1153. Retrospective study of the vomiting Schnauzer with urinary stones in kidney and bladder

Oct 23, 2012  8.56 am

The Schnauzer, F, 4 years is still not eating. But I had given her the IV drips including glucose and some hand feeding of the L/D diet. She would just lick a bit and not swallow, according to Dr Daniel who was assisting me in this case. She could sit up and look at me with sad eyes. The only good news is that she does not vomit anymore, unlike the 5 days and on the day of surgery.
I am now reading the voluminous records of previous vets and summarise the findings below:



1.  Nov 14, 2009
Health check and vaccination

2. Sep 28, 2011
Ear infections treated.

3. Feb 18, 2010
Intermittent cough when sleeping. Vomits mostly fluids. Spay and dental scaling done.
4. Nov 8, 2011
Urinating blood. Bladder stones palpated. X-ray. Cystotomy to remove stones
Stones removed digitally and by retropropulsion
Post-op X-ray - no stones in the bladder

5.  Nov 11, 2011
Cystostomy to remove bladder stones. Bladder entry swab c/s to lab.  Heavy growth of Coagulase-negative staphylococcus
Stone analysis to Minnesota. Stone and shell 100% magnesium ammonium phophate (struvite)

5. Nov 13, 2011
Discuss options
1. See if recurrence, then start food trial
2. start food trial

6. Nov 14, 2011
Follow up. Owner said dog vomited few times at night on the 3rd day afer surgery.
W/D canine dry

Nov 19, 2011
Review.  Owner says some vomiting on 3rd day of surgery might be due to eating something downstairs. No more vomiting. Advised owner to monitor for uroliths. Pet is female and there is the option of urohydropropulsion. To change from S/D to W/D as the breed is prone to pancreatitis or RC urinary s/o

Dec 2011, Feb, April & Jun 2012
W/D canine 8.5 lbs dry


Jul 22, 2012
Straining to urinate and leaking urine for 2-3 days
Bladder stones palpated and seen on X-ray
Unable to get urine for analysis
Treat UTI first, try to dissolve stones with 1 S/D can/day and review in 3 weeks.
Blood test. low RBC, HCT, HGB.
High total WCC 22.4 (5-17), N 18 (3-12), M 1.4 (0.16 - 1.1)


Aug 12, 2012
Multiple large bladder stones on X-rays. Vet 1 advised surgery. Owner did not accept advice. Went to Vet 2 who treated with antibiotics, acidifying tablets and then S/D

Oct 19, 2012
A few days ago, the owner asked me whether he could buy medication from Toa Payoh Vets as the Jurong vet was too far for him to collect medication and S/D.
I advised another X-ray and blood test as Vet 2's 2nd x-ray already showed multiple stones in August 2012 and the owner said that the urine was very smelly.

The dog started vomiting for 5 days before Oct 19, 2012. Test showed bacteraemia and toxiaemia with low platelets. Dog was operated on Oct 19, 2012. Around 13 stones removed from bladder.  Normally I don't do exploratory laparotomy in cases of bladder stones as this was the case. However, I checked the stomach and intestines for foreign bodies as there were radio-dense objects inside the
intestines on X-ray taken by me.


Oct 23, 2012.
Dog on drips and medication daily. Not eating. Alert.
At 10 am I asked Dr Daniel to take her out to have some sunshine. She peed red blood and pooped soft brown stools. No vomiting. The blood could be from the chronic cystitis of the bladder wall as stones were left too long. Also, possibly from the bladder bleeding.
So far, the dog is walking and alert. No fever. Just would not eat.

Oct 23, 2012  10.09 am
That was when I found a 3x enlarged purplish red left kidney with prominent blood vessels in its capsules and as big as a golf ball compared to the normal right kidney. Some bleeding spots near this kidney and brownish stained spot in the omentum. This was serious as the left kidney could be bleeding. There was anterior abdominal pain on palpation earlier.

She would walk about, drank water and sit on her backside. Some panting.

CONCLUSION
Each vet has his or her own advices on the management of struvite stones to prevent recurrence after surgery. Vet 1 advised S/D and W/D dry which is also indicated for struvites. For this dog, I have advised:

1. 2-3-weekly urine analysis
2. X-ray 2 monthly for 3 times
3. S/D canned food for 4 weeks followed by C/D canned food for 3 months with the usual urine tests and X-rays.
4. No dog treats or other food and no DRY dog food of any kind.
PROBLEM: What about the enlarged right kidney with the stone?
If the stones are small and packed in the renal pelvis, I hope they will pass down the ureter to the bladder and gets peed out. Wait and see as the dog is now active and starts to eat.

Due to economics, contrast radiography is not advised for the time being. Prevention is better than cure and for struvite stones in Miniature Schnauzers and other dogs, 2-monthly urine analysis and at least one X-ray of the abdomen for urinary stones are best done. Seldom do owners do it as monitoring requires discipline and planning.  
.

1152. A pet rat in Singapore fractures his tooth

Unusual case as I seldom see pet rats as Singaporeans don't keep pet rats.

October 18, 2012

This handsome black and white rat fractured the lower gum end of his low right incisor teeth as he chewed on the bars of his cage. Hamsters and rabbits commonly do that too. The tooth did not fracture completely and so he would be feeling the pain every time he tried to eat. His owner quickly took him to the vet and I was surprised to see my first pet rat patient in over 30 years of practice.


What is the solution? Clipping off both lower incisor teeth and levelling them.  Now, this young rat strenuously object to any human opening his mouth even to examine the teeth. So, I needed to put him under anaesthetic isolflurane + O2 gas and clip off both lower incisors to the same gum level. His fracture was at the gum level.

 

 

 

 

FEEDBACK FROM THE OWNER ON OCT 23, 2012

Dear Dr.Sing,

Thank you for the photos. S... is recovering well. Today - for the first time since the procedure - he was able to chatter his teeth (which he normally does when he's happy). He's also been able to start eating his regular Lab Blocks food again, albeit very slowly and with some difficulty as the teeth have just grown back a little bit. We're supplementing his diet with softer, easier to eat foods like vegetables and he doesn't appear to be losing an unhealthy amount of weight.

1151. Kidney & stone Schnauzer not eating

Today is Monday, 48 hours after operation to remove the 13 stones and an exploratory laparotomy to find that the left kidney was 3X larger than normal, as big as a golf ball, congested and red, hepatititis and congested spleen with bleeding spots around the omentum of the right kidney and one dark brown patch on the omentum, an abnormal finding. Was the right kidney breaking down due to the long delay in getting the bladder stones removed since X-ray by Vet 1 had shown their presence in August 2012?

Some bleeding from the posterior end of the wound. Bleeding and infections are complications of surgery. No fever. Could it be infection? I needed to take out two stitches to drain.  A protein and glcouse drip will be given. Other than that, the dog looks alert.

Never delay bladder stone surgery. Best is to have routine urine analysis to detect presence of stones esp. in breeds prone to bladder stone, e.g. Miniature Schnauzer. The couple with their two young children visited yesterday Sunday and the dog wagged her tail and was wanting to go home yesterday. There was already redness in the cranial part of the stitch which I presumed was due to licking as the e-collar was smaller. "My dog is great at licking," the husband said. Today, fluid came out from this part and I review again with Dr Daniel. This is a teaching case for him as this dog could have right kidney stones as shown in the X-ray.

Vets usually take the bladder to check for stones and in nearly all cases, there will be no need to check for kidney stones. But this case shows that exceptions do occur. Now what to do with the right kidney stones?

The only good news is that this dog does not vomit for the past 2 days. She was vomiting daily before surgery for at least 6 days including the day of surgery.   

"It is due to infection," my assistant Min said. "Pus comes out."
"Since the area is so clean with no blood clots unlike the cranial part of the wound, I would say it was due to licking." But the dog does not lick in the presence of Mr Min or owners and so many assume that licking could not exist with an e-collar being worn. I got Min to change to a bigger collar and got Dr Daniel to take out two stitches. "Nothing inside the wound," he said as I followed up. So it was inflammation and swelling due to traumatic licking. We gave a drip. The cephalic veins had been bust due to previous IV drips at Vet 1 where the dog had one bladder surgery to remove the stones and another surgery to spay 2 years ago.

Prevention of diseases is cheaper than treatment as Vet 1 had quoted $1,200 for the bladder stone surgery for the 2nd time and the owner said he had paid $1,800 for the first bladder stone removal surgery. That would total at least $3,000. Yearly or half-yearly urine analysis would be much cheaper but no Schnauzer owner would ever do it.

 

1150. Rabbit biting herself passes away

The owner phoned to tell me that his 4-year-old rabbit with the jaw abscess in which I took X-rays and treated, passes away in her sleep.

The young couple had boarded the rabbit at a friend's place and she started to bite off her front paw fur and lately her back paw. She was drooling and wet. The jaw abscess was not present and so it was strange that she passed away. She was on pain-killers and antibiotics and had some appetite.

"She started to bite her front legs again," the husband said. "Also her front paws."

Could this be an allergic reaction or infection? It is a mystery.

1149. An Hougang cat scratches her owner

Monday Oct 22, 2012

"It is OK," the young Malay woman smartly dressed in grey, made up well and covering her head with a deep blue head scarf had made an appointment for her cat to spay. She was from Hougang.

She got her left hand scratched as Dr Daniel held the cat while I injected the xylazine+ketamine 0.2+0.8 ml IM.  She had asked me whether she ought to be around while I gave the anaesthesia injection as her presence would calm her cat.

"My cat starts being aggressive when she is taken out of the carrier at the other vet for her two vaccinations," she said.

"It is good idea," I said. "The other female cat I spayed recently went ferocious as a lion inside the crate when the owner left and when we wanted to take her out for injection. In front of the owner, she was OK and cool."

As predicted, her cat hissed. Dr Daniel had prepared the injection. He held the cat by the scruff while the lady talked to the cat. I injected the left side of the muscle quickly.

"Is it done?" the lady asked as the cat swiped her left hand and left a claw mark more than 3 cm long. "Is your hand bleeding?" I asked,
"No, no, it is only superficial."

I was relieved that the cat didn't scratch her face but her presence was most vital to the sedation as the cat was distracted. Dr Daniel put the cat back into the carrier.
"Just close the door," I said as the lady tried to push back the fabric bedding inside. Her cat hissed out and shot another claw at her. This was a 3-year-old cat and it took her 3 years to have the courage to spay her.

"Is she caterwauling?" I asked.
"No," she said. "She caterwauled last month."
Actually cats come onto heat by caterwauling at non-regular intervals and 4 weeks is about the time that ovaries would enlarge and caterwauling would come. During the spay, the ovaries and uterus were much enlarged as a cat on heat and so it took a longer time to spay.

Young cat owners like this lady are more well informed as she knows what caterwauling means and kinder to cats. That was why she did not want her spayed as that would be 'cruel'.


 "Since the cat scratches you so often, have you thought of declawing ," I advised as cat scratches can be infectious and can cause bad scars on a young lady.

"No declawing," she asked me what tool to buy to clip the sharp nails.
"Just buy one of those cutters used to cut chicken bones or hedges," I described to her the tools. "Use the sharp tips. I don't encourage declawing and almost 100% of the Singapore cat owners don't declaw their cats. 



OCT 25, 2012
The owner just phoned at 6.30 pm saying that her cat was panting and meowing. Earlier she could not poop. But the spay wound was OK. "Can she pee?" I asked. "Not today," she said. "My cat was OK this morning." I could hear the cat meowing in the background and asked her to bring the cat down the surgery for examination.

Compared to the cat of the Nepalese couple spayed around the same time and written in an earlier blog, this cat has some strange behaviour 3 days after spaying. The cat of the Nepalese couple was much younger.

1147. Barking dog upsets peace for 96-year-old mother-in-law

Today is Monday Oct 22, 2012. I was at the clinic at 8.30 am and an interesting phone call came in at 8.55 am.

"May I know what this telephone number 6254-3326 belongs to?" the man asked. "I checked the 'internet by typing "SPCA tel no.' and I got your phone number."
"It is Toa Payoh Vets," I said. "It provides veterinary services."

"I just wanted to ask SPCA advice about my barking dog. He disturbs the sleep of my 96-year-old mother-in-law by barking every time somebody walks past the door."
"Is he a male dog and what breed is he?"I asked. "Is he sterilised?"
"He's a Chihuahua cross, male sterilised dog" the man said. "He just keep barking and barking every time somebody passes by the apartment and my mother-in-law can't rest!"

"How come my clinic phone number is displayed when you google SPCA tel no."?" the man told me he was using yahoo.com and that there was another phone number 62875355 shown.

"Dogs are good pet therapy for old people," I said. "The dog keeps the senior citizens company as the adult children usually are away at work. My son's dog barks every time somebody passes by and he still does it if I am not around. I train him not to bark at passers by using a loud commanding voice and he will not do it if I am around. It takes time to train.

So, what was the problem with this owner? The vet must understand the situation. Probably there were neighbours' complaints esp. those who need to work shifts. But an aged mother-in-law may also need peace to rest.

What are his solutions?
1. Re-homing of a 3-year-old cross takes time and is difficult.
2. Giving to the SPCA means euthanasia after a few days if nobody adopts him. "Your wife will be very upset with this," I said as the dog sleeps on the mattress beside the wife. "My wife is unhappy about giving the dog away," the husband confirmed that women are generally kinder to animals than men.

"There is one last-resort solution which involves de-barking surgery," I said. He would talk to his wife.

Barking dogs need early training when they are young. Some older male dogs just can't be trained and they are discarded.    

.

1146. Kenny Rogers at Singapore Indoor Stadium - success tips for young vets

Monday Oct 22, 2012

Yesterday evening, I had an enjoyable evening listening to Kenny Rogers singing at the Singapore Indoor Stadium. Half the Stadium was used and I would say it was 90% full. No young people of less than 30 years were present as they were not born.  Kenny said that his fans were those born before 1960s and those born after 1960s do not know about songs of the 1960s.

Kenny knows how to connect with the audience and get audience participation and singing. If you watch some of you-tube videos of Kenny Rogers, you can learn some wise tips from him on his success and longevity as as singer. He said that you can never be rich as a singer if you think you want to make money. If you sing with your heart, focus and persevere and have some talents, you will succeed were similar advices he gave during his youtube interviews of his 50th anniversary.

The Indoor Stadium's sound system was very bad but the audience enjoyed his performance. "I am waiting for 'Lady'," I thought he would not sing this song as he was finishing his act from 8.15 pmn to 9.30 pm. He sang it last and the audience appreciated it very much.

Readers may like to watch this video at:
http://www.youtube.com/watch?v=4N-D-Yfisn0  


SUCCESS FOR YOUNG VETS

Vets can never be rich if they just operate one clinic and not be a manager-owner of several clinics. Kenny Rogers can sell millions of records but vets cannot operate on millions of dogs and cats. The important thing for young vets to build their name is to be available.

 

If he or she keeps taking holidays or time off every month, more than usual, then owners just go to other vets who are hardworking. So, skills cannot be acquired or honed. Talents may be there, but the heart is not there for the pets and the clients.

So, being a successful vet practice operator is not easy too as there are high overheads of rentals, staff and stiff competition by younger vets who under price their services and talents don't mean much to Singaporeans who are seduced by the brand name and modern external appearance of the waiting room. Kenny Rogers is an example of success as a singer but there are many more are not known. 

Young vets who want to be successful must be available most of the time. Work-life balance is difficult if you want to be successful in your field. It is good for employees who want time for themselves and their families and employ other vets to run their practices. 

------------------------------

IMAGE OF SINGAPORE INDOOR STADIUM on 14 Mar 2024.
Disney On Ice performances

 

 

 

 

 

1145. KPI Vomiting female Schnauzer - Cystotomy + Exploratory Laparotomy

Yesterday, Sat Oct 20, 2012, I performed the surgery on this vomiting 4-year-old female Schnauzer. Vomiting past 5 days. Not eating. Had 2 bottles of drips before surgery today.

Anterior abdominal pain - dull whimpering sound. Why?  X-ray - a left kidney stone or stomach stones?  Liver enzymes higher than normal.
Bladder pain - struvite stones known and seen on X-ray. Still vomiting prior to surgery white mucus or water and during mask anaesthesia.


ANAESTHESIA
A: Inject sedation drug   10.20am
B: Isofl first given           10.27 am. Mask, then intubate. Dog vomited again.
C:  Isofl stopped             11.37 am
D: First skin incision       10.39 am
E: Completion of skin stitching   11.37 am

E-A = 57 min
E-D = 58 min  (time taken to check out stomach, kidneys visually and remove >10 bladder stones)
C-B = 64 min

SURGERY
1. Exploratory laparotomy. Big incision. Stomach empty. Intestines with some gas. Colon with black streaks inside. Spleen dark red. Liver dark red. Blood spots near to enlarged left kidney (3x normal right kidney - pic taken).  No foreign bodies inside stomach or intestines.  Kidney stones inside the right kidney?  To review X-ray again.

2. Bladder surgery. Bladder chronic cystitis.Wall >5mm thick, dark red, 9 big yellow bladder stones and four smaller ones. Previous bladder surgery scars. Bladder empty, size of quail's egg.
Incision 1 cm long. Stones massaged out. PDS 3/0 x.  1 apposing stitch closes mucosa. 2 layers of inverting sutures. Syringe of saline to flush out any sand.
 
UPDATE 24 HOURS POST OP (Sunday Oct 21, 2012)
Dog Ok. Drinks, not eat. Had passed water (brownish colour). On medication.
No vomiting as at 11.35 am

PROBLEM
Right kidney much swollen and congested capsule (pic taken). Kidney stones and infection?
Total WCC was high, platelets low indicating a septicaemia.
The liver and kidneys

1144. Struvite urinary stones?

Oct 17, 2012

In August 2012, Vet 1 x-rayed the 4-year-old female Miniature Schnauzer's bladder as she could not pee. "Bladder stones again," the vet recommended another bladder operation. The first operation was done. Updated report at:

http://2010vets.blogspot.sg/2012/10/1152-female-schnauzer-vomits-and.html

1152. The female Schnauzer vomits and dribbles urine

"Jurong is too far for me, I live in Hougang" the owner asked me whether he could purchase the medication for his vomiting Miniature Schnauzer in October  that had been treated by Dr Jason Teo in his Jurong clinic in August 2012. This dog had been X-rayed by Vet 1 at another practice and big urinary stones were seen in the bladder. Vet 1 advised surgery to remove the bladder stones.

As the owner had paid $1,800 to Vet 1 for a similar surgery 10 months ago, the bladder stones had recurred again. He did not want another surgery and so consulted Dr Teo at Toa Payoh Vets on a Saturday. He showed me the X-rays from Vet 1 and the stones were several and big.   

"Vomiting has many causes," I said. "Your dog's abdomen is bloated and there is pain in the anterior abdomen as well as in the bladder. I advise an X-ray and blood test."

"I had done the X-ray in August 18, 2012," the gentleman said. "Why don't you prescribe me some medication first?"

I understand that he had spent quite a bit and prescribed him reluctantly. The next 2 days, the dog continued vomiting some time after drinking water. Urine dribbled out whenever she sat down. So, was this a sure case of urinary tract infection involving the kidneys. Infected kidneys cause toxic blood and therefore vomiting. Urinary incontinence due to bladder stones irritating the bladder and infecting it as confirmed by the urine test. Easy diagnosis.
Yet there was this whole swollen abdomen, as firm as a full-blown balloon and causing the dog to wince when I palpated the anterior part as well as the bladder part. So I insisted on an X-ray. Results showed foreign bodies and gas in the intestines.

Tomorrow is Saturday and my day off. I still need to do the surgery to remove the FB as the dog continued vomiting and not eating. The IV drips for the past 2 days sustained her. The blood test showed increased white cell count and neutrophils and reduced platelets. A bacteraemia causing vomiting and possibly death if left untreated. Unfortunately surgery is the only option and highly risky in a sick dog. The man has a 6-year-old daughter.

"Is it possible her toys and possibly necklaces are thrown all over the floor and this dog had swallowed them." 

Tomorrow's surgery will provide the evidence. The wife was most furious, he said to me. I am most worried that the dog may die on the operating table. The owner knew the risks of death as the dog had been vomiting for 5 days and was having a blood borne bacterial infection. The rectal temperature was 37.6 on admission but today it was 38.5 C after IV drips and antibiotics. "I will be doing only the intestinal surgery to remove the foreign bodies," I informed the owner. "Removing the struvite stones will prolong the surgery and increase the risk of death on the op table." He understood.

Report written: Friday Oct 19, 2012  7.35 pm