Sunday's interesting case: The case of the missing Struvite Stones

E-MAIL TO DR SING SUN JUL 11, 2010

On Sun, Jul 11, 2010 at 3:15 AM, ...@gmail.com> wrote:

Hi. I found out about Toa Payoh vets as I was browsing pet forums and blogs. I have a 5yr old female mini schnauzer (high risk for stones). I adopted her from one of my husband's friend's last year. She has been struggling with struvite stones ever since we adopted her. There was blood in her urine last July/Aug. It subsided after a course of antibiotics. The condition recurred again this year (June). I reckon it was due to the new food supplement I gave her. I have already consulted 2 vets, but they said surgery is main cure. I was browsing your website and saw that you guide owners who do not want surgery. I am interested in this approach.

I hope to have a second opinion. I am already cooking for my pet and she eating home cook food with Urinary s/o and cranberry juice. I hope to do more for her to ensure she has a better quality of life. Not sure if I can bring my pet down this coming week (preferably Mon, Fri or Sat mornings) for a consultation.
P/s: My pet is outside trained, and if she starts peeing indoors for no reason, it means the stones are back. She urinated at home again today, but not sure if it is due to stones or the change in schedule since we brought her for grooming and didn't bring her for her usual long walk due to the heavy downpour.
Thank you for patience in reading this long email.

An anxious owner,
Name and telephone



FOR THE BENEFIT OF OWNERS WHO WANT TO USE MEDICAL TREATMENT FOR THEIR WITH URINARY STRUVITE STONES, HERE IS A CASE STUDY.


Sunday July 11, 2010. Bright sunshine. Blue skies. Should be outdoors.
I phoned the owner after reading the e-mail as this is a case with no definitive diagnosis!

HISTORY
Spayed dog was adopted when she was 4 years old.

July 2009. Passed blood in urine. Vet 1 took X-ray and check urine pH. Vet 1 was unsure whether there were bladder stones but said urine pH was alkaline but the owner could not say whether it was pH 7 or 8. Clavet antibiotics for 2 weeks and Royal Canine Urinary S/O diet for one month. No problem. The owner stopped giving dry and canned dog food and treats. Home-cooked food with a piece of chicken meat now gave her peace of mind till the dog started peeing at home, an abnormal behaviour in July 2010.

June 2010. Passed blood in urine and urinary incontinence. Vet 2 from the same practice prescribed same antibiotics for 2 weeks. Now no blood in the urine and bladder control. Will the stones come back again?

WHAT THE OWNER WANTS
"What do you want for your dog?" I asked. I might have woken her up from sleep by phoning at 10 am.
"No recurrence of the blood in the urine and urinary incontinence problem for the 3rd time." She forgot to mention no urinary stone removal surgery.

OTHER INFORMATION
Licked vulval area most of the time after outdoor walk.
Dental hygiene poor - tartar.

PHONE DIAGNOSIS:
It seemed that there was no veterinary diagnosis of struvite stones. The owner believed that the dog has struvite urinary stones. The presence of struvite stones was not confirmed by urinary analysis. Although the Miniature Schnauzer is one breed prone to getting urinary stones, this case may be a case of urinary tract infection. She may not have non-struvite urinary stones.

ADVICE
1. Get a proper diagnosis:
t is best to get the dog examined for stones by palpation. A blood test to check the kidney function as the owner had been giving her own prescriptions. A urine test for crystals - collect urine via catherisation. X-ray after emptying bladder and use air contrast.

2. If the struvite urinary stones are very small, medical dissolution of the stones + acidification + prescription diet may be possible. 3-monthly check ups of urine will still be necessary.
3.
Behaviour - licking of vulval area must be stopped. Dental work must be done as the mouth is full of bacteria which may have infected the bladder via vulval licking. The female dog has a short urethra and bacterial infections are common. Veterinary cases such as this case of the recurrence of blood in the urine are more interesting than Sherlock Holmes' cases. However, I don't have Dr Watson to help me.