from his diet Being that he is 4. I reviewed your nutrition info and everything is a bit overwhelming rite now. It doesn’t seem like he was getting to much. His grain (about a handfull) is low, we feed a nice timothy mix. I was giving him accel and yucca as a supplement because he doesn’t eat much grain. Just wonder if I should not worry about supps so much being a rugid breed does he get what he needs out of a hay/grass diet? I know the prognoses is not very promising. I may look into some holistic type of approaches but will consult an equine nutritionist and my vet before making any changes. My understanding is this is rare and not a lot of research has gone this direction. Im located about 4hrs from Cornell, if you know anyone specializing in bladder dysfunctions Im open to any thoughts they may help us. Westlee is also on bute to dull pain if that may be a reason for him to not be emptying. He is also on smz’s to help protect from irritation/infection. Thanks again for your time and for having such an informative web site. Thank You ~ DB
Moderator:
DrO

Posted on Monday, Oct 16, 2006 - 7:39 am:

Thanks DB,
He is a Haflinger and Haflingers tend to make ponies look like difficult keepers so I don't think feeding a good quality timothy hay / grass is going to be a problem. Has there been any discussion of removing all this sediment surgically? Check out the topic and particularly the discussion, Diseases of Horses » Urinary System » Excessive or Uncontrolled Urination » Discussion on Loss of sphincter tone in young mare.
DrO
New Member:
Dorene

Posted on Monday, Oct 16, 2006 - 9:21 am:

Good Morning Dr. O, I hope Im not driving you crazy. During the exam the vets mentioned his bladder was a size of a softball which im assuming is normal. When I asked about flushing the bladder out I was advised its high risk because of the bacteria’s that can enter the bladder. I read on one of the your discussions that ecoli did enter the bladder. How risky is this surgery? Being that Westlee is 4 is this going to be an ongoing disease for the rest of his life, or can I look at is as flukey and hope to correct it? I also saw in one of the discussions you mention manually manipulating the bladder to get it to flush. Can you give me more info on that? Should I be contemplating a trip to Cornell or be more patient to see if we get any changes in the next 3wks?
Moderator:
DrO

Posted on Tuesday, Oct 17, 2006 - 4:04 pm:

It is not an easy surgery and will require laying the horse down in a hospital environment but if the paralysis is because of the chronic distension caused by the crystals it may be reversible it not too long standing. Of course the paralysis may contribute to the collection of the crystals. Your veterinarian could try manually expressing the bladder trans-rectally with or without a catheter. I would recommend with a catheter so the bladder can be repeatedly flushed to help remove sediment. If your veterinarian is uncertain with the diagnosis or uncomfortable with the procedure referral makes sense to me.
DrO
Member:
Dorene

Posted on Thursday, Nov 2, 2006 - 10:06 am:

Hi Dr O,
Just thought I would give you an update on Westlee. Last week he had slight colic symptoms. So being that we didn’t yet have a dx I brought him up to Cornell. What an experience! Everyone was wonderful and cared for each animal as if it was their own. Westlee was a trooper.
1)Bloods- neg 2)cultures-neg 3)u/s kidney & bladder- neg 4)radiographs-neg 5)scoped bladder-neg(flushed out the sediment) 6)endoscopy- neg 7) intestinal fluid tap- neg. We discussed diet changes to get calcium down and ph up. Westlee’s colic symptoms have gone and he is happy to be home. Although we have not been able to dx him, It’s somewhat comforting to r/o the threatening things like the hypotonic bladder, tumors etc. Im having a Chiro/acupuncture specialist coming toward the end of the month and we will watch him closely. Thanks for your input and advice. Thank’s to everyone at Cornell University Vet Hospital.
Moderator:
DrO

Posted on Friday, Nov 3, 2006 - 7:24 am:

Delighted to hear the sediment small enough to get flushed out and on the bladder not being hypotonic.
DrO
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