1472. REVIEW of my case - Follow up on poodle with bladder & kidney stones

The Jack Russell with 10 bladder stones returned today with swelling and seepage of plasma in his wound. So I warded it as he was too active at home. JRs are very active by nature and so the wound healing is affected by jumping up and down. There is a swelling in the op area and the owner brought the dog back for confinement. We sent the dog home to lower medical costs for the owner and usually they can't do good nursing. The dog would have no nonsense from the owner and will not be confined. Free as a bird and this leads to complications if the owner can't confine him.  

I followed up on the poodle as the dog went home on the 2nd day of surgery, it is best for me to follow up with the owner. The past few days showed large areas of bruise on her inguinal area and he had WhatsApp to my intern who forwarded to me. "Now the bruises have gone to the thighs," the owner said at 6.57 pm today Jun 18, 2013. I asked him to WhatsApp my phone as previously my intern Ms Toh had used her phone to WhatsApp to him.

"My dog is eating more and is much more active today," he said.
I asked him to measure the amount of water drank and the colour of urine. Previously, the urine was discoloured dirty brown during the bladder stone operation.

HISTORY
Toy poodle, F, 9 years

1. May 2, 13 Vet - Dr Daniel Sing.   Haematuria few months. On heat. Stranguria
   URINE TEST May 4, 13
  pH 7, SG 1.025, Protein 3+, Blood 4+, WBC >2250, RBC >2250. Bacteria Occasional, Crystals Nil.
  After reviewing this urine test report as I do for all cases handled by my associate vets every day, I asked Dr Daniel whether he had advised X-ray and he said he did. The owner did not want any X-ray to be done.


I scribbled on the report: 1. UTI  2. Bladder stone - didn't want X-ray. I circled Protein 3+ and wrote "kidney".

2. Jun 6, 13  Vet - myself.  Dog not eating for 2 days. Blood in the urine for 2 days. Dripping urine ie. incontinent since last visit for past 2 weeks. No vomiting.
I reviewed the May 2 case. This was serious as Protein 3+ is not usually found in bladder stone cases. Blood test, urine test and X-ray using air contrast were done.

Female dog urethral catherisation using forefinger to feel for the urethral opening and inserting the catheter (see image).
1. Digital rectal examination. No tumour.
2. Digital vagina/vestibular examination.  A soft tissue mass cranial to the urethra.
3. Urethral catherisation
4. 30 ml of air was pumped into the bladder before X-ray

BLOOD TEST
Significant findings
Calcium 0.49 (1.5-3.6)
Urea 10.5 (4.2-6.3) but creatinine level is normal at 135 (89-177)
Total white cell count 41.7 (6-17)
Neutrophils 92.6%. Absolute is 38.61 (very high).
--- bacteria in blood stream. That is why the dog has fever 39.8C



URINE TEST (urine from catherisation, emptying bladder before air contrast X-tay)
pH 8, SG 1.027, Nitrite +, Protein 3+, Blood 4+, WBC 1125, RBC 15, Bacteria 3+, Crystals Triple phosphate +


X RAY 
Left kidney stones, bladder stone (large x1), no bladder tumour seen on X-ray.

I advised antibiotics and surgery to remove bladder stone 7 days later and 10 cans of S/D diet . Dog went home but did not eat the S/D as she did not like it.


3. Jun 14, 13
BLADDER STONE REMOVAL SURGERY
Dark brown cloudy urine seen. Not analysed to save money for the owner.
One large bladder stone of 1.5 cm across, taken out. Video and images.
"Need to analyse stone" recorded in the medical record as the owner took home the stone.

Follow up on Jun 18, 2013
Dog has more appetite and is active.