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Juveria | 10 months ago
Struvite (Ammonium Mg Phosphate) Stones Left Behind Following My Cat’s Cystotomy

My initial question : https://www.pawbly.com/question/hello-i-live-in-san-jose-california-and-need-urgent-help-with-my-male-7yr-old

Update: My cat went through a cystotomy on Friday, the surgery went well and he was sent home the same day. Unfortunately he was still blocked as the surgeon did not remove the stones in his urethra (He did not take any xrays after the surgery and also discharged my cat without making him pee on his own). I rushed him to the ER as he was very restless and trying to pee, the ER doctor immediately unblocked him with a catheter and while doing so, she was able to push the stones back into the bladder. Xrays (attached) were taken which shows three stones in the bladder. As the cost of ER was adding up and the surgeon who did his surgery was not available over the weekend, I decided to shift him with the catheter on to the hospital where his surgery was done. I would like to add that in the initial surgery, the surgeon successfully removed all the stones in his bladder but the stones in the urethra were left behind even though he said he flushed them. The ER doctor is very certain that she pushed those stones back into the bladder while unblocking him the second time when he landed in the ER post the surgery.

My cat is currently doing well, he is on Ivy and has a catheter on. He is on CD food since two days. The urine color has improved from bloody to fairly clear. Urinalysis results showed struvite (Ammonium Mg Phosphate) crystals . I will be meeting the surgeon tomorrow and need your advice on what should be the next steps for my cat. Which of the following would you advise?

1. Re surgery to remove the remaining three stones from the bladder. After the initial surgery, the surgeon had mentioned that my cats heart is weak and hence he had to adjust the anesthesia to a lower level (1 instead of the usual 2), though the ER doctor does not see why would that be the case as there is no murmur seen in his reports and he has taken the sedation well while he was unblocked twice in the ER.

2. CD food therapy: Urinalysis results showed struvite (Ammonium Mg Phosphate) crystals. Should we remove the catheter, make him pee on his own at the hospital and then get him home. Watch closely for re blockage while continuing his CD diet. What are the chances of his re blockage? Will the bladder have greater chances of rupture if he gets re blocked since he just had surgery?

Please advise.

@KristaMagnifico

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Heather | 4 years ago
My Cat Is 12 Years Old. We Noticed She Had Lost Some Weight Over A Short Period …

My cat is 12 years old. We noticed she had lost some weight over a short period of time and booked a visit to see our vet on Monday. Then she stopped eating over the weekend and became lethargic so we took her to the ER vet. They diagnosed her with CKD and it is very advanced. Her values were so high they needed to dilute their sample to get a reading. We were told it would not be inappropriate to euthanize her right then and there or we could hospitalize her but she might not handle the treatment well because of her heart murmur. It was such a shock I had no idea she was so unwell, but I couldn’t put her down without trying anything. She was admitted for 2 days and hydrated and while she did perk up and start eating, her numbers did not go down significantly. She came home and was perky for roughly 45 minutes, then laid down to sleep on our sofa and has been using that spot as home base for the last 2 days. She’ll get up to drink and use the litterbox and greet us but then promptly returns to her spot. She is grooming herself. These are some good signs. What worries me is she has already gone off eating. She didn’t have much the first day but today she licked some gravy off some wet food and has had a few treats. She is less perky already. The vet sent us home with mirtazpine ointment and subQ fluids… but nothing for nausea. My question is: should I force feed her? Should I have a tube put in? Should I let her go? I don’t want her to suffer if it’s her time but I also want to give her a chance if she can still lead a good life. She’s an agreable cat and tolérâtes the sub Q fluids well, though I don’t think she would like to be force fed. I won’t give up on her but I don’t want her to suffer either by putting in a tube or force feeding if it will only keep her with me another week.

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  1. Laura

    I wouldn’t force feed without vet guidance. I would, however, call your regular vet and have a serious conversation about what you can do for her, and what sort of prognosis your vet can give you.

    I will say she needs to start eating, so I would get her in to your vet today if at all possible.

    I’m so sorry this is happening. It’s scary when it’s so sudden. My heart goes out to you as my stinky kidney cat burps in my face. Let us know what happens?

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megan | 4 years ago
Hello. My Vet Suspects My Cat Has One Or More Nasal Polyps. I’ve Been Going …

Hello. My vet suspects my cat has one or more nasal polyps. I’ve been going through this process of getting towards his surgery for a while. The vet told us he has a heart murmur, but only a grade 1 out of 6, I brought him to a 2nd vet and they said his heart sounds great, I went back to the first vet and they looked at him again and the doctor said he has a murmur and even his vet tech looked over it and didn’t hear it the first time and the doctor had to tell her where to listen and she finally heard it. They said we would need some test on his heart before during surgery to make sure his heart doesn’t fail while under anesthesia. I got an x-ray done of his heart which came back fine and i also got blood test done which came back fine. The test he got were included in the basic wellness screen. I’m thinking he has a intermittent heart murmur because of his heart rate going up due to stress of being in the car and at the vet. The vet is still telling me i can have an echocardiogram done to be really sure his heart is really fine. That’s another $390 on top of the $500 i’ve already spent and i just can’t afford it. I believe if 2 vets could simply look over it, and it’s only a grade 1/6, and the test and x-rays came back fine so far, he should be good… right? Well another thing is they don’t know how many polyps he has or where exactly they’re located, we asked for a throat/head xray and they told us they can only do it if he’s under anesthesia first. They are adding on so much stuff i feel like he doesn’t even need and gave us a price estimate from $450-$1,500. We asked the other vet and they said they can do a head x-ray, but they don’t even know if the procedure of removing the polyps is even anything they can do, and he might have to go to a specialist. Can the polyps for sure be seen on the x-rays because i really don’t want to waste any more money on something that doesn’t even help get down to the problem. I’m thinking i can just skip over the echocardiogram because it doesn’t seem it’s really needed, i get an x-ray of his head, find the size, how many, and where the polyps are located, then get a real price estimate. Can someone please answer my questions or give any advice! Thanks:)

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  1. Sarah

    Good morning- sorry you are having such a time with all of this. I am thinking that an X-ray won’t show much because a polyp is soft tissue. It is my understanding that an X-ray will only show bone? I am guessing you would need something along the lines of a CT scan to check where and what size any soft tissue mass would be. I’m thinking you should sit down with your vet and have a frank discussion about budget and options and explain your thoughts. At the end of the day- you both want what is best for your cat. Perhaps in talking through it, you both can come up with something that you’re both comfortable with. Best of luck !!????????

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Ed Schmitz | 4 years ago
My Dog Sampson Is A 15 Year Old Boxer/pittie Mix(50 Pounds). Has Had Diabetes For 7 Years. …

My dog Sampson is a 15 year old boxer/pittie mix(50 pounds). Has had diabetes for 7 years. Been on arthritis pain meds the last year.. Has become very sluggish the past 2-3 weeks. Vet diagnosed him with a early stage heart murmur and slight anemia. Changed his arthritis pain meds to Gabapentin. It made him so drowsy that he fell asleep while eating. Became unable to walk without assistance. We weaned him off the Gabapentin and back on the old pain meds. His walking has improved a little but still is wobbly. Yesterday he refused to eat, which is highly unusual for him. Still drinking, but not eating today. He sleeps a lot but also has 30-60 minute spells of restless/repetitive behavior. I’m thinking he may have dementia. Any suggestions on how to help him?

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  1. Krista Magnifico

    Hello,
    This is largely a diagnosis of exclusion. I would call your vet back. Go over everything and repeat the blood work, cheat radiographs and discuss a cardiologist. There are too many things going on with your pup for me to say with any kind of degree of confidence to add that diagnosis to the list. All of the conditions you speak of can cause mental depression. So I would start over and ask for a referral to both an internal medicine specialist and even a catdiologist. I have a lot of information on my blog about cognitive dysfunction and there are lots of things you can do at home to help. But don’t over look previous issues before jumping into a new condition. To find the information on cognitive dysfunction please go to kmdvm.blogspot.com and in the search bar type cognitive dysfunction. I hope this helps.

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Moika | 5 years ago
I Inherited A Healthy, Except For A Slight Heart Murmur, 10 Year Old Chihuahua. She Is Current …

I inherited a healthy, except for a slight heart murmur, 10 year old chihuahua. She is current on shots and had no reaction to them. She ate small breed pedigree at first, but now feed Lotus good grain chicken kibble and pet plate topper (left over from a dog that died). I noticed she scratched her back alot, but didn’t see fleas, hair loss, a rash, and she mostly scratches after coming in from walks or arriving anyplace other than home. For a month, I left her home with my 7 year old chihuahua. They had the run of the house. One day I noticed pieces of my carpet in the hall. Now a whole corner of the rug is gone. I crated her. She screamed and whined and eventually escaped. I secured the crate with a carabiner. I came home to a crime scene. The bridge of her nose was bloodied and one of her nails was pulled out. I am taking her to work with me at a doggy daycare and boarding facility. Her nose has hair missing. I want to treat it, but with what and when will the hair grow back? Money is an issue because my hours are severely deceased now

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  1. Sarah

    Oh my goodness! I am so sorry this has happened. I think it depends on a few things as far as treatment. If it is a deeper wound, then you will need antiseptic solution to keep it clean, and possibly antibiotic because of possible infection. If it is superficial, then that would be a different story. I am more concerned about her nail pulled out. I think that needs to be seen by the vet. I would call and get her in to be checked out. I know these are tough times. Your vet does too- and would hopefully be willing to give you a bit of time to pay for service. I hope your dog is ok????????

  2. Krista Magnifico

    Hello,
    I am not too worried about the abrasions to the nose or the nail. I have seen these both happen many times and they always heal well if given time. I am more concerned about the heart and based on age and breed; dental disease. The rest needs behavioral assistance as it sounds like separation anxiety. This is resolvable with time, attention and patience. I would see a vet. Have the degree of heart disease assessed and discuss preventative care like heartworm etc if needed. The carpet, if ingested is also a real threat to health as it can cause a foreign body obstruction. There’s a lot going on here. Your vet with a simple exam can help you. Find someone who is willing to take the time to help you and budgets are a normal constraint for most of us these days. Ask around for a reputable kind and patient vet. They are out there.

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Me | 5 years ago
Dr Krista – I Am A YouTube Watcher With A 22yo Cat That May Have Nasal …

Dr Krista – I am a YouTube watcher with a 22yo cat that may have nasal or ear polyps. We have spent 8 weeks trying every antibiotic, nasal steroid drop, antibac nasal drop and still fighting the snorking sound and her inability to breathe. Did nasal swab wk of 4/20 – found 2 bacteria, getting compounded anti bacs at this point since both bacs are super resistant apparently – Citrobacter freundii and pseudeomonas species. Antibacs will arrive to me in California by Thur 4/30 . She has a grade 3 heart murmur and hyper thyroid (on 5mg Methimazole daily). Just as your YouTube vid about Stripes with polyps (2/23/2018), I think I may be in the same situation – I have a vet telling me to go to a specialist for $$$ because everything we are throwing at this isn’t working. How in the world do I find someone like you who is willing to help me for a reasonable cost? I am calling all over for vets and everyone is ‘specialist focused’. Do you have tips on what to ask, experience, and honestly, I need someone with your confidence to do this. Or I need you 🙂 I have been in cat rescue over 30 yrs and ‘get; the lingo but have never had such difficulty finding a vet who could assist. Thank you in advance!

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  1. Krista Magnifico

    Hello,
    I’m sorry to hear about your cat. I think that based on age alone it is less likely that it is a polyp and more likely that it is cancer. I say this based solely on experience. I think that I would call all the rescues and shelters around and ask for a trusted vet who would be willing to do a sedated exam to look for a polyp. After that it gets expensive to do the rhiniscopy and ct scan and honestly there is little to gain if it is cancer as it is not treatable. I would try the antibiotics, inquire about a steroid (difficult based on the thyroid and heart murmur but might be worth a trial) and even ask about intranasal cerenia drops. Also look for a feline medicine specialist and be honest about your budget.
    I hope this helps.

    1. Me Post author

      Thank you Dr Magnifico. I have now been/talked to 11 vets since this message to you 2 weeks ago, been to specialists, had nothing but the run around. This process has been agonizing, thousands of dollars, vets more interested in ensuring I know risk and that their liability is removed than caring for my kitty. I have labs, xrays, eco results, UA’s, spent thousands of $$ – and no one will do what you do – do a quick sedation and see if there are any polyps. Maybe she does have cancer but we DONT KNOW THAT FOR SURE. Is there anyway to pay you to review her records and advise me? I am up at nights, crying to figure this out and meanwhile losing valuable precious time and money where I could be helping my baby have a few more quality months/years. Thank you for considering.

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megan | 5 years ago
Is There Any Symptoms Of My Cat Having A Heart Murmur That I Could Tell At …

is there any symptoms of my cat having a heart murmur that i could tell at home?

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  1. Krista Magnifico

    Hello,
    A heart murmur is diagnosed with a Stethoscope. A severe murmur can be an indicator of heart disease. Heart disease in cats can cause many clinical signs like lethargy, decreases eating and trouble breathing. I would say that it would be hard to identify a murmur at home. .

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megan | 5 years ago
My Vet Thinks My Cat Has A Nasopharyngeal Polyp But He Needs To Go Under Anesthesia …

My vet thinks my cat has a nasopharyngeal polyp but he needs to go under anesthesia so he they can know for sure and get it out, but he was also listening to my cats heart and said he has a grade one mitral heart murmur and that he needs to have xrays and ultrasounds and such done to make sure his heart is ok before going into surgery because they said his heart could fail while under anesthesia and he could die. My dad said they we should just go ahead with the surgery without spending $550 extra dollars because he doesn’t think he has anything serious wrong his heart considering it was only a grade one heart murmur and my cat was already very nervous about the car ride and being at the vet and that could have caused his heart rate to be off a little. Would it be necessary to look into his heart further or just go ahead with the surgery considering it would only be a 20-60 minute surgery? Would a cat with any type of heart conditions die during surgery? What should I do next?

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  1. Krista Magnifico

    Hello,
    These cases often arise in my practice. Hears how I address them. I present my findings of the physical exam to my client and discuss recommendations and suggestions to provide the best care possible. Ideally all cats with heart murmurs should have echocardiograms Especially before anesthesia. But based on a cost of about $600 most people decline to do it. It doesn’t change the need for removing the polyp so we typically do the procedure with as many precautions as possible but not knowing everything we would like to because we don’t have the heart scan to know what’s going on in that department. We veterinarians want all of our patients to be as safe and receive the best care possible. But in a lot of cases this isn’t feasible so we do the best we can knowing that we don’t have all the information we would like. Talk to your vet and find the place everyone is comfortable. If you have a bet that isn’t willing to work with you based on budget or diagnostics ask for a referral or seek a second opinion.

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Josephine | 5 years ago
Hi, I Have A 16 Yr Old Shih Tzu That Has Had Brain Tumour Surgery But Had …

Hi, I have a 16 yr old shih tzu that has had brain tumour surgery but had complication of regrowth of a cyst several times and went for fine needle cyst drainage quite a few times. She has degraded to the point of being totally non-ambulatory except for some head movements. She has to have her urine and stools expressed everytime and she has to be handfed. But she still eats very very well. I need advise on what my pet needs at this point and whether is there any reason/last wish that is making her hang on so dearly to her life despite her quality of life and body already failing her? Shes like a family. i am torn between keeping her alive and letting her go if shes suffering but my love for her and our bonds is muddling my thoughts and decisions. I have taken care of her intensely for almost a year now from prior surgery to post surgery and she had so many complications, cyst regowth several times, loss n regain limbs ability, pneumonia, anemia. She always pulled through but now shes at a stage where shes really just hanging onto her dear life i feel, lying the whole day, only able to move her head during mealtimes when she is hungry. I have spent over 30 thousand dollars this while for her medications and procedures and vet visits, she even goes for rehab/pt/accupuncture and hyperbaric which are very costly. It has gotten to a point that I am spending more than I earned every month on her rehab (even though she cannot move, she still does ultrasound therapy on her severely arthritic joints and some accupuncture to relieve any pain from not moving everyday and her mountain of medications and supplements. I really cannot imagine life without her, she is my pillar of hope and support in my dark and depressed life and family full of issues. Now my pillar is crumbling. I still take care of her, i dont care about my finances, i stopped going out except to work, i bring her everywhere whenever i can in a dog pram she just lies motionless. Its amazing how she would wake and eat so very very well and finish all her big plate of food every day twice a day but lies motionless and tired after that. Its amazing how she would use her whatever remaining energy to poop when i try to rub and stimulate her anus once everyday without fail. She would be so tired after all that. It kills me to see her like this. Before that she can move n walk or at least drag ard the hse n look happy still so its ok worth all these. I wake up 3 4 times every night to help her drink water eat snacks she would wake from hunger and pant everynight even now maybe from prednisolone. But now shes just motionless and heart murmur has reached grade 5 or 6 and anemic and totally cannot move at all but still eats super well and pee poo normal with help express. A part of me feels like euthanasing her to end her misery and my own heartache seeing her suffer yet i cant bring myself to do it thinking that she would be reallly gone and that i might have done it wrong because shes still wants to be ard and live that is why she is hanging on so dearly. Please advice me..please. i am so loss and torn between choices its killing me every moment im awake.

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  1. Krista Magnifico

    hello,
    this question was answered elsewhere. I applaud you for your dedication and devotion to your pup. You have gone above and beyond. i wish you well,

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Elza | 5 years ago
Hello! I Have A 14.5 Year Old Japaenese Splitz Who Had Disc Surgery 2 Years Ago. This Year …

Hello! I have a 14.5 year old japaenese splitz who had disc surgery 2 years ago. This year he developed new weakness in his lower extremities and had a 2.5 kg weight loss so he had a full body ct with contrast and ct brain.
Findings included a chronic herniated disc explaining his weakness and an incidental finding of a splenic mass with some splenomegaly and no evidence of metastasis. Ultrasound findings were non significant. The nature of the mass remains unknown. His blood tests were good and he has no anemia. My veterinary doctor recommends a splenectomy. But i am worried of putting him through general anesthesia given that he has a heart murmur (on no medical Tx). I want to maximize his quality of life. I dont know if i should put him through major surgery given that he is asymptomatic but i am also worried abt internal bleeding and the suffering of metastatic disease if i dont operate. What should i do?

4 Responses

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  1. Sarah

    Good morning-
    The first thing that I would do is sit down with the vet and have a heart to heart about your thoughts and concerns. Hopefully you have a good relationship with them, and you are able to have an open discussion regarding whether or not surgery is the best option. I would mention your concerns (anesthesia, etc.) about quality of life and surgery risks for sure. I would also recommend having a “family” meeting with the household of applicable, regarding the pros and cons, the vets advice, and the recovery process (if you go through with surgery) or any other day to day changes that will be necessary in the near future for your pet. But again, my first step would be with my vet to weigh the options for my pet. Best of luck.

  2. Krista Magnifico

    Hello,
    I had the same situation a few weeks ago. I am asking that patients mom to contribute to this question too.
    My first piece of advice is to ask for an echocardiogram exam. You don’t mention the degree or severity of the heart murmur (usually graded on a scale of 1-6) and it is important to say that a low grade doesn’t always indicate it is safe or irrelevant.
    From here you can better assess anesthetic risk.
    In general I tell clients to take out the spleen before it becomes a problem. A bleeding spleen can kill a dog quickly. So quickly you may not even have time for successful surgical intervention.
    You have done an amazing job with diagnostics and treatment options. Don’t stop here.
    Please let us know what happens.
    Best of luck

  3. Trish Powers

    Wow, what you are going through sounds quite sillier to what I just experienced with my oldest dog, who is almost 12. He is a Lab mix weighing about 54 lbs. A few months back he had is senior checkup, including a full blood panel and all looked good except trace amounts of blood in his urine and he has had a heart murmur his whole life and had never been on heart medication. He ate carpet a few weeks ago and while doing X-rays and ultrasounds to be sure it wasn’t causing a bowel obstruction, we found he had an enlarged heart and two masses on his spleen, with no indication of metastasis. He was acting himself, except for the belly issues from eating the carpet. Once we knew the carpet issue was under control, I got a second opinion about the spleen and had long talks with my vet about the situation. Both veterinarians suggested a splenectomy, and also to consider a cardiology evaluation to be sure his heart was strong enough for surgery. I was so nervous about what to do, he is older, acting fine and his quality of life is great. The thought of putting him through what I felt was major surgery was so frightening, especially since he is older, but I was also getting nervous about internal bleeding and ending up in emergency surgery and that being life threatening. I made the decision to see a cardiologist and they cleared him for surgery, and started him on heart medication; he then had the splenectomy the next day. The recovery was quick and he actually wasn’t much bothered by the surgery, maybe a day or two of lethargy. By the end of the first week I was having to keep him from playing and running, he was back to himself. Now, a few weeks later, I am so thankful I made the decision I did, he is just so happy, playful and back to being his energetic (in the old man style) self and even starting play sessions with his siblings. It was a roller coater ride for the few weeks after getting the diagnosis, getting a second opinion and making the decision to go forward with the surgery, but it was all worth it to have him back and not sit here and worry if he might be bleeding internally. I learned your mind can play those games with you when you know there is a potential unseen problem with your dog. One thing that made the decision a little easier was my vet telling me the surgery wasn’t much more on him then say a spay for a girl, it really wasn’t as major as I thought it would be, and based on the experience I went through, I’d agree it really didn’t take much out of him at all. I wish you all the best in making your decision, and I’d be happy to help answer any other questions you may have.
    Trish

  4. Krista Magnifico

    this is the answer from my client, Trish, who’s dog had a very similar issue (heart murmur and incidental splenic mass found via ultrasound).

    “Wow, what you are going through sounds quite sillier to what I just experienced with my oldest dog, who is almost 12. He is a Lab mix weighing about 54 lbs. A few months back he had is senior checkup, including a full blood panel and all looked good except trace amounts of blood in his urine and he has had a heart murmur his whole life and had never been on heart medication. He ate carpet a few weeks ago and while doing X-rays and ultrasounds to be sure it wasn’t causing a bowel obstruction, we found he had an enlarged heart and two masses on his spleen, with no indication of metastasis. He was acting himself, except for the belly issues from eating the carpet. Once we knew the carpet issue was under control, I got a second opinion about the spleen and had long talks with my vet about the situation. Both veterinarians suggested a splenectomy, and also to consider a cardiology evaluation to be sure his heart was strong enough for surgery. I was so nervous about what to do, he is older, acting fine and his quality of life is great. The thought of putting him through what I felt was major surgery was so frightening, especially since he is older, but I was also getting nervous about internal bleeding and ending up in emergency surgery and that being life threatening. I made the decision to see a cardiologist and they cleared him for surgery, and started him on heart medication; he then had the splenectomy the next day. The recovery was quick and he actually wasn’t much bothered by the surgery, maybe a day or two of lethargy. By the end of the first week I was having to keep him from playing and running, he was back to himself. Now, a few weeks later, I am so thankful I made the decision I did, he is just so happy, playful and back to being his energetic (in the old man style) self and even starting play sessions with his siblings. It was a roller coater ride for the few weeks after getting the diagnosis, getting a second opinion and making the decision to go forward with the surgery, but it was all worth it to have him back and not sit here and worry if he might be bleeding internally. I learned your mind can play those games with you when you know there is a potential unseen problem with your dog. One thing that made the decision a little easier was my vet telling me the surgery wasn’t much more on him then say a spay for a girl, it really wasn’t as major as I thought it would be, and based on the experience I went through, I’d agree it really didn’t take much out of him at all. I wish you all the best in making your decision, and I’d be happy to help answer any other questions you may have.
    Trish”

    hope this helps.. i am going to ask Trish to add Reggie’s story to our storylines section asap!