Monday Oct 29, 2013
At 2.30 am, I woke up. I took the Bichon to the grass as that is his usual elimination area. He has a urinary catheter bandaged since 2 days ago, on Sat evening.
He stood, raised his right hind limb while balancing on3 legs. I counted 55 seconds before he put down his right hind leg indicating he had peed.
He will not pee indoors and will hold his urine for around 12 hours till he is ler outdoors. Urine stasis encourage crystal deposits and infrection as in people, leading to UTI and stone formation.
He does not pee on newspapers or pee tray and so he had been holding onto the urine for the past 7 years. When he goes to the grass, he will urine mark a few spots, esp. the lamp post although he had been neutered as a young dog.
Therefore, the lifestyle of the male dog - holding back urine to urine mark, leads to stone formation and UTI.
Tuesday, October 29, 2013
Monday, October 28, 2013
1133. Follow up on Bichon Frise Oct 27, 2013
Oct 27, 2013 was a Sunday. In the early morning, I got the Bichon Frise to go to the grass. I noted that the Bichon Frise whose urinary catheter was taken out the previous evening, strained but no urine came out. His bladder was distended about the size of 2 golf balls. He was given canned S/D diet but would not eat it. Many dogs don't eat it. The trick is to give 90% of canned A/D and 10% of S/D initially if this happens, increasing daily to 100% of S/D. But few owners comply with such instructions and would not bother.
In the evening after I returned from the Jurong Bird Park dinner hosted by the SVA till 11 pm, Dr Daniel had just taken the dog to Toa Payoh Vets to irrigate his bladder under sedation. A urinary cathether was used to flush out the bladder. "I used a bigger catheter," he said. "There was no urethral obstruction. There are only two stones and he gets obstructed again."
"From the X-ray, the urethral stone is the one causing the problem. It is small, about 3 mm across and will lodge inside the urethra near the bladder, causing difficulty in urination. When you used the small cathether, it by-passed this urethra but did not dislodge it, as evident from its presence in the X-ray."
October 28, 2013
At 6 am, I got the Bichon to the grass. He stood a long time like a statue trying to pee. He had the urinary catheter bandaged and wrapped around his waist. After a while, he went indoors and ate only the canned A/D food. "Given 10% of S/D mixed with A/D 90% until he eats all S/D," I advised the caregiver. The canned S/D was offered in full and was discarded for the past 2 days as the caregiver said the dog would not eat it.
DIETARY AND MEDICAL DISSOLUTION OFL THE TRIPLE PHOSPHATE CRYSTALS AND STONES
1. No stones were recovered for analysis as no surgery was done.
2. Uro-hydropropulsion using catheter and syringe did not recover the small stones.
3. CATHETER-ASSISTED RETRIEVAL OF STONES. The bigger urinary catheter was used yesterday to irrigate and flush out the stones using normal saline. The recommended saline infusion is 4 ml/kg bodyweight so as not to overdistend the bladder. The bigger urinary catheter may need to be slit open at one end to permit that small stone to be aspirated out.
The diameter of the hole at the end of the catheter should be around 5 mm. This is easier said than done. The aspirated saline into the glass cup should be checked for the stone which can be retrieved for analysis.
As this dog is not my patient and each vet has his or her own way of treatment, the point No. 3 regarding enlargement of the "eye" of the end catheter is my opinion.
CONCLUSION
This dog has only two stones (triple phosphate) and high alkaline urine, with bacteria 2+. It is the smaller urethral stone that causes difficulty in urination due to obstruction. Some reports claim* that it takes 2 weeks to dissolve struvite stones medically in immature dogs. It is hard to say as the stone may not be just triple phosphate crystals and no actual stone is available for analysis. This case will be monitored closely for medical treatment without surgery.
Reference: Small Animal Clinical Nutrition Hand, Thatcher, Remillard, Roudesbush, Novotny 5th Edition, Pg 830-831.
5. Medical dissolution using acidifiers rather than S/D diet may be used for 4 weeks but it is better to use S/D diet for 4 weeks.
6. Bacterial infection of the bladder (UTI) to be treated.
7. Urinalysis to be done weekly.
In the evening after I returned from the Jurong Bird Park dinner hosted by the SVA till 11 pm, Dr Daniel had just taken the dog to Toa Payoh Vets to irrigate his bladder under sedation. A urinary cathether was used to flush out the bladder. "I used a bigger catheter," he said. "There was no urethral obstruction. There are only two stones and he gets obstructed again."
"From the X-ray, the urethral stone is the one causing the problem. It is small, about 3 mm across and will lodge inside the urethra near the bladder, causing difficulty in urination. When you used the small cathether, it by-passed this urethra but did not dislodge it, as evident from its presence in the X-ray."
October 28, 2013
At 6 am, I got the Bichon to the grass. He stood a long time like a statue trying to pee. He had the urinary catheter bandaged and wrapped around his waist. After a while, he went indoors and ate only the canned A/D food. "Given 10% of S/D mixed with A/D 90% until he eats all S/D," I advised the caregiver. The canned S/D was offered in full and was discarded for the past 2 days as the caregiver said the dog would not eat it.
DIETARY AND MEDICAL DISSOLUTION OFL THE TRIPLE PHOSPHATE CRYSTALS AND STONES
1. No stones were recovered for analysis as no surgery was done.
2. Uro-hydropropulsion using catheter and syringe did not recover the small stones.
3. CATHETER-ASSISTED RETRIEVAL OF STONES. The bigger urinary catheter was used yesterday to irrigate and flush out the stones using normal saline. The recommended saline infusion is 4 ml/kg bodyweight so as not to overdistend the bladder. The bigger urinary catheter may need to be slit open at one end to permit that small stone to be aspirated out.
The diameter of the hole at the end of the catheter should be around 5 mm. This is easier said than done. The aspirated saline into the glass cup should be checked for the stone which can be retrieved for analysis.
As this dog is not my patient and each vet has his or her own way of treatment, the point No. 3 regarding enlargement of the "eye" of the end catheter is my opinion.
CONCLUSION
This dog has only two stones (triple phosphate) and high alkaline urine, with bacteria 2+. It is the smaller urethral stone that causes difficulty in urination due to obstruction. Some reports claim* that it takes 2 weeks to dissolve struvite stones medically in immature dogs. It is hard to say as the stone may not be just triple phosphate crystals and no actual stone is available for analysis. This case will be monitored closely for medical treatment without surgery.
Reference: Small Animal Clinical Nutrition Hand, Thatcher, Remillard, Roudesbush, Novotny 5th Edition, Pg 830-831.
5. Medical dissolution using acidifiers rather than S/D diet may be used for 4 weeks but it is better to use S/D diet for 4 weeks.
6. Bacterial infection of the bladder (UTI) to be treated.
7. Urinalysis to be done weekly.
Sunday, October 27, 2013
1132. Follow up: Bichon Frise has difficulty peeing once catheter is taken out
I observed the 7-year-old Bichon has great difficulty peeing this morning and kept licking his lips.
From the X-ray, the stone has lodged and obstructed the urethra once the catheter is taken out. So, an op is necessary. No point trying to acidify the urine and dissolve the struvite stones which can be done if there is no obstruction.
The dog seems to be losing weight. I am worried that the kidneys would be affected. Dr Daniel has scheduled tomorrow for surgery.
The X-ray did not show clearly the stone in the urethra. The other young vet who took the X-ray said there was one and I could see it too. It was faint and not radio-op on the lateral view. None seen on the V/D view. So, Dr Daniel was not fully convinced.
"Is there difficulty in passing the cattheter?" I asked.
"Yes," he said.
"So, there would be the stone inside the urethra before the bend," I postulated
From the X-ray, the stone has lodged and obstructed the urethra once the catheter is taken out. So, an op is necessary. No point trying to acidify the urine and dissolve the struvite stones which can be done if there is no obstruction.
The dog seems to be losing weight. I am worried that the kidneys would be affected. Dr Daniel has scheduled tomorrow for surgery.
The X-ray did not show clearly the stone in the urethra. The other young vet who took the X-ray said there was one and I could see it too. It was faint and not radio-op on the lateral view. None seen on the V/D view. So, Dr Daniel was not fully convinced.
"Is there difficulty in passing the cattheter?" I asked.
"Yes," he said.
"So, there would be the stone inside the urethra before the bend," I postulated
1131. Earn more when you have your own vet practice?
I had this comment with a young vet when I asked if she would be opening her own practice.
"You earn more when you have your own practice," she said.
"This is not correct," I said. "There are over 60 practices in Singapore. Unless you have no nearby competitors in the housing board estate as in Woodlands, you will not generate income. With investments and equipment and overheads, you will lose money!"
Vet students are never taught the economics of practices in the Vet School and so they have no idea of depreciation of equipment and other costs which make suck in the expenses, leading to low net profits or even losses. More than one practice has just closed down.
"You earn more when you have your own practice," she said.
"This is not correct," I said. "There are over 60 practices in Singapore. Unless you have no nearby competitors in the housing board estate as in Woodlands, you will not generate income. With investments and equipment and overheads, you will lose money!"
Vet students are never taught the economics of practices in the Vet School and so they have no idea of depreciation of equipment and other costs which make suck in the expenses, leading to low net profits or even losses. More than one practice has just closed down.
1130. Retained abdominal testicle in cats
I seldom see such cases. It appeared to be common when I spoke to two young vets at other practices.
1. Vet 1 has many stray cats brought in for sterilisation by activists. "Very common," she said. "Do you hook out the testicle inside the abdomen" I asked.
"No, the vas deferens may be ruptured."
2. Vet 2 saw her 2nd case as she consulted me..
"Just open up the abdomen and the smaller retained testicle is lying near the bladder area," I said.
"I watched a video where a hook is used to pull out the testicle," she told me.
"It is theoretically possible as in a spay, but I have not done it."
"How many cats have you seen?"
"This is the 2nd one."
"What did you do for the first one?" I asked.
"It was rejected as my senior vet asked me not to do it."
"Are you sure it is not the same cat?" I asked as I thought this was a rare condition in cats.
"It was a domestic shorthair and the present one is a Persian."
I would like to video this case if possible.
1. Vet 1 has many stray cats brought in for sterilisation by activists. "Very common," she said. "Do you hook out the testicle inside the abdomen" I asked.
"No, the vas deferens may be ruptured."
2. Vet 2 saw her 2nd case as she consulted me..
"Just open up the abdomen and the smaller retained testicle is lying near the bladder area," I said.
"I watched a video where a hook is used to pull out the testicle," she told me.
"It is theoretically possible as in a spay, but I have not done it."
"How many cats have you seen?"
"This is the 2nd one."
"What did you do for the first one?" I asked.
"It was rejected as my senior vet asked me not to do it."
"Are you sure it is not the same cat?" I asked as I thought this was a rare condition in cats.
"It was a domestic shorthair and the present one is a Persian."
I would like to video this case if possible.
Saturday, October 26, 2013
1129. TIPS - LONGER LIVES FOR PETS - Delayed treatments
It is best to seek prompt treatment for your pets when they have small tumours or swellings as their health deteriorates when there is delay in treatments or seek treatments from other vets as illustrated in the following cases:
Case 1. Syrian hamster with a massively swollen right hind limb showing only toes much bigger than her head. Abandoned in a bottle with wood shavings. The old mother and son brought the hamster for consultation.
"Very slim chance of survival as removal of the whole right hind limb to the hip level - amputation involved a big loss of blood. The hamster is likely to die on the op table." The mum was very sad as the hamster was eating and adorable. "Spend a few days with her," I said. "This operation has very slim chances of survival."
"Is there other ways?" the son asked.
"No medication will resolve this problem. The leg is becoming gangrenously black."
The man left without the surgery.
Case 2. Rabbit with left upper jaw abscess below the left eye. Thick pus clog the left nostril when I started to dig and clear the pus.
"The other vet did some test and said the rabbit was not fit for surgery. So we cleared the pus. But in the last 2 weeks, she became very thin, though she is eating."
"It is likely that the rabbit is poisoned by the bacterial toxins inside the jaw abscess. The thick creamy pus flowed into the nose and got breathed into the lungs. That is why the rabbit cannot breathe normally."
I got the pus dug out from the jaw abscess. Some rotten pieces of teeth were extracted out too and the big hole thoroughly flushed. The thick pus inside the left nostril was cleared when it seeped out later.
I took an image to educate and show the owner the presenting pus in the left nostril when she came for the rabbit.
"You don't need anaesthesia?" the lady asked me later.
"The rabbit is so weak and is at death's door. So, she did not respond much to pain."
In this case the rabbit was alive and went home to intensive nursing.
The first vet had said that the rabbit was not fit for anaesthesia and would die. So the owner did self treatment which was ineffective. The jaw abscess is usually a curable condition esp. when in its early stages and the rabbit is strong but it requires veterinary treatment rather than home treatment to suck out the thick pus.
Case 3. Dwarf hamster 2.5 years old, male with big chin tumour. "The hamster is at the end of life. He is so thin although he can eat. The chin tumour 8 mm x 8 mm involved the lower lip. So, it is not possible for the hamster to eat normally after excision of such a large area. No surgery was done.
Case 4. However Case 3 has a daughter of one year. On her right side, the skin ballooned out softly. "It is one sided," I said and so it may be a cyst.
The owner was warned of high anaesthetic risk as the hamster was very thin but young. "She is not fit for anaesthesia," I said. However the wife decided on surgery. The hamster bit anyone who touched her and was not moving much although she ate. "She looked fat," the wife said. In the op room, the whole swelling ruptured spilling over 20 ml of unclotted blood. A haematoma. The hamster was barely breathing one hour later. "Chances of survival are very slim," I warned the father and wife and 2 young daughters. . "There is a big loss of blood. Where it came from, is a mystery. Probably some ruptured big blood vessel." The hamster was not active and the breathing movements were barely visible when the owner brought her home. Usually the hamster is awake and running 30 minutes after anaesthesia and surgery.
Case 1. Syrian hamster with a massively swollen right hind limb showing only toes much bigger than her head. Abandoned in a bottle with wood shavings. The old mother and son brought the hamster for consultation.
"Very slim chance of survival as removal of the whole right hind limb to the hip level - amputation involved a big loss of blood. The hamster is likely to die on the op table." The mum was very sad as the hamster was eating and adorable. "Spend a few days with her," I said. "This operation has very slim chances of survival."
"Is there other ways?" the son asked.
"No medication will resolve this problem. The leg is becoming gangrenously black."
The man left without the surgery.
Case 2. Rabbit with left upper jaw abscess below the left eye. Thick pus clog the left nostril when I started to dig and clear the pus.
"The other vet did some test and said the rabbit was not fit for surgery. So we cleared the pus. But in the last 2 weeks, she became very thin, though she is eating."
"It is likely that the rabbit is poisoned by the bacterial toxins inside the jaw abscess. The thick creamy pus flowed into the nose and got breathed into the lungs. That is why the rabbit cannot breathe normally."
I got the pus dug out from the jaw abscess. Some rotten pieces of teeth were extracted out too and the big hole thoroughly flushed. The thick pus inside the left nostril was cleared when it seeped out later.
I took an image to educate and show the owner the presenting pus in the left nostril when she came for the rabbit.
"You don't need anaesthesia?" the lady asked me later.
"The rabbit is so weak and is at death's door. So, she did not respond much to pain."
In this case the rabbit was alive and went home to intensive nursing.
The first vet had said that the rabbit was not fit for anaesthesia and would die. So the owner did self treatment which was ineffective. The jaw abscess is usually a curable condition esp. when in its early stages and the rabbit is strong but it requires veterinary treatment rather than home treatment to suck out the thick pus.
Case 3. Dwarf hamster 2.5 years old, male with big chin tumour. "The hamster is at the end of life. He is so thin although he can eat. The chin tumour 8 mm x 8 mm involved the lower lip. So, it is not possible for the hamster to eat normally after excision of such a large area. No surgery was done.
Case 4. However Case 3 has a daughter of one year. On her right side, the skin ballooned out softly. "It is one sided," I said and so it may be a cyst.
The owner was warned of high anaesthetic risk as the hamster was very thin but young. "She is not fit for anaesthesia," I said. However the wife decided on surgery. The hamster bit anyone who touched her and was not moving much although she ate. "She looked fat," the wife said. In the op room, the whole swelling ruptured spilling over 20 ml of unclotted blood. A haematoma. The hamster was barely breathing one hour later. "Chances of survival are very slim," I warned the father and wife and 2 young daughters. . "There is a big loss of blood. Where it came from, is a mystery. Probably some ruptured big blood vessel." The hamster was not active and the breathing movements were barely visible when the owner brought her home. Usually the hamster is awake and running 30 minutes after anaesthesia and surgery.
5680. Vet Case Study. The 13-year-old Bichon Frise has difficulty in urination
SCRIPT FOR VIDEO
1. Timeline
2006
AUSTRALIA Perth
A bichon frise puppy was purchased by a young vet student studying in Murdoch University
5 years of stay in Perth. Dry food convenient.
2010
SINGAPORE. Back. Now the young vet student has graduated.
Dry dog food. Lots of treats from family members. Go outdoors in the evening and mornings. urine marking.
2013 October. 22. Cannot pee. Obstructed
Oct 25, 2013 video
Bichon frise, male, neutered, 7 years
difficulty in peeing
obstruction of urethra - vet catherised and bandaged to hold cathether. E-collar to prevent the dog from pulling the catheter out.
Urinalysis: pH alkaline + bacteria + triple phosphate crystals
X-rays
Lateral view shows two urinary stones. Kidneys OK.
Ventral dorsal view - no stones visible
Syringed 20 ml air into bladder via catheter.
Different vets have their own views for and against this procedure. Pumping air may cause bacterial infection of the bladder and so two vets I spoke to don't want to do it.
My view is that air contrast radiography is useful to show bladder wall tumours as this is an older dog. Urine of this dog has bacteria. Antibiotic is given
TREATMENT
Therapeutic food to dissolve the struvite stone by acidification of the urine. Hills' S/D dry food was fed for the next few years. No complaint of urinary difficulty to old age.
CONCLUSION
Any breed of dog can be affected. This Bichon Frise lived to a ripe old age past 12 - 15 years life-span. He passed away in his sleep in 2023 at the age of 17 years.
---------------------
20 MAR 2024.
PHOTOGRAPHY TIP: I used P Mode in 2010 to take this image.
Now I don't use it, but was advised to use P Mode in my younger days
as I was not used to doing Manual Mode, AV or TV Modes.
AP
Mode is often advised by photographers in magazine articles. TV Mode
is used for moving animals. Manual speed is favoured by some
photographers. No magazine recommends P Mode. I am no longer using it
nowadays.
Image of Gatsby, the 4-year-old male Bichon Frise,
Perth, Australia. 2 Apr 2010. 5.26pm. He is active and playful during
his evening exercise in a Perth park. He came to stay in Singapore
from 2010 to his passing away in 2023.
His diet was
Hills' S/D in his later years as he had one or two phosphate stones
leading to difficulty in urination. On this therapeutic diet, his
stones were dissolved as he had normal urination and was not obese
since the first episode of dysuria in 2013 at the age of 7. He had
been on a dry diet since young.
The life span of a Bichon
Frise is 12-15 years. He lived 17 years, passing away in his sleep on
23 May 2023.
Canon EOS 40D, 70-300mm lens, P Mode, 214mm,
1/800sec, f/5.0, IS0 400.
AUSTRALIA - 2 APR 2010: 5.26pm. A
young male Bichon Frise enjoys his evening run in a Perth park
with his master. Exercising a pet dog boosts an owner's mental
and physical wellness.
#youngbichonfrise
#perthaustralia
#bichonfrise
#exercisingdog
#singapore
#toapayohvets
#kongyuensing
#singkongyuen
#shutterstock.com/g/toapayohvets
TO
BUY PHOTO:
www.shutterstock.com/g/toapayohvets
UPDATE:
https://2010vets.blogspot.com/2013/10/the-vets-bichon-frise-has-difficulty-in.html
Good morning. Gatsby the Bichon Frise as a 4-year-old enjoying his evening exercise in a Perth park in Australia with my son. My wife and I were visiting him in his final year undergraduate vet studies and we were joyful that he did not stray off his studies. My photography skills were minimal as I used the P mode to take all photos, as that was recommended by a friend. P mode is like Automatic mode. Just shoot and hope for the best.
Gatsby lived to a ripe old age of 17. The life span of Bichon Frise is 12 - 15 years. He passed away in his sleep on 23 May 2023.
ORIGINAL IMAGES X3 BELOW
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