Struvite Crystals… Pesky Buggers

What causes Struvite crystals?

Struvite crystals are also known as magnesium ammonium phosphate crystals, The causes of struvite crystals include extremely alkaline urine (often from a biologically inappropriate diet), high steroid use, abnormal retention of urine, a urinary tract infection, or another disorder of the urinary tract.


Crystals under the microscope

Symptoms of Struvite Crystals

Some pets with show no symptoms, but common symptoms include frequent urination, straining to urinate, an abnormal urinary stream (for example, the dog lifts his leg and maybe a few drops come out, and then a few drops more), urinating in inappropriate places (especially if it’s an indoor kitty), cloudy or bloody urine, and oftentimes, increased thirst.


Treating Crystals

The first thing to do for a pet with crystals to create a healthy urine pH that is neither too acidic nor too alkaline. A pH of 7 is neutral. Everything above 7 is alkaline, and everything below 7 is acidic.

Dogs and cats, as carnivores, should have a slightly acidic urine pH, optimally between 6 and 6.5. We want to maintain the urine pH at no more than 7, because a higher pH will predispose the animal to developing struvite crystals.

Some pets are genetically predisposed to producing a protein called cauxin, which is excreted into the urine, causing sterile crystals or sterile struvite crystalluria. This means the crystals can form without the presence of infection. These animals are very prone to chronic cystitis, as these sharp crystals cause microtrauma to the lining of the bladder that results in discomfort and irritation.

To reduce urine pH – which is the goal in most struvite situations – you must feed your pet a Veterinary Prescription food like Royal Canin Urinary S/O.

Creating more dilute urine by offering a moisture-rich diet is critical to avoiding a recurrence of crystals. A species-appropriate diet in combination with infection management is often effective at dissolving struvite crystals, but it can take a few weeks to several months for the crystals to completely disappear.


Crystal formation chart

Why is it important to treat for struvite crystals?

If left untreated, struvite crystals will aggregate and form struvite stones. These stones can become lodged in the urethra or the ureters (the tubes that connect the kidney to the bladder). In most cases, the stones must be removed surgically along with any stones that don’t dissolve despite dietary changes and medical management.

Surgery to remove a bladder stone is known as cystotomy. Depending on the patient and the location and size of the stone, there are some other less invasive procedures that might be appropriate. These include a technique called laser lithotripsy that breaks down stones into smaller pieces that can then be voided out, and a procedure called voiding urohydropropulsion, which is a technique that involves manually expressing stones out through the urethra while the patient is sedated.

If your pet has been diagnosed with struvite crystals or stones, it’s imperative that you continue treatment until the condition is resolved, and then incorporate a proactive prevention plan to avoid recurrence.

A urinalysis should be completed monthly until all the crystals are dissolved and then every six months to ensure your pet isn’t brewing additional crystals or stones


Me hoping I don’t end up in the dog house with crystals in my urine!!

To make sure your furry friend like me doesn’t get urinary crystals, you can take precautionary steps to avoid them, like giving your dog filtered water!

There you have it!

Straight from The Dog’s Mouth,

Love, Sequoia

Why do IV Fluids with Surgery?


The next time your canine companion needs a surgical procedure, you might want to ask your veterinarian if she or he administers IV fluids during every surgery, no matter how minor. WE ALWAYS DO with dogs and cats!


Dog on IV fluids

A recent study performed at the University of Pennsylvania School of Veterinary Medicine points to the importance of administering IV fluids during even minor surgery on pets. This is currently the recommended standard of care, but isn’t practiced routinely in many veterinary hospitals.

For the study, the UPenn researchers focused on the effect of IV fluids on the network of small arterioles, venules, and capillaries that directly feed an animal’s tissues and cells. Collectively this network of small vessels is known as the micro-circulation.

The researchers used a video microscope to capture the blood flow of dogs undergoing spays and discovered that increasing the amount of IV fluid they received improved the number of vessels receiving blood flow.




Monitoring Blood Flow at the Cellular Level

Your dog’s circulatory system transports oxygen and nutrients to the cells and tissues of his body, and removes waste products and carbon dioxide. Arteries and veins travel to and from the heart, lungs, and other organs, and these larger vessels branch off into smaller arterioles and venules that contract and expand to allow blood to flow to and from the capillaries. Cells reside inside the network of tiny capillaries.

Depending on his hydration level, metabolism, hormones, and other factors, your dog’s body can regulate when and how much blood travels to different parts of his circulatory system.

Anesthesia can inhibit the body’s ability to regulate blood pressure, and the combination of fluid loss and anesthetic drugs can result in a decrease in blood flow to and from the cells of your pet’s body.


Inserting IV catheter to give anesthesia and meds through.

According to lead study author Deborah Silverstein, an associate professor at UPenn in the School of Veterinary Medicine’s Department of Clinical Studies:

“When we monitor a patient’s blood pressure or oxygen levels, we’re not always able to discern what is happening at the cellular level. Sometimes there are tissues and cells that are getting a surplus of oxygen while other cells or tissues are in need of more, but our measuring the big things, like blood pressure, doesn’t tell us that. The only way we figure that out is when the patient develops organ dysfunction or new complications arise following anesthesia.”


What Silverstein is saying is that vital sign monitoring procedures used during surgery don’t give a complete picture of how things are going in the cells and tissues fed by the microcirculatory system.

In human medicine, it’s routine during even the most minor surgical procedures to administer an IV drip to offset fluid loss. The same standard of care is recommended by the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP), however, it isn’t uniformly practiced by all veterinarians, probably because of the added cost.


Tech monitoring pet during surgery


Study Results Indicate That IV Fluids Affect Circulation During Veterinary Surgical Procedures

When they reviewed the videos, the researchers found no differences among the three groups in the number of vessels receiving blood flow or the amount of blood flow. To their surprise, they also found no differences among the groups in the tiny capillaries that are less than 20 micrometers in diameter.

The researchers did, however, see a difference in the blood vessels larger than 20 micrometers. The dogs in the group that received the highest level of fluids had greater densities of these blood vessels than the other two groups.

These results suggest that fluids do affect circulation, but more research is needed to better understand what this information means, as well as the optimal rate of fluid delivery. According to researcher Silverstein:

“The larger vessels are the ones that are constricting and dilating to feed the microcirculation. And it appears that the animals that got the highest rate of fluids in this study – which may not be the optimal rate – are the ones that seemed to have the greatest recruitment of arterioles and venules.”

During their spay surgeries, about a third of the dogs in the study had a drop in blood pressure that required an infusion of fluids, which further emphasizes the need for constant blood pressure monitoring as well as IV fluid support.

Silverstein noted that some of the dogs might have gone into surgery slightly dehydrated after spending the night in the hospital and possibly refusing to eat or drink due to stress.


The Microcirculatory System: So Small, But So Important

The researchers hope to conduct future studies using different types and amounts of IV fluids to test their impact on the microcirculation. She also plans to continue her study of microcirculation in animals with diseases such as sepsis to see if measuring blood flow to the smallest vessels can be used to better detect or predict outcomes. Silverstein says she loves being able to focus on something so small, but so important.

“The microcirculatory system is one of the largest organs in the body but impossible for the naked eye to see.”



Me resting

So there you have it! Why you should make sure your pet ALWAYS gets fluids during surgery! I want to be sure all my friends receive the best care….and this will happen with EVERY surgery at my mommas hospital!

Straight from The Dog’s Mouth,

Love, Sequoia

My dog has MRSP! What does that mean?

Does your furry friend have a skin infection that just doesn’t seem to respond to ANYTHING your vet prescribes?  Has your friend been on a few different antibiotics?  Is the skin infection spreading all over your friend and your friend is uncomfortable? WELL IT’S TIME FOR A SKIN CULTURE!!!

Trust me, this is the best thing to do….I know about this personally….I almost lost all my hair because of MRSP….I’m 14 and my immune system isn’t up to par….my friend Quincy also has this problem.  I’m hoping that this blog can help Quincy find a foster home AND help other furry friends who might have resistant skin infections as well….these skin infections aren’t the end of the world, they just need more progressive care….COME SEE MY MOMMA!  My momma and her staff at Union Park Veterinary Hospital have now successfully treated 5 cases of this IN THE PAST MONTH!!!

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) IS BECOMING VERY PREVALENT DUE TO INDISCRIMANT/”SHOTGUN” ANTIBIOTIC USE in older and immunocompromised pets! 

This bacteria was previously known as Staphylococcus intermedius (MRSI).

MRSP is NOT the same as methicillin-resistant Staphylococcus aureus (MRSA), which affects humans.


MRSP rash and sores on the belly.



Staphylococcus pseudintermedius is the most common species of bacteria found on dogs. Usually, this bacteria resides on the skin but does not cause any problems.

However, some dogs develop a skin infection (pyoderma) that can usually be cleared with one of the common antibiotics.

A small percentage of dogs may develop skin infections caused by methicillin-resistant Staphylococcus pseudintermedius (MRSP), which means that the more common antibiotics will not clear the infection.

This bacteria is most common in pets with recurrent skin infections due to underlying causes such as allergies, endocrine diseases, or other reasons for immune compromise (old age, cancer, etc).


Close up of some skin sores.



Staphylococcus pseudintermedius causes infections in pets and only rarely causes infections in people.

However, because this is a more resistant bacteria than the usual bacteria that infects pets, we want to decrease the chance of it being transmitted to you or your family.

The most important thing that you can do is frequent hand-washing after touching your pet and always before meals.

If you or family members are immune compromised, you should either avoid direct contact with your pet or thoroughly wash your hands after handling.

Remember, the risk of transmission to humans is very low. If, however, you develop a non-healing skin wound, please see your physician.


Megan loving on Quincy.

Megan one of our tech’s said “I can love on and interact with Quincy all day. I give her a bath every other day, put ointment on her rash and sores, and scrub her wounds with my bare hands and then just wash them and go home to my pets who don’t have it, and haven’t gotten it because I wash my hands thoroughly.”



The best thing we can do to treat MRSP in your pet, is aggressive topical therapies. It is very important that you follow treatment instructions exactly as given to you so the infection will be cleared.


Quincy’s basic plan.



  1. How did my pet get MRSP?

Similar to human medicine, resistant bacteria are becoming more common in veterinary patients.

We see this bacteria most often in patients with a history of recurrent skin infections and previous antibiotic use.

In order to prevent future infections we will work with you to identify and control the underlying cause (allergies, endocrine disease). We must control the underlying cause in order to reduce skin infection recurrence.

  1. Can my other pets catch this bacteria?

Pets that live together share bacteria. Thus, other dogs or cats in the home may be colonized with MRSP.

As long as the other animals have no underlying diseases that predispose them to skin infections, then the bacteria should not cause problems.

If other pets develop skin lesions, then examination by your regular veterinarian and possible skin culture should be performed to determine if MRSP is the cause.


Quincy says “you can still love me with MRSP!”

There you have it! Dogs that get MRSP, (like me and Quincy) can still be loved and because our humans washed their hands, they didn’t get it and we can be cured of this pesky bacteria!  Remember, any non healing skin wound needs a proper work up which includes a skin culture…not just more oral antibiotics…..

Straight from The Dog’s Mouth,

Love, Sequoia

Lepto What?

Do you hike, camp, backpack with your dog?
Do you take your dog on river trips? Fishing trips? Hunting? My mom takes me! And I love it!!
All it takes is a small amount of leptospirosis (lepto for short) infected water and you and your pet are at risk for leptospirosis which can be costly to treat and fatal if left untreated.

Me playing in the water after a long hike.

Does your pet like to step in a puddle and then lick its paws? Most do….
Does your pet like to drink out of streams and rivers? Most do….
The lepto map IS RED HOT all around Salt Lake City and our adventurous clients need to think about lepto before they head out to the Uintas, Moab, and surrounding Montana, Wyoming, and Colorado wilderness areas with their canine companions.

Some causes of Lepto

Lepto is carried by wildlife vector species who will urinate in a water source and then contaminate that water. Guaranteed wildlife creatures don’t know how to read a map to stay out of Utah….it is likely here…just being unreported. Some of these animals include raccoons, skunks, squirrels, and other wildlife.
Lepto causes liver and kidney failure and is ZOONOTIC!  (People can get it!!)
Why would you put your pet and you at risk when you could just prevent lepto with a vaccine?

Then you can enjoy the outdoors without having to nag your pet all the time to stay out of the water!

Me wondering around camp in the mountains.

Me wondering around camp in the mountains.

There you have it! All the info on Lepto Vaccines!

Straight from The Dog’s Mouth,

Love, Sequoia

Rattlesnake Vaccines 101

The Myths and “Magic” behind Rattlesnake Bites. Why you should vaccinate your dog against it! (I know your fur babies will thank you!)



Well, we live in Utah.  We have sunny skies and amazing scenery and many things to sniff- chances are you do not leave Fido at home while you are playing outdoors.

Mountain biker, climber, hiker, camper?

Guess what?  While you are hanging off that rock crag, chances are your dog has grown bored waiting for “master” to return and has his nose stuck into a crack you used as a hand hold hours ago.

While you are flying down the trail on your bike kicking up dust, you may also be riling up some snakes in the nearby bushes, just in time for your dog to trot by minutes later.

While you are enjoying a nice campfire with friends after a long hike, chances are Fido is not tired and is out rummaging around under rocks, and bushes.

The point is: even though you may not see rattlesnakes all that commonly, your dog has a different point of view and is looking for trouble. This is why we love them so much, right? (We have our humans wrapped around our paw!)


Newman and Friend checking the scenery out on a hiking break.

Venomous snakes bite about 150,000 dogs and cats every year. Dogs and cats are about 20 times more likely to be bitten by venomous snakes than people and are about 25 times more likely to die if bitten. A dog or cat is about 300 times more likely to be bitten by a venomous snake than to get rabies. Snake bites are life threatening, extremely painful, expensive to treat, and can cause permanent damage even when the dogs survive.


Myth #1:  If my dog gets bit by a rattlesnake all I need to do is give Benedryl.

Um, no.  Benedryl at 1 mg/pound body weight given once orally is a great start if you are in the middle of nowhere.  However, the insult from a snake bite, even a non-rattler, is multifaceted.  There is anaphylaxis which can cause swelling, edema, and difficulty breathing.  This in and of itself can become life threatening VERY FAST!

But then there are neurotoxins of the venom, the necrosis it causes, intense pain, and the secondary bacterial infection.  All of these things compound to take a very large systemic toll on your pet leading to liver and kidney damage, hemolysis and anemia as well as platelet dysfunction and severe dehydration.

This is why any snake bite warrants an emergent vet visit and likely hospitalization with blood work and intravenous fluids and antibiotics among other supportive care.

Bottom line: A snake bite is not a small potato deal.


Myth #2:  Small dogs are more likely to die than a large dog that gets bitten.

Um, no. There are too many factors at play for this generality.  Small dogs are more likely to get bit once and get scared and run away.  Large dogs may try to play with the snake and get bit multiple times.

A “dry bite” is better than a venomous one (how would you know if it were “dry” unless you were in the snake’s mouth?) and juvenile snake bites are the worst because they release all their venom at once whereas adult snakes may hold back some venom.

Some parts of the body are worse for getting bit than others.  Some dogs may already have kidney or liver compromise or anemia and a snake bite pushes these dogs systemically faster than a 100% healthy dog.  Some dogs have collapsing tracheas and any hypersensitivity can turn life threatening for oxygen depletion quickly.

Bottom line:  Size doesn’t matter.


Myth #3: My dog got bit. There is nothing I can do other than put my head in the sand. My dog is going to die. 

YOU ARE NOT AN OSTRICH!! (Although they would be fun to chase…) You are a knowledge empowered pet owner!!  What to do (ie. What Dr. Doub would do with her dog (me!)):

  • Give Benedryl ASAP before airway compromise 1 mg/lb by mouth once
  • Try to keep your dog calm. Lowered blood pressure will keep the toxins localized
  • No tourniquets or sucking venom out!!!
  • Do not give any human pain meds: aspirin, ibuprofen, etc and even a Rimadyl or other doggie NSAID can be very harmful to your pet and are CONTRAINDICATED with snake bites
  • Get to a vet ASAP. The closest to your location, the better.  They can always transfer to a 24 hour facility or your regular veterinarian once your pet is stabilized.
  • Get a friend to help you carry your dog to your vehicle and keep your dog cool (not cold, cool) to try to minimize exertion. You can rinse the bite site with tap water or saline (no peroxide!!!  It kills tissue)
  • Think about the rattlesnake vaccine for your dog
Dog bitten by rattlesnake

Dog bitten by rattlesnake


The Magic

Vaccine??   The 411….

Initially, a dog should receive two subcutaneous doses about 30 days apart. Dogs over 100 lbs or under 25 lbs may benefit from a three dose initial series. It is best to give vaccination boosters about 30 days before beginning of exposure to rattlesnakes. Protection peaks about 30 to 45 days after boosters and lasts about six months.


Rattlesnake vaccine has been on the market since 2003 and is a standard of veterinary care for dogs at high risk for rattlesnake bites. It is listed in the American Animal Health Association’s 2006 canine vaccination guidelines. It is conditionally licensed by the USDA and is recommended in over 4,000 veterinary hospitals nationwide. It is highly recommended by VPI, the largest pet insurance company in America. Over 500,000 doses have been used in over 100,000 dogs. Antivenin is not contraindicated because the vaccine uses no horse or sheep products.


Adverse events are reported in far fewer than one percent of all vaccinated dogs. Most of these side effects are mild and need no veterinary care. Injection site lumps can be treated with hot moist compresses, antibiotics, and pain relief medication if necessary. Systemic reactions (typically flu like symptoms) are reported in fewer than one in 3,000 vaccinates and usually self-resolve in two to three days.


Reported benefits include delay of onset of symptoms, less severe symptoms, faster recovery times, and lower mortality rates. About 90% of veterinary clinics nationwide report that the vaccine works well or very well, about 5% of clinics report mixed results, about 3% of clinics see no apparent effect and about 2% of clinics are undecided. Though many vaccinated dogs won’t need additional veterinary care other than initial stabilization, rattlesnake bites can be complex and should still be evaluated by a veterinarian immediately.


A vaccinated dog’s resistance to rattlesnake venom can be overcome with enough venom or special circumstances. These circumstances include very small dogs, very large snakes, multiple snake bites to the same dog, or some snake species that the vaccine has little or no protection against.


The vaccine will not protect against coral snakes, cottonmouth snakes, or the Mojave rattlesnake. It has limited protection against the eastern diamondback rattlesnake. Red Rock has conducted a survey and received hundreds of rattlesnake bite reports from vet clinics across the country indicating that the vaccine helps protect dogs from many different species and subspecies of rattlesnakes.



A note from Dr. Doub:  I love living in Utah.  Part of this love comes from treating cases like snake bites.  I would take them hands down over a lyme nephritis case any day. These cases are very rewarding to treat because you can see a daily improvement in these patients.

A chaotic and scary situation becomes controlled very fast once the patient is stabilized.  In my experience, with a compliant owner and with quick and proper veterinary assessment and care, most of these patients make a full recovery.

The vaccine will “buy you time” to get out of the wilderness and get your pet to the vet.  It is not to serve as a replacement for immediate veterinary care.  It is definitely something to consider for any active pet.  The staff at UPVH would love to discuss this vaccine with you and decide if it is right for your pet.

(My mom would have had me vaccinated if she was a more avid mountain biker and I wasn’t an old lady and could keep up with her…;))

My old lady self resting in the snow at the park.

My old lady self resting in the snow at the park.

So there you have it! The 101 on Rattlesnake Vaccines!

Straight from The Dog’s Mouth,

Love, Sequoia

Iron Toxicity in Dogs

The other day we had a furry friend come into the clinic feeling under the weather. Milo ate an Iron Packet 2 days prior and was now acting very abnormal (Milo is pictured below). The race was on for Dr. Doub to help my fellow furry friend to getting feeling back to normal!


So what is Iron Toxicity in dogs you ask?

“In the event that there is a high volume of iron present in the blood, damage can occur within the cells. While iron is an essential nutrient for the regular functioning of a dog’s body, when it is present in large quantities in the bloodstream, it can become lethal. Dogs may be ingesting unhealthy amounts of iron when they are being given multivitamins that are not appropriate for their age, size or health status, or when they are ingesting dietary supplements or pregnancy supplements that have been left within their reach but that are not intended for them.” ~PetMD 

Iron can be found in these little packets that they put in Human food, as well as in my dog treats, to keep them fresh. And if ingested, especially for my kind, it can be lethal.


And what are the symptoms to look for?

Stage 1 (0-6 hours):

  • Vomiting
  • Diarrhea
  • Depression
  • Gastrointestinal hemorrhage
  • Abdominal pain

Stage 2 (6-24 hours):

  • Apparent recovery

Stage 3 (12-96 hours):

  • Vomiting
  • Diarrhea
  • Depression
  • Gastrointestinal hemorrhage
  • Shock
  • Tremors
  • Abdominal pain

Final Stage (2-6 weeks):

  • Gastrointestinal obstruction from stricture formation (from narrowed gastrointestinal tubes).


Milo was hospitalized with us for 2 days because he was so sick, (iron toxicity is very serious!) but now he has made a full recovery and is doing much better.


If you think that your fur baby, my fellow dog and cat friends, has ingested one of these, call your vet immediately and schedule an appointment! Your pet will thank you and my family here at the clinic can start the treatments needed to getting you back out to play!

Thanks for tuning in this week! Stay tuned till next week!

Straight from The Dog’s Mouth,

Love, Sequoia





Welcome! Get to Know Us!

Pets are humanizing. They remind us we have an obligation and responsibility to preserve and nurture and care for all life. ~James Cromwell

Welcome to our new blog site! We are excited to announce that we will be starting a blog of life at the clinic, narrated by me Sequoia! (The beautiful, glamorous Belgian Malinois in the picture below). Giving you lots of exciting, fun, informative information about your pets!IMG_5082


I wanted to start off by introducing each of the human staff members: Owner of the clinic (and me!) and head doctor is my mom, Dr. Kirsten Doub.kDr. Doub is originally from Baltimore, Maryland.  She received her undergraduate degree from the University of Virginia in 2002 and her Doctorate of Veterinary Medicine from Tufts Cummings School of Veterinary Medicine in 2009.  Dr. Doub has an extensive skill set including surgery, dentistry, and preventative medicine. She is head of The Paw Project Utah and shares her home with me and my many cat siblings. Dr. Doub enjoys working with rescue groups and she frequently opens her home to a myriad of foster dogs and cats.  In her free time, Dr. Doub is an avid resort and backcountry skier, kayaker, and backpacker.


Next up we have our head tech Megan Hyde. (Who is often the one poking and prodding me).megan

Megan received her associates degree in Animal Science from the Bel-Rea Institute of Animal Science in Denver, CO. Megan has been a Certified Veterinary Technician since 2004 and has over 10 years of technical experience at AAHA hospitals. Megan recently went back to school for Dental Assisting to further her knowledge in oral health and periodontal treatments. She has wanted to work with animals since she was a little girl. Every day that she helps other people’s pets is a pure delight for her! Megan spends her free time with her son London, and her 2 cats, Samuel and Kitty.


Bridget Williams is a tech and my second mom who takes care of me when my mom is off adventuring.bridget

Bridget has been studying in the veterinary field since 2009. She has loved animals, and wanted to work in the veterinary field since she was a child. In pursuit of this dream, Bridget recently graduated from Utah State University with a bachelor’s degree in Animal Dairy and Veterinary Science with an emphasis in Bio-Veterinary Science and a minor in Chemistry. When not working or studying, Bridget loves to cook, read, ice skate, play volleyball and hang out with her family, including her two cats Sam and Greycee.


Our last tech is Heather Cannon, who is our newest family member.heather

After spending several years working at Walt Disney World, Heather decided to pursue a degree in Veterinary Technology from St. Petersburg College. She graduated in May 2014 and became a certified veterinary technician that July after taking the VTNE. When not working, Heather loves to be outdoors, study continuing education, cook, and cuddle her two cats Capone and Keller.


Our receptionist is Misha Busch. Answer-er of phones and treat giver.misha

Misha received her Associates degree in Anthropology at Salt Lake Community College, and is now attending the University of Utah pursuing a Bachelor’s degree in Anthropology and Environmental Science. In her free time Misha enjoys playing soccer, hiking, backpacking, camping, skiing, and going on adventures with her family dogs Toodles, Dunny and Azlyn.


That’s our small little family! Stay tuned till next week!

~From the Dog’s Mouth,

Love, Sequoia