Tuesday, June 10, 2014

1374. Yangon veterinary talk to vets - July 5, 2014. Pyometra & Uroliths (treatment & prevention)

Veterinary Articles for a video production for presentation to vets in Yangon on July 5, 2014:


Treatment & Prevention

1. Calcium oxalate to struvite stones
http://www.sinpets.com/dogs/20120218recurrent-urolithiasis-urinary-stones-calcium-oxalate-struvites-toa-payoh-vets_Singapore_ToaPayohVets.htm



2. How to create a compelling educational video
http://www.youtube.com/watch?v=xAlGLSCFfuI&feature=youtu.be





3. How I suture the bladder in 2 layers after stone removal - Images of a case
http://www.toapayohvets.com/surgery/20080818Shih_Tzu_Urolith_Dysuria_ToaPayohVets.htm


2007 Case. Dysuria (difficulty in peeing)
Shih Tzu,
Female, 5 years. Peeing a bit here
and there many times a day for many months

Shih Tzu, Female, 7 years. Large bladder stone. Toa Payoh Vets Middle-aged and older dogs are seldom given much attention by many owners all over the world, unlike puppies. Such dogs don't live long lives if their sickness is not treated. 
After many months of painful urination, the owner consulted me. I palpated a large bladder stone and advised surgery after 10 days of antibiotics. The owner forgot about the surgery and the difficulty in urination problem recurred. Surgery was inevitable to resolve the problem. But was it too late and would the old dog survive the anaesthesia and not die on the operating table or after surgery? The owner understood the risk. The dog was alive after the surgery. The pictures of the surgery are shown below.  
Shih Tzu, Female, 7 years. Large bladder stone. Toa Payoh Vets Shih Tzu, Female, 7 years. Large bladder stone. Toa Payoh Vets 8-mm thick bladder wall. Needs 2 layers 3/0 absorbable stitching to close. Toa Payoh Vets
I prefer to incise the ventral wall of the bladder and find no problem of "the heavy weight of the internal organs pressing down on the bladder" and therefore adversely affecting the healing. Thick and reddish bladder wall of nearly 5 mm in thickness indicates that the bladder infection has gone on for many years. Some dogs die as bacterial infection spreads to the kidneys and into the blood. The submucosa of the bladder is stitched with an inverting suture pattern. 
Chronic cystitis - large bladder stone. Stitching up bladder wound with 2nd layer. Toa Payoh Vets Shih Tzu, Female, 7 years. Large bladder stone. Toa Payoh Vets Shih Tzu squatted, cried and passed urine every few minutes. One spherical bladder stone removed 6 days ago. Toa Payoh Vets
2nd layer of inverting suture is now placed. Forceps on the left anchors the knot of the first layer. No omental fat layer is sutured onto the suture line although some vets do it.




CASE 4
POOR VETERINARY WORK - Some vets, not only in Singapore but elsewhere consider urine analysis unnecessary as in this case  


2010 Case. Dysuria (difficulty in peeing)
 at the end stage of urination
Feb 26, 2010.  At 13 years of age, he just had dental scaling at another vet practice. The vet had performed 2 blood tests 3 weeks apart and this indicated excellent health. Then the owner consulted another practice (Vet 1) as the dog took a long time to pee at the end part of urination. Vet 1 advised surgery. The owner phoned me for advice after Vet 1 had been consulted. I had not seen the case and I asked "Was the dog's urine analysed?  Struvite urinary stones, if small, may be dissolved by the acidification of urine."  The young lady owner said, "No." Later, she told me that Vet 1 considered urinalysis unnecessary.     I saw the case and got the owner's permission to do a urine analysis. The urine pH was 6.5 and there were no crystals in the urine on urinalysis. So, these tests indicated that the urinary stones might not be struvites and therefore acidification of the urine would not be effective. Surgical removal, as advised by Vet 1 was my recommendation. But will the dog that growled at me,  die on the operating table as he was so old?   


----------------------------------------------
THERE ARE OWNERS WHO DO NOT WANT SURGERY TO REMOVE BLADDER STONES 
Case 1: 2010 - The Shih Tzu keeps passing blood in the urine every day
X-rays and blood tests would be best but sometimes it is not possible due to economic reasons. The vet has to be compassionate when the owner request least-cost surgery. However the diagnosis must be spot-on and the surgery must be planned to ensure survival of a dog during anaesthesia.
 

young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore "Your Shih Tzu needs an operation to remove the big bladder stone I felt," I advised the young man whose female dog passes blood in the urine for the past 2 months. I could feel the creptitus (gas-like feeling) in the bladder. But the owner did not want an X-ray nor surgery. He wanted drugs.
young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore One month later, his dog had not stopped passing red blood. He requested surgery, but no blood tests or X-rays. I was OK with this request.
young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore "It is an open-and-shut case," I thought when I saw one stone coming out. "This was the big stone I had palpated. Stitch up the bladder and go home.
Another big stone was stuck partially in the urethra as my catheter could not pass through. What to do?
The stone was stuck fast. Finally the forceps managed to grip one end and pull it out 
young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore
Smaller stones spilled out like small bombs when the bladder was flushed. Catheter was earlier passed
out via the vagina
No more urinary stones after irrigation of the bladder
  urolithiasis, urinary stones, haematuria, blood in urine, shih tzu, toapayohvets, singapore urolithiasis, urinary stones, haematuria, blood in urine, shih tzu, toapayohvets, singapore
Day 3 after surgery. There has been difficulty in passing urine but the dog eats and has no fever. Antibiotics and pain-killers are given. I phone the owner that the dog can't go back today Sep 6, 2010 as the dog has dysuria.


REFERENCES
http://www.cvm.umn.edu/depts/minnesotaurolithcenter/
 

RECOMMENDATIONS ON TYPES OF STONES

http://www.cvm.umn.edu/depts/minnesotaurolithcenter/recommendations/home.html

                                             
Dog warded 3 days for observation. Goes home. No complaint about difficulty in urination for the next 18 months.
The gentleman owner was not interested in follow up health checks and urine testing. Urinary stone (right) is from the bladder of this Shih Tzu. The two stones (left) are from another dog.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 




 

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