Saturday, April 27, 2013

2nd day of European travel: Lake Titisee & Rhinefall Waterfall. A second opinion from a vet

Sunday, April 28, 2013, 5.17 am
riverside hotel in Switzerland, 25 km from Lake Titisee
drizzling and cold

15 year old male, not neutered Maltese

Not eating for 2 weeks. Hospitalised for 5 days by Vet 1. Given 0.9% NaCl drip IV and heart failure medication tablets (2 types). Very high BUN and creatinine taken 3 times in 5 days suggestive of kidney failure. The son wanted a second opinion and the father phoned me.

On examination, the dog, wrapped up in pampers to prevent urine spraying, was unable to stand, had vomited k/d diet fed, had a bad breath according to the mother. “Dog with kidney failure has a uraemic gastritis and therefore bad breath,” I could not detect any halitosis. “Slightly dehydrated,” I pulled up the neck skin which stood up. Vet 1’s diagnosis were kidney and heart failure.
“What tests were not performed by Vet 1?” the adult daughter in her late 20s was scribbling note. The adult son was busy and so only the parents and daughter came.

“Possibly X-rays of the bladder and kidney to check for stones,” I had palpated a rock hard globular mass likely to be a bladder stone or tumour which may include the prostrate. The dog was said to be able to control his urine. The Pampers pad wrapped round his lower body are to prevent him from urine marking which started only for the last year. He has no problems in bladder control, according to the owner. I got the Pampers taken out and checked. There was some light yellow coloured urine at the penile tip, no discoloured one. It is hard to say whether there was bladder stone or tumour as the dog had been on IV drip for 5 days.  No medical records were available as the owner did not ask for them. Judging from the receipts, no antibiotics were given. The blood tests done were for checking BUN and creatinine.”

“Urine test and a complete blood test may be useful as aids to diagnosis,” I gave my opinion. “Vet 1 tested for kidney disorders only and was spot on.”

“Each vet will handle a case differently,” I said. “Vet 1 is an old experienced vet. Maybe he just wanted to save you some money by not running the various tests since the dog is very old.”  Yet by not doing other tests, the owners were not fully satisfied.

The discussion was long, lasting over an hour. In view of the heart and kidney disease, the son decided to bring the dog home, accepting the oral electrolytes and no antibiotics. The rectal temperature was normal and probably was normal at Vet 1. The dog stopped eating because he had toxic by-products in his blood stream, the high BUN (Blood Urea Protein).  Was there a bladder stone which could have been removed earlier as now the dog was at a very high anaesthetic risk and not operable.
A second opinion could be frank. The owners did not want to hurt Vet 1’s feelings and so I did not pursue for the medical records. Vet 1 had treated this dog as a puppy and so was much respected. “Many old age problems like prostate enlargement or cancer, as is probable in this case, could be avoided if the dog had been neutered,” I said to the parents. But neutering was considered cruelty and so this situation of the male dog starting to urine mark at the 14th year arose. “Enclosing his penis with Pampers pad is not good for the male dog,” I remarked. “He would have to hold his urine and cause back pressure of urine onto the bladder, damaging the kidneys. Why didn’t you consult your vet when your old dog behaved abnormally?”

The testicles felt normal. As to the cause of this need to urinate at various places inside the apartment during senior years, this would possibly have been avoided had the dog been neutered young. However, it is not guaranteed. This dog was well cared for, had a good food and was thus not the usual emaciated ones I see at old age.

I hope my second opinion was satisfactory. In this case study, Vet 1 could have done all the other tests to give the owners closure as nowadays, the young internet generation can know the shortfalls of the vet on the road to diagnosis of a beloved old dog.

P.S The riverside hotel in ch-8192 zweldlen-glattfeiden, 44 rooms, is so beautifully constructed and new. It was a big factory with a chimmney.  Everything was well designed for the guest.
All the 30 Singaporean tourists were housed in the 4th level, unlike the previous hotel at Frankfurt where we faced the road at first floor. I could see greenery from my window frame, like a painting.  On looking out, a flowing stream and more trees. The bathroom, sited in the centre of the room has glass walls with a curtain to provide privacy, so making it appear bigger. Usually packaged tour agencies from Singapore provide poor quality hotels but this one hotel was exceptional. The trick for competitive tour packages is to cut down on dinner as we had to buy our own at Hotel riverside which has 3 restaurants and a bowling alley.

Will post some images later.  

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