LITHOTRIPSY

Note:  The author has had no veterinary or medical training. She has merely documented her experience with her dog's health problems. My notes are about my experience.  Be sure to check with your veterinarian before acting on any information you see here. This is the article my vet Claudia Lewis saw that led us to lithotripsy. Get your vet to read this article and see other net sites (see links) to become informed. There are now 3 other institutions that perform lithotripsy on dogs.
 

EMERGING SCIENCE & TECHNOLOGY, Fall 1996
Excerpt: "News from the Literature"."Shock Wave Lithotripsy for Dogs: A Potential Alternative to Nephrotomy."J. Am Vet Med Assoc, 1996 208:531-536. Gary Block, DVM; Larry G Adams, DVM; William R Widmer, DVM; James E Lingeman, MD. Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN, and Methodist Hospital Institute for Kidney Stone Disease, Indianapolis. Also see J Am Vet Med Assoc 1995; 207:592-595.

Dr Adam's article says that a much lower shock is used than in humans. There still is potential for kidney damage. See the Indiana University Medical College article about potential injury in humans. Soft tissues and bones are not affects by the shock waves.

Before the lithotripsy Amie went to Purdue December 12, 1996 for an evaluation to determine the treatment plan. Although she recently had radiographs, x-rays and ultrasound imaging, the tests were done again to make sure the stones had not traveled.

Dr. Adams had been doing lithotripsy for about four years when we spoke to him in November of 1996. By December 1996 he had performed the procedure on twenty dogs and cats. The stones in all but two dogs were in small purebreds and the others were over thirty-five lbs. He had performed the procedure on four very small dogs - schnauzer, yorkie, lhasa apsa, shitzu. By February 1997 only three animals had formed new stones. The quickest a stone reformed was in about a year. Larry said it is highly variable if the stones would return. Mostly, they don't. The success rate is high. About 1/3 needed another treatment because of larger stones.

The lithotripsy was performed at Indianapolis Methodist Hospital, for humans. The lithotripsy machine was the first one used on humans in 1980. When it was replaced, it was set aside for research. Since pig kidney structure is close to human kidneys, the human hospital permits pig lithotripsy research. This opened the door to perform lithotripsy on other animals.

On December 17 we brought Amie and her medicines and homemade food to Purdue, Katherine's alma mater. Amie was prepped, including an IV catheter at Purdue, and then she was taken by van to Indianapolis around 2 pm. Surgery was around 4 and the return trip at 6 pm. Amie was the 21st animal that Dr. Larry Adams had treated. (See report.)

That night's phone call reported that Amie was sedated with an empty bladder, passing lots of fragments, doing great. She was in the ICU on fluids. They could see fragmentation of the stones in both kidneys as they treated her. They kept her on fluids and checked for hemorrhage to avoid clotting. There was a mild elevation of pancreatic enzymes, due to slight trauma to the pancreas. The creatinine level was 1.6, below where it was before the procedure. The vets were cautiously optimistic and thought she should be fine. The next day they did a radiograph to check.

The radiographs showed that there were fragments on both sides. There were three fragments on the right and they couldn't see a stone on the left. The blood creatinine level was elevated from the evaluation tests the previous week. It was 1.8 on Thursday and 2.1 today. Could be due to the shock waves. Will monitor. She's not depressed. She ate well and walked around.

We picked up Amie on December 19. Her report listed as the diagnosis mild chronic renal failure and possible mild pancreatitis post-lithotripsy. Prognosis was good. Her creatinine level had returned to slightly above normal at 1.6 (normal is 0.5 - 1.5). We were told that she should be re-checked in early January with a radiograph and blood work, maybe ultrasound. We scheduled radiographs, serum chemistry panel and urinalysis with Eric Heitman for January 2, 1997.

For a few days after, the patient may feel some discomfort, fever, nausea or slight bleeding around the kidney and blood may be seen in the urine. Bleeding is normal and should stop in a day or two. A woman told me she was in such pain after her lithotripsy she didn't move for about 5 days and was uncomfortable for about 3 weeks. Amie didn't seem to be in pain at all. Humans may have pain, colic, fever or nausea and pass stone fragments up to three months after lithotripsy.

It was four days later that we experienced one full day of her using her papers instead of the kitchen rug. The success was short-lived because she was truly obnoxious on Christmas and continued eating her papers, barking, barfing, until New Years Day when she had the best day she's had in over a year. She acted vital and happy, no trembling, no paper eating, or inappropriate urination.

The next day she had her follow-up tests. Her usual weight was 7.25 lbs and she was down to 6 lb 8 oz. Results of the tests were sent to Dr Adams. He said that the stone was about a third as big as it was before lithotripsy but was still too large to safely pass through the ureter. She would need another treatment.

By the end of January Amie seemed pretty healthy - not twitchy or feverish and with a higher newspaper hit rate than before. She still was chewing her papers about one out of three days. Compared to before the first treatment, she was much peppier and playful.

On January 30 we returned to Purdue for a second lithotripsy treatment. Her analase was slightly elevated, and the lipase (pancreatic function) was normal. Creatinine was 2.0 (high normal), same as before the treatment (1.5 is normal). Post lithotripsy radiographs revealed fragmentation of right nephrolith and absence of nephroliths in the left kidney. The radiographs did not show an increase in size of the stone fragments. (See Report.)

Follow-up tests were ordered for March 3, 1997. Dr Heitman found cystitis, inflammation of the urinary bladder. He prescribed Antirobe. Results of her follow-uptests were sent to Purdue and Dr Adams was pleased. The stones were confirmed to be calcium oxalate and they were completely eliminated. He prescribed Urocit. Urine pH was to be maintained at around 7.0.

Two weeks later I took a urine sample to Claudia. Amie's pH was 5.0, no blood or crystals were found in her urine. She still had a urinary infection and Amoxicillin was prescribed. Amie had gained an ounce. She didn't seem to be feeling well, but Dr Adams thought it was due to metabolism and allergies. She still wasn't concentrating her urine and Larry Adams said that her mild kidney problems probably would not heal. It's not curable, but it's controllable.

Amie continued eating the turkey-buckwheat groats-vegetable diet. She still had occasional problems with barkiness, chewing her papers, growliness, and generally not feeling well. Her coat was very thick and she was so much better than a year ago that we had to be grateful.

At the recommendation of Hill's, a sample of her food was analyzed by Woodson-Tenant Labs. It found that the calcium, sodium and fat in her diet were too low. In mid-September 1997 her blood test showed that her calcium level was 11.5 (normal is 8.5 to 11.0). Bone meal was added in the amount recommended by the Hill's Elimination Diet recipes.

We will be checking Amie a few times a year and comparing her test results to her post-lithotripsy tests. (See Monitoring). She had begun vomiting and not feeling well, which prompted us to do a complete blood count and urinalysis at the end of October 1997. Her upset stomach and malaise was attributed to the Urocit. Claudia said poodles have a delicate GI tract and we began searching for a Urocit substitute.

The tests showed:

Pancreatic function - OK
Kidney function - OK
Almost anemic - 5.7 (5.5 is normal low)
BUN - 34 (normal is 10-25)
Creatinine 2.6 (normal .8 - 2.2)
Electrolytes - OK
Calcium - in the normal range
There were no calcium oxalate crystals in her urine and there were indications of struvite disease. She had a urinary infection and was taken off Urocit white receiving antibiotics.

We found a Urocit substitute (see Baking Soda) which has its own set of problems. Since the last lithotripsy in January 1997 Amie has begun dribbling and urinates in inappropriate places. Being allergic to Hill's u/d diet, which prevents calcium oxalate stones, we have been working on customizing her diet, but it is not yet balanced.
 
 

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