Sunday, October 27, 2013

1133. Follow up on Bichon Frise Oct 27, 2013

Oct 27, 2013 was a Sunday. In the early morning, I got the Bichon Frise to go to the grass. I noted that the Bichon Frise whose urinary catheter was taken out the previous evening, strained but no urine came out. His bladder was distended about the size of 2 golf balls. He was given canned S/D diet but would not eat it. Many dogs don't eat it. The trick is to give 90% of canned A/D and 10% of S/D initially if this happens, increasing daily to 100% of S/D. But few owners comply with such instructions and would not bother.

In the evening after I returned from the Jurong Bird Park dinner hosted by the SVA till 11 pm, Dr Daniel had just taken the dog to Toa Payoh Vets to irrigate his bladder under sedation. A urinary cathether was used to flush out the bladder. "I used a bigger catheter," he said. "There was no urethral obstruction. There are only two stones and he gets obstructed again."

"From the X-ray, the urethral stone is the one causing the problem. It is small, about 3 mm across and will lodge inside the urethra near the bladder, causing difficulty in urination. When you used the small cathether, it by-passed this urethra but did not dislodge it, as evident from its presence in the X-ray."

October 28, 2013
At 6 am, I got the Bichon to the grass. He stood a long time like a statue trying to pee. He had the urinary catheter bandaged and wrapped around his waist. After a while, he went indoors and ate only the canned A/D food. "Given 10% of S/D mixed with A/D 90% until he eats all S/D," I advised the caregiver. The canned S/D was offered in full and was discarded for the past 2 days as the caregiver said the dog would not eat it.

DIETARY AND MEDICAL DISSOLUTION OFL THE TRIPLE PHOSPHATE CRYSTALS AND STONES

1. No stones were recovered for analysis as no surgery was done.
2. Uro-hydropropulsion using catheter and syringe did not recover the small stones.
3. CATHETER-ASSISTED RETRIEVAL OF STONES. The bigger urinary catheter was used yesterday to irrigate and flush out the stones using normal saline. The recommended saline infusion is 4 ml/kg bodyweight so as not to overdistend the bladder. The bigger urinary catheter may need to be slit open at one end to permit that small stone to be aspirated out.

The diameter of the hole at the end of the catheter should be around 5 mm. This is easier said than done. The aspirated saline into the glass cup should be checked for the stone which can be retrieved for analysis.
As this dog is not my patient and each vet has his or her own way of treatment, the point No. 3 regarding enlargement of the "eye" of the end catheter is my opinion.

CONCLUSION
This dog has only two stones (triple phosphate) and high alkaline urine, with bacteria 2+. It is the smaller urethral stone that causes difficulty in urination due to obstruction. Some reports claim* that it takes 2 weeks to dissolve struvite stones medically in immature dogs. It is hard to say as the stone may not be just triple phosphate crystals and no actual stone is available for analysis. This case will be monitored closely for medical treatment without surgery.

Reference: Small Animal Clinical Nutrition   Hand, Thatcher, Remillard, Roudesbush, Novotny 5th Edition, Pg 830-831.


5. Medical dissolution using acidifiers rather than S/D diet may be used for 4 weeks but it is better to use S/D diet for 4 weeks.
6. Bacterial infection of the bladder (UTI) to be treated.

7. Urinalysis to be done weekly.

 


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