Second opinion on bloodwork/urinalysis

Hello Everyone, Long story short I have a 3 year old Havanese named Bentley, who back on September 15th was seen for a possible UTI. My vet was out so we had to see someone new who was very nice. He took a look at his urine and told my there was slight amount of blood, and no bacteria, but because of the accidents and smell of urine he went ahead and put him on Clavamox, which he has been on before. A week later I took him back because the accidents weren’t really getting any better and again not our regular vet, he recommended doing a blood panel and urinalysis. Got a call same day that everything was normal, and to go back to basic potty training and maybe limit a bit of his water intake. The results of his blood work and both urinalysis finally were uploaded to his file in the app of the vet clinic I go to. The first photo is his first urinalysis on the 15th, second photo is his blood work on the 23rd, and the 3rd is his second urinalysis on the 23rd. I noticed that on the first urinalysis it says Occult blood-Trace, I have a friend that used to be a veterinary technician, and she told me that that means there was a little bit of blood found. She said because they used a catheter it’s not uncommon for there to be a little bit of blood, however just some thing I noticed I took a look at a urinalysis he had done back in February, they also use the catheter then and no blood was traced. Also I noticed on the blood work his RBC is 21-50 and normal is 0-3. At first my friend thought that those results were the first urinalysis so before he was on an antibiotic, and said that yes that is abnormal and why they then decided to put him on an  antibiotic. However I told her that that was the results of his bloodwork which was done a week after his first visit and after he had been on an anabiotic. She then said oh I misunderstood yeah that’s a concern and I would mention it to your veterinarian. She also mentioned that because a catheter was used the veterinarian could have thought that his red blood cell count was off because of that, but again back in February catheter was used and his red blood cells were not abnormal. Also on his second urinalysis I noticed platelet count 435 and normal is 170-400, Neutrophils is 41 and normal is 60-77, and Lymphoctes is 50 and normal is 12-30. Is any of this not considered abnormal? Am I just being a paranoid dog mom? I did post in another group and a couple people have told me possibly red blood cells could mean kidney stones? Are kidney stones found the same way as bladder stones? The only reason I ask is because when we went for the bloodwork and second urinalysis, the veterinarian did take a look at his bladder with the ultrasound machine and did not seen any bladder stones or crystals. I did leave a message with my veterinarian that I always say and have not yet heard back. Any advice is much appreciated, thank you

Hello!   Just to be clear, we do not give second opinions.  A second opinion is done by someone who has at least the same amount of information as the vet who did the first opinion, and (usually) specialist or better-developed knowledge in that particular area of the body, in order that they can build on whatever has been found.  They also act with the full knowledge and consent, and generally at the initiation and request of, the referring vet.        (more useful stuff to follow).

However, it may be possible that you don't need a second opinion at this point.  I think what has happened in reality is, that the findings on the bloodwork don't appear to match what your vet is saying to you, which is leading you to have difficulty in trusting your vet.   Hopefully I can make some general comments that may help to put your mind at rest a little.

First, a little aside with a very familiar example from human medicine.  Imagine that all you know about a child is that they have blood coming out of their nose.  A nose-bleed can be a sign all kinds of things, from a ball in the nose to a broken nose, to a tumour up the nose, to a life-threatening clotting problem, to simply picking the nose too much or having a foreign body up there or even full blown cancer.  Although cancer is a possibility, it is much more likely the child has bashed their nose on something or picked it too much, and the first question would be:  have you bashed your nose on something?  Common things are, after all, common.......

Blood in the urine, likewise, can indicate no end of scary things but there are many less scary things, too.  One has to interpret them in context.  Inserting a catheter can indeed cause blood cells to end up in the urine but they may not end up in the urine every single time a urinary catheter is placed.  Furthermore, if a whole potful of urine is collected, there may not be very many blood cells in there.  One stick might detect a trace of urine, but another stick on a different sample from the same kidney dish of urine, may not.

While we're talking about urine sticks, many vets use ones that are made for the human market and it is fairly common practice not to take too much notice of the white blood cells (leukocytes and so on) because they don't work very well on animal urine.  Red blood cells, on the other hand, are similar across the species so a weak, strong or moderate positive is valid.  The glucose square also works well - which is another reason why we vets like to use those sticks.

There are various causes of blood in the urine of dogs and urine infections are a very common one.  Others include bleeding from the prostate (usually in entire - i.e. not neutered dogs), bladder stones, bladder crystals, bleeding from the kidneys (kidney stones can happen and so can spontaneous kidney bleeds, apparently) and yes, bladder or urethral tumours in some dogs (but usually much older ones).  However, common things are common.  It sounds as though treatment has been more or less successful so far - I wouldn't expect a kidney stone to respond to antibiotics, for example.

To be clear, I do not think you are being a paranoid dog Mum.  I think you want to understand the apparent contradictions in what you are perceiving, which is good and important.  Vets are fascinated by anatomy and physiology and pathology and will, in general, enjoy explaining it to you.  My advice would be to keep asking questions - 'How do you know that it isn't -'    and 'What should I expect (if treatment is effective)'  are very good ones.  'Do you think it's worth testing for - at this point'  are always very good ones.  Best of luck to Bentley from here.