Monday, December 1, 2014

1121. A shih tzu had kidney and bladder stones again

I was referred to give a second opinion on this case. The vet had scheduled bladder stone removal. 3 years ago, the same practice had removed calcium oxalate stones from the bladder. Three urine test monthly showed calcium oxalate crystals initially as the owner had fed the same dry food. After switching to U/D diet, the urine was negative and two tests. No more tests done and the dog was on U/D diet during the past 3 years.

"Did you feed treats during the last 3 years?" I asked.
"No," the owners said. "We did give dog biscuits and sometimes bread. This dog was given a health screening and the bladder stones were discoveed."

Blood tests, including biochemistry taken one month ago by the vet were normal. I reviewed the report and the owner had to phone the vet for the urine analysis. This was faxed over. Urine pH was alkaline at 6.0 with few calcium oxalate crystals, few red and white blood cells. 

"There is sore throat and mild abdominal pain in the kidney and bladder area," I palpated the dog's throat and abdomen. Based on some urination difficulty, this dog could have urinary tract infection. Antibiotics were prescribed.

As regards bladder surgery to remove stones, my opinion was that this dog would have a higher chance of survival from anaesthesia above 70% after antibiotics and recovery of full appetite and no peeing problems. However, I warned that this dog had kidney stones as well as bladder stones. Surgery was only for bladder stones. 

The dog went home with antibiotics for the next 10 days. No more dog treats, biscuits or bread or any additional food.

The U/D diet does not dissolve the calcium oxalate, but alkalines the urine to prevent any formation of the crystals. Yet, in this case, the urine was alkaline but the crystals were still present.   .
Now the dog had lost appetite recently but was still active. The wife said that the dog was peeing smaller puddles of urine unlike previously but there was no blood in the urine.

CONCLUSION
The first X-ray and medical record of the urinary stones were no longer available at this first vet practice, according to the owner. So, we don't know whether kidney stones were already present when bladder stones were removed.

RECOMMENDATIONS - Monitoring the dog's health
1. Urine tests 6 monthly after stone removal.
2. X rays yearly after stone removal and after surgey to remove the stones
3. Only U/D diet is fed exclusively with no other dog treats or food.
I would say that the vast majority of dog owners in Singrapore do not adopt such recommendations and so recurrence may be presented. 

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