Cystocentesis alternatives

4 y/o Shiba has unintentional weight loss in the last 3 months. From 20# down to 18. No change in food or activity. she is on a home cooked meal, this was designed by a canine nutiritionist. She has a history of IBD like symptoms, is a picky eater so home cooked has been the only thing she has eaten consistently. She has been on This for the past 2 years without any major issues. I took her to the vet who ran labs and ran tests on her stool. Her creatinine was elevated, and cholesterol was a little high. Stool was negative. The vet wants to do a cystocentesis to see if there is protein in the urine. She does not have any frequency or urgency of urination, she is not urinating in the house. In the past, a cysto was attempted but she was not having it. I know she won’t tolerate this procedure. Is the cystocentesis necessary just to look for protein? Any alternative testing that can be done?

Hello!   You will have heard of people doing a 'free catch' of urine, i.e. standing behind the dog with a tub or (for low-down squatters) a flat tin.  However, if there is protein in the urine, then the vet doesn't know whether the protein comes from the urine in the bladder and perhaps from the kidneys, or from inflammation in the tract below the bladder (or even from dropping off the little hairs at the end).  This can be important when they are trying to deduce whether kidney disease may be present.  There is an additional practical bonus that urine can be collected and tested immediately, in a sterile way while it is fresh, or sent away immediately for further tests e.g. cortisol : creatinine ratio. Inserting a needle is quite a specialist procedure but your vet has likely done it many times before.  For larger dogs, some use an ultrasound probe to help to visualize the bladder. Gerardo Poli, an expert writing in the veterinary times, explains that even the smallest amount of protein in (relatively dilute) urine ought to raise suspicion because there shouldn't be any protein usually.   "A reasonably large amount of protein has to be present" for a positive dipstick result.  A urine protein to creatinine ratio may be useful if kidney disease is suspected, which your vet might need to send away. If your dog does have kidney issues than the sooner they are known about, the sooner interventions can be made.  When I did this sort of procedure, I used to find that the needle wasn't scary for most dogs; they barely actually notice it.  However, it is important to keep the patient still and calm and most dogs don't like to be held still for any reason.  I find it easier if the owner does not come into the room because dogs are sensitive creatures and owners are naturally worried by the concept of inserting a needle into the bladder;  if the owner is anxious, the dog will magically pick it up.  If the dog is not suspicious, then the nurse can often disguise being held still as a huge fuss.  Furthermore, the dog then has the owner as a 'safe place' to come back to after the procedure. This is widely practiced as the best alternative.  I hope that something there is of help.