Sunday, August 18, 2013

Dysuria - X-rays taken. S/D trials not properly complied with

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   20 August, 2013  
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Proper use of the S/D diet to dissolve the crystals 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   20 August, 2013 
Be Kind To Pets
Veterinary Education
Project 2010-0129


Wednesday, August 14, 2013

1078. The Ang Mo Kio Silkie Terrier ate lots of treats

I had known Celebrity since she was a puppy in 2005. After the puppy vaccination, no more visits. In Jul 3, 2013, blood appeared in the urine. I took a urine test.

July 3.  Haematuria. Urine test. pH 9.0, SG 1.034, Protein +, Blood 3+, Crystals triple phosphate +, amorphous phosphate 3+ . No bladder stone palpated.  I advised X-ray and S/D for 3 months. 

July 10. Cannot pee. Owner sent the dog for X-rays at another practice. No stones seen.

Aug 13. The owner brought in the urine for test. pH 8, SG 1.020, Blood Trace, Bacteria +, amorphous phosphate 2+, Triple phosphate occasional

After July 10, no problems of urination or visible blood in the urine and so the owners were satisfied. Surprisingly, the wife brought in the urine sample on Aug 13, for analysis as advised by me. Most Singaporean dog owners don't bother since the dog had no urination problems. 

Dissolving of urinary crystals
My advice on the first consultation. S/D 3 months to dissolve the crystals. Urine test monthly.  Then C/D dry.

Dog will not eat the S/D and so the owner did not comply with my instructions.  I advised the owner to feed 10% S/D and then add to become 100%. However, the owner bought S/D x 7 cans on Jul 6, 12 cans on Jul 20 and now 12 cans on Aug 13.

No dog treats given. Fed Pedigree Canned + rice in the past month.

The dog had no episodes of urination difficulty since Jul 10 to date. However, the mixture of S/D diet and other food did not dissolve the crystals as the owner needs to convert to 100% of S/D. I text the husband who says he will do it.

Aug 15, 2013. The husband phoned to see me in 20 minutes. I advised medication and review of the X-rays taken by another vet again. Many cases need monitoring and review but vets will have no "work-life" balance if they really review ever case and write case report to understand the effects of home management on S/D diet. So, we can't do it for every case.

In this case, S/D diet would have worked to eliminate the amorphous phosphate crystals in the urine if the owner had diligently converted the dog to 100% of S/D in July. Although the dog did not get 100%, she still benefited in that she no longer had urination problem.

But the latest urine test in Aug showed that blood, bacteria and crystals are coming back in the alkaline urine again.

Many owners don't understand the technical use of S/D diets in dissolving the crystals by acidification of the urine. So they don't comply since the dog will not eat it. The trick is to give 5% increasingly and consistently.

Let's hope this dog will be OK with the new motivation and participation of the owners, a couple in their late 50S  -----------------------------------------------

Sunday, August 18, 2013

Dysuria - X-rays taken. S/D trials not properly complied with

The old female Shih Tzu peed blood in the urine 3 days ago in July 2013. The owner did not want an X-ray.

"Practising heartlander medicine is not as easy as practising in a practice where clients do not worry about medical costs," I said to the two Raffles Institution interns from Secondary Four working on Aug 19, 2013.  "Some owners don't want x-rays. Some don't want blood test and so the vet has no complete evidence to support his diagnosis and treatment. 

Then the dog could not pee normally 7 days later. The owners phoned me. They went to a clinic to get the X-rays done and consulted me with the X-rays. There were no radio-dense stones.
  I had advised S/D diet to acidify the urine which had amorphous phosphate urinary crystals, bacteria, blood and alkaline pH 3 days ago during the first consult. I also advised S/D based on urine test and get another urine test 1 month later.

"My dog will not eat the S/D" the couple said.
"Mix with the original food and increase to 100% S/D," I advised. "Otherwise the stones may form."

One month later, the wife brought in a bottle of dog's urine for testing. The amorphous phosphate crystals were lesser in amount but a bit of blood and bacteria were present. "You didn't feed 100% S/D for the last 4 weeks. Based on the latest test, the blood is coming back in the urine."

This time the couple was serious. "How did you do it?" I asked.
"Just starve the dog. He will eat 100% S/D".
S/D is fed to dissolve the phosphate crystals for 1-3 months. Urine tests must be done monthly. Then the owner has to be careful in feeding commercial food. No more dog treats for sure.
Updates will be on this webpage:

More info at: Dogs or Cats
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