Friday, May 29, 2015

2173. VIDEO. A young Shih Tzu has a bladder full of stones and an abdominal testicle


Case report
May 30, 2015

"The dog bites," the couple said as I palpated the kidneys and the bladder. The dog reacted to kidney palpation as if there is kidney pain. The bladder was empty of urine and was the size of two grapes packed with hard gritty stones.

Vet 1 had taken urine tests and X-rays.
Urine pH 8 and numerous crystals suspected to be urates??
X-rays of bladder stones were too radio-opaque to be urates.
Had advised removal of retained abdominal testicle in one surgery as bladder stone removal.

"A retained testicle can easily be seen around the neck of the bladder," I told Dr Daniel. "It can be excised promptly by ligation in less than 2 minutes."

As this dog is "obese" at 8.5 kg, any prolonged anaesthesia is risky but abdominal cryptorchidism needs to be done at the same time to save on having to open up the abdomen again. As for the descended testicle, this can be removed another day to reduce risks.

Operation will commence after lunch and the dog will go home in 3 days, providing all goes well with anaesthesia. Stones need to be analysed as the prevention depends on the composition of the stones.

In the meantime, no dry food and give the dog plenty of water to drink.

Red swollen bleeding bladder showing inflammation and damage from sharp bladder stones stuck inside the mucosa.  Every fragment had to be flushed out after picking out as many as possible with forceps. The dog's urinary bladder was catheterised but he pulled out the Elastoplast-taped catheter overnight, despite wearing an Elizabeth collar.  

The stones are sharp and may be urates as suspected by Vet 1. They will be sent for analysis.

To reduce anaesthetic time, no neutering was done.


Sunday, May 31, 2015

2178. Clinical Research on methone. Day 3 - sharp bladder stone Shih Tzu goes home

June 1, 2015

Bright sunshine blue sky day. Vesak Day. The couple is free to bring their 3-year-old Shih Tzu home today as they are a working couple. Nobody at home.

Yesterday on Day 2, this dog had ripped out his urinary catheter. I checked that he had tried to bruise his surgical wound near the flank of the penis, with his e-collar. I gave him methone inj. 10mg/ml at 0.3 ml SC. He also had Rimadyl 25 mg tablet.  I checked his surgical area. There was little pain on palpation and less bruising. He ate the U/D can and was very active. I videoed him peeing normally without one leg up.

At 3 years old, he appeared "obese" but actually he was broad-chested. The first vet had provided a good detailed examination report. She had said he was obese with body score BCS 8/9.  She said he could have "urate" crystals and that X-rays of the bladder stones were too radio-dense to be urate stones.  Urate stones are said to be radio-opaque in some reports but it is not true.

Free catch urine dipstick. pH 8, Protein 3+, blood 4+, leucoyctyes negative, "rest wnl."

The dog was super-active today and went home with instructions

1.  not to feed any more dry food as he may have a familiar tendency to develop bladder stones.
 2. pee more than 2 times per day. Not practical as the couple works and nobody is at home during weekdays. So the dog holds his urine from 8 am to 8 pm waiting to go downstairs.

3. to measure volume of water drank/24 hour and record. Drink lots of water.
4. to use dipstick monthly to measure pH, blood, etc and let me know
5. to send urine for lab test 6-monthly and if there are small crystals, I can flush out the bladder.
6. stones sent for analysis
7. U/D diet can be expensive. Eat canned food exclusively. No dog treats, rice, bread. Stone analysis to confirm urates will be available in one week's time.

I don't know how many of the above-mentioned instructions the couple will comply with.

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