Saturday, April 19, 2014

1355. 7 small bladder stones in a 12-year-old Miniature Schnauzer on Good Friday

April 20, 2014

"The stones are so small," Dr Daniel commented from the X-rays taken on April 19, 2014, a Good Friday which was a working day for me. "They can be dissolved using dietary management as in Gatsby who was fed S/D diet and is now OK, without any surgery required." The biggest stone was around 4 mm across. Not the usual big pebbles. 

"Each dog is different," I said. "I have not seen Gatsby's X-rays and any routines and instructions on the on the dietary dissolution of stones must by complied by the owner.  Yesterday, you unblocked the bladder. The urinary catheter came out when the owner's daughter visited. This morning, the parents came. The dog lifted his leg and no urine came out. So, his urethra was blocked again. The parents consented to surgical removal and I had advised on the high anaesthetic risk of dying."   

Yesterday, on April 18, 2014, this 12-year-old male, not neutered Miniature Schnauzer came with a history of not eating for the past two days. "He had never been sick in his life," the wife told me. "He went to Vet 1 for the usual vaccinations, but 2 years ago, he passed blood in the urine. Vet 1 gave me a course of antibiotics, saying that this dog was too old for anaesthesia and if the medication worked, there would be fine. And he had no more blood in the urine since then!"

The dog was lethargic but had no fever. His body smelted strongly of urine. The stench of urine not easily washed off by bathing as he was incontinent. I suspected urinary stones as Schnauzers are prone to this condition. I palpated the bladder. It was as full as an orange. "Is he able to pee normally?" I asked the maid. "No," she shook her head. "Very difficult and urine drops here and there."

Dr Daniel would unblock the bladder. He commented that the bladder would not be obstructed but I said it was. Only urethral catheterisation confirmed my findings. 

Dr Daniel flushed the stones back into the bladder and removed. I noted the surgery took around one hour. The bladder was bright red and inflamed. The bladder wall was 5 mm thick. He stitched the mucosa and the wall.

On April 20, 2014, now, a Sunday, the parents came in at 9.30 am after breakfast. The dog was jumping for joy inside the cage. I showed them a video of the dog peeing freely outside the clinic, plain yellow urine without blood, taken just 10 minutes ago. 

The parents wanted to take an image of the dog active with their handphone for their 26-year-old son studying in England. "Take a video," I advised and got the container of the small urinary stones for the mother to video.

This story has a happy ending but it is not guaranteed as the dog was 12 years old and lethargic.

Blood tests showed high total white cell count and neutrophilia as follows:
Total white cell count 28.5   (normal 6-17)
Neutrophils  95.5 %    (normal 60-70%).
Neutrophil absolute 27.2  (normal 3-12)

Urine tests
pH 9.0, protein 2+, blood 4+, white blood cells 33, red blood cells >2250,crystals triple phosphate +

MY MANAGEMENT OF THIS CASE
1. Fluid therapy 2 bottles of Hartmann and dextrose saline  + amino acids and glucose IV
2. Baytril + Spasomogesic for first day.

3. Fluid therapy during surgery.on 2nd day. The dog was much more alert.
4. X-rays x 3. First X-ray showed stones in os penile urethra. I had a the dog's bladder evacuated of dark red turbid urine and given 20 ml of air to get two better X-rays. The two bigger stones were obviously seen as a guide to the operating surgeon Dr Daniel who took out 7 small stones. 
5. Stones for chemical composition.
6. Dog to be warded for 7 days.
7. Bad teeth with thick crusty tartar should be removed 7 days later.

It is likely that this dog will be OK. Medical dissolution of stones was not realistic as the dog's penile urethra keeps getting obstructed and the dog was incontinent and dysuric. The first vet had not taken any urine tests but just prescribed antibiotics which cured the blood in the urine. It will be good practice to get the urine tested in cases of haematuria but owner economics or the vet's personality might not lead to this practice being done.  

UPDATE ON MAY 1, 2014.
The dog came at Day 14 after stone removal for stitch removal. He is very active. Dental scaling of the thick crusty golden plaques were done by Dr Daniel on this Labour Day (May 1, 2014) afternoon. 2 decayed premolars were removed. Surprising the other teeth were strong and not loose. See the video: "The dog with the golden teeth."

Everybody in the home including the domestic workers were extremely happy with the outcome. No more urine-smelling odour on the belly of this dog now as the dog is no longer incontinent. Urine shot out normally.

A happy ending is not guaranteed if the owner had delayed seeking veterinary treatment as the kidneys could be damaged severely as in the case of "The Miniature Pinscher" with kidney failure due to multiple urinary stones obstructing urine flow for many months.


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