Thursday, September 27, 2012

Follow up: The 3rd sister loves and cares for the old dog

1121. Bladder stone dog goes home - 3 sisters




"Are you the sister who spoke to me by phone about the dog having kidney stones and whether an operation is necessary?" I asked the bigger of two adult ladies who came this afternoon to pick up the 12-year-old male cross-bred that looked so much like a miniature version of a Golden Retriever.



"No," she said.

"Are you the eldest of the 3 sisters?" I asked.

"No, I am the 2nd sister."

"Is the other shorter lady the youngest sister?" I asked.

"No, she is the eldest sister."

"So, the youngest sister is the most intelligent," I said. "To seek a second opinion."

"She is the one who loves the dog most," second sister said. I had talked to her by phone many times to update her of the dog but never saw her.



I put the dog on the exam table and palpated the bladder and prostate for pain. Not a whimper unlike 2 days ago.



"I need a tissue paper to wipe away the blood," 2nd sister said. The dog was so active and had pounced on her left knee and scratched 4 inches of red rash."



"This dog needs to be neutered as Vet 1 had done an ultrasound and said that the prostate was much enlarged."

"Why must he be neutered?" 2nd sister asked.

"The male hormones are produced by the testicles and they make the prostate grow bigger and it had become inflamed and infected. The enlarged prostate caused the urethra to be narrowed, making urination difficult for this dog. Bacteria from the bladder was present and could have infected the prostate. That was why it was painful 2 days ago and earlier. Vet 1 did give an anti-male-hormone injection called Tardak and advised weekly injections. Neutering would have been the alternative. Now, the dog's prostate is not inflamed or enlarged and so the dog pees normally for the last 2 days."



The dog did not pee in front of the sisters this afternoon but he had peed a few times freely in the morning.



"I have advised no bladder stone removal operation as the dog is very thin and will wait till he has difficulty in urination the next time," I said. "Although there is no crystals or struvite crystals present in his urine analysis, it does not mean he has no struvite stones. The pH is 6.0 for the past two urine analysis but bacteria is present in the urine. The bacteria in his bladder may have gone to the prostate, causing pain and inflammation of the prostate.



As the 2nd sister is an adult, she understood what a prostate is and so I need not explain further.



EXPLANATION

1. The male dog does not urine mark for the past two days. He just pees a few times in the morning when taken out for the walk. Why? This is because he was given an anti-male-hormone injection called Tardak by Vet 1 around 1 week ago and he is "feminised."



2. The urinary pH is 6.0. In struvite stone formation, the pH is usually alkaline and urease bacteria must be present. That is the norm. However, Vet 1 had recommended K/D diet and the dog was eating it. So, the urinary pH may have been affected. It is hard to say. It is too technical to explain to the sisters about alkaline urinary pH and struvite stone formation as there is information overload.



3. I advised S/D diet for the next 3 weeks as an alternative to surgery due to the high anaesthetic risks involved at present (prostate enlargement and infection, bladder infection with bacteria). This old dog much loved by this 3rd sister and it is better to build up the dog's weight and health if the bladder stone surgery is needed in the future. Neutering is advised next week as neuter is a very short 5-10-minute surgery compared to around one hour for bladder stone removal. Struvites are more common in dogs seen by me and if this S/D trial works and X-rays of the bladder are taken in a month's time, the stones would have dissolved or reduced in size, permitting urohydropropulsion. That will get rid of all the smaller stones.



4. Owners seldom comply with veterinary instructions and so much depends on educating the owner and the 3rd sister. Somebody who loves the old dog and usually it is a lady family member who cares very much for this old companion to get things done by the vet.

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