The first question for Dr. Top came from yours truly! As Bolo is the main topic of conversation on this site and in my life presently, my inquiry was naturally directed in how to care for his ongoing bladder and back leg issues.
Dr. Top arrived after a busy morning of seeing other patients, and a surgery, with his typical polite and unassuming manner, ready to jump in and give Bolo an initial checkup. He always starts off with giving him gentle pets and whispering kind words, putting him at ease. Bolo LOVES Dr. Top. He pretty much lets him do whatever he wants while lying there being fawned over.
He examined Bolo’s tummy as he’s very bloated, and continues to be very distended, even after urination. He checked his response of sensitivity by pinching between his back toes, and all okay there. He’s just lost muscle mass, he is ancient so no surprise there.
We discussed his medication and how I felt he was doing. I told him he’s in a holding pattern, has been about the same for many weeks. We have been treating Bolo for bladder problems for several months now, with up and down results. He had an ultrasound done and found that he had sediment in the bladder, most likely from his age.
He was treated three times with antibiotics and Cranberry Extract(decreases the adhesion of bacteria to bladder), along with Rimadyl(a nonsteroidal anti-inflammatory = NSAID, used to reduce pain and inflammation due to osteoarthritis) for his leg weakness, and Silymarin, or Milk Thistle(eases inflammation and promotes cell repair in the liver) for his increased liver function.
This went on for several months, and we switched him over to Bethanchol(used to treat some bladder conditions, such as the inability to urinate or empty the bladder completely)about 6 weeks ago to help with his bladder function. This helps him in the sense that he urinates fewer times per day, but with a much higher amount of urine. We continued with the Rimadyl, but I had already cut that back as not to tax his liver any further.
He asked if it would be okay to drain his bladder and see if that might bring his stomach distention down, of course I agreed. It was hard to watch him put the catheter in, but Bolo didn’t flinch, and he proceeded to remove about 70 ml of liquid. I’d never seen anything that color come out of a dog or human – it was bright orange! The whole procedure took no time at all, and he collected the sample to get to the lab that is off his premises. He then collected blood as well to see how his liver was doing.
I’d say he left then, but he sat with Bolo stroking him and taking his time in answering any other random questions I had. His patience is remarkable. Most Thais have this commendable quality, but Dr. Top is next level, and I’m always so thankful for the time he takes with my pets.
So…the results showed a good complete blood count. His liver function is the same, but that’s okay it hasn’t worsened. The Milk Thistle seems to keep that from happening. His urine found protein, higher white bloods cells, lower red cells, and numerous bacteria. He feels it’s chronic cystitis, again age is to blame there. Results showed an increase of bilirubin, this can be caused from the liver not clearing waste products entirely, and from ageing as well.
Examples of that include cholestatsis (a condition in which substances normally excreted into bile are retained), and hepatobiliary disease (a liver disease with various causes including bacterial and parasitic infections, etc.). In this case he recommends being careful of medication and the doses, so we’ll taper the Rimadyl again to every other day, and continue with the Bethanchol, Milk Thistle and Cranberry Extract. We will continue on, going week to week, discussing how Bolo is doing and adjust as we go. It’s a very fluid situation – no pun intended.
The last part of Dr. Top’s message was a welcome one indeed. He reached out to his colleague that practices in neurology, and she has charitably offered to send instructions, including a video, on how to administer acupressure to Bolo myself, to aid in his bladder function and support for his back legs. I cannot thank Dr. Top enough!
Once again, he has gone above and beyond to research Bolo’s case and find the best resolution to his complicated case, due to his very advanced age. Forever grateful!
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