1129. Script for RGS Intern. No excuses - The old Shih Tzu had big bladder stones

Dec 9, 2014

HOOK

The Shih Tzu has blood in the urine some days and "none" on other days for the past 4 years. What is the big deal? He could still eat his home-cooked food. Some dry food on stand-by. He goes to the newspapers to pee. On Dec 8, 2014, the dog stopped eating and vomited 3 times.


INTRODUCTION
Dr Daniel took the blood test and got the dog's abdomen X-rayed as he palpated bladder stones. His blood showed hepatitis and a high serum urea. The dog was given the I/V drip and was warded. He passed away in his sleep at around 9.30 am the next day. 



"Why did my dog die?" the husband asked me. His wife was grief-stricken. "Is it due to the I/V drip?"


MIDDLE
"No," I had the blood test evidence of hepatitis and high serum urea. "The dog was not well as he had vomiting. Vomiting is not a good sign in dogs with long-standing urinary stones inside the bladder. The 6 stones are large as you can see from the X-rays and must have caused bladder irritation and urinary tract infection over the past 4 years. Did the dog vomit during the past 4 years?

"Yes, yellow vomitus now and then," the husband recalled. "Do dogs not vomit now and then?"
"No," I said. "Unless they are not healthy. With blood in the urine, your dog could have suffered from urinary tract infections and hence vomiting."

   FLASH BACK (VIDEO OF SHIH TZU PUPPY)

I knew this male Shih Tzu as a puppy some 10 years ago. Gave him his puppy vaccination. A young couple with no children. The tricolour grew up and I have grown to become elderly.

The couple brought the Shih Tzu in for vaccination in 2013 and Dr Daniel gave him the jabs.
"Did Dr Daniel advise you to treat for blood in the urine?" I asked the husband. as I reviewed the medical records with a heavy heart. This dog was such a lovely tricolour puppy and now he had died.
after vomiting 3 X yesterday. Vomiting is not a good sign for an old dog.

The owner had switched to home-cooked food in the past   years. "Whenever he ate dry food, he passed blood in the urine," the husband told me when I asked him yesterday whether the dog had urine, blood tests or X-rays done by another vet.  He did not consult other vets although he lived
"far away" from Toa Payoh. There was a vet clinic in his neighbourhood. Presently, Singapore has over 60 veterinary clinics satisfying the proximity and convenience for the Singaporean pet owners.

 DEATH CERTIFICATE AND GRIEVING WIFE
I issued a death certificate today as the husband phoned me for one, to cancel his dog licensing by the authoritiies. "I cannot understand why you did not do further tests to remove the bladder stones last year when Dr Daniel advised you," I asked him. "This dog could have lived to a ripe old age. I mean you are not like those lowly educated Singapoean dog owners who would only feed the dog despite old rotten decayed teeth and bad breath. They would let the teeth drop off and would not seek veterinary treatment." 

His wife was badly affected by the death as women are closer to the companion than men, generally

I was most saddened by this loss as this was a puppy I had vaccinated over the earlier years. There was no complaint about blood in the urine which was present some 5 years ago.  I advised against immediate bladder stone removal surgery as the dog was not eating and was vomiting. Otherwise, he would have had died on the operation table as he was such a high risk candidate for anaesthesia and surgery..  

Dr Daniel advised blood tests and X-rays yesterday and there were around 6 big bladder stones. But vomiting was what brought the dog here yesterday.

X RAYS

VIDEO OF DR SING'S REMARKS ON X-RAYS


Conclusion
Regular blood and urine tests after the age of 7 years for small breeds and 5 years for big breeds are advised. X-rays must be taken when there is blood in the urine but most Singapore dog owners do not do it.