1154. Why is the dog still vomiting 19 days after swallowing a chicken rib bone?

TOA PAYOH VETS toapayohvets.com Date:   08 November, 2013   Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits A young Silkie vomited daily for 19 days   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129. Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   08 November, 2013     November 6, 2013 Today, I insisted that the owner had 4 X-rays taken of his dog. 4 X-rays are the minimum number to show whether his dog has chicken rib bones lodged inside his throat (2 X rays), chest - oesophagus (1 X ray), and abdomen - stomach or intestines (1 X-ray). The owner protested: "Vet 2 had taken X-rays of the chest and abdomen on Oct 21 and had stated no chicken bones were presented!" Vet 2 had also used ultrasound on October 28 and reported no chicken bones. I found out that Vet 2 had not taken X-rays of the throat and so had advised.  As the dog was still vomiting lots of white froth after drinking, the owner got him X-rayed this morning and was not keen on another 2 "unnecessary" X-rays since Vet 2 had done it with negative results. From my experience, it is best to repeat the test since the dog had not recovered after 19 days. He swallowed chicken rib bones after scavenging the rubbish bin on Oct 18 and was sent to Vet 1 and was treated but still continued vomiting. Vet 2 did the X-rays and ultrasound and gave medication but the dog still vomited. "He would want to bite us if we feed him medication," the father said today. "But this morning he was active and barked. For the past 19 days he was sleepy and his stomach was heaving. He kept vomiting and would not eat."    The father had consulted me on Nov 2 but did not approve any X-rays. So I treated the dog with IV drips and sent him home on Nov 4. He continued to vomit on Nov 4 and 5 and so he had to be reviewed again. That meant X-rays, a minimum of 4. Sometimes vets try to accommodate the owner's wishes to save medical expenses. In this case, if I had not insisted on the repeat of the chest and abdominal X-rays and just did the throat's X-rays, the outcome for this dog would be very bad as he really has a large chicken rib bone in the chest X-ray! The throat X-rays may have bone fragments but his main problem was the big rib bone in his caudal gullet near his stomach. For 19 days, he could not retain his water and hence he would vomit a few times, retching and heaving to the distress of the family members daily for the past 19 days! Now that the problem of the stuck rib inside the caudal oesophagus is evident, what is the treatment? TREATMENT OPTIONS 1.  "Any drug to dissolve the bone?" the father asked me. "No," I said. I consulted a senior vet who told me that the gastric acid from the stomach would dissolve chicken bones after some time. This would not apply to pork rib bones though. "It has been 19 days," I said. 2.  "The second approach is to pass a stomach tube to push the bone into the stomach," he advised. "However you may rupture the oesophagus although it is a tough muscular tube. You would need to do surgery then." "The dog would be dead then," I said. 3. "The third method is to open up the chest and extract the bone from the gullet. There is little space to maneouvre and the surgical costs would be around $2,000." 4. "How about extracting the bone via the stomach using forceps to grasp it?" I asked him. "I don't think you can do it." DIAGNOSIS So now, I have a diagnosis. My solution will be the least traumatic and cheapest. To use Method 4.  But the dog is in poor health. "No blood test as the dog had normal results from Vet 2," the owner disapproved my request. The blood test taken by Vet 2 was on Oct 30, 2013 and now it is Nov 6, 2013. I am giving him the IV drip for the next 2 days before surgery as there is no other option unless the bone "dissolves". This may be science fiction but there is a possibility. At around 5 pm, I gave the dog 2 ml of Spasmogesic and Baytril. He was still panting and his abdominal movements were marked. I video-taped his abdominal movements. He vomited canned food just eaten. When the owners and friends numbering 8 people came to visit him at 7 pm, he was barking furiously and jumping about wanting to go home. "His bone had gone down to his stomach," Dr Daniel remarked. I thought of taking another X-ray but the owner would have to pay for it and the X-ray was just taken this morning. So I did not insist.  Chest & abdominal X-ray (original at left & photoshopped) Chicken rib bone was seen in the caudal oesophagus 24 hours before surgery     Head & neck X-ray showed some small bone fragments? Original X-ray Vet 2 reported no bones but the dog vomited daily. Blood tests were normal  THE SURGERY Nov 7, 2013 The dog was active and barking furiously at one time to get attention in the morning. In the afternoon, he was operated by Dr Daniel and I. A long tissue forceps was used to grasp the bone inside the caudal oesophagus but there was no solid bone. A stomach tube passed into the stomach without encountering obstacles at first. The tube was full of gastric froth and withdrawn. It was passed again. There was some obstruction. It was withdrawn and passed into the stomach again. The bone was in small fragments. An examination of the small and large intestines, all inflamed, was undertaken. No large bones. The gastric incision of 1 cm was stitched. The chicken rib bone had disintegrated and was no longer intact as in the X-ray. As at 9 pm, the dog had recovered from anaesthesia. He should live a normal life and must be kept away from scavenging the garbage bins for chicken bones. .    Updates will be on this webpage: http://www.sinpets.com/dogs/20131107 chicken_rib_bone_oesophagus_dog.htm   More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: November 08, 2013 Toa Payoh Vets

1152. Four Singapore dogs have urinary stones around Oct 2013

TOA PAYOH VETS toapayohvets.com Date:   06 November, 2013   Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits 1.  A young Shih Tzu cannot pee   2.  A Miniature Schnauzer pees blood 3.  An older Bichon Frise cannot pee 3 bladder stone case studies toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129. Dr Sing Kong Yuen, BVMS (Glasgow), MRCVSDate:   06 November, 2013     Case 1.  A young Shih Tzu cannot pee   The owner had the Shih Tzu x-rayed at another practice. 3 X-rays were taken. One of them showed the spikes.  However, the images needed imagination and Photoshopping.It is not usual for vets to drain the bladder of urine via a catheter and pump in 20 ml of air to provide a good contrast. This is because the vet believes bacteria will be introduced into the bladder via the air. During surgery by Dr Daniel, the large beautiful stone looks so much like a lady's precious stone. FOLLOW UP ON NOV 3, 2013 9.50 AM SUNDAY Around 42 hours post-cystotomy,  on this bright sunshine Sunday, my assistant walked the dog at 9 am. I checked the wound.  The size 15 e-collar prevented direct licking of the surgical stitches but bruised the surrounding areas. There is no commercially available size 18. Size 20 will be too big. The dog is extremely active and is normal. He urine-marked the clinic floor. I noticed some discoloured urine. 3 rows of sutures were placed on the bladder according to Dr Daniel as the bladder was bleeding (a blood vessel was nearby and stitched). Usually, I place 2 rows of sutures and there will be bladder wall bleeding. Each vet has his or her own assessment on the spot and each case differs. Urine test 42 hrs post surgery. dipstick. Fed dry food from owner. Blood 4+  pH 5, SG 1.04, WBC +,  protein 2+. The dog should recover well and go home. Stone analysis is being done by the lab.   Stone analysis is being done.   Case 2.  A young Schnauzer pees blood"The urine test on Oct 2, 2013 shows the presence of occasional numbers of calcium oxalate and triple phosphate crystals," Dr Daniel said to me when I asked him about the urine test after he had completed the bladder stone removal surgery. He could see that the few numbers of crystals in the urine does not co-relate with the number of formed stones which exceeded 20 big and small ones in this case. "Absence of crystals in the urine" does not mean there is no bladder stone. X-rays will be best. Each vet has his own approach to this type of surgery.  He had injected saline into the bladder to check for leaks and there was none. "A fine needle was used," he said to me. I am aware of this way of checking for leakage. Usually I inject saline via the urinary catheter in the female dog. I did a video of the stones being taken out as there were numerous. I had done videos of bladder stone removal and so I do not video this type of surgery as it takes a lot of time to produce a video. AUDIT OF THIS CASE tp 42373 Miniature Schnauzer, White, Female, 3 years old. Born Nov 4, 2010. Significant time-lines Feb 24, 2012. I spayed the dog. Uterus was enlarged but not from pregnancy.  Blood test normal. Nov 30, 2012. Blood in the urine. I advised urine test and no dry food. Urinary tract infection. Jul 14, 2013.  During annual vaccination, I palpated the bladder and felt "crepitus" - feeling of gas and bladder stones rubbing against each other inside the bladder. I advised X-rays as I was quite sure these were bladder stones. Interestingly, I recorded the following 4 words "Dr Daniel said no." I had asked his opinion and he had palpated the bladder. Sometimes I would be present during his consultations as a mentor. Palpation of the bladder for crepitus is not as convincing to the owner as X-rays. Therefore, X-rays must be advised. Every vet has his or her own opinions and each vet, after palpation of the bladder may give different points of view as in this case and that does not reflect on the vet's competence. X-rays will be most helpful but the owner came for vaccination and not for urinary tract problems like blood in the urine in this case. So the owner does not want to incur "unnecessary" medical costs of X-rays. Oct 1, 2013. Dr Daniel was consulted for decreased in appetite of the dog and vomiting of digested food. He advised X-rays and urine tests. Urine tests showed pH 8.0, USG 1.020, bacteria 3+, blood 4+, calcium oxalate and triple phosphate occasional. X-rays showed numerous large stones. Dr Daniel opened up the bladder and removed the stones. FOLLOW UP WITH OWNER ON OCT 3, 2013. The owner said that he had given canned food since my advice to cut out the dry food in Nov 2012. He said that his relative's Shih Tzu called Mikki also had similar problems and eating the same brand of wet food called "Burp". I remember Mikki. He had difficulty in urination and urine tests showed triple phosphate. X-rays showed no stones and the dog is on S/D diet for the time being till the urine test is negative. It is important to follow up with the owner but this takes time and some vets may not want to do it. As to what to do now after the operation, the stone analysis will need to be known first. From appearance, I would say they are struvite stones. S/D canned diet for 1-3 months and urine test 3 monthly will be my advice but many owners have their own ideas. It is my opinion that the stones were formed much earlier and the changing to "Burp" canned food was too late and probably does not contribute to the struvite stone formation unless it alkalinises the urine. The bacterial infection of the bladder in an alkaline urine causes triple phosphates and struvites to form. It is inconclusive evidence that "Burp" cause the formation of stones. "Miniature Schnauzers are one breed famous for bladder stones," I said to the owner. Circumstantial evidence of "Burp" causing bladder stones in this Schnauzer is made because  Mikki had similar difficulty in urination problems too when fed on "Burp". But no stones were seen in Mikki's X-rays. I remember this Mikki very well since this Shih Tzu's owner had two episodes of urination difficulties in Mikki. In the 2nd episode, the couple had the X-rays done and no stones were seen. Now the dog is on S/D diet and so far, no more dysuria problems. Mikki is another story. Struvite stones confirmed by laboratory analysis FOLLOW UP ON OCT 7, 2013 BY PHONE AT 8.05 pm, 5 days post-removal of bladder stones by Dr Daniel. Owner is satisfied today as the dog is active, eats and drinks. Urine no blood. Stools are normal. As at November 4, 2013, no complaints from the owner.   Case 3.  An older Bichon Frise cannot pee X-rays show 2 stones. The one inside the urethra caused the dog great difficulty in peeing. He was catheterized a few times when this happen so that the stone is pushed back into the bladder. Medical dissolution of the stones is in progress as the owner does not want surgery. The final report to be written some weeks later. As at Nov 6, 2013, the Bichon can pee freely. He is on medical treatment using canned S/D diet to dissolve the stones for 1-2 months. Ensuring that the dog has ACCESS to the grass in the backyard is important as the dog prefers to stay indoors and control his bladder till being let out a few hours later. The dog no longer eats dry dog food.        3827 - 3828. A Bichon Frise has difficulty in peeing (blog)   Case 4.  An older Shih Tzu pees bloodDr Daniel advised an X-ray for this 6-year-old male neutered Shih Tzu, much loved by his owner. "He is the king in the apartment," she said. "He would bite me when I discipline my son and similarly will protect me when he thinks I am threatened by biting my son." "He is fair and good protector," I said. The X-rays showed stones in the bladder and at the bend of the urethra. "What to do?" she asked. "My dog died under anaesthesia when I was a young girl and I do not want surgery." Methods of treatment 1. Medically to acidify the urine and to dissolve the stones if they are struvites. "How long does it take?" she asked. "If the stones are small, it may take from one month onwards." 2. Surgery to remove the stones via the bladder. A syringe pumps normal saline to flush the urethral stones into the bladder. "How long is the surgery?" "Around 40 minutes." URINE TEST Alkaline pH, amorphous phosphate crystals, blood + The owner decided on surgery 5 days later. I advised 4 days of antibiotics to clear the bladder of infections.  Urine test will be done soon.  FOLLOW UP ON NOV 5, 2013 The 2-year-old Shih Tzu was operated 3 days ago. Yesterday, another Shih Tzu of much bigger size but also Gold/White had 13 spiky stones removed by Dr Daniel. The parents and teenaged daughter came at 7 pm, 4 hours after surgery to feed the dog chicken by hand and gave soup. The dog ate some food. At 11.38 am I checked both Shih Tzus. The 2-year-old growled at me and wagged his tail. He was most unfriendly for some reason and would not look at me. The older one was friendly. The dog ate all the chicken pieces today when the couple and their teenaged daughter visited the dog in the afternoon. This was Day 2 after surgery to remove spiky stones. The dog also ate some 5 hours after surgery when the owners brought his favoured cooked chicken meat.  Stones have been sent for analysis. Updates will be on this webpage: www.sinpets.com/F5/20131104 Singapore_dog_bladder_stones.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: November 06, 2013 Toa Payoh Vets

1151. The roboroskvi can't walk properly

Tumours grow and grow, till the roboroskvi can't walk properly.
"Why didn't you get the tumour removed when they were much smaller?" I asked this bank analyst. "The trend is for the tumour to grow larger. Just like in a banking situation. If you analyse the economic situation incorrectly for your client, he may have gone bankrupt!"

"Actually I have brought my hamster to consult a vet much earlier," she said. "But he says they are fatty tumours and to leave them alone! Now she can't walk normally."

It is much safer and cheaper to excise dwarf hamster tumours when they are very small but many Singapore hamster owners wait till the hamster can't function normally before they decide to risk the anaesthesia. Dr Daniel wanted to excise both tumours at the same time. The hamster survived and went home 2 hours later to a happy owner who actually wanted to wait or watch the surgery.

1150. The 2nd Shih Tzu had 13 spikey bladder stones

Nov 5, 2013

The 2-year-old Shih Tzu was operated 3 days ago. Yesterday, another Shih Tzu of much bigger size but also Gold/White had 13 spikey stones removed by Dr Daniel. The parents and teenaged daughter came at 7 pm, 4 hours after surgery to feed the dog chicken by hand and gave soup. The dog ate some food.

At 11.38 am I checked both Shih Tzus. The 2-year-old growled at me and wagged his tail. He was most unfriendly for some reason and would not look at me. The older one was friendly.

1149. The owner disbelieved that his 12-year-old Silkie had false pregnancy.

Today, Nov 5, 2013, Tuesday, the owner brought  back the Silkie Terrier with multiple breast tumours and a very large and painful armpit breast tumours.

"My dog could not sit on her chest," he said. "That is why I have to bring her to the vet."

The  I saw this dog 3 days ago and prescribed antibiotics. Definitely, this dog had widespread breast tumours and I asked the couple to seriously consider the high anaesthetic risk of surgery to remove so many tumours.

"The dog is old at 12 years and the tumours may have spread to the lungs and internally" I said. "The tumours are likely to recur after you spent so much money operating."

They could not decide. I had given the antibiotic injections and advised 3 days later to do the surgery.

"I went back to Vet 1 to ask whether she had seen the breast tumours during dental scaling 3 months ago," he had stated that the breast tumours were not present at that time and today was disbelieving that the diagnosis of false pregnancy was correct.. "Vet 1 said the large swelling on the left armpit was due to false pregnancy."

"It was possible false pregnancy and breast tumours," I said. "When was the dog on heat?"
"Very long ago."
"False pregnancy occurs 2-3 months after the heat and your dog could be on heat 3 months ago as I can see the vulva swelling now."

I advised spaying first to remove the female hormones and then breast tumour excision 2-4 weeks later.