1136. Follow up on Bichon Frise Wed Oct 30, 2013

Wed Oct 30, 2013

At 5.30 am, I woke up and checked on the Bichon. This time the caregiver complied with my instructions to let him sleep in the sheltered area outside the kitchen so that he has access to the grass to pee anytime. He would be taken to the grass at other times in the day. This morning, he had no need to rush to the grass. I said "In" which is a command to move "forward" to any place I wanted him to. He has this habit of barking loudly whenever anyone comes to the front door as he positions himself in the living room. It is good but as some family members come home at 3 am, his loud barking disturbed my sleep. Whenever he barks in this way, I will get up and train him by depriving him of the privillege of being in the living room. He would have to go to the kitchen and stay there whenever he barks in this way in my presence. My family members do not adopt this method of training and so he is 70% trained. Yesterday when I came back in the afternoon, he barked again.

In medical dissolution of the struvite stones, the Bichon must also have access to the grass to pee and that is why he cannot stay indoors. We lock our front and back doors to prevent burglaries and so the dog will not pee for more than 10 hours per day till he is let l oose  outdoors to the grass.   

For the past 7 years, he lived indoors and would hold his bladder till it is full and go to the grass in the evenings once a day. This is quite common for dogs as they don't want to soil the inside of the house or apartment and are not paper trained. Urine stasis leads to urinary stone formation in this Bichon as he was fed mainly dry dog food and given treats by family members daily. He prefers to be indoors and so would not pee till brought to the grass outdoors. Sometimes after work past 8 pm, I would take him to the grass. His usual habit would be to raise his right leg and urine marked the lamp-post and other places. A few drops of urine here and there peed out within a second or two.    

This morning at 5.30 am, after complying with my "In" command, he gave up thoughts of coming into the house and walked down the steps to the back garden grass. He stood like a while looking at me and then raised his right hind leg and stood like a statute.

I counted "1, 2, 3......." till he stopped peeing by putting down his right leg. Today, he took just 13 seconds approximately. His urinary catheter was removed by Dr Daniel yesterday evening as it is not advisable to put it in for more than 2 days to prevent bladder infection. He is still under medical treatment as an alternative to bladder stone surgery and so he must be allowed access to the grass at least 3  times per day nowadays. The caregiver is the one who must be trained to understand the rationale of ths need to access the grass to pass out any crystals dissolved by special diet. As for today's observation, it seems he can pass urine much faster than yesterday 2.30 am at around 55 seconds from raising to lowering of his right leg.

There needs to be a lot of work to get this dog to pee and the responsibility is great.     

1135. Travel story. Purchase of a How-To You Tube book in New York

On my last day at New York, I did not want to go to the top floor of Rockerfeller Centre where I can see the panaromic view of the city at "The Rock". I had only 2 hours before going to the airport to go back to Singapore. So I took off to Barnes and Nobles nearby. It is a small 2-level store with basement and does not sell veterinary books or even "The Pill Book for the Dog and Cat owner".The employee checked her computer and said that she would order from Ohio. I had bought "The Pill Book" for human beings earlier at a supermarket where the tour guide took us to. There was "Medi-Sleep" which he recommended for those who can't sleep. It contains 50 mg diphenylhydramine which is for cough mixture.

I had no time to visit another Barnes and Noble 30 blocks away which was half an hour's walk. I bought a "How to You Tube book" and went back to the tour group at 4.30 pm to go to the airport for home to Singapore.  It is a pity that I did not know the Public Library of New York is at 5th Avenue too and so did not visit it. The tour group leader was giving what the Singaporean tourists want - the malls of 5th Avenue and said nothing about the book stores or libraries. So we all went on our materialistic ways to one side of 5th Avenue where the upscale shops are. The other side is where the bookstores and Public Library are and the tour guide did not mention this. He simply stated that the other side had no upscale shops.  It is like Ion Shopping Centre in Singapore's Orchard Road with upscale shops. Don't go to Plaza Singapura side as the tourists will see "nothing" of interest. The National Library will be at that dull side.        

1134. Follow up on Bichon Frise at 2.30 am. 55 seconds to complete peeing

Monday Oct 29, 2013

At 2.30 am, I woke up. I took the Bichon to the grass as that is his usual elimination area. He has a urinary catheter bandaged since 2 days ago, on Sat evening.

He stood, raised his right hind limb while balancing on3 legs. I counted 55 seconds before he put down his right hind leg indicating he had peed.

He will not pee indoors and will hold his urine for around 12 hours till he is ler outdoors. Urine stasis encourage crystal deposits and infrection as in people, leading to UTI and stone formation.
He does not pee on newspapers or pee tray and so he had been holding onto the urine for the past 7 years. When he goes to the grass, he will urine mark a few spots, esp. the lamp post although he had been neutered as a young dog.

Therefore, the lifestyle of the male dog - holding back urine to urine mark, leads to stone formation and UTI.

1133. Follow up on Bichon Frise Oct 27, 2013

Oct 27, 2013 was a Sunday. In the early morning, I got the Bichon Frise to go to the grass. I noted that the Bichon Frise whose urinary catheter was taken out the previous evening, strained but no urine came out. His bladder was distended about the size of 2 golf balls. He was given canned S/D diet but would not eat it. Many dogs don't eat it. The trick is to give 90% of canned A/D and 10% of S/D initially if this happens, increasing daily to 100% of S/D. But few owners comply with such instructions and would not bother.

In the evening after I returned from the Jurong Bird Park dinner hosted by the SVA till 11 pm, Dr Daniel had just taken the dog to Toa Payoh Vets to irrigate his bladder under sedation. A urinary cathether was used to flush out the bladder. "I used a bigger catheter," he said. "There was no urethral obstruction. There are only two stones and he gets obstructed again."

"From the X-ray, the urethral stone is the one causing the problem. It is small, about 3 mm across and will lodge inside the urethra near the bladder, causing difficulty in urination. When you used the small cathether, it by-passed this urethra but did not dislodge it, as evident from its presence in the X-ray."

October 28, 2013
At 6 am, I got the Bichon to the grass. He stood a long time like a statue trying to pee. He had the urinary catheter bandaged and wrapped around his waist. After a while, he went indoors and ate only the canned A/D food. "Given 10% of S/D mixed with A/D 90% until he eats all S/D," I advised the caregiver. The canned S/D was offered in full and was discarded for the past 2 days as the caregiver said the dog would not eat it.

DIETARY AND MEDICAL DISSOLUTION OFL THE TRIPLE PHOSPHATE CRYSTALS AND STONES

1. No stones were recovered for analysis as no surgery was done.
2. Uro-hydropropulsion using catheter and syringe did not recover the small stones.
3. CATHETER-ASSISTED RETRIEVAL OF STONES. The bigger urinary catheter was used yesterday to irrigate and flush out the stones using normal saline. The recommended saline infusion is 4 ml/kg bodyweight so as not to overdistend the bladder. The bigger urinary catheter may need to be slit open at one end to permit that small stone to be aspirated out.

The diameter of the hole at the end of the catheter should be around 5 mm. This is easier said than done. The aspirated saline into the glass cup should be checked for the stone which can be retrieved for analysis.
As this dog is not my patient and each vet has his or her own way of treatment, the point No. 3 regarding enlargement of the "eye" of the end catheter is my opinion.

CONCLUSION
This dog has only two stones (triple phosphate) and high alkaline urine, with bacteria 2+. It is the smaller urethral stone that causes difficulty in urination due to obstruction. Some reports claim* that it takes 2 weeks to dissolve struvite stones medically in immature dogs. It is hard to say as the stone may not be just triple phosphate crystals and no actual stone is available for analysis. This case will be monitored closely for medical treatment without surgery.

Reference: Small Animal Clinical Nutrition   Hand, Thatcher, Remillard, Roudesbush, Novotny 5th Edition, Pg 830-831.


5. Medical dissolution using acidifiers rather than S/D diet may be used for 4 weeks but it is better to use S/D diet for 4 weeks.
6. Bacterial infection of the bladder (UTI) to be treated.

7. Urinalysis to be done weekly.

 

1132. Follow up: Bichon Frise has difficulty peeing once catheter is taken out

I observed the 7-year-old Bichon has great difficulty peeing this morning and kept licking his lips.
From the X-ray, the stone has lodged and obstructed the urethra once the catheter is taken out. So, an op is necessary. No point trying to acidify the urine and dissolve the struvite stones which can be done if there is no obstruction.

The dog seems to be losing weight. I am worried that the kidneys would be affected. Dr Daniel has scheduled tomorrow for surgery.

The X-ray did not show clearly the stone in the urethra. The other young vet who took the X-ray said there was one and I could see it too. It was faint and not radio-op on the lateral view. None seen on the V/D view. So, Dr Daniel was not fully convinced.

"Is there difficulty in passing the cattheter?" I asked.
"Yes," he said.
"So, there would be the stone inside the urethra before the bend," I postulated   

1131. Earn more when you have your own vet practice?

I had this comment with a young vet when I asked if she would be opening her own practice.
"You earn more when you have your own practice," she said.
"This is not correct," I said. "There are over 60 practices in Singapore. Unless you have no nearby competitors in the housing board estate as in Woodlands, you will not generate income. With investments and equipment and overheads, you will lose money!"

Vet students are never taught the economics of practices in the Vet School and so they have no idea of depreciation of equipment and other costs which make suck in the expenses, leading to low net profits or even losses. More than one practice has just closed down.
 

1130. Retained abdominal testicle in cats

I seldom see such cases. It appeared to be common when I spoke to two young vets at other practices.

1. Vet 1 has many stray cats brought in for sterilisation by activists. "Very common," she said. "Do you hook out the testicle inside the abdomen" I asked.
"No, the vas deferens may be ruptured."

2. Vet 2 saw her 2nd case as she consulted me.. 
"Just open up the abdomen and the smaller retained testicle is lying near the bladder area," I said.
"I watched a video where a hook is used to pull out the testicle," she told me.
"It is theoretically possible as in a spay, but I have not done it."
"How many cats have you seen?"
"This is the 2nd one."
"What did you do for the first one?" I asked.
"It was rejected as my senior vet asked me not to do it."
"Are you sure it is not the same cat?" I asked as I thought this was a rare condition in cats.
"It was a domestic shorthair and the present one is a Persian."
I would like to video this case if possible.