Crystals in urine.

[peekawho]

This is an update about Jake, our neutered 8 y/o Dobe who had repeated UTI's.  

He finished his Clavamox (on it for more than a month) and had a repeat UA yesterday.  It was loaded with crystals, both tripleP and amorphous.  His urine Ph was 8.  No bacteria, no white cells, nothing else.  (last UA didn't show crystals b/c the SG was 1.002 from his excessive drinking)

So the vet put him on Hills c/d.  I thought it was wet food, but they had it in dry so that's what I got--they said it didn't matter which kind I got.  

My questions:
1. Can he be on this indefinately?  The vet kind of made a "Well...." noise and didn't answer.

2. Should be be on something else to acidify his urine?  Would supplementing with VitC or Cranberry tablets help? (Vet said "the diet will be enough").

3. Could this (crystal business) have anything to do with his twice daily vomiting? He vomits every day, an hour before eating--famotidine does not help one bit.  All blood chemistries repeatedly normal.  This has gone on for a year.

4. Which, in your opinion, would be the best follow up to see if he has stones (last year a plain radiograph was normal when he had blood in his urine).  Should he have another xray (which might not show anything again), or an xray with contrast, or an ultrasound?  Which would be the most cost effective way, considering that one year ago his xray showed nothing and he was very symptomatic?  They want to start with another plain film in 2 weeks.  I don't particularly want to throw away $100 if there is a more definitive test.

Thank you again for your time and thoughts.  I personally think he has a stone.  It would explain a lot.  

[peekawho]

I'm a bit downcast today.  He's got leukocytes in his urine (I tested it at work) on an extremely dilute urine (1.005).  
So he might be percolating another infection.

We've discussed endoscopy with the vet, but she seems to not think it will be helpful, and wants to try just treating him symptomatically.  He never vomits if you can get him something to eat about an hour or two prior to when he usually vomits.  So I get up at 1am to feed him a couple of dog biscuits, and he'll be fine.  If I sleep straight through, he vomits.
Same in the afternoon.  

[Aleda M Cheng, D.V.M., C.V.A]

1.  He can be on Hill's C/D or equivalent indefinitely, but I would add supplements such as Colostrum, probiotics, Missing Link, and Corn silk extract.
2.  C/D diet does acidify the urine, but I would put him on a good combination antioxidant supplement that contains Vitamin C,  E, Selenium, Glutathione, SOD and Carotene's.  Cranberry capsules are necessary not because they acidify the urine but because compounds in the cranberry help to prevent adherence of bacteria to the walls of the urinary bladder.  The antioxidants help to boost the immune system.
3.  The vomiting and the crystals are not directly related as far as I can see.  I am concerned about the vomiting.  Maybe your dog should also be on digestive enzymes. I think that the vomiting should be investigated, maybe with endoscopy with biopsy.
4.  Dogs with chronic urolithiasis and chronic urinary tract infections should be monitored diagnostically by frequent urinalysis's (every 2-3 months) and by bladder X-rays every 3 months.  Bladder X-Rays do show struvite/triple phosphate crystals, whereas ultrasound is necessary for other crystal types.  A urine culture and sensitivity may also be necessary occasionally.