Most vets use "empiric" antibiotics on the first UTI. Basically that means it is an educated guess. MOST UITs are E.coli and MOST are pretty sensitive to anything you throw at them. Being that a urine culture and sensitivity test is upwards of $80, MOST people elect to just try a course of antibiotics based on best guess and results of the urinalyis sediment exam and if it doesn't completely clear the infection, then either try a different antibiotic or go with the C&S. Some types of bacteria (Proteus, Staph) that cause UTIs are urease-splitters, which causes the rise in urine pH. In dogs it is common for UTIs caused by these bacteria to lead to more alkaline urine. Clear the infection, and the urine pH returns to normal. There is usually no need to use special diets or foods to lower urine pH if the cause of the increased pH is a UTI. I guess back in the day it was thought that high urine pH led to UTIs, but now we know that it is just the opposite. In some unlucky dogs, the alkaline urine can then lead to the formation of struvite crystals or even stones. Most female dogs have no trouble passing urine with even a lot of struvute crystals, but stones are a different story. Male dogs may have trouble passing urine even with just crystals. If the stone stays in the bladder, the bladder becomes irritated, inflamed, and predisposes to UTIs in any animal! It's a vicious cycle. Sometimes a vet will be faced with a dog with all 3 problems at the same time- UTI, struvite crystals and/or stones, and high urine pH. In that case, the vet may elect to treat all 3 problems at once via antibiotics for the UTI and special food and/or medication to lower urine pH and to dissolve the stones/crystals. There are many reasons that an animal may have recurrent or refractory UTIs. Hyperadrenocorticism, diabetes mellitus, congenital abnormalities (hooded vulva, ectopic ureters), renal disease, and steroid use are just the beginning. If you really want to get this under control, my suggestion would be to stop antibiotics for 5 days, have a urine culture and sensitivity test done. This will determine exactly what bacteria is causing the infection and more importantly, what antibiotic kills it. 5 days after completing the course of antibiotics (usually 4 weeks unless there are signs of upper urinary tract infection), have the urine culture and sensitivity repeated to make absolutely sure that nothing is growing in the urine. Then you know the antibiotics have completely cleared the infection. This is important because if Dusty gets another UTI, you'll know that it is a new one, not the same one that was never completely cleared. Trust me I know that is very expensive. I just had to deal with recurrent UTIs in my lab, Max. Turns out, he had an upper urinary tract infection too- his left kidney was basically rotten. That was why he kept having UTIs. Normal dogs have other signs of kidney infection (fever, anorexia, increased frequency or quantity of urination), but Max is different and didn't show anything besides a raging UTI and urine the color of root beer. Yeah, it was gross. We had to diagnose the kidney infection with repeated ultrasounds. Eventually it showed up enough to see, and he had to have that kidney removed. All kinds of things happen to animals. You never know. The surgeon said she had never seen a dog with such a rotten kidney not be sick, and she's been a surgeon for quite a while. You could just try to keep switching antibiotics, relying on best guesses and hope for the best, but if you really want to know what's going on and how to fix it, better bite the bullet and go with the C&S. It will save you money and the animal pain and suffering in the long run. Good luck. I hope Dusty's problem is nowhere near as serious as Max's was. At least he's all better now!

Trilostane is very recently available in the US for treatment of Cushings with less side effects than lysodren. Well, except for the very low risk of sudden death. But other than that, it is a reversible non-cytotoxic drug that doesn't carry the risk of making your dog Addisonian like lysodren can. Some vets use trilostane in conjunction with ketoconazole (an anti-fungal drug) to increase the bioavailability of the trilostane and reduce the dose. As far as behavior changes, most dogs don't have that many except the already mentioned increased hunger, thirst, and perhaps panting and lethargy. I've heard a few people say that their dog got aggressive or had other odd personality changes with Cushings in the untreated stage, but that seems rare. Once treated and stable, it seems all those signs go away. As far as pain and quality of life go, I think it depends on how well the disease is being managed. Most seem like happy dogs, unless they go into a Addisonian crisis. Then they are pretty darn miserable until their cortisol levels are fixed. But that is pretty easy to do. If they are accidently made permanently Addisonian, that is treatable too. I guess it would be a big problem if your dog was hard to medicate for some reason, because treating either Cushings or Addisons is usually a lifelong ordeal. Another issue would be if your dog get stressed at the vets or resented frequent blood draws. I think the biggest issue in treating Cushings is the expense and inconvenience to the owner, because the dog must be pilled, monitored at home carefully, and the drug dose must be monitored closely requiring many blood draws and trips to the vet. This isn't a type of disease where you just give some pills for a couple of weeks and it goes away. It's generally life long. So it requires a lot of committment from the owner. But dogs are well worth the effort IMHO. Their quality of life is much improved with treatment.

You need to find a new vet. Struvite stones in dogs are caused by UTI. There is absolutely no reason to make a diet change for struvite stones in dogs. Either your vet doesn't know that, or is trying to sell you an Rx diet your dog doesn't need. Your dog needs to have the correct antibiotics in order to kill the infection that caused the stone formation. There should have been a urine culture and sensitivity done at time of admittance, and your dog should be on the appropriate antibiotic. You should also have a recheck urine culture scheduled for 5-7 days after completion of the antibiotics. As long as *all* of the stones were removed, and that was confirmed by x-ray after surgery, then all you need to do is complete the antibiotics and make sure the infection is cleared by rechecking the urine C&S. I also generally recheck a urine culture after a couple of months, because some dogs are prone to infection which makes them a risk for stone formation. My own lab Max had struvite stones due to recurrent UTI. The second bout was 100% my fault because I did not follow up on urine culture often enough, and he developed another infection which caused the stones. The first time he had struvites, he blocked and needed surgery, was put on appropriate antibiotics guided by the urine C&S results. But I didn't follow up on the recheck C&S, and the infection wasn't really cleared. He got stones again, but this time didn't block, so I was able to use Hills S/D to dissolve the stones while he was on appropriate antiobitcs to cure the infection. That time, I made sure I had repeat C&S to show the infection was cured and the stones never came back. Once the stones were gone, I switched him back to his regular food (Natural Balance). He never got stones again. Sorry to be so blunt in the beginning but if all the vet does is Rx a diet then your dog will still be at risk for struvite stone formation.

Pet peeve of mine. KIDNEY stones are NOT the same as BLADDER stones. They are 2 completely different anatomical locations, with completely different consequences, and completely different therapies for management and prevention. KD is not made to prevent the formation of BLADDER stones, though it may help in cases of calcium oxalate (due to restricted calcium levels) or cysteine (due to restricted protein levels) stones. KD does help prevent KIDNEY stones in cases of renal failure because it has greatly reduced phosphorus levels, which is a major cause of KIDNEY stones in patients with kidney disease, which then worsens the kidney disease. KD does nothing to manage struvite stones, which are the most common bladder stones in dogs. Struvite stones are NOT managed with diet- they are caused by urinary tract infection. All you have to do to prevent the recurrence of struvite stones is to prevent (or quickly manage) UTIs. My own Max has had struvite stones twice. First time, he blocked and I had to remove the stones surgically. I cultured his urine and put him on ABX. The infection cleared according to culture. Unfortunately I did not check his urine culture on a routine basis and he got struvite stones again. This time, I cultured his urine, used the appropriate Abx, fed him SD to dissolve the stones (he didn't block 2nd time around), and continued to culture urine monthly for 6 months, then every 2 months, now every 6 months. He has been on regular commercial dog food since then and has not had any recurrences, only because when he cultures positive I treat him right away. Max is NOT on a restricted-protein diet; in fact he eats the same as my other dogs. There is no indication for a Rx diet because he had struvite stones. You must ask your vet why the KD was prescribed and ask him/her if there are any other options. Purina makes NF which is comparable to KD as far as protein restriction, reduced sodium, phosphorus, and calcium. I don't think it will be any less expensive than KD though. Sometimes it is less expensive to do homemade diets, but it is time consuming, and you have to get the recipe from your vet or a veterinary nutritionist. Your vet can use BalanceIt to help him/her formulate an appropriate diet if necessary (you can't get an Rx diet from their website, just routine maintenance diets). In any case, I wouldn't switch diets without consulting your vet. S/he needs to know that KD is getting very expensive for you (I know the prices have gone up quite a bit in the last year or so) and you need options.