I got an email in June of 2004 from someone with whom I had placed a deerhound four years earlier, needing to let him come back to me either temporarily or permanently. He had not been very happy in our big pack, so I was glad to find a good home for him with experienced deerhound owners with just one other dog. I still owned him, or rather, co-owned him with his breeder.

His family wrote to tell me that their older deerhound was sick, and in his pain had begun attacking the younger deerhound. Also their infant son had become very ill, and they felt unable to give Rebel the attention he deserved.

Of course I took him back immediately. I was actually kind of excited, for a few reasons. One, I have his sister and I thought they would like to see each other again. Two, I hadn't seen him in a while and was looking forward to getting to know him again. And three, he's a really gorgeous dog, already a champion, and I thought it would be fun to show him a little. I haven't had a dog to show in some time now.

The first day he was here he was incredibly stressed out, and was peeing in the house. I thought it could have been from stress but his urine looked dark, possibly bloody, and his urine stream was weak, so I took a urine sample to the vet. I was very fearful he would turn out to have cystinuria but had my fingers crossed it would be a urinary tract infection. And of course, my fears were confirmed when his urine sample came back loaded with cystine.

He went to the vet the next day and they were unable to unblock him without doing a full scrotal urethrostomy (the same surgery that Skye and Fraser had). Fortunately Dr. Brown was able to take him as an emergency right away. The surgery took nearly 3 hours, and Dr. Brown called me around 8 PM that night and let me know that it had gone as well as could be hoped. They removed a large number of stones, one of which was enormous. Dr. Hamilton said she believed he'd been building up these stones for around a year. I spoke to several members of the family that had him, and all were absolutely positive that he did not show any abnormal urination whatsoever until Sunday. I got him on Monday and noticed it immediately myself (which is what prompted me to take his urine sample in to the vet on Tuesday).

If they didn't just miss it (which seems unlikely given how they DID notice on Sunday it wasn't normal, even though they didn't think anything of it except with hindsight), it is amazing how long these dogs can have all these stones in there without it causing noticeable symptoms. I remember when Skye first had a reduced urine stream, we were very alert for it because Fraser had this a year earlier, and we took him in immediately, and he too was packed with stones. So I think that those of us with C+ dogs, or C-prone breeds, need to treat this as an emergency when we notice it and not wait to seek diagnosis. If we're lucky it will just be a UTI or something (which is what I'd hoped for Rebel), but better safe than sorry.

We were able to bring him home on Friday night, as he wasn't bleeding as much as some dogs do. Dr. Brown also mentioned that there have been some refinements in the surgical procedure that result in better healing and less bleeding than they used to have with it. I did some internet research and believe he is referring to the use of a technique using a continuous suture pattern and a three-needle bite sequence for urethrostomy closure, instead of the older surgery that used a simple interrupted, 2-bite closure. According to Daniel D. Smeak of Ohio State University in "Scrotal Urethrostomy Closure: Technical Details for Success," "This modification has dramatically reduced active bleeding, bleeding after urination, and bruising postoperatively." Since this means that the dog may not have to be hospitalized as long after surgery, this does reduce the cost of this procedure accordingly.

However, although the bleeding was reduced, it's definitely still a serious management issue that can't be underestimated. We had put down plastic drop cloths on all the carpets, with canvas dropcloths on all the "traffic pathways" through the house. I also put incontinence pads on all the dog beds, then covered them up with dog blankets. Although the bleeding was less than with Skye, there was still a huge amoung of blood splattered everywhere he walked, with some large areas of blood that were far beyond splatters. H was very groggy from the sedation and when he urinated it would run down his legs and get all over his feet, so he had to be cleaned up after every trip outside - something I especially enjoyed at midnight, 2 am, 3 am, 4:30 am, and 6 am.

Dr. Hamilton sent him home with Ace Promazine to keep him quiet and keep his blood pressure low (which I think is part of why he was not bleeding so much), and with a pain med called Tramadol. He was supposed to get the Tramadol every 12 hours but it seemed to last only around 4 hours, so I called the emergency hospital and got his dosage adjusted to provide better pain relief. There is no way around it, this surgery is extremely painful for the dog, and I think we need to be VERY aggressive in demanding pain control for our dogs afterward. Don't let them fob you off with Rimadyl! I wish I'd thought, in fact, to ask about an epidural, which I had made a mental note to ask about the next time a dog I own needed surgery, but forgot about until afterward. So he was well and truly drugged up, which meant he was mostly just sleeping. He would eat from my hands but not from a bowl - with a distinct preference for scrambled eggs with parmesan cheese.

I was surprised to hear from Dr. Hamilton that she doesn't think a preventative urethrostomy is a good idea in dogs who form cystine stones if they can be unblocked another way- I have to say I don't agree with her, given the stories I've heard from those on the Canine Cystinuria list and my own experiences. It seems to me that since the dogs will keep forming stones no matter what we do, the best thing we CAN do is reduce the chances they'll block again. However, in this case we had no choice.

While I was researching this, I discovered that there are temporary urethrostomies (which I think some of the dogs whose owners are on the list have had), and also perianal urethrostomies, which are not as good as scrotal urethrostomies. I also heard from another list member that Dr. Brown had recommended a surgeon to her in her area who could do this surgery, so do encourage any of you who have dogs needing this procedure but who can't come to the San Francisco area to have it done, to contact Dr. Brown and see if he can recommend someone locally to you. Having an experienced surgeon really makes a huge difference (even though it also jacks the bill up considerably). Dr. S. Gary Brown DVM, Diplomate American College of Veterinary Surgeons, can be contacted in Fremont, CA, at 510-657-6343.

Speaking of the bill - it was around $4000, almost a thousand dollars more than a few years ago when we did Skye's, even though Skye was hospitalized for three days. His breeder, his former family, and I split it, and we were able to use Care Credit to finance it. But I'll tell you, in addition to the pain and the messy recovery period, the financial aspect of this is horrible. Breeders in the cystinuria-prone breeds have got to understand how serious this condition is. It's nothing to mess around with.