Monday, October 22, 2012

1153. Retrospective study of the vomiting Schnauzer with urinary stones in kidney and bladder

Oct 23, 2012  8.56 am

The Schnauzer, F, 4 years is still not eating. But I had given her the IV drips including glucose and some hand feeding of the L/D diet. She would just lick a bit and not swallow, according to Dr Daniel who was assisting me in this case. She could sit up and look at me with sad eyes. The only good news is that she does not vomit anymore, unlike the 5 days and on the day of surgery.
I am now reading the voluminous records of previous vets and summarise the findings below:

1.  Nov 14, 2009
Health check and vaccination

2. Sep 28, 2011
Ear infections treated.

3. Feb 18, 2010
Intermittent cough when sleeping. Vomits mostly fluids. Spay and dental scaling done.
4. Nov 8, 2011
Urinating blood. Bladder stones palpated. X-ray. Cystotomy to remove stones
Stones removed digitally and by retropropulsion
Post-op X-ray - no stones in the bladder

5.  Nov 11, 2011
Cystostomy to remove bladder stones. Bladder entry swab c/s to lab.  Heavy growth of Coagulase-negative staphylococcus
Stone analysis to Minnesota. Stone and shell 100% magnesium ammonium phophate (struvite)

5. Nov 13, 2011
Discuss options
1. See if recurrence, then start food trial
2. start food trial

6. Nov 14, 2011
Follow up. Owner said dog vomited few times at night on the 3rd day afer surgery.
W/D canine dry

Nov 19, 2011
Review.  Owner says some vomiting on 3rd day of surgery might be due to eating something downstairs. No more vomiting. Advised owner to monitor for uroliths. Pet is female and there is the option of urohydropropulsion. To change from S/D to W/D as the breed is prone to pancreatitis or RC urinary s/o

Dec 2011, Feb, April & Jun 2012
W/D canine 8.5 lbs dry

Jul 22, 2012
Straining to urinate and leaking urine for 2-3 days
Bladder stones palpated and seen on X-ray
Unable to get urine for analysis
Treat UTI first, try to dissolve stones with 1 S/D can/day and review in 3 weeks.
Blood test. low RBC, HCT, HGB.
High total WCC 22.4 (5-17), N 18 (3-12), M 1.4 (0.16 - 1.1)

Aug 12, 2012
Multiple large bladder stones on X-rays. Vet 1 advised surgery. Owner did not accept advice. Went to Vet 2 who treated with antibiotics, acidifying tablets and then S/D

Oct 19, 2012
A few days ago, the owner asked me whether he could buy medication from Toa Payoh Vets as the Jurong vet was too far for him to collect medication and S/D.
I advised another X-ray and blood test as Vet 2's 2nd x-ray already showed multiple stones in August 2012 and the owner said that the urine was very smelly.

The dog started vomiting for 5 days before Oct 19, 2012. Test showed bacteraemia and toxiaemia with low platelets. Dog was operated on Oct 19, 2012. Around 13 stones removed from bladder.  Normally I don't do exploratory laparotomy in cases of bladder stones as this was the case. However, I checked the stomach and intestines for foreign bodies as there were radio-dense objects inside the
intestines on X-ray taken by me.

Oct 23, 2012.
Dog on drips and medication daily. Not eating. Alert.
At 10 am I asked Dr Daniel to take her out to have some sunshine. She peed red blood and pooped soft brown stools. No vomiting. The blood could be from the chronic cystitis of the bladder wall as stones were left too long. Also, possibly from the bladder bleeding.
So far, the dog is walking and alert. No fever. Just would not eat.

Oct 23, 2012  10.09 am
That was when I found a 3x enlarged purplish red left kidney with prominent blood vessels in its capsules and as big as a golf ball compared to the normal right kidney. Some bleeding spots near this kidney and brownish stained spot in the omentum. This was serious as the left kidney could be bleeding. There was anterior abdominal pain on palpation earlier.

She would walk about, drank water and sit on her backside. Some panting.

Each vet has his or her own advices on the management of struvite stones to prevent recurrence after surgery. Vet 1 advised S/D and W/D dry which is also indicated for struvites. For this dog, I have advised:

1. 2-3-weekly urine analysis
2. X-ray 2 monthly for 3 times
3. S/D canned food for 4 weeks followed by C/D canned food for 3 months with the usual urine tests and X-rays.
4. No dog treats or other food and no DRY dog food of any kind.
PROBLEM: What about the enlarged right kidney with the stone?
If the stones are small and packed in the renal pelvis, I hope they will pass down the ureter to the bladder and gets peed out. Wait and see as the dog is now active and starts to eat.

Due to economics, contrast radiography is not advised for the time being. Prevention is better than cure and for struvite stones in Miniature Schnauzers and other dogs, 2-monthly urine analysis and at least one X-ray of the abdomen for urinary stones are best done. Seldom do owners do it as monitoring requires discipline and planning.  

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