Sep 19, 2012. Today Wednesday, I examined the shih tzu's urethral opening. There was some granulation tissue trying to close it. It is only Day 7 since I did the operation (scrotal ablation and urethostomy extension) last Wednesday when Dr Daniel went to Langkawi. It took 2 hours although it seemed to be easy if you read the vet text book.
The dog pees from there. The owner is quite happy with the outcome. Financial costs had been very high to him due to recurrence. I advise S/D strictly for 1 month and then C/D. Monthly urine tests for 3 clear tests.
I also showed him another similar case where the owner of the Miniature Schnauzer had two surgeries on blocked bladder. After the first surgery, she did not accept our advice to go on therapeutuic diet but did so on the 2nd recurrence.
The dog went home today with instructions on how to clean the urethrostomy wound using clean boiled water twice a day. Urine comes out from this wound and stitch removal will be done in 7 days' time.
Wednesday, September 19, 2012
1106. DR SING'S AUDIT CASE - Dog with urinary stones twice
I hope this real case of calcium oxalate and struvite urinary stones in one day may make revision much easier for vet undergraduates struggling to remember the treatment for calcium oxalate and stgruvite stones!
TRUST AND AUDIT OF URETHRAL OBSTRUCTION IN A MALE MINIATURE SCHNAUZER
Sep 19, 2012
I checked the case records today and reviewed one case of an 8-year-old salt & pepper Miniature Schnauzer, not neutered, born in Feb 22, 2003. Today, I phoned the owner's mum who said that the dog is normal. As to what diet, she does not know as her children has the dog.
Sep 15, 2011. I was presented with this dog. Dysuria 7 days, incontinence (nuisance of dribbling urine), anorexic (not eating), not drinking last 2 days. Dry food usually fed.
Abdominal palpation - painful distended bladder.
Urethral obstruction. I got the following done: urine test, blood test and X-ray of bladder.
Sep 16, 2011
The case was operated by Dr Vanessa. 15 urinary stones removed from bladder. Stones sent to NUH lab for analysis.
LAB RESULTS - Significant findings
Sep 15, 2011
1. Blood test - Total WCC 13.6 (normal). Neutrophils 92.7% (high) Absolute 12.6
Lymphocytes 6.5% Absolute 0.88
2. Urine test - pH 7.0 SG 1.030, Protien +, Blood 3+, Bacteria +, WCC 504. RBC 1440
crystals NIL
Oct 25, 2011
1. Stone analysis by Minnesota Urolith Center
Analysis is done on nidus, stone, shell, surface and approximate % is as follows:
Stone = 100% calcium oxalate monohydrate
Shell = 5% calcium oxalate monohydrate, 95% calcium oxalate dihydrate
Due to financial situation, the owner did not want the prescription diet.
FOUR SCENARIOS
Recommendation for canine calcium oxalate prevention by Minnesota Urolith Center is:
1. Urine analysis (UA) and medical imaging.
1.1 If urine pH >6.5, USG <1 ---="---" .020=".020" crystals="crystals" no="no"> UA monthly and adjust therapy till goals are achieved. Then UA every 3-6 months.
1.2 Crystalluria Calcium oxalate
Verify persistgent crystalluria from urine sample
If USG >1.020, give canned diet or add water to food
If pH < 6.5, promote less acidic urine. Use U/D or urinary alkalinizers eg. postassium citrate.
1.3 Crystalluria Struvite
If no urease bacterial infection, no clinical problem for the dog. That means, no UTI, no problem.
1.4 Uroliths
Advise voiding urohydropropulsion if uroliths are small.
Some stones left alone in patients not showing clinical signs (haematuria, dysuria).
With persistent clinical signs, remove uroliths with appropriate methods
Submit urolith for quantitative analysis to verify composition.
Vets to review manufacturers' literature on therapeutic diets and consider other factors when pets with multiple health problems
-------------------------------
RECURRENCE
In Feb 3, 2012, dog was aggressive when handled. Presented to Dr Vanessa for "straining to urinate". 4.5 months ago, owner declined therapeutic diet owing to cost issues and fed only "porreidge and pork".
X-rays revealed multiple stones inside bladder and in urethra near the bladder. Owner took possession of the X-rays
Feb 5, 2012
Emergency cystostomy. 15 stones removed.
Feb 6, 2012
Urine Analysis - pH 9.0 SG 1.025, Blood 4+, RBC 2250, WBC 0, Bacteria +, Crystals Triple phospate +, Amorphous phosphate 3+. Struvites are present in the urine in this UA.
*Mar 15, 2012
Urine Analysis - pH 6.5 SG 1.012, Blood +, RBC 5, WBC 13, Bacteria NIL. Crystals NIL
Feb 7, 2012
STONE ANALYSIS BY NUH, Dept of lab medicine, Singapore
Calcium, stone +
Phosphate, stone +
Oxalate, stone trace
Magnesium stone +
Ammonia stone +
From the analysis, MAP = struvite. S/D advised until 3 urine tests are clear.
Dates of purchase of S/D by owner
Feb 28, 2012 6 cans
Mar 2, 2012 7 cans
Mar 8, 2012 6 cans
Mar 15, 2012 urine analysis*
Mar 15, 2012 6 cans
Mar 20, 2012 6 cans
Mar 27, 2012 6 cans
Apr 1, 2012 6 cans
No more news from the owner till today Sep 19, 2012 when I phoned the mother who said that the dog is OK. Urine analysis every 3 months or monthly is not done by most Singaporean owners till there are urinary problems.
However, there seems to be no problems with this dog as at Sep 2012 and now news as to what type of feeding is being given. The owner does go to other vets and so there is no definite ending to this story.
TRUST AND AUDIT OF URETHRAL OBSTRUCTION IN A MALE MINIATURE SCHNAUZER
Sep 19, 2012
I checked the case records today and reviewed one case of an 8-year-old salt & pepper Miniature Schnauzer, not neutered, born in Feb 22, 2003. Today, I phoned the owner's mum who said that the dog is normal. As to what diet, she does not know as her children has the dog.
Sep 15, 2011. I was presented with this dog. Dysuria 7 days, incontinence (nuisance of dribbling urine), anorexic (not eating), not drinking last 2 days. Dry food usually fed.
Abdominal palpation - painful distended bladder.
Urethral obstruction. I got the following done: urine test, blood test and X-ray of bladder.
Sep 16, 2011
The case was operated by Dr Vanessa. 15 urinary stones removed from bladder. Stones sent to NUH lab for analysis.
LAB RESULTS - Significant findings
Sep 15, 2011
1. Blood test - Total WCC 13.6 (normal). Neutrophils 92.7% (high) Absolute 12.6
Lymphocytes 6.5% Absolute 0.88
2. Urine test - pH 7.0 SG 1.030, Protien +, Blood 3+, Bacteria +, WCC 504. RBC 1440
crystals NIL
Oct 25, 2011
1. Stone analysis by Minnesota Urolith Center
Analysis is done on nidus, stone, shell, surface and approximate % is as follows:
Stone = 100% calcium oxalate monohydrate
Shell = 5% calcium oxalate monohydrate, 95% calcium oxalate dihydrate
Due to financial situation, the owner did not want the prescription diet.
FOUR SCENARIOS
Recommendation for canine calcium oxalate prevention by Minnesota Urolith Center is:
1. Urine analysis (UA) and medical imaging.
1.1 If urine pH >6.5, USG <1 ---="---" .020=".020" crystals="crystals" no="no"> UA monthly and adjust therapy till goals are achieved. Then UA every 3-6 months.
1.2 Crystalluria Calcium oxalate
Verify persistgent crystalluria from urine sample
If USG >1.020, give canned diet or add water to food
If pH < 6.5, promote less acidic urine. Use U/D or urinary alkalinizers eg. postassium citrate.
1.3 Crystalluria Struvite
If no urease bacterial infection, no clinical problem for the dog. That means, no UTI, no problem.
1.4 Uroliths
Advise voiding urohydropropulsion if uroliths are small.
Some stones left alone in patients not showing clinical signs (haematuria, dysuria).
With persistent clinical signs, remove uroliths with appropriate methods
Submit urolith for quantitative analysis to verify composition.
Vets to review manufacturers' literature on therapeutic diets and consider other factors when pets with multiple health problems
-------------------------------
RECURRENCE
In Feb 3, 2012, dog was aggressive when handled. Presented to Dr Vanessa for "straining to urinate". 4.5 months ago, owner declined therapeutic diet owing to cost issues and fed only "porreidge and pork".
X-rays revealed multiple stones inside bladder and in urethra near the bladder. Owner took possession of the X-rays
Feb 5, 2012
Emergency cystostomy. 15 stones removed.
Feb 6, 2012
Urine Analysis - pH 9.0 SG 1.025, Blood 4+, RBC 2250, WBC 0, Bacteria +, Crystals Triple phospate +, Amorphous phosphate 3+. Struvites are present in the urine in this UA.
*Mar 15, 2012
Urine Analysis - pH 6.5 SG 1.012, Blood +, RBC 5, WBC 13, Bacteria NIL. Crystals NIL
Feb 7, 2012
STONE ANALYSIS BY NUH, Dept of lab medicine, Singapore
Calcium, stone +
Phosphate, stone +
Oxalate, stone trace
Magnesium stone +
Ammonia stone +
From the analysis, MAP = struvite. S/D advised until 3 urine tests are clear.
Dates of purchase of S/D by owner
Feb 28, 2012 6 cans
Mar 2, 2012 7 cans
Mar 8, 2012 6 cans
Mar 15, 2012 urine analysis*
Mar 15, 2012 6 cans
Mar 20, 2012 6 cans
Mar 27, 2012 6 cans
Apr 1, 2012 6 cans
No more news from the owner till today Sep 19, 2012 when I phoned the mother who said that the dog is OK. Urine analysis every 3 months or monthly is not done by most Singaporean owners till there are urinary problems.
However, there seems to be no problems with this dog as at Sep 2012 and now news as to what type of feeding is being given. The owner does go to other vets and so there is no definite ending to this story.
Tuesday, September 18, 2012
1104. I don't want my old dog to be chopped up - urinary stones by ultrasound
Yesterday, an old realtor acquaintance phoned me at home. His 10-year-old Golden Retriever was ultrasound scanned by the "most expensive" veterinary practice in Singapore. The vet said his dog has cysts in the prostate and bladder stones and advised surgery to remove the stones.
"My dog is so old," he said over the phone. "I don't want him to be chopped up."
"Was a urine test done?"
"No," he said.
"How many stones were there?"
"I don't know," the realtor said to me in a worried voice.
"Were the stones big or small?"
"I don't know."
In many Singapore families, the dog is family and so the best vet in Singapore should be the best for the pet. The brand-name veterinary surgery.
Unfortunately, the pockets need to be very deep. "Frankly, I can't afford the surgical fees in this practice," the realtor said. "That is why I seek a second opinion from you." He has not consulted me for many years and this is common amongst Singaporean dog owners who tend to doctor-hop and to look for the glitz and presentation of new clinics or proximity. It is good that they have an estimated 50 choices of veterinary practices in Singapore. Brand-name and beautiful veterinary practices certainly attract Singaporeans.
"There are some types of bladder stones that can be dissolved by special diet," I said. "If you have time, bring the dog to me for urine collection and testing at 9.30 am tomorrow (Sep 18, 2012)."
"My dog pees all at around 8 am when I take him out," he laughed.
"You can try to collect a clean sample of urine from him. Wait for a few seconds and collect the middle stream into a urine collection bottle which you can get from the polyclinic."
Urine analysis is important in the diagnosis and treatment of urinary bladder stones.
See my article to educate dog owners at:
http://www.kongyuensing.com/folder8/20120724struvite_stones_dogs_toapayohvets.htm
"My dog is so old," he said over the phone. "I don't want him to be chopped up."
"Was a urine test done?"
"No," he said.
"How many stones were there?"
"I don't know," the realtor said to me in a worried voice.
"Were the stones big or small?"
"I don't know."
In many Singapore families, the dog is family and so the best vet in Singapore should be the best for the pet. The brand-name veterinary surgery.
Unfortunately, the pockets need to be very deep. "Frankly, I can't afford the surgical fees in this practice," the realtor said. "That is why I seek a second opinion from you." He has not consulted me for many years and this is common amongst Singaporean dog owners who tend to doctor-hop and to look for the glitz and presentation of new clinics or proximity. It is good that they have an estimated 50 choices of veterinary practices in Singapore. Brand-name and beautiful veterinary practices certainly attract Singaporeans.
"There are some types of bladder stones that can be dissolved by special diet," I said. "If you have time, bring the dog to me for urine collection and testing at 9.30 am tomorrow (Sep 18, 2012)."
"My dog pees all at around 8 am when I take him out," he laughed.
"You can try to collect a clean sample of urine from him. Wait for a few seconds and collect the middle stream into a urine collection bottle which you can get from the polyclinic."
Urine analysis is important in the diagnosis and treatment of urinary bladder stones.
See my article to educate dog owners at:
http://www.kongyuensing.com/folder8/20120724struvite_stones_dogs_toapayohvets.htm
1103. Red slider moans
A professor who loves his 8-year-old Red-Eared Slider which came back from Seattle where he did his PhD. He took the time to send the slider for treatment as earlier, some medication he got from me to treat it at home did not work. Usually we don't advise getting medicine to treat at home, without examination. For this slider, it was lethargic. But you can't take rectal temperature and palpate and do several examination procedures as you can do for a dog or cat! So the vet must use common sense and general principles of diagnosis and treatment!
SMS TEXT BETWEEN VET AND CLIENT SAVES TIME
Sep 3, 2012
Hi Dr Sing, I've left my Red Ear Slider at your clinic. As mentioned, he is active for 15 min a day and become mostly lethargic throughout for past 4 to 5 days. He made a few moaning sounds yesterday. Many thanks for your help, Kevin Koh.
Sep 3, 2012 SMS From Dr Sing
Need to treat n observe
Reply: Okay. Thanks a lot, Dr Sing.
Sep 5
Hi Dr Sing, is there any improvement o my red eared slider? Many thanks for advice. Kelvin.
Slider was hospitalised. Dr Daniel gave 2 injections IM of baytril in the back muscles for 2 days. I became more active than on arrival. Cleaned. Sent home.
Sep 7
Hi Dr Sing, the slider ate some shrimps yesterday and poop this morning. Still not very active and eyes open and closed at times. Will continue to monitor. thanks. Kelvin
Sep 7 from Dr Sing
Good news. Give fibreplex
Sep 14 from Dr Sing
Is slider eating normally now?
Sep 14 from Kelvin
Hi Dr Sing, thanks for asking. Slider is more active and eating now. Kelvin.
Sep 14 from Dr Sing
What he eats daily?
Sep 14 from Dr Sing
Pork and shrimp and a little pellet. Kelvin.
Sep 14 from Dr SingInside a plate or in water?
1102. Struvite bladder stones in Singapore dogs (edited version)
STRUVITE BLADDER STONES IN SINGAPORE DOGS
What are bladder stones?
Bladder stones or uroliths are common in domesticated animals. There are many types of bladder stones depending on their composition.
Struvite bladder stones
Struvite bladder stones are most commonly seen in canine cases at Toa Payoh Vets and this article is to educate dog owners regarding their diagnosis and treatment. They can be formed anywhere along the urinary tract in the kidneys, the urethra and the bladder when the urine is supersaturated with magnesium, ammonium and phosphate (MAP). MAP supersaturation may be associated with several factors, including urinary tract infections, alkaline urine, genetic predisposition and diet. Breeds usually affected by struvite bladder stones include the Miniature Schnauzer, Shih Tzu, Bichon Frise, Miniature Poodle, Cocker Spaniel and Lhasa Apso, but any breed can be affected. Female dogs are said to form approximately 85% of bladder stone cases.
Symptoms of bladder stones
Some dogs may not show clinical signs such as blood in the urine, difficulty in urination, or inability to urinate, until much later in the disease with severity of signs depending on the location, size, and number of uroliths formed. Your vet will take a comprehensive history to determine the start and severity of the disease. Physical examination includes bladder palpation to feel the crepitus (sounds of gas and stones rubbing against each other) inside the bladder or the solid stones if they are large.
Diagnosis
Urine analysis is the most useful and a sterile sample is taken by catheterisation or cystocentesis (straight from the bladder). The pH of your dog’s urine will also give a good idea of the nature of the stone. The urine sample will show the presence of bacteria, which is usually cultured to find out the type of bacteria causing the urinary tract infection. Antibiotic sensitivity tests are needed to figure out what appropriate antibiotics can be prescribed.
Uroliths need to be of a certain size before they are evident. The number and size of urinary stones seen in the x-ray may not correlate with the severity of clinical signs. A radiograph is highly recommended to find out the number and size of stones and where they are located prior to surgical removal, if surgery is required. In spite of all the tests above, the composition of the actual stone cannot be determined unless a stone sample (from the surgery or that has been urinated out) is sent for analysis.
Treatment
There are two types of treatment for struvite bladder stones; surgery or medical dissolution of the stones. The benefits of surgery include a shorter recovery period and the ability to identify the actual type of stone involved. Surgery is needed if the stones are too large as they may not dissolve medically. Disadvantages of surgery are that it is more invasive and there are risks associated with general anesthesia in a sick and/or older dog.
Medical dissolution takes a much longer time (about three months on average) to take effect and large stones may not dissolve at all. It revolves around three main concepts – to acidify urine, reduce the intake of MAP such that it does not saturate in the urine and dilute urine so crystals do not have a chance to form. Affected dogs are usually prescribed calculytic diets and appropriate antibiotics to treat the bacterial infections. No other food or treats should be given and plenty of water drinking should be encouraged.
Most importantly, your dog’s health should be reviewed every three months with urine tests and X-rays to ensure that no new stones are. Be alert as to the urination pattern of your older dog and seek veterinary advice promptly if there are signs of blood in the urine, urinary difficulty or inability to pee.
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Toa Payoh Vets
Acknowledgement - Thanks to Dr Daniel Sing ZongZheng for help in writing the edited article as in this blog.
The detailed article is at:
http://www.kongyuensing.com/folder8/20120724struvite_stones_dogs_toapayohvets.htm
What are bladder stones?
Bladder stones or uroliths are common in domesticated animals. There are many types of bladder stones depending on their composition.
Struvite bladder stones
Struvite bladder stones are most commonly seen in canine cases at Toa Payoh Vets and this article is to educate dog owners regarding their diagnosis and treatment. They can be formed anywhere along the urinary tract in the kidneys, the urethra and the bladder when the urine is supersaturated with magnesium, ammonium and phosphate (MAP). MAP supersaturation may be associated with several factors, including urinary tract infections, alkaline urine, genetic predisposition and diet. Breeds usually affected by struvite bladder stones include the Miniature Schnauzer, Shih Tzu, Bichon Frise, Miniature Poodle, Cocker Spaniel and Lhasa Apso, but any breed can be affected. Female dogs are said to form approximately 85% of bladder stone cases.
Symptoms of bladder stones
Some dogs may not show clinical signs such as blood in the urine, difficulty in urination, or inability to urinate, until much later in the disease with severity of signs depending on the location, size, and number of uroliths formed. Your vet will take a comprehensive history to determine the start and severity of the disease. Physical examination includes bladder palpation to feel the crepitus (sounds of gas and stones rubbing against each other) inside the bladder or the solid stones if they are large.
Diagnosis
Urine analysis is the most useful and a sterile sample is taken by catheterisation or cystocentesis (straight from the bladder). The pH of your dog’s urine will also give a good idea of the nature of the stone. The urine sample will show the presence of bacteria, which is usually cultured to find out the type of bacteria causing the urinary tract infection. Antibiotic sensitivity tests are needed to figure out what appropriate antibiotics can be prescribed.
Uroliths need to be of a certain size before they are evident. The number and size of urinary stones seen in the x-ray may not correlate with the severity of clinical signs. A radiograph is highly recommended to find out the number and size of stones and where they are located prior to surgical removal, if surgery is required. In spite of all the tests above, the composition of the actual stone cannot be determined unless a stone sample (from the surgery or that has been urinated out) is sent for analysis.
Treatment
There are two types of treatment for struvite bladder stones; surgery or medical dissolution of the stones. The benefits of surgery include a shorter recovery period and the ability to identify the actual type of stone involved. Surgery is needed if the stones are too large as they may not dissolve medically. Disadvantages of surgery are that it is more invasive and there are risks associated with general anesthesia in a sick and/or older dog.
Medical dissolution takes a much longer time (about three months on average) to take effect and large stones may not dissolve at all. It revolves around three main concepts – to acidify urine, reduce the intake of MAP such that it does not saturate in the urine and dilute urine so crystals do not have a chance to form. Affected dogs are usually prescribed calculytic diets and appropriate antibiotics to treat the bacterial infections. No other food or treats should be given and plenty of water drinking should be encouraged.
Most importantly, your dog’s health should be reviewed every three months with urine tests and X-rays to ensure that no new stones are. Be alert as to the urination pattern of your older dog and seek veterinary advice promptly if there are signs of blood in the urine, urinary difficulty or inability to pee.
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Toa Payoh Vets
Acknowledgement - Thanks to Dr Daniel Sing ZongZheng for help in writing the edited article as in this blog.
The detailed article is at:
http://www.kongyuensing.com/folder8/20120724struvite_stones_dogs_toapayohvets.htm
1101. Update: Edited article on struvite bladder stones for magazine
Update: SEP 18, 2012. Magazine article for Pets Magazine -‘Pets Health and Veterinary Special 2012’ in October 2012. This Special will be positioned as an educational and informative publication to benefit the health and welfare of pets through the education of pet owners.
The edited article from the editor had assumed that the article was about bladder stones in general but it is specifically about only one type of bladder stones - struvite bladder stones and I have amended accordingly.
STRUVITE BLADDER STONES IN SINGAPORE DOGS
What are bladder stones?
Bladder stones or uroliths are common in domesticated animals. There are many types of bladder stones depending on their composition.
Struvite bladder stones
Struvite bladder stones are most commonly seen in canine cases at Toa Payoh Vets and this article is to educate dog owners regarding their diagnosis and treatment. They can be formed anywhere along the urinary tract in the kidneys, the urethra and the bladder when the urine is supersaturated with magnesium, ammonium and phosphate (MAP). MAP supersaturation may be associated with several factors, including urinary tract infections, alkaline urine, genetic predisposition and diet. Breeds usually affected by struvite bladder stones include the Miniature Schnauzer, Shih Tzu, Bichon Frise, Miniature Poodle, Cocker Spaniel and Lhasa Apso, but any breed can be affected. Female dogs are said to form approximately 85% of bladder stone cases.
Symptoms of bladder stones
Some dogs may not show clinical signs such as blood in the urine, difficulty in urination, or inability to urinate, until much later in the disease with severity of signs depending on the location, size, and number of uroliths formed. Your vet will take a comprehensive history to determine the start and severity of the disease. Physical examination includes bladder palpation to feel the crepitus (sounds of gas and stones rubbing against each other) inside the bladder or the solid stones if they are large.
Diagnosis
Urine analysis is the most useful and a sterile sample is taken by catheterisation or cystocentesis (straight from the bladder). The pH of your dog’s urine will also give a good idea of the nature of the stone. The urine sample will show the presence of bacteria, which is usually cultured to find out the type of bacteria causing the urinary tract infection. Antibiotic sensitivity tests are needed to figure out what appropriate antibiotics can be prescribed.
Uroliths need to be of a certain size before they are evident. The number and size of urinary stones seen in the x-ray may not correlate with the severity of clinical signs. A radiograph is highly recommended to find out the number and size of stones and where they are located prior to surgical removal, if surgery is required. In spite of all the tests above, the composition of the actual stone cannot be determined unless a stone sample (from the surgery or that has been urinated out) is sent for analysis.
Treatment
There are two types of treatment for struvite bladder stones; surgery or medical dissolution of the stones. The benefits of surgery include a shorter recovery period and the ability to identify the actual type of stone involved. Surgery is needed if the stones are too large as they may not dissolve medically. Disadvantages of surgery are that it is more invasive and there are risks associated with general anesthesia in a sick and/or older dog.
Medical dissolution takes a much longer time (about three months on average) to take effect and large stones may not dissolve at all. It revolves around three main concepts – to acidify urine, reduce the intake of MAP such that it does not saturate in the urine and dilute urine so crystals do not have a chance to form. Affected dogs are usually prescribed calculytic diets and appropriate antibiotics to treat the bacterial infections. No other food or treats should be given and plenty of water drinking should be encouraged.
Most importantly, your dog’s health should be reviewed every three months with urine tests and X-rays to ensure that no new stones are. Be alert as to the urination pattern of your older dog and seek veterinary advice promptly if there are signs of blood in the urine, urinary difficulty or inability to pee.
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Toa Payoh Vets
-----------------------------------------------------------------------------------------------------------------------------------------------
COMPARE TO MY ORIGINAL REPORT
Wednesday, August 1, 2012
1818. Struvite bladder stones in Singapore dogs
Magazine article for Pets Magazine -‘Pets Health and Veterinary Special 2012’ in October 2012. This Special will be positioned as an educational and informative publication to benefit the health and welfare of pets through the education of pet owners.
Struvite Bladder Stones in Singapore dogs
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Toa Payoh Vets
July 31, 2012
Difficulty in peeing, not able to pee and peeing urine with blood are the most common reasons for dog owners to seek veterinary advices at Toa Payoh Vets. Sometimes, the owner sees stones passed out in the urine.
Urolithiasis in dogs is such a large topic of a few hundred pages as there are several types of bladder stones affecting the dog and their diagnosis and treatment vary. Therefore, only struvite urinary stones, being most commonly seen at Toa Payoh Vets will be discussed in this article.
Breeds usually affected include the Miniature Schnauzer, Shih Tzu, Bichon Frise, Miniature Poodle, Cocker Spaniel and Lhasa Apso, but any breed can be affected. Female dogs are said to form approximately 85% of bladder stone cases.
Some dogs may not show clinical signs of blood in the urine, difficulty in urination or inability to urinate until much later in the disease with severity of signs depending on the location, size,and number of uroliths formed. These stones can be formed anywhere along the urinary tract in the kidneys, the urethra and the bladder.
Struvite stones are composed primarily of Magnesium, Ammonium and Phosphate (MAP). They are formed within the urinary tract and occur when the urine is supersaturated with MAP (i.e. large quantities of the crystals are present). MAP supersaturation of urine may be associated with several factors, including urinary tract infections, alkaline urine, genetic predisposition and diet.
Your vet will take a comprehensive history to determine the commencement and the severity of the disease. Physical examination include bladder palpation to feel the crepitus (sounds of gas and stones rubbing against each other) inside the bladder or the solid stones if they are large.
However, a complete blockage of the urinary tract is life-threatening as the dog can't pee and the full bladder may rupture with delays in treatment. In such cases, a urinary catheter will be used to unblock the obstruction or the urine is extracted via the bladder as soon as possible. This is done to protect the bladder and kidney from further damage.
Blood screening, urine analysis and radiographs are usually performed to confirm the presence of urinary stones. Abnormal blood work may show if the obstruction of the urinary tract is severe. Blood tests may show changes to the kidney function or an increase in white blood cell counts affecting the health of the dog.
X-ray of a male dog that cannot pee. If the dog cannot pee, the likely cause is urethral obstruction caused by urinary stones being stuck inside the urethra.
Struvite uroliths are radio-dense and can be detected on radiographs.
X-ray of a catheter to push back the stones into the bladder in a female dog that could not pee at all as the stone was stuck inside the urethra
Calcium oxalate is another type of urinary stones seen in dogs
Urine analysis is the most useful and should always be done. A sterile sample is taken either via catherisation (passing a tube into the bladder) or cystocentesis (straight from the bladder). With the urine sample analysed, MAP crystals can be present but this is not always the case. For example, stones that are too well formed or too large may not shed crystals. Therefore, the vet should not deem the absence of crystals in the urine as no struvite or urinary stones being present in the affected dog.
In addition, urine pH gives the vet a good idea of the nature of the stone. Struvite crystals are formed very commonly in an alkaline environment in which bacteria is present. A urine sample can show the presence of bacteria. The bacteria be cultured to know the type of bacteria causing the infection and antibiotic sensitivity tests can be performed by the laboratory to advise on the appropriate antibiotics to be prescribed.
Struvite uroliths are radio-dense and can be detected on radiographs.
However, they need to be of a certain size before they are evident. The number and size of urinary stones seen in the X-ray may not correlate with the severity of clinical signs.
However, a radiograph is highly recommended for the vet to know the number and size of stones and where they are located prior to surgical removal, if surgery is to be advised.
Clients need to understand that in spite of all the tests above, the composition of the actual stone cannot be determined unless a stone sample (from the surgery or that has been urinated out) is sent to the laboratory for analysis.
Treatment options for struvite bladder stones revolve around surgery or medical dissolution of the stones.
Benefits of surgery include faster recovery times, and the ability to identify the actual type of stone involved. Surgery is indicated if the stones are too large or too well formed as they may not dissolve medically. Disadvantages of surgery are that it is more invasive and there are risks associated with general anesthesia in a sick and/or older dog.
For clients that are not so comfortable with surgery or in cases where surgery is not advised due to health concerns (e.g. the dog is very old and in poor health), the alternative is medical dissolution. This medical solution is non-invasive but takes a much longer time to show the effect as the stones are dissolved slowly. However, large stones may not dissolve at all. One important note to take into consideration is that there is no way to accurately determine the nature of the stone without sending it for laboratory analysis. Obviously, the medical solution is not applicable to all types of urinary stones (e.g. calcium oxalate stones), but it is especially effective and useful in struvite stone dissolution.
Medical dissolution revolves around 3 main concepts. They are to acidify the urine, to reduce the intake of MAP such that it does not saturate in the urine and to dilute the urine so crystals do not have a chance to form. For struvite uroliths, there are specially formulated diets such as the Canine S/D, C/D or W/D that I have used to dissolve the stones.
Medical dissolution of stones takes a mean time of 3 months. The time taken for complete dissolution is varied depending on the size of the uroliths and the quantity. Severe cases can take up to 6 months before the stones are fully dissolved. However, very large stones will not dissolve.
Along with this diet change, I prescribe an appropriate antibiotic course to treat any primary or secondary bacterial infection. During treatment, only the prescription diet should be used. I usually advise no dog treats or other food and to encourage the dog to drink water.
The S/D diet is used initially for 1-6 months before switching over to the C/D or W/D diet. It is not recommended for:
1. Use concurrently with urinary acidifiers
2. Feeding longer than 6 months
3. Dogs with non-struvite uroliths (urinary stones).
Transition to feeding S/D should be done over a period of seven days, gradually introducing the amounts during the transition period and monitoring the patient. Most dogs will not eat the S/D diet immediately and so the owner must be educated to switch to the S/D diet gradually over at least 7 days.
After successful dissolution of struvite stones confirmed by urine analysis and X-rays, Canine C/D or W/D can be used for maintenance. Canine S/D should not be used for the prevention of bladder stones as the diet is low in MAP and protein. Long term use of this diet is not recommended as the nutrients are not sufficient.
Key benefits of Canine S/D include:
· Low levels of MAP to aid in dissolution of struvite uroliths and crystals.
· Promotion of acid urine by reducing the urinary pH to 5.9-6.1 (targeted) to increase the solubility of struvite crystals.
· Lower protein levels result in increased urine volume and more dilute urine.
· Antioxidants are added to defend cells from free radicals and to promote a healthy immune system.
In this article, I have written about the S/D, C/D and W/D prescription diets for the medical treatment of struvite urinary stones as I have used them in my practice. However, there are other equivalent prescription diets from other manufacturers and it is up to your vet to advise you as to the type of prescription diet to use or to get bladder surgery done to resolve the problem fast.
Many Singapore dog owners do not adopt my advices to review the cases 1-3 monthly and do urine tests and X-rays to ensure that no new stones are formed after surgical removal of the stones or after using the S/D diet. They are happy to see that the dog has not passed blood in the urine and does not have difficulty in urination and continue with feeding the usual dry dog food again.
In some cases, the problem recurs and it can be heart-breaking and costly if another surgery is required. So some owners elect to euthanase the dog. Regular urine tests would have been most useful in detecting the presence of struvite stones although the absence of struvite crystals in the urine does not mean that there are no stones present. Only X-rays will be able to tell. Sometimes, a dog that has had struvite stones may become later affected with another type of stone such as calcium oxalate stones and that is why regular urine tests are so important.
In conclusion, be alert as to the urination pattern of your older dog and seek veterinary advice promptly if there are signs of discoloured urine, urinary difficulty or inability to pee. For more detailed case studies of urinary stone cases seen at Toa Payoh Vets, goto:
http://www.bekindtopets.com/animals/20081201PG7_Dog_Surgery_Anaesthesia_Urinary_Tract_Problems_ToaPayohVets.htm
Acknowledgement: I thank Dr Daniel Sing for his contribution to this article and various dog owners for permitting me to record their cases in this article
---------------------------------------------------------------------------------------------------------------------------
As only one images has been uploaded to blogger.com, see the other images at:
Toa Payoh Vets webpage:
http://www.kongyuensing.com/folder8/20120724struvite_stones_dogs_toapayohvets.htm
The edited article from the editor had assumed that the article was about bladder stones in general but it is specifically about only one type of bladder stones - struvite bladder stones and I have amended accordingly.
STRUVITE BLADDER STONES IN SINGAPORE DOGS
What are bladder stones?
Bladder stones or uroliths are common in domesticated animals. There are many types of bladder stones depending on their composition.
Struvite bladder stones
Struvite bladder stones are most commonly seen in canine cases at Toa Payoh Vets and this article is to educate dog owners regarding their diagnosis and treatment. They can be formed anywhere along the urinary tract in the kidneys, the urethra and the bladder when the urine is supersaturated with magnesium, ammonium and phosphate (MAP). MAP supersaturation may be associated with several factors, including urinary tract infections, alkaline urine, genetic predisposition and diet. Breeds usually affected by struvite bladder stones include the Miniature Schnauzer, Shih Tzu, Bichon Frise, Miniature Poodle, Cocker Spaniel and Lhasa Apso, but any breed can be affected. Female dogs are said to form approximately 85% of bladder stone cases.
Symptoms of bladder stones
Some dogs may not show clinical signs such as blood in the urine, difficulty in urination, or inability to urinate, until much later in the disease with severity of signs depending on the location, size, and number of uroliths formed. Your vet will take a comprehensive history to determine the start and severity of the disease. Physical examination includes bladder palpation to feel the crepitus (sounds of gas and stones rubbing against each other) inside the bladder or the solid stones if they are large.
Diagnosis
Urine analysis is the most useful and a sterile sample is taken by catheterisation or cystocentesis (straight from the bladder). The pH of your dog’s urine will also give a good idea of the nature of the stone. The urine sample will show the presence of bacteria, which is usually cultured to find out the type of bacteria causing the urinary tract infection. Antibiotic sensitivity tests are needed to figure out what appropriate antibiotics can be prescribed.
Uroliths need to be of a certain size before they are evident. The number and size of urinary stones seen in the x-ray may not correlate with the severity of clinical signs. A radiograph is highly recommended to find out the number and size of stones and where they are located prior to surgical removal, if surgery is required. In spite of all the tests above, the composition of the actual stone cannot be determined unless a stone sample (from the surgery or that has been urinated out) is sent for analysis.
Treatment
There are two types of treatment for struvite bladder stones; surgery or medical dissolution of the stones. The benefits of surgery include a shorter recovery period and the ability to identify the actual type of stone involved. Surgery is needed if the stones are too large as they may not dissolve medically. Disadvantages of surgery are that it is more invasive and there are risks associated with general anesthesia in a sick and/or older dog.
Medical dissolution takes a much longer time (about three months on average) to take effect and large stones may not dissolve at all. It revolves around three main concepts – to acidify urine, reduce the intake of MAP such that it does not saturate in the urine and dilute urine so crystals do not have a chance to form. Affected dogs are usually prescribed calculytic diets and appropriate antibiotics to treat the bacterial infections. No other food or treats should be given and plenty of water drinking should be encouraged.
Most importantly, your dog’s health should be reviewed every three months with urine tests and X-rays to ensure that no new stones are. Be alert as to the urination pattern of your older dog and seek veterinary advice promptly if there are signs of blood in the urine, urinary difficulty or inability to pee.
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Toa Payoh Vets
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COMPARE TO MY ORIGINAL REPORT
Wednesday, August 1, 2012
1818. Struvite bladder stones in Singapore dogs
Magazine article for Pets Magazine -‘Pets Health and Veterinary Special 2012’ in October 2012. This Special will be positioned as an educational and informative publication to benefit the health and welfare of pets through the education of pet owners.
Struvite Bladder Stones in Singapore dogs
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Toa Payoh Vets
July 31, 2012
Difficulty in peeing, not able to pee and peeing urine with blood are the most common reasons for dog owners to seek veterinary advices at Toa Payoh Vets. Sometimes, the owner sees stones passed out in the urine.
Urolithiasis in dogs is such a large topic of a few hundred pages as there are several types of bladder stones affecting the dog and their diagnosis and treatment vary. Therefore, only struvite urinary stones, being most commonly seen at Toa Payoh Vets will be discussed in this article.
Breeds usually affected include the Miniature Schnauzer, Shih Tzu, Bichon Frise, Miniature Poodle, Cocker Spaniel and Lhasa Apso, but any breed can be affected. Female dogs are said to form approximately 85% of bladder stone cases.
Some dogs may not show clinical signs of blood in the urine, difficulty in urination or inability to urinate until much later in the disease with severity of signs depending on the location, size,and number of uroliths formed. These stones can be formed anywhere along the urinary tract in the kidneys, the urethra and the bladder.
Struvite stones are composed primarily of Magnesium, Ammonium and Phosphate (MAP). They are formed within the urinary tract and occur when the urine is supersaturated with MAP (i.e. large quantities of the crystals are present). MAP supersaturation of urine may be associated with several factors, including urinary tract infections, alkaline urine, genetic predisposition and diet.
Your vet will take a comprehensive history to determine the commencement and the severity of the disease. Physical examination include bladder palpation to feel the crepitus (sounds of gas and stones rubbing against each other) inside the bladder or the solid stones if they are large.
However, a complete blockage of the urinary tract is life-threatening as the dog can't pee and the full bladder may rupture with delays in treatment. In such cases, a urinary catheter will be used to unblock the obstruction or the urine is extracted via the bladder as soon as possible. This is done to protect the bladder and kidney from further damage.
Blood screening, urine analysis and radiographs are usually performed to confirm the presence of urinary stones. Abnormal blood work may show if the obstruction of the urinary tract is severe. Blood tests may show changes to the kidney function or an increase in white blood cell counts affecting the health of the dog.
X-ray of a male dog that cannot pee. If the dog cannot pee, the likely cause is urethral obstruction caused by urinary stones being stuck inside the urethra.
Struvite uroliths are radio-dense and can be detected on radiographs.
X-ray of a catheter to push back the stones into the bladder in a female dog that could not pee at all as the stone was stuck inside the urethra
Calcium oxalate is another type of urinary stones seen in dogs
Urine analysis is the most useful and should always be done. A sterile sample is taken either via catherisation (passing a tube into the bladder) or cystocentesis (straight from the bladder). With the urine sample analysed, MAP crystals can be present but this is not always the case. For example, stones that are too well formed or too large may not shed crystals. Therefore, the vet should not deem the absence of crystals in the urine as no struvite or urinary stones being present in the affected dog.
In addition, urine pH gives the vet a good idea of the nature of the stone. Struvite crystals are formed very commonly in an alkaline environment in which bacteria is present. A urine sample can show the presence of bacteria. The bacteria be cultured to know the type of bacteria causing the infection and antibiotic sensitivity tests can be performed by the laboratory to advise on the appropriate antibiotics to be prescribed.
Struvite uroliths are radio-dense and can be detected on radiographs.
However, they need to be of a certain size before they are evident. The number and size of urinary stones seen in the X-ray may not correlate with the severity of clinical signs.
However, a radiograph is highly recommended for the vet to know the number and size of stones and where they are located prior to surgical removal, if surgery is to be advised.
Clients need to understand that in spite of all the tests above, the composition of the actual stone cannot be determined unless a stone sample (from the surgery or that has been urinated out) is sent to the laboratory for analysis.
Treatment options for struvite bladder stones revolve around surgery or medical dissolution of the stones.
Benefits of surgery include faster recovery times, and the ability to identify the actual type of stone involved. Surgery is indicated if the stones are too large or too well formed as they may not dissolve medically. Disadvantages of surgery are that it is more invasive and there are risks associated with general anesthesia in a sick and/or older dog.
For clients that are not so comfortable with surgery or in cases where surgery is not advised due to health concerns (e.g. the dog is very old and in poor health), the alternative is medical dissolution. This medical solution is non-invasive but takes a much longer time to show the effect as the stones are dissolved slowly. However, large stones may not dissolve at all. One important note to take into consideration is that there is no way to accurately determine the nature of the stone without sending it for laboratory analysis. Obviously, the medical solution is not applicable to all types of urinary stones (e.g. calcium oxalate stones), but it is especially effective and useful in struvite stone dissolution.
Medical dissolution revolves around 3 main concepts. They are to acidify the urine, to reduce the intake of MAP such that it does not saturate in the urine and to dilute the urine so crystals do not have a chance to form. For struvite uroliths, there are specially formulated diets such as the Canine S/D, C/D or W/D that I have used to dissolve the stones.
Medical dissolution of stones takes a mean time of 3 months. The time taken for complete dissolution is varied depending on the size of the uroliths and the quantity. Severe cases can take up to 6 months before the stones are fully dissolved. However, very large stones will not dissolve.
Along with this diet change, I prescribe an appropriate antibiotic course to treat any primary or secondary bacterial infection. During treatment, only the prescription diet should be used. I usually advise no dog treats or other food and to encourage the dog to drink water.
The S/D diet is used initially for 1-6 months before switching over to the C/D or W/D diet. It is not recommended for:
1. Use concurrently with urinary acidifiers
2. Feeding longer than 6 months
3. Dogs with non-struvite uroliths (urinary stones).
Transition to feeding S/D should be done over a period of seven days, gradually introducing the amounts during the transition period and monitoring the patient. Most dogs will not eat the S/D diet immediately and so the owner must be educated to switch to the S/D diet gradually over at least 7 days.
After successful dissolution of struvite stones confirmed by urine analysis and X-rays, Canine C/D or W/D can be used for maintenance. Canine S/D should not be used for the prevention of bladder stones as the diet is low in MAP and protein. Long term use of this diet is not recommended as the nutrients are not sufficient.
Key benefits of Canine S/D include:
· Low levels of MAP to aid in dissolution of struvite uroliths and crystals.
· Promotion of acid urine by reducing the urinary pH to 5.9-6.1 (targeted) to increase the solubility of struvite crystals.
· Lower protein levels result in increased urine volume and more dilute urine.
· Antioxidants are added to defend cells from free radicals and to promote a healthy immune system.
In this article, I have written about the S/D, C/D and W/D prescription diets for the medical treatment of struvite urinary stones as I have used them in my practice. However, there are other equivalent prescription diets from other manufacturers and it is up to your vet to advise you as to the type of prescription diet to use or to get bladder surgery done to resolve the problem fast.
Many Singapore dog owners do not adopt my advices to review the cases 1-3 monthly and do urine tests and X-rays to ensure that no new stones are formed after surgical removal of the stones or after using the S/D diet. They are happy to see that the dog has not passed blood in the urine and does not have difficulty in urination and continue with feeding the usual dry dog food again.
In some cases, the problem recurs and it can be heart-breaking and costly if another surgery is required. So some owners elect to euthanase the dog. Regular urine tests would have been most useful in detecting the presence of struvite stones although the absence of struvite crystals in the urine does not mean that there are no stones present. Only X-rays will be able to tell. Sometimes, a dog that has had struvite stones may become later affected with another type of stone such as calcium oxalate stones and that is why regular urine tests are so important.
In conclusion, be alert as to the urination pattern of your older dog and seek veterinary advice promptly if there are signs of discoloured urine, urinary difficulty or inability to pee. For more detailed case studies of urinary stone cases seen at Toa Payoh Vets, goto:
http://www.bekindtopets.com/animals/20081201PG7_Dog_Surgery_Anaesthesia_Urinary_Tract_Problems_ToaPayohVets.htm
Acknowledgement: I thank Dr Daniel Sing for his contribution to this article and various dog owners for permitting me to record their cases in this article
---------------------------------------------------------------------------------------------------------------------------
As only one images has been uploaded to blogger.com, see the other images at:
Toa Payoh Vets webpage:
http://www.kongyuensing.com/folder8/20120724struvite_stones_dogs_toapayohvets.htm
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