Thursday, January 24, 2013

1262. Schnauzer has bladder stones for the 3rd time

Jan 25, 2013.
Today Dr Daniel and I will be operating to remove the bladder stones. The lady owner came in with another dog, a male 9-year-old Golden Retriever that was eating less and was limping on his "left hind limb".

"He has a big lump below the chest," she said. "One lump had holes in which pus came out yesterday. Now he can walk. The past few days he was not willing to stand up and was not eating. Now he eats a little."

"Two gigantic lumps under the skin of the chest," I had the dog sleeping sideways on the floor of the consultation room and palpated two big lumps. The one in front has no holes but the bigger back one has a few holes "Likely to be tumours which have been infected. The dog has a fever of 40.7degrees C. Do you want a blood test to check the health of this dog before surgery?"

She consented to a blood test..
"Surgery will be in 2 days' time," I said. "The dog is not well now and needs the IV drips, antibiotics for the next 2 days, just like your Schnauzer with the bladder stones." 

Her Schnauzer to be operated this afternoon came in on Jan 20, 2013, with blood in the urine and recent vomiting. She looked very ill and her rectal temperature was below normal at 37.8 degrees even on the 2nd day after the IV drip. The blood test on this Schnauzer showed septicaemia with the white cells being high, the platelets being very low and the kidney function compromised.

Total WCC 21.4 (1-17), N=83%, Absolute 17.8. L=6%, M=9%, E=0%, B=2%.  Platelets <10 br="" large="" nbsp="" platelets.="" platelets="" present.="">
On day 2 of admission, Dr Daniel said of the life-less inactive dog, not eating or moving: "This dog is unlikely to survive."
"You will be surprised," I told him. "With IV drips, multi-vitamins, proteins and Vit K1 for the 2 days and glucose", some dogs respond well.
"If there is urethral obstruction, it is not advised to give IV drip," Dr Daniel said.
"The dog can pee," I replied. "I saw her peeing blood in the urine on the floor of the waiting room.A lot of small stones in the bladder plus one large one, in my bladder palpation, There is no wish to X-ray as the owner wants to save money."

On Day 3 after admission (yesterday), the owner came in the morning to visit her. The Schnauzer got up ready to go home and barked furiously. The lady owner was very happy. "The dog can pee," I mentioned about surgery in the afternoon. As the dog had eaten and would benefit an extra day of nutrition and rest, I phoned the owner to operate today (Day 4) giving the dog the higher chances of survival on the op table and post-op.

"The dog has not vomited at all," I told the owner. "That is good news.". I showed her the blood test of kidney disorder. The urea was 44.3 (4.2-6.3) and creatinine was 449 (89-177). Evidence-based medicine is the best.

AUDIT OF PREVIOUS 2 CASES DONE BY MY ASSOCIATE VETS.
According to the owner,  two bladder surgeries were performed in Oct 2010 and Oct 2011.After bladder stone removal, Vet 1 emailed to her a video and advised drinking lots of water while Vet 2 from Jurong gave some prescription diet. 

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