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Friday, August 29, 2008

Back to medicine

Pyelonephritis: a kidney infection. Literally, pus in the kidneys (see a very early post of mine). I treated two such cases in the last two weeks. These were very sick cats, clinically affected with laboratory values consistent with pyelo (that's what we call if for short). Often, these cats don't read the textbook, but both of these did. Both were painful on kidney palpation, their total white blood cell counts were significantly increased, with mostly the neutrophil component increased, most consistent with infection. Their kidney values, notably the blood urea nitrogen (BUN) and creatinine were significantly affected, indicative of decreased kidney function (and dehydration). And of course, pus in the urine indicating a severe infection. One cat had undergone a surgical procedure a decade ago that essentially turned him into a her. at least externally. He likely had become obstructed on many occasions, or was unable to be unblocked after one serious obstruction. This procedure, called a perineal urethrostomy, is still done from time to time, but not as often as it was in the past. The wider urethral orifice, like that of a female, predisposes the cat to ascending urinary tract infections. Interestingly, the cat was fine for a decade. Perhaps with the cat's advanced age, he is becoming somewhat immunocompromised. He may have had a chronic, mild, sub-clinical infection for quite a while, that ascended his urinary tract to his kidneys.
The other cat, an uncontrolled diabetic, had pyelonephritis and was in DKA (diabetic ketoacidosis). Not a great combination. At first she was diabetic, then uncontrolled, then was hit with pyelo, and the infection threw her into DKA. Ketosis ain't about sugar (glucose). That's how it works.
Over a few days, we got her out of ketosis, treated her pyelo, and turned her into a "regular" diabetic.
After two weeks at home on antibiotics, insulin, and a special diet for diabetic kitties, her insulin requirements are down to almost nil. She will be treated with antibiotics for at least a month. Most importantly, she is back to same ol' kitty she used to be.
We're all very happy with the outcome of these two cases.

Warning: gross photo below:



A kidney severely affected with pyelonephritis.

4 comments:

Marie said...

I'm glad to have found your blog again and that you are contributing regularly. Yay!

I do have to disagree with thinking Mr. Milan is sensible though. Forcing dogs into an alpha roll, a technique that was recanted by the people who came up with it based on the fact it was based on misinturpreted wolf behavior, is anything but sensible. I do agree with him that dogs aren't people in fur coats and need exercise and clear boundries however. The reason behaviorists feel strongly about him is that he does some stuff that is outdated and dangerous, in front an an audience that tries to mimic him, sometimes with disasterous results.

But I still love your blog. Glad to hear you made the move well. Thanks for sharing your expertise with us. :-)

TorontoVet said...

Marie,

While critics claim his teachings are harsh, and often dangerous, he is forcing US, the pet owners, to regain the alpha role. Not the other way around. He teaches that dogs need leadership. If not, they assume the alpha role (leading to aggression, barking, destructive behaviours, etc, etc).
If he wants to go one-on-one with an aggressive dog, let him (I wouldn't). As long as pet owners are taught exercises that do NOT put them in harm's way.
Read this article for a great success story:
http://seattletimes.nwsource.com/html/living/2004011666_cesar14.html

Thanks for reading and enjoying!

Marie said...

Ahh but that is the key.
"As long as pet owners are taught exercises that do not put them in harms way" is the issue we take with him. Much of his stuff is very confrontational (and heavy handed) to the dog and can result in provoking a bite, which if you watch his show happens to him regularly.

But I do agree he is pointing out good stuff with letting people know dogs need rules and limits and regular exercise. I just disagree with most of the methods he uses to get compliance for behavior issues.

Suppression of behavior doesn't nessasarily mean changing behavior for the long term. It only means you can manage it IF you are there to keep the dog in check. Behavior modification works to change the emotion of the event for the dog which means long term results without the needed presence of the person.

And just because there isn't an owner in the home taking the leadership role in a dominating way doesn't mean the dog is acting out because of that. Sometimes it is just because it is a dog, and they act like dogs. A dog trying to go out the door ahead of it's owner MOST times is just trying to get outside. Train it not to and it won't go first. It isn't always about control in the dogs perception. Many times it is about getting somewhere or doing something.

Just my two cents from the front lines. I prefer Victoria Sillwell from "It's me or the dog" or the people on the show "Barking Mad"

Tail wags,

Anonymous said...

I've never had pyelo, but had many patients (human) suffering from it. They were in a LOT of pain while waiting for the antibiotics to start kicking the infection. Many were on PCA pumps, including pregnant women, who tried very hard not to press that button out of fear of harming their baby, but eventually had to because they couldn't bear the pain.

Because of seeing my patients suffer like that, if one of my pets was diagnosed with pyelo, I'd ask for a few days on pain meds, until the fever and WBC came down.