Sunday, August 4, 2013

1054. A Westie passes blood in the urine since July 2011

Haematuria - Blood in the urine in a dog. Every vet has his or her own way of diagnosis and treatment as illustrated in the case of this 9-year-old male Westie.

July 27, 2011. Vet 1 took a blood test which was quite normal and prescribed antibiotics. No more blood in the urine for 2 weeks. Haematuria recurred on and off for the next year. More incidents in 2013.

Around December 2012. Vet 2 consulted. X-rays showed bladder stones. "No need urine test as surgery will be done to remove the stones."

Dec 27, 2012. Vet 3 (Dr Daniel) at  Toa Payoh Vets was consulted with Vet 2's X-rays for a "second opinion". Bladder stones - one big and two small. The dog was given an injection.

Aug 1, 2013. I was consulted as the dog had haematuria today. The owner did not want a urine test. I palpated a "fish-ball" sized bladder stone. The owner consented to a blood test for health screening as the couple was worried about anaesthetic death. Except for a rise in SGOT/AST to 229 (normal <81 br="" nbsp="" normal.="" results="" the="" were="">
The dog was given antibiotics and would be operated by me today Monday at 1 pm. The owner wanted the dog home after surgery. There will be owners who want the dog back immediately as they feel that the dog would be home-sick. "Is it a major surgery?" she asked me. "Yes," I said.

It seemed that the owner was worried about anaesthetic deaths in old dogs and financial considerations resulting in delays getting treatment.

The couple preferred an older vet to operate on their dog when I asked her whether she would mind Dr Daniel operating on her dog. She did object but said that an older vet ought to be more experienced. So I would be doing the surgery.

The two Sec 4 interns from RI should be around today to video the surgery. Urine crystals were calcium oxalate but it is best to get the stones analysed.

After surgery review of X-rays again to determine the number of stones thought to be 3 prior to surgerty. The view was cropped. It appeared there were 4 stones

Never trust the X-rays. Use the artery forceps to palpate systematically 360-degree sweep of the interior of the bladder. If 3 stones were taken out, the 4th stone would cause haematuria and the vet would be deemed incompetent. 

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