Senior Wellness~Nellie’s Health Series Part 5: Urinalysis

Senior Wellness~Nellie’s Health Series Part 5: Urinalysis

How does one collect a urine sample?

The best time to collect a urine sample for diagnostic tests is the first urine sample of the morning. This will give you the best Specific Gravity results (more on that later). Once collected it should be stored in the refrigerator until you can bring it into the clinic, if left out bacteria can multiple and crystals can form and you don’t know if this is part of the results or artifacts. . It shouldn’t be older than 12 hours. If you can’t collect a sample at home you can let the clinic know and set up a time to come in and have a lovely technician collect the sample. If you are feeling adventurous you  can collect the sample at home it is best to use as sterile of container as you can. Using a clean rubbermaid flat container, a clean butter container, a soup ladle or a coat hanger with a plastic bag. If collecting at the clinic and the dog doesn’t want to pee in the cup then the doctor can get the sample via urinary catherization or cystocentesis both of those methods are considered sterile samples as a regular collection is a free catch sample. The technician and doctor will take the collection device into consideration when looking at and reading the urine results.

The urine collection system that my mom designed.

As you can see Nellie is very happy to show off my urine collection system….NOT!

Success, it worked.

Once the female dog squats you slide the bag under her whoo ha and collect the urine. A male dog, you slide it under if it squats or stick it around the side if it lifts it’s leg, being careful not to get it out of there in time before it steps in it when he brings his foot down. If winter time like it is now in WI you want to be careful not to get snow in the sample as it my alter the results.

Components of the Urinalysis – What is the Doctor looking at when reading urinalysis results?

1. Color and Clarity of urine sample –  odor or no odor

2. Specific Gravity

3. Dipstick

4. Microscopic Exam

5. Culture

Components

First you will note the color and clarity of the sample, then the odor. The color will tell you how the kidneys are concentrating the urine. It’s kinda a quick glance to tell you if there is a problem before the whole urinalysis is done. You then want to smell it and note if it has a odor or not, again that will tell you if there is a problem before you are done.

Refractometer – checking urine specific gravity.

Second you need to put a drop of urine on the refractometer to see what the urine specific gravity is. The specific gravity will tell you how the kidneys are concentrating the urine. Dark urine means they urine is well concentrated, light urine means the kidneys are not concentrating the urine meaning there might be a problem with the kidneys.

Urine dipstick

Third we will do a urine dipstick. The dipstick will tell us the PH of the urine, if blood is present, if protein is present, if glucose or ketones are present and if bilirubin is present. All these test could mean there is a problem with the urine, kidneys or if a animal is diabetic.

Centrifuge

Fourth we will spin down the urine in a centrifuge, the centrifuge uses great force to separate the  solid components of the urine from the liquid. After the urine sample is spun down it is set up for microscopic exam on the sediment.

It’s time to read the sediment under the microscope.

Staining of the sediment.

You can look at the sediment stained or unstained. Staining the urine sediment will make some structures more visible.

Culture on the urine.

A culture should be set up on each urine sample to check for bacteria in the bladder. It is best to do a culture on a sterile urine sample but that isn’t always the collection method so you do it on a free catch sample taking note if something grows on the plate it may be a contaminant and not a bacteria that is really causing a problem. If bacteria grows then we send it to a outside lab to run a id (tell us what bacteria it is) and sensitivity (a drug sensitivity to test which drugs will kill the bacteria). A culture may take up to 3 days to grow and another couple of days to get the sensitivity results.

Now what did Nellie’s urine tell us?

The main reason we did a urinalysis is because of her slightly high BUN from her bloodwork that I talked about on Tuesday, that you can view here. The doctor wanted a specific gravity to see if she was concentrating urine or not. If she wasn’t concentrating urine it would be another sign that the kidneys aren’t working like they should be. Since I had the urine I did a complete urinalysis. Nellie’s concentration was >1.050 which meant she was concentrating urine just fine that the kidneys were working good.

Microscopic exam showing many white blood cells (all the round cells to the right of the picture.

There was bacteria seen, epithelial cells and all the round cells to the right are all white blood cells. So at first glance you would look at this and see TNTC (too numerous to count) white blood cells and think that she has a major infection going on and needs to be put on antibiotics.

Urine results

When the doctor looked at the results and got a history from me which was that she was showing no signs of a urinary tract infection (increase drinking, increase urinating, frequent urination, blood in urine, accidents in house) she thought we need to find out if the WBC’s were really coming from the bladder (which would say bladder infection) or from the vagina (which would say vaginitis). So this lead us to the cystocentesis we performed that you saw on Wednesdays post, if you didn’t see it view it here.

Jackpot

A interesting way of getting a cysto sample. You put the dog on it’s back pour rubbing alcohol on the belly and where it pools you stick the needle in the deepest part of the pooled area and you will hit the bladder and get your sample, if there is enough urine in the bladder at that time. This is considered a sterile sample (you might hit the intestines and get fecal matter so that will not be a sterile sample if you see “floaties” and the urine is brown) so if there are WBC’s in it then we know she has a bladder infection.

Microscope exam.

You can’t see all those sheets of wbc’s in this sample so it means the wbc’s were coming from the vagina which means she has a vaginitis, which you can read about here. You need to combine the history with all the components of the urinalysis to come to a diagnosis.

Stop back tomorrow for:

Friday: Senior Wellness ~ Nellie’s Health Series Part 6: Pulled Tendon

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We are joining Linda at 2browndawgs and Jodi at Heart Like A Dog for this great blog hop.

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Senior Wellness ~ Nellie’s Health Series Part 3: Bloodwork

Today’s Tasty Tuesday post is tied in with the results of Nellie’s bloodwork.

Tuesday: Senior Wellness ~ Nellie’s Health Series Part 3: Bloodwork, why routine bloodwork is a good idea.

You say your going to poke me now?

The American Heartworm Society  recommends annual testing for heartworm disease. To test for heartworm disease you need to have a blood sample drawn as heartworm is detected in the blood from the antigen it produces. You can also see microfilaria in the blood if positive for heartworm disease. Even know I give my gang year round heartworm medication I still check them. You just never know when the medication is going to fail, when they will spit out a pill and not be protected or vomit up a pill. It’s better to catch early then later when more damage is done.

A fecal examination is also recommended once if not twice a year to check for intestinal parasites. My gang gets dewormed each month for intestinal parasites along with the heartworm medication they take. I still check a fecal sample for parasites that aren’t covered by the heartworm medication.

Since we were drawing blood for the heartworm test we drew more blood to have Nellie’s annual chemistry panel (checking internal organ function) and complete blood count (checking for infection) done. Bloodwork should be performed on young animals once a year and on seniors a couple times a year as the values can change quite quickly. Along with the chem panel/cbc I had her thyroid checked. All this was done as a package deal through the laboratory we use. Besides doing bloodwork at least once if not twice a year did I want to make sure I ran bloodwork on Nellie? Remember back on Sunday when I talked about her “funny” belly and I said her belly could have that look from cushing’s disease. If not you can read it here. As dogs get older they can come down with different diseases. One of those diseases is cushing’s disease where the adrenal gland isn’t producing any steroid this conditions medical terminology is called Hypoadrenalcorticism. The signs are lack of muscle in the abdomen making the dog look like it has a pot belly. This is the only sign I thought Nellie had. Other signs include, increase drinking/urination, excessive weight gain, fat deposits on the back end, hair loss. One way you can see if there is a chance the dog has cushing’s disease is by running bloodwork and checking the Alk Phos level. In cushing dogs the level is really high so that is one reason I wanted to do bloodwork.

Here are Nellie’s results:

The fecal exam (which isn’t shown) was negative for intestinal parasites. The heartworm test was negative. Her thyroid test was normal, her CBC (complete blood count) was normal.

CBC- Normal

Her Alk Phos that I was worried about was completely normal so really the chances of her having cushing’s disease right now is pretty much zero. The only abnormality is her kidney function. Her BUN (Blood Urea Nitrogen/Urea N) was 33 which is just over the high normal of 8-30.

 

Urea N – Slightly elevated

What does this mean? It means she has lost some kidney function. She could of lost it due to age relation, another disease going on, high protein diet that is excreting high levels of nitrogen. As long as it stays where it is and doesn’t creep up she will be ok. We do need to watch the protein levels in her diet and make sure she is getting highly digestible proteins so there are fewer nitrogen by-products that have been found in dogs with kidney failure to make the kidneys work harder. In dogs with kidney failure the excess nitrogen can become high in the bloodstream which can cause problems with other tissues. This last fall/winter Nellie took to taking off and eating deer carcass’s so her high protein diet could be coming from that. The doctor suggested we run bloodwork again in the summer when Nellie isn’t taking off and see if the values change. When the kidney value is elevated it is a good idea to run a urinalysis one to make sure the kidneys are concentrating urine and to make sure there isn’t a hidden bladder infection that may of lead to a kidney infection that might elevate the levels. Doing this urinalysis is what uncovered Nellie’s vaginitis which I wrote about yesterday, you can read it here. Thursday I will write about the components of a urinalysis.

Stop back tomorrow to read: Senior Wellness ~ Nellie’s Health Series Part 4: Cystocentesis

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Tuesdays, Just Got Tastier!Tuesdays, Just Got Tastier!
We are joining the Tuesday Blog Hop Hosted By Kol’s Notes and Sugar The Golden Retriever

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Senior Wellness ~ Nellie’s Health Series Part 2: Vaginitis

Today’s Monday Mischief post is the second in the six part series on Nellie’s Health Series. This post should of come after the urinalysis post since this is how I found out Nellie has vaginitis but I thought this made for a mischief post so bear with me on the order.

Monday: Senior Wellness ~ Nellie’s Health Series Part 2: Vaginitis (when your male dog sticks his face where it doesn’t belong may mean there is a problem).

What you mean this is a problem? I don’t think it’s a problem at all!

Yes, yes you recognized the culprit, it’s the Gman to the rescue to tell you there might be a problem with Nellie. Gambler is constantly sticking his face where it doesn’t belong.

A frequent scene at out house.

After we got the results of the bloodwork the doctor wanted a urinalysis done on Nellie’s urine (more on that this Thursday). I got a urine sample, ran the urinalysis and the results were “are the white cells coming from the bladder or from the vaginal tract”, we needed to rule out a “bladder infection” vs a “vaginitis”.

I’m telling ya “Dr. G” says there is a problem Houston!

In order to find out where the white cells were originating from (bladder vs vagina) we needed to collect a sterile urine sample that came right from the bladder (more on that Wednesday). The sterile urine sample had no white blood cells in it so it ruled out a bladder infection in which I didn’t think she had a bladder infection because she wasn’t showing any signs of an infection which are: frequent urination, blood in urine, accidents in the house.

The supplies needed to check for a vaginitis.

To find out if the white blood cells were coming from the vaginal tract we needed to a vaginal cytology. In order to do this you take a sterile long q-tip wet it with water and then insert it into the vagina and roll to pick up the cells. You then put that sample on a microscope slide, stain it then read it.

View from the microscope.

The big round purple cells are epithelial cells which are normal in the vagina, all skin contains epithelial cells. All the other small purple structures are bacteria which ranged from cocci to rods. Some bacteria is normal as it isn’t a sterile environment but this slide contains too numerous of bacteria which means there is a problem. There were a few white cells but not like what was seen in the urine sample. The urine sample I ran was the first morning catch (which is the one the doctor wants to interpret the results correctly) so the white blood cells had time to collect in the vaginal tract and then be flushed out with the first urine sample. My boss wanted another urine sample from later in the day and there were a few white blood cells in that one so if not flushed out there is more white blood cells. Now why are these white cells present? It can be a normal vaginitis or it could mean there is a mass in the vaginal canal that is causing it. Nellie’s diagnosis is a vaginitis but after research on other cases like hers we decided not to treat the vaginitis because again she isn’t showing any symptoms of a problem so we are going to leave it alone until a problem arises. Why, well because if we start treating with antibiotics to get rid of the white cells and bacteria it may disrupt the balance and then she will show signs in the future and have to be continually treated. I am going to start her on a probiotic to see if we can’t get the bacteria balance back to normal.

Can Gambler stay out of my backend now?

ahhhhh NO!

I will check Nellie in a few weeks and if we get the same results we will look further as to why the white cells are present but for now we will leave her alone, well at least I will leave her alone. Gambler has other ideas.

Stop back tomorrow for:
Tuesday: Senior Wellness ~ Nellie’s Health Series Part 3: Bloodwork, why routine bloodwork is a good idea.

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Senior Wellness ~ Nellie’s Health Series Part 1: Radiographs

This Black And White Sunday starts off the first out of a  six part series on Senior Wellness. Since it is Black And White Sunday I start my series with Radiographs. Nellie is a senior at 10 years old. Her annual physical exam and vaccinations were coming due this month. A couple other issues cropped up that I wanted to discuss with the doctor so I compiled my list and brought Nellie with me to work last Monday. To talk about everything she had done and why Senior Wellness is important I broke it down into six parts.

Sunday: Senior Wellness ~ Nellie’s Health Series Part 1: Radiographs

Monday: Senior Wellness ~ Nellie’s Health Series Part 2: Vaginitis

Tuesday: Senior Wellness ~ Nellie’s Health Series Part 3: Bloodwork

Wednesday: Senior Wellness ~ Nellie’s Health Series Part 4: Cystocentesis

Thursday: Senior Wellness ~ Nellie’s Health Series Part 5: Urinalysis

Friday: Senior Wellness ~ Nellie’s Health Series Part 6: Pulled Tendon

Where we going mom?

Since I am a Veterinary Technician I am hyper vigilant on noticing things with my animals. I am constantly looking at them, feeling them over and sometimes making myself think there is a problem. For sometime when Nellie lays next to me her belly looks funny. Funny you ask, yup funny my technical term for it. I couldn’t quite put my finger on what I thought I was seeing. She has been sneaking off and eating deer carcass’s so she has been coming back all bloated and looking like a engorged wood tick. I thought A: she might just be getting fat, B: she is older does she have cushing’s disease, C:  do I see a lump in her belly. All of the above needs addressing hence the car ride with me to work.

Nellie started out with a full physical exam this is important for every animal at least once a year and for seniors it’s a good idea to have a physical exam twice a year as things can change just like that. It’s better to “catch” things earlier than later.

What is a full physical exam? It is a head to tail exam of each part of the animals body.

1. Checking for changes in the eyes.

2. Checking for changes/infections in the ears.

3. Checking teeth for broken teeth/tarter/gingivitis/tumors.

4. Checking lymph nodes below lower jaw, pre scapular, poplitial, ingunial.

5. Checking heart and lungs for murmurs and respiratory problems.

6. Checking abdominal cavity for masses.

7. Checking rectum for masses, temperature, parasites.

8. Checking whole body for any masses and abnormalities.

Nellie’s physical exam went great, she is looking and doing well for a senior pet. Her liver felt slightly larger (which can be normal in older animals) and what about the funny thing I was seeing with her belly?

When I lay on my left side you can see a alien in my belly.

While relaxing over the lunch hour the alien appeared so I had the doctor look and feel it. It was right about where her hair is thin (white) on the picture right in front of her back legs. The doctor thought it was her spleen. The dogs spleen is very long and the “tail” of it can “poke out”. But why is it “poking out”? It could be normal or it could be enlarged because of a mass on it. So to find out you start with abdominal radiographs to see how things look inside.

Right lateral is the most preferred position.

A ventral/dorsal (on the back) is second preferred.

After the two radiographs are taken they are developed so the doctor can read them.

Right lateral

Ventral dorsal view.

There was something suspicious on the right lateral view so we did another radiograph and did a left lateral this time to see if they could see the same thing.

left lateral

The suspicious area wasn’t on the left lateral so not to much of a concern. The radiographs can’t rule out a mass there was nothing obvious so the next step would be a abdominal ultrasound which will be done at a later date.

Nellie’s liver wasn’t a concern either after looking at the radiographs.

She was such a good patient for her radiographs, she didn’t move a muscle. Nellie did receive her annual vaccinations this day as there were no concerns not to give them.

Stop back tomorrow for: Monday: Senior Wellness ~ Nellie’s Health Series Part 2: Vaginitis

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Nellie’s Annual Veterinary Visit

Nellie’s annual veterinary visit is each January.  At this time she will get a full physical exam from nose to tail. This will include an eye exam, ear exam, teeth exam, check the lymph nodes, listen to heart and lung sounds, palpate abdomen, feel pauses in back legs, check skin, check fur, check rectum and vagina. The Veterinarian will then address any problems found and will address any questions the owner may have. If found healthy vaccinations are given at this time as well as blood draw for the yearly heartworm check and chemistry panel/cbc to check internal organ functions.

Outline of Nellie’s exam:

Nellie's weight check.

Nellie’s weight check.

Nellie weighed in before her examination. She weighed 73#. She is 10# over weight. I blame this on too many treats and not enough exercise. She is on Purina OM (obesity management) dog food but she still finds scrapes out in the fields to eat. Nellie is 6-7 on the body chart below. Click on body chart link to see  how your pet compares.

body chart

Today I will get an exam and some vaccinations.

Today I will get an exam and some vaccinations.

Today Nellie got vaccinated for Lyme disease, Bordetella (kennel cough) and DHLPP (distemper, hepatitis, leptospirosis, parainfluenza and parvo). She is current on Rabies so she doesn’t need that this year.

Lyme: Vaccination is by far the most effective way to protect your dog against Lyme disease. Recombiteck(TM) Lyme caccine uses the same advance technology as the human Lume disease vaccine. It works by blocking transmission – from tick to dog – of the spirochete that causes the disease. Recombitek Lyme is now available only from veterinarians. Per Merial brochure. Lyme is a yearly vaccine.

Bordetella: Your dog can have the kennel without the cough. Prevention is the key to kennel cough. If at any time in the next year your dog will be exposed to possibly infected dogs or group situations like those in dog parks, grooming facilities or even veterinary clinics, it’s wise to vaccinate for B. bronchiseptica and canine parainfluenza. Boarding kennels often require a kennel cough vaccination. Per Merial brochure. Bordetella is a yearly vaccine.

DHLPP:  (distemper, hepatitis, leptospirosis, parainfluenza and parvo) This combination vaccine is a yearly vaccination until the veterinarian feels your pet as built up enough immunity to spread the DHPP vaccine out over either 2 or 3 years. The Lepto portion of this vaccine is still concidered a yearly vaccination. It will only hold it’s immunity in the dog for one year so it needs to be re booster each year. This year Nellie’s DHPP vaccine is good for 3 years now.

2011 AAHA canine vaccine guidelines

The ear exam.

The ear exam.

Using a otoscope Dr. Hartay is able to look down deep in Nellie’s ear to see if she might have an ear infection. She does not have an infection and very clean ears. I don’t think I have ever treated Nellie for an ear infection in her 8 years of life.

The eye exam.

The eye exam.

Using a opthamascope Dr. Hartay looks for any changes in Nellie’s eyes. Her eyes were clear and no changes. As they get older they have some changes that if they were human they may need reading glasses but they don’t read so it doesn’t bother them. They can also develop cataracts but she doesn’t have any.

Nellie giving her mean face just after the teeth exam.

Nellie giving her mean face just after the teeth exam.

Nellie’s teeth were clean. She had a dental last year when she was spayed and they are still tarter free this year. If she would have tarter on her teeth she would need a dental cleaning. Not this year and hopefully not next if I keep up on the brushing.

Feeling The lymph nodes.

Feeling The lymph nodes.

Nellie has lymph nodes in her neck area, in front of her shoulders and by her thighs. She has many more lymph nodes but these sites are the ones that can be palpated during an exam for any abnormalities.

The ascult of her heart and lungs.

The ascult of her heart and lungs.

Dr. Hartay is asculting Nellie’s heart and lungs. She is listing for any murmers and making sure her lungs sound fine. Nellie is sounding normal.

The abdominal palpation and pulse check.

The abdominal palpation and pulse check.

Nellie had her abdomen palpated for detectable tumors. She then had her pulse checked by feeling the femoral artery in the inside of her back legs. No tumors felt and pulse was normal.

Vaccination time.

Vaccination time.

Vaccines can be given in several spots. They are spread out so if there is a reaction at the vaccination site the veterinarian will know what vaccine caused the problem. The vaccine is administered just under the skin.

Another vaccination.

Another vaccination.

Blood draw time.

Blood draw time.

The fur is wet down with alcohol before the blood draw. This helps make the vein pop out better and adds a bit of sterility to the site. There are different blood tubes for different tests. This year Nellie is having her annual heartworm test, a CBC (complete blood count) and chemistry panel with T4.