1382. Naypyidaw. Visit to Vet University, Yesin

June 18, 2014

Yesterday, I visited the Veterinary University at Yesin, Naypyidaw and the Zoo. White lions and white tigers were seen. Giraffes, hippos and Himalayan bear. A leopard or cheetah was napping. All animals in excellent bodily condition.

But the visit I like was to visit a family of my friend Shirley, living in a village near the Vet University, Yesin. The matriarch, 63 years old, brought up four sons when her husband passed away many years ago. Three went to become graduates and she is well provided and loved now.

On the 2nd floor of a building in the Veterinary University, Yesin, a notice board displayed examination marks of lst and mid-term examinations. "How's your result?" I asked the 2nd year student (right in photo, below) as her aunt said she is a very bright student. Aunts can be biased. She pointed to her name and her marks were high, showing she is focused on her studies. Lady students must book into the hostel by 6 pm. Probably 100 undergraduates per year.   

Yangon Vet Talk - treatment of urethral stones - retrograde urohydropropulsion

DRAFT NOTES FOR THE SEMINAR

FELINE UROLITHIASIS

Case study. TP 45355.
Cat, Male, Neutered, 4 years old. Apartment has 2 other cats with no similar problem. 

HISTORY & SIGNS: Since being neutered at 8 months of age, dysuria is seen lasting around a few days every 2-3 months. No veterinary treatment as the cat recovers the recurring dysuria. However, on Jun 19, 2014, the cat hid under the sofa and could not pee for a long time. Dr Daniel of Toa Payoh Vets treated him. Signs of postrenal uraemia not obvious (e.g anorexia and vomiting).

PHYSICAL EXAMINATION. Signs of outflow obstruction: 
1.  Palpation of a large painful urinary bladder palpated.
2.  Detection of urocystoliths by palpation is unreliable.
2.  Examination of distal penis and penile urethra showed urethral plugs. A cat catheter passage is obstructed.

DIAGNOSIS
DIFFERENTIAL DIAGNOSIS.
1. Other causes of dysuria, haematuria and pollakiuria and outflow obstruction.
2. Analysis of uroliths or urethral plugs to differentiate struvites from other types. Tests include urinalysis, radiography, ultrasonography and cystoscopy.   

3. CBC/BIOCHEMISTRY/URINALYSIS
3.1    Post-renal azotemia (high BUN, creatinine and phosphorus) for complete outflow obstruction. Not done in this case owing to financial constraints.
3.2   Urine tests.
3.2.1 Microscopic examination of the magnesium ammonium phosphate crystals. They look like colourless, coffin-like prisms with 3 to 8 sides. The lab report shows triple phosphate crystals.
3.2.2 Bacterial urine culture and antibiotic sensistivity tests. Not done due to financial constraints.
3.2.3 Chemical analysis of urethral plugs. Not done due to financial constraints.

4.  IMAGING

4.1 Survey radiography. Two views of the abdomen must be taken, not just one view as is sometimes done by vets in Singapore to reduce medical costs for owners.
No struvite uroliths but some struvite urethral plugs are seen. Struvites are radio-dense on X-rays.   They are most common mineral (80%) in urethral plugs in cats (The 5-minute Veterinary Consult, 3rd Edition)
4.2  Contrast urethrocystography. Not done due to financial constraints.

5. ULTRASONOGRAPHY
determines the precise location, number and size of uroliths. Not done due to financial constraints. Does not indicate the degree of radiodensity or shape of uroliths

6. CYSTOSCOPY reveals the location, number, size and shape of urethroliths and urocystoliths.  Not done due to financial constraints.
  

 







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http://www.sinpets.com/20090530Canine_Uroliths_ToaPayohVets.htm


Retrograde urohydropropulsion - usually male dogs 
1. X-ray
2. Health of dog
3. Technique - Best is to use a 30-ml syringe, soft or hard catheter, saline as 30-ml syringe provides excellent pressure as compared to 10-ml or 60-ml syringes. Some vets use 10-ml syringes and find it difficult to flush the urethral stones back into the bladder.

1380. Hypothermia & anaemia

Jun 15, 2014

A 14-year-old Maltese, not spayed came in yesterday Saturday with the following:

Recently, she had  "snoring" breath and howled when nobody was at home. Did not move when placed in a location as if immobile. Vomited twice on Friday. Drank and peed a lot.
The dog's gums were white and the rectal temperature was low at 36.8 C.  This was a dog seriously ill.

"Normal dog's temperature is from 38.5 to 39.5 C," I said to the mother and adult son. "This is not a good sign as the dog also had pale gums, meaning loss of blood or insufficient blood."

I palpated the bloated tense abdomen. There was a swelling in the lower 1/3 of the abdomen, as if the uterus was swollen with pus. I checked the nipples. The back ones discharged reddish black fluid when expressed. So, the dog could have false pregnancy and now had closed pyometra. Blood test was taken.

However the dog passed away despite I/V drips and medication. The tongue and gums had become snow white.

It is best to get female dogs spayed when they are young as old ones may suffer from closed or open pyometra (infection of the womb) and internal bleeding from toxaemia.

Fits due to tooth ache not other reasons

Saturday, Jun 14, 2014

"You know, my Papillon does not have fits," the mother who had to take care of this 14-year-old emaciated dog said to me today. "After you had extracted the rotten teeth, he has no more fits and so I did not give the anti-fits medication."

That was in Jan 12, 2014 when Dr Daniel extracted 12 rotten teeth. The dog was given IV drips, antibiotics and anti-fits medication for 3 days. A blood test was done indicating kidney disorder with high blood urea and creatinine.

She really recovered as the owner said: "My dog was eating the canine K/D diet since the extraction and so I did not give the dogs anti-fits tablets. Now, she cries whenever I carry her. She did not eat for past 3 days and would not move, like being a statute. What to do? Should I put her to sleep?"

"She is in great pain," I said. "Probably kidney pain. It is up to the owner to decide on euthanasia as the dog needs much nursing and time and you would be travelling overseas. Your daughter would not want to nurse this dog. "

There was also no budget for X-rays and other tests and so this was the best I could do, from the blood test.  Brain scan is out of question but was advised by the other vet. The dog was eating well when I followed up on Feb 26, 2014 when the owner came for 5 cans of K/D and antibiotics.

From March to June 14 today, no news from the owner. Probably not well cared for as now the dog is emaciated and in great pain.  

How long can the Papillon live? Much longer than the 14 years if given annual check up such as dental scaling and careful nursing. But many Singaporean owners do not bother with the dog's rotten teeth which pass bacteria to the heart and other organs, causing the dog to live shorter lives.

Yangon Vet Talk in July 5, 2014 - Treatment of pyometra video

Time is running out
Dog will die within a week if the father does not want the operation owing to poor prognosis and pragmatism. Why spend money if the vet (myself) said that the dog has 20% chances of survival?


https://www.youtube.com/watch?v=J9WJqmVPfw8

Treatment of pyometra for valuable breeders - using uterine irrigation

Jun 12, 2014

TREATMENT OF PYOMETRA
Experiences of my associate, a senior vet aged 75 years old who did treat a few cases of pyometra in dogs.

1. Spay is the best solution. Some owners just want antibiotics. After a few cycles, the dog becomes paraplegic and it would be too late even with spay. The dog would die during surgery or not able to stand again. It is believed that the toxins from the pyometra has reached the brain or spinal cord.

2. OPEN PYOMETRA - Midline incision to view passage of the catheters into uterus via vaginal speculum. 2 cathethers via vaginal speculum to 2 uterine horns. Irrigate and flush out the pus. Use of saline and hydrogen peroxide


3. CLOSED PYOMETRA  - Treatment of uterine irrigation as for open pyometra. In one case, the owner of a Pekinese wanted the treatment. The Pekinese got pregnant with one pup at the next cycle.

4. Conclusion. Spay is the cheapest. Blood test and ultrasound needed. Polydipsia is a sign.

Two urolith cases in 2 dogs. Bladder stones in 2009. Kidney stones in 2014

TOA PAYOH VETS toapayohvets.com Date:   11 June, 2014   Focus: Small animals - dogs, cats, hamsters, guinea pigs, tortoises & rabbits toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Case 1 in 2009. Bladder stones Mum complained that the Chihuahua peed too many times a day  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First Written: 4 March, 2009 Updated: 11 June, 2014 Summary: If your dog does not pee normally, do consult your veterinarian promptly as the bladder gets inflamed severely and the wall thickens considerably over time, due to chronic infections by bacteria. CALCIUM OXALATE UROLITHIASIS IN A CHIHUAHUA The 6-year-old male Chihuahua was in excellent body condition. Lots of good food had given him a padded body. He stayed in an apartment and seldom went down for exercise.  Around the beginning of December, he stayed with another family member - the brother. At the brother's apartment, he was shut out of the bathroom which he normally used as his toilet as the brother wanted to have a clean bathroom.  History: The brother took the dog outdoors to pee. The dog took a long time to pee. Sometimes he took 2 hours to pee. But the dog could not pee normally in Jan 20, 2009. Urinary stones blocked the flow of urine as I could not push the catheter into the bladder easily. "There is a need to analyse the urine under the microscope for urinary stones, cells and infections," I advised the owner. As the dog could pee, the owner did not want any tests as that would add to the costs of veterinary service.  "If he can't pee, I will have no choice but put him to sleep as it is too costly to treat him," he laughed. I could not persuade him to take urine tests. Clients have the freedom of choice but they must be adequately advised and such advices are best put in writing to prevent miscommunication and mistrust in a litigious society - when the dog dies and family members become very unhappy. "Do not worry, my family will not sue you," he laughed when I told him that the problem of difficulty in urination would recur and some family members might be unhappy with no tests being carried out. Unhappy people see an opportunity to sue the veterinarian to gain money for "incompetent" services and negligence and to prevent other dogs from suffering the same fate of negligence. In such cases, the vet ought to give the owner a written statement that he had had been forewarned about the prognosis. I did not do it but would record this advice in my medical records. On the 10th day after the first consultation the dog could not pee at all. "My dog did not really pee normally for the past 10 days," the slim man in his late 30s commented. Urine tests and X-rays were permitted and done. Surgery on Jan 30, 2009. Two Calcium Oxalate urinary stones removed from a dark red bladder with walls as thick as 0.8 - 1.0 cm. Normal bladder walls are around 0.2 cm. The urinary stones could not be palpated via the bladder as they were too small and the inflamed bladder was too thick. In any case, such a thick bladder wall would prevent palpation to be done properly. The dog was hospitalised till Feb 10, 2009 when he could pee normally.  What happened after the dog went home? The following record is a follow-up as I met the owner at the Surgery on March 4, 2009. At home in a high-rise apartment from March 4, 2009 1. "The dog urinated all over the kitchen floor for the first 4 days at home," the owner revealed his observations. "He drank a lot and peed a lot. I told him to pee onto the grating (drainage hole cover) in the kitchen.  "He is an intelligent dog and by the 8th day, he peed at the grating. He is now back to normal in peeing." 2. Going outdoors. The owner said, "I make sure that I bring the dog down to the grass at least once a day, particularly in the morning. I want to see that he pees in a large amount all at once. If the dog is indoors, he will stand on  the kitchen grate to pee." 3. Urine marking. "Nowadays, after the surgery, the dog would pee a lot all at once when brought down. Then he would lift up his leg to mark but sometimes a small amount of urine would come out. Other times, nothing. Prior to surgery, he would pee a little bit at a time. I had to wait 2 hours to ensure that he urinates completely. Other dog owners were puzzled as to why my dog takes such a long time to pee. Now, there is no need." The owner had time as he was self-employed. I don't really know what he was doing in his profession. He is a happy-go-lucky man in his forties, in my observation and sends out good vibrations. 4. Mum's complaints in the past. "For some weeks, mum had complained that she needed to wash the toilet floor many times" the man said to me in retrospective analysis. The dog used to stay with the mum in another apartment and would use the toilet floor to pee as he had been doing so for the past 6 years. Mum would then flush the floor with water as family members had to use the toilet. But lately, mum had to do it so many times. Nobody had thought of bringing this dog for a veterinary check up. Other dog owners had also asked the man when he took over the dog to live with him in December 2008, "Why your dog takes such a long time to pee?"  "As long as two hours outdoors," the owner would wait patiently for him to pee all his urine. This behaviour is not normal but the owner did not think it was abnormal. 5. Sorrowful demeanour. "I can't remember why I brought this dog to see you," the owner said when I asked why he consulted me in the first instance.  "It must be because the dog was sorrowful." 10 days before the day of surgery on Jan 10, 2009, the owner consulted me because the dog had difficulty in urinating. The urine was cloudy. The dog seemed to be incontinent, leaking urine drops onto my consultation table. The urethra was blocked. Catherisation of the urethra lead to easier urination. The owner was not keen on X-rays and blood tests then due to the need to save money. Since the dog could urinate, he wanted the dog home. However, I did warn him that there would be the same dysuria again as the urethra was obstructed when I passed the catheter into the urinary bladder with great difficulty. 10 days later on Jan 10, he consulted me as the dog could not urinate. "The dog had never peed normally since I got him home," he said. Catherisation of the blocked urethra enabled the dog to pass golden yellow. The smell of urine ammonia was strong, as if, the toilet bowl's urine was not flushed for 24 hours. This time, the owner was agreeable to urinalysis but no blood tests (complete cell count, serum chemistry) and X-rays. Veterinary costs can add up to a large amount and I understood his financial concerns. This recession would be the worst in decades, according to all the experts.  6. Urinalysis. Calcium oxalate crystals + were the significant finding. See blood test report above. 7. X-Rays. As no big stones were palpable and the bladder wall was considerably thickened, it would be wise to X-ray the bladder to see how many urinary stones were present. The owner consented. Calcium oxalate crystals are radio-dense and 2 were easily seen on the X-ray. If no X-rays were done, the owner would feel that the bladder stones were not all removed should there be a recurrence of difficulty in peeing. Therefore, X-rays are advisable except in certain cases where the urinary stones were so large that they were palpable. This is because the owner may want to reduce veterinary costs. Every test add up to the high costs. 8. Surgery. In this case, 2 stones were seen on the X-ray. It was extremely difficult to pick up the 2nd stone as both stones were around 0.5 mm in diameter and the bladder incision had to be as small as possible. A big bladder incision would not be good for the dog. Extremely thickened bladder wall indicated that the bladder had been infected by bacteria for several years. The infection had caused the bladder to thicken and thicken its wall to fight against the bacteria. It was a losing battle and therefore the bladder became severely reddened and swollen. The mum was not aware of the need to get the dog examined when she had to wash the bathroom floor so many times a day - a change of the dog's behaviour.  In retrospect, her complaint of having to flush the toilet floor many times recently would be a clue to the urinary tract infection. Mum used to clean the floor once a day previously. Mum's complaints "Must clean the floor many times. The dog did not urinate in a big amount." Therefore frequency increased while urine volume decreased per occasion. 9. Post Surgery. Today is Mar 4, 2009. Surgery was on Jan 30, 2009. The owner was now satisfied and pleased that the dog's first urination in the morning when brought outdoors was a big volume, as in the past. "There is a very small wound which seems not to heal," the owner commented. It was difficult to know what he was saying as he did not bring the dog in for consultation. Overall, he was happy so far as his best friend was living a normal pain-free life now - not having intense pain when passing urine and therefore taking a very long time to pee. Now, the dog just urinate one large volume at one go and get on with enjoying his outdoor exercise and urine-marking (with little or no urine to mark). As at Mar 4, 2009. Home-cooked food. Dog drank normally and not a lot as in the lst 4 days home. Urine-marking downstairs where other dogs had been. However little urine production or none at times. I said, "The dog may start to leave more urine inside his bladder in time to come. Then stones might form again." I asked the owner to monitor the urine intake, colour and consistency over 24 hours. The dog was banned from the bedroom because he would "pee" onto the mattress which had to be thrown away. Doors would be locked. He would pee at the kitchen drainage grate but the owner would always bring him outdoors in the morning so that he could pee all urine at one go within the first time. He continued to urine-mark with little urine as this is the natural behaviour of male dogs that have not been neutered. The dog has to pee on the spots to over-ride the smell of other dogs - to mark his territory. Conclusion X-rays are necessary before surgery in this case so as to know how many urinary stones are present in the bladder.  Calcium oxalate crystals are radio-dense and will be easily spotted on X-rays. Due to financial considerations, no X-rays were done after surgery although this is recommended. Two stones were shown to the owner as evidence. It is best to produce evidence to educate the owner. Urinalysis is also necessary. There is no guarantee that urinary stones will not be formed again. Unlike struvite (triple phosphate) urinary stones which form in the presence of alkaline urine and bacteria, calcium oxalate crystallisation is not related to the alkalinity of urine and therefore acidification of the urine in this case is not advised. If you review the blood test report, the dog's urine was acidic actually. Will the special Hills' urinary stone prescription diet to prevent calcium oxalate crystallisation work? One veterinary book doubts this will help. The owner feeds home-cooked food, so the answer in this case will not be known for some time. For other dog owners, it is advised that you get your dog examined by your vet at the first sign of difficulty in peeing as it is much more inexpensive to get early treatment than surgery and hospitalisation.   As at Aug 31, 2010. No complaint from the owner. This case may be one to "justify" neutering of the male dog to prevent urinary stasis and stone formation at an older age. This male dog needs to urine-mark his territory. He tries to retain some urine to urine-mark. Retention of urine causes crystallisation and bacterial infections of the bladder wall over the passage of time. Urinary stones form. Urine flow gets obstructed when they get stuck in the urethra. The dog can't pee normally and to some owners, it is costly to consult the veterinarian and get treatment for the dog in pain. It is hard for the dog owner to envisage the sequences of physiological events. Therefore advices to neuter this dog fall on deaf ears. I hope for the best for this dog. He would definitely be well cared for and much loved by the brother. If his health is good, he should live to a ripe old age of 15 years.   Updates will be at this webpage: bekindtopets.com/animals/20090305Calcium_Oxalate_ Urinary_Stones_Chihuahua_ToaPayohVets.htm   Case 2 in 2014. Kidney stones First written: Tuesday, June 10, 2014 Blog 1376. A 13-year-old poodle has kidney stones   The 13-year-old poodle could not stand up, leaked urine and did not eat for the past few days. She was overweight and had lost all teeth. One last upper left canine tooth remained and was as black as carbon. "What happened?" the couple asked me when I palpated the anterior abdomen and the dog reacted with painful cries. "I need an X-rays to check the abdomen," I said. "She might have urinary stones." X-rays showed kidney stones in both kidneys. This explained the anterior abdominal pain. The owners did not want to spend more money for blood and urine tests. In any case, the prognosis was poor as both kidneys were affected and would be severely inflamed and inoperable.  They took the dog home. She died the next day and was cremated.   Kidney stones (2 kidneys) Kidney stones (2 kidneys) Blog: http://2010vets.blogspot.sg/2014/06/1376-13-year-old-poodle-has-kidney.html See interesting cases in male dogs at: Urine tests for 2 dogs - shivering and leaking urine - Part 1 Tumours in 3 male dogs - Sertoli cell tumour, circum-anal tumour and oral tumour Toxaemia and anaemia in a young male Shih Tzu. What to do? Struvite stones in two Miniature Schnauzers - 2008 & 2010

1375. AUDIT. Owner's financial constraints. An 11-year-old Miniature Pinscher has calcium oxalate stones

Case TP 44133
The 11-year-old Miniature Pinscher was overweight at 12 kg and could not stand up yesterday. Two weeks of dribbling urine. He stopped eating for the past 2 days and had been dribbling urine for the last 2 weeks or more.

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Thursday, April 24, 2014

1358. An old Miniature Pinscher can't pee

"It is always best to get an X-ray done rather than just unblocking the bladder," I said to Dr Daniel as the owner of the overweight Miniature Doberman Pinscher dribbling urine wanted to save on medical costs and so the dog was warded for 2 days. So today, I got the dog X-rayed. Several big urinary stones obstructed the urethra at the os penis area and many more were in the bladder.

"The bladder is about to rupture," I advised an emergency surgery. "Around 10 stones in the os penis and more than 16 inside the bladder!"

The owner had delayed seeking veterinary treatment for many weeks. Blood tests showed kidney failure, thus explaining the persistence of daily vomiting by the dog.

The owner gave permission for the emergency surgery. The dog survived anaesthesia and surgery done by Dr Daniel. However, he passed away 3 days later.

Chances of survival after surgery are much lower if owners have been dragging their feet in getting their dog treated early by the vet.

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BLOOD TEST
Urea 44.6  (4.2-6.3), Creatinine 514 (89-177)
Haemoglobin and red cell count were below normal. Total white cell count at 26.1 (6-17) with Neutrophils at 95.5%. Haemocrit was low at 0.32 (0.37 - 0.55). However, the platelet count was normal. The dog was obese and very ill. This was a very high anaesthetic risk but the owner consented to the surgery.

X-RAYS
Urethral stones and bladder stones
To upload X-ray

URETHRAL OBSTRUCTION relieved by catherisation by Dr Daniel.
URINE TEST
pH 7, SG 1.011, Blood 4+ Crystals Nil, Bacteria Nil
No urine culture done

The dog passed away a day after surgery. The owner did not want any stone analysis.

I sent the stones c/o Hills to Minnesota Urolith Center Quantitative Urolith Analysis
Results: Calcium oxalate stones

1377. Territorial disputes of a dog

The 4-year-old Cross-bred bit the child who sat on the sofa. This was the 4th time he bit family members. Two years ago, he bit the owner and I had advised neutering him to reduce his aggression.

"This aggression could have been much reduced if you had neutered this dog 2 years ago," I said to him.  The dog was healthy and should not be put to sleep.
 
"I was advised not to neuter him," the man in his late 30s said to me as he brought the dog to me for euthanasia. Yesterday, he went to a bigger practice, but the vet rejected his request to put the dog to sleep and told him to come to me instead. SPCA apparently did not want the dog.

There was one option. To house him with Noah's Ark but would they accept this dog? Would this dog stop eating once he was not with this owner as it had happened before. "I am not a good owner," the man said as he spent time with the dog outside the clinic. "My dog is territorial and that was why he bit my nephew."

He would house the dog in Noah's Ark if I would be responsible for all the administrative arrangements. What if the dog bites and kill other people since he had "tasted blood" four times. I declined the heavy responsibility.

Territorial disputes happen in the canine kingdom too as between large countries. Only that the dog is the loser. He decided on euthanasia and later scattered the dog's ashes off the East Coast seas. "This is the only time I can kiss him," the wife planted a kiss on the euthanased dog. This scene reminded me of "Sleeping Beauty". Only that, the dog did not wake up when kissed by "true love",  a person who truly loved him as in the Disney movie "Maleficent" I watched recently.

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1376. A 13-year-old poodle has kidney stones

The 13-year-old poodle could not stand up, leaked urine and did not eat for the past few days. She was overweight and had lost all teeth. One last upper left canine tooth remained and was as black as carbon.

"What happened?" the couple asked me when I palpated the anterior abdomen and the dog reacted with painful cries.
"I need an X-rays to check the abdomen," I said. "She might have urinary stones."

X-rays showed kidney stones in both kidneys. This explained the anterior abdominal pain. The owners did not want to spend more money for blood and urine tests. In any case, the prognosis was poor as both kidneys were affected.  They took the dog home. She died the next day and was cremated.