MEDICATIONS

Note:  The author has had no veterinary or medical training. She has merely documented her experience with her dog's health problems. Be sure to check with your veterinarian before acting on any information you see here.

Diet and fluid intake are the most important factors in treating stones. Amie will no longer drink water, but she will drink defatted turkey broth.

Make sure you get a package insert with the medication and read it. Also check the Internet. I have found problems with medications on the Internet that were not listed on the package insert or on the pharmacy's fact sheet. In deciding to use a medication, the risks of taking the medicine must be weighed against the good it will do.

The following are medications that have been used in Amie's treatment for calcium oxalate kidney stones.
 

ANTIBIOTICS
Amoxicillin
This is the preferred antibiotic for Amie's type of kidney stones. It is a penicillin antibiotic. Side effects in humans may include vomiting, loose stools, loss of appetite, or a rash. Should any occur, stop the medication and call the veterinarian.

Bactrum
Used for skin staph infections, it can permanently dry up tear ducts.

Baytril
Amie was put on Baytril for an e coli infection in her kidneys.  An Internet search shows that this is one of the safest antibiotics. The one side effect listed that Amie showed was loss of appetite.  We decreased the size of her portions and mixed in ground Baytril. If she didn't want to eat we put a minute amount of peanut butter on the cut edge and she always ate it.

Chloramphenical
When Amie recently developed a pseudomonis infection, vet Claudia Lewis despaired that there was any effective treatment.

Cloxacillin
Treats infections. Stronger antibiotic than Cephalexin. Don't give if your pet has had an allergic reaction to a penicillin antibiotic. Side effects in humans include rash, itching, hives, vaginal irritation or discharge.

If prone to forming kidney stones, struvite stones can develop. If a stone develops in the kidney, ammonia producing bacteria can change it into a struvite stone. AHA - acetohydroxamic acid is an inhibitor of chemical action caused by invading bacteria, which can be used to retard struvite stone formation.
 
 

pH ADJUSTERS
Ammonium Chloride
A urine acidifier. Do not use with calcium oxalate stones.

Methionine
A urine acidifier. Do not use with calcium oxalate stones.

Urocit
Urocit-K, 5 meq tab, generic name is potassium citrate.
Urocit is used to prevent certain types of kidney stones. It raises urine pH to make it more alkaline (higher pH). The Urocit flyer says, "The metabolism of absorbed citrate produces an alkaline load. The induced alkaline load in turn increases urinary pH... (It) produces a urine that is less conductive to the crystallization of stone-forming salts (calcium oxalate, calcium phosphate, and uric acid)."

The medication begins working by the first hour and lasts for 12 hours. Do not give if there is an active urinary infection because the rise in urinary pH from Urocit might promote bacteria growth.

When I checked the internet I found that the potassium in Urocit may worsen or cause heart problems. A possible side effect, which may go away during treatment, is mild diarrhea. It can also cause weakness, confusion or tingling of hands (human side effects). Discontinue if there is severe vomiting, abdominal pain or G-I bleeding. A pathologist said it is a 90% probability that any digestive upset is due to this medication.

The human instructions say to not break, crush or chew before swallowing but Amie will only take the large tablet sprinkled on her food. Based on her morning urine pH Claudia adjusted the quantity of Urocit. So in adjusting her medication, we had to break it. We gave her 1 tab in the morning, 1 1/2 tab at night because urine should be more acidic at night. She would spit out a whole Urocit wax matrix tablet. We tried putting the pill down her throat but she will wait as long as she needs to bring it up and spit it out. Since Amie will eat anything with butter, we coated the tablet lightly with it, but she just licked it off. Claudia said that since dogs don't begin digestion in the mouth, maybe it isn't hurting her to have it crushed. The pathologist veterinarian Claudia Lewis consulted said the way to administer Urocit is to crush it and put it on the food. Canine kidney specialists (Jody Lulich and Carl Osborne) say it can be broken and mixed into food.

Urocit instructions say to not use a salt substitute. We use plain, pure salt with no additives. Salty food may cause side effects.

Gail Golumb (the Kidney Stones Handbook) said urine pH is only one of the Urocit effects. Urocit also manages citrates. This is much more than I can comprehend. In an email Gail wrote, "Getting the pH to the proper level helps prevent stones. The vast majority of  citrate is made in the right kidney and is controlled by urinary pH (in humans). The kidney makes more citrate is urinary pH is high. The only function of citrate seems to be to control the formation of stones. Many, many stone patients do not make enough citrate, thus their need to take Urocit-K.  It's definitely related to stone prevention."
 

Baking Soda (sodium bicarb)
Amie had bouts of not feeling well after the last lithotripsy in January, 1979. She started taking Urocit and a few months later began feeling sick. She was off Urocit in October of 1997 because she had developed a urinary infection. When Amie went back on Urocit she became really sick.

The Urocit kept her urine pH around 7.0 but she would often become very trembly, not feel well, but there was no fever. Claudia and I suspected some connection to the Urocit. She suggested we see how little Urocit Amie needed to still maintain a pH over 6.5. Well, we couldn't. We would take her off Urocit for a few days and she would feel much better, although her urine pH was at or lower than 5.5. Then we'd add a tiny amount of Urocit to her food and she'd go downhill again. She occasionally would throw up. By the end of November '97 she was very subdued and not eager to eat. She was obviously not feeling well. She stopped eating and was urinating only 2 - 3 times a day and in inappropriate places. I would rather have time with Amie feeling good (but producing stones) than prevent stones with Urocit and have her miserable.

I began searching the Internet for a substitute for Urocit. I emailed every kidney specialist I could find - veterinary and human. A canine kidney specialist at UC Davis told me to have my vet call him. He recommended adding 1/8 teaspoon of baking soda to each meal. It is simple, inexpensive and effective. It is very easy to maintain her urine pH around 7.0. The only problem we've noticed is that the baking soda needs to be well mixed in her food or it upsets her stomach. Lulich and Osborne's article on canine calcium oxalate uroliths says that baking soda enhances urine calcium excretion - a bad thing. Claudia said that because Amie's last tests showed alow urine calcium we had to weigh the alternatives and therefore, baking soda seemed to be the best choice.

In mid January 1998 Claudia contacted Larry Adams, who performed the lithotripsy last year, and asked him about using baking soda alone. He said it will alkalize urine, but it increases the sodium load causing calcium excretion. "The solubility of CaOx crystals is not pH dependent. Instead, alkalizing the urine mildily increases the tubular reabsorption of calcium. This effect would be counteracted by the increased naturesis and calciuresis induced by Na bicarb." Whatever! He also said that Amie's lack of urine control might be due to the baking soda because it acts as a mild diuresis.

He had not seen any Urocit K side effects, but suggested Polycitra-K syrup. We discontinued baking soda and started Polycitra-K.
 
 

Polycitra-K Syrup
Made by Baker Norton, costs $23 per pint. 10 meq/teaspoon (or 2 meq per cc)
This product insert said "This medicine is a urinary alkalinizing agent used to prevent certain type of kidney stones."  Mild diarrhea is listed as a side effect.

We mixed 1/2 teaspoon in her food twice a day. It smells like bad candy and she hates it. She won't eat until she is starving, so it looks like we will have to squirt it in her mouth. After about a week of dosing her urine pH hadn't risen above 5.5 and she hadn't stopped urinating in inappropriate places.

March 31, 1998.  Amie didn't eat well when it was mixed in her food and about two weeks into dosing her with polycitra she developed a bad smell, bumps on her back. We noticed clumps of her hair on the carpet and she was chewing her back. We took her off the Polycitra and she immediately began to eat and feel much better. She still has allergic symptoms. What can we attribute to the unusually high mold due to El Nino's very mild winter effect?  She was using her newspapers less than half the time, but she was happy and playful. We went back to using baking soda but her latest tests showed irritation, so we stopped.

Any input would be appreciated.
 

DIGESTIVE ENZYMES
A nutritionist from a pet supplement company suggested digestive enzymes for a low urine pH. She also said it would increase thirst. Then I found on the Internet a suggestion for digestive enzymes for the same condition. I began sprinkling Dr Goodpet's digestive enzymes. Haven't seen an increase in thirst. Dr Adams recommended not using digestive enzymes or any holistic supplements. Since we have seemed to exhaust the allopathic med system, we will continue to pursue naturopathic remedies.
DIURETICS
Diuretics have sometimes been recommended to delete concentrations of minerals in urine. Loop diuretics should not be used for calcium oxalate stones. Thiazide may promote sodium and calcium reabsorption but it has variable results. It may increase, decrease or not affect the level of urine calcium. It is associated with dehydration, hypokalemia and hypercalcermia. Doesn't sound good.
OTHER TREATMENT
Lulich and Osborne recommend the following procedure for calcium oxalate treatment.

1. As soon as possible, get baseline information - radiography, urinalysis, serum calcium concentration.

2. Eliminate risk factors - acidifying diets, glucocorticoids.

3. Modify the diet.

Consider - Reducing calcium, oxalate, sodium, protein
- Checking for adequate phosphorus and magnesium
- Adding water and citrate to the diet.

Avoid - Vitamins C & D
- Urinary acidifiers
- High calcium and oxalate foods

4. After 2-4 weeks begin regular testing.
 

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