OSU veterinarians get Golden Retriever back on track after four surgeries

Monday, September 27, 2021

The year got off to a rocky start for Juno Brown, a 5½ year-old golden retriever owned by Mary Nelson and Rodney Brown of Oklahoma City. In January, she underwent emergency surgery for a kidney stone in the first of four surgeries she would have before the end of May.

“While many dogs develop urinary stones, Juno was a very unusual case because she developed such large kidney stones that one tried to pass, just like people try to pass a stone,” said Dr. Laura Nafe, a small animal internal medicine specialist. “In the process, the stone blocked her ureter [the path from her kidney to her bladder], causing her ureter to tear and leak urine. Juno arrived at the hospital with free urine in her abdomen, which is a surgical emergency.”

Brown starts the story of the pup’s rough year: “We first knew something was wrong on Jan. 2 when Juno started throwing up and was lethargic. We took her to an emergency vet who said they needed to open her up and take a kidney out. After talking with a friend, who is a veterinarian in Florida and an OSU alumnus, we decided to get a second opinion. They determined what the problem was but didn’t have the capability to do the procedure. We were lucky that Oklahoma State was able to do it. On Jan. 5, we discharged her at noon, drove up to Stillwater at a pretty good clip and met with Dr. Danielle Dugat, a small animal surgeon. We went over the procedure, they worked Juno up, and she was on the table that evening.”

Dugat and her team placed a subcutaneous urethral bypass system in Juno.

“We do this procedure more frequently in cats,” Nafe said. “It’s fairly rare to use a SUB system in a dog, but we had no choice since the ureter was no longer intact. The device re-routed the flow of urine from Juno’s kidney to her bladder.”

Shortly after Juno’s initial surgery, she became lethargic. It turned out her SUB system had pulled out of her bladder, requiring a second emergency surgery to replace it, Dugat said.

“Juno’s second SUB system seemed to be working, but she kept developing these consistent UTIs,” Brown said. “They discovered that she had an anatomical abnormality, which had been driving these urinary tract infections probably for years. The best course of action for Juno long-term was an episioplasty, which they did. Juno’s third surgery was very successful.”

“Juno’s vulva was recessed or hidden in her skin so we did the episioplasty to make it stand out more since the vulva should not be covered by skin,” Dugat said. “She did great.”

However, the UTIs continued.

“As an internal medicine specialist, I was very involved in the management of her UTIs associated with her SUB system,” Nafe said. “We were able to clear the infection on antibiotics but as soon as we came off antibiotics, the infection would return. My suspicion was because the device was still implanted, we weren’t removing the nidus or breeding ground for the infection.”

So a fourth surgery was planned for Juno on May 31 to determine if Juno’s right ureter could be salvaged and repaired.

“Our initial plan was to place a ureteral stent using a scope, which is a minimally invasive procedure, and then remove the SUB system,” Nafe said. “In surgery, to our surprise, we discovered her right ureter — the one that had been torn — had repaired itself. It was completely intact, flowing normally with no leakage. So we were able to remove her SUB device, getting rid of that source for infection. Her ureter is working normally, Juno has no devices, and her stones have either been removed or dissolved, which is fantastic news for Juno.”

Brown verified that, saying the dog has recovered brilliantly. “She comes in for checks every couple of months. She’s really thriving,” Brown said. “It’s just an absolutely amazing outcome.”

“Juno’s prognosis at this point is very good,” Nafe said. “We’re watching her closely for signs of infection. Every three months, we monitor her kidney values and urine for evidence of infection. Periodically, we ultrasound her urinary tract to determine if she has recurring stones. A lot of pet owners may not have gone as far and wide as the Browns did, but Juno was an otherwise young, healthy dog, and she did great through all of her procedures. Many of her procedures were considered minimally invasive and, therefore, did not bring on a lot of pain or stress to Juno’s body. Honestly, if she hadn’t had such dedicated owners, I don’t know if we would be here talking now. If you don’t know if there’s something that can be done for your pet, try to investigate what the options are. Many veterinary clinics are performing minimally invasive procedures similar to the way it’s done in human medicine, which I think has really advanced our field.”

“Advocate for your pet because they can’t talk,” Brown said. “What I learned from this is to be curious. Ask questions and ask what are the worst case scenarios. For us, it was a 60-minute drive from our driveway to Stillwater. If you’re ever curious, please get in your car and drive here. The care is incredible. You’re going to get access to specialists and technologies that you’re just not going to have at your family vet, which is understandable. That’s why we have a teaching university here. I want people to know that we have an amazing resource at Oklahoma State Boren Vet Hospital. Don’t hesitate to come and get a second set of eyes and possibly avert a situation like Juno’s.

“What you all have done for our family is amazing. It’s moved us and touched us. The care that she’s received here, our interaction with the students and the way Juno has bonded. I was laughing, every time we drive up and make the turn, Juno’s up and her tail is wagging. She knows she is coming to see friends, and that’s a truly amazing gift that you have given people, so thank you for that.”

Preventing Kidney Stones

According to Dr. Laura Nafe, internal medicine specialist, kidney stones are actually fairly common.

“There are two types of stones — calcium oxalate and struvite,” Nafe said. “There are urinary-specific diets made by the big food companies that are available by prescription. They are fairly similar in their characteristics and their goal is two-fold. One is to neutralize the urine pH because we know if the urine gets too acidic, pets are more likely to form calcium oxalate stones. If the urine gets too alkaline or too basic, they’re more likely to form struvite stones. The second thing these diets do is increase the pet’s need to drink water. Having dilute urine is a good thing for stone formers because it reduces their chance of forming stones.

“Stones always start with crystals and then they begin to conglomerate together. The more concentrated the urine, the more likely multiple crystals will start to stick together and form a stone. If dogs don’t have evidence of urinary stones, these diets aren’t needed. If your pet has evidence of stones, it’s important to determine which type of stone it is if you can. It’s also important to try to prevent infection so that the pet won’t develop secondary stones to a urinary tract infection.”