2150. A female Miniature Schnauzer has bladder stones packed to the gills again

May 11, 2015

Another case of recurrent struvite bladder stones 19 months after removal by Dr Daniel in Oct 3, 2013. This 5-year-old female Miniature Schnauzer has bladder stones packed to the gills.
Schnauzers have a familiar tendency to develop urinary stones and owners need to monitor the urine and do X-rays regularly to prevent recurrence.


Nearly 100% of the Schnauzer owners do not bother to come for regular monitoring and they either put the dog to sleep, get the dog operated again. But some kidney stones are inoperable as the dog also has septicaemia and kidney failure.

Images of today's surgery for this female Schnauzer are:

 



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FLASH BACK TO OCT 2013   FIRST SURGERY RECORDED IN BLOG NO. 1173

Wednesday, October 2, 2013

1173. Audit: A young Miniature Schnauzer has a bladder full of big stones

"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 cathether 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.

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.

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 bladdder 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.

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 normal. 

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UPDATE IN MAY 12, 2015
The owner did not come back for check up or follow up since the first surgery done in Oct 2013. The stone analysis reveal MAP (Magnesium, Aluminium, Phosphate) and Calcium.  Yesterday, the dog was operated and more than 40 large stones and a hundred small ones were removed from the bladder. The kidneys do not have any stones.  See top of page for latest information.

1191. FIC (FUS, FLUTD) in cats. Dr Susan Little's talk on urethral obstruction, FIC in cats

May 10, 2015. The talk at M Hotel, on Sunday, a Mother's Day was limited to 50 pax and was full house. Dr Susan Little is a co-owner of 2 cat clinics and an author of cat books, amongst other veterinary achievements. Here are some of her opinions.

1.  URETHRAL OBSTRUCTION

1.1 Stablise the cat by decompressing the bladder in some cases, before catherisation. Do cystocentesis. Insert 25-G needle at 45 degrees towards the neck of the bladder. Not at 90 degrees or into the apex of bladder as bladder shrinks away freom the needle when the urine is collected.

1.2. Use a 3-way stop valve to draw urine and collect it for urine analysis

1.3 Massage penile tip for some time - around 10 minutes to express out the urethral plug and so avoid the need to catetherise. This method is successful in some of her cases.

1.4. She uses warmed saline with sterile lubricant to flush the bladder. Apparently the lubricant is effective in cleaering the mucosa.

1.5 A commercial firm sells the appropriate cat cathether. An orange one which is softer for indwelling. The one with the stylet (costs more) but can be used for both purposes - flushing and indwelling. Has a butterfly for suturing to penile skin.

1.6. Pain relief is important. Suggested opiod and NSAID.

Medocab for cats (Boelinger?) is great as it is tasteless and given in the cat's food. She uses it.  Her opinion is that tolfedine is old school and not as good as meloxicam.  

1.7  ACP 2.5 mg/cat oral as anti-spasomodic and anti-anxiety is said to be effective.

1.8. Duration of indwelling catheter depends on lab analysis of urine and blood electrolytes.

1.9. Recurring cases. She did not mention perineal urethrostomy in her lecture.

1.10. Damage to pelvic urethra from catherisation rupture case - dye seen pooling in pelvic area on X-ray shown.

1.11. Blood test. Monitor for K+

2. FIC in cats

2.1  Only 5% are due to bacterial infections. 60-70% idiopathic. Therefore she does not prescribe antibiotics.

2.2 Most cases are self-limiting according to her, whether treatment is given or not.

2.3 Litter boxes insufficient. Should be 4 boxes for 3 cats instead of lesser.

2.4  Pain relief is important. Opiod is her favourite.

3.  NASAL TUBE FEEDING OF CATS

She said it is easy in her practice with the nurse holding the cat. But give sedation if necessary.

Can email to her if you have queries.

1190. How your dog can live longer - The left head-tilting Schnauzer passes away at home

ed Yesterday, May 9, 2015, the 11-year-old Miniature Schnauzer that collapsed twice in the dog-sitter's boarding place passed away at home in the early hours of the morning. He first collapsed and became recumbent and trembling in his whole body around 14 days ago at the dog-sitter.

The daughter of the owner brought the dog to see me. I gave the IV drips and medication and the dog recovered and went back to the dog-sitter the next day.  "The prognosis is poor as he has very low rectal temperature," I warned the daughter.
"Can he survive till my parents come back from Japan?"
"Hard to say, but he started eating and was able to stand in the evening, after treatment."

The dog was OK for the next 4 days. On Sunday, the parents picked him up but he had collapsed again. The father brought him to see me on Monday. The blood test showed only slightly high blood urea but may not be significant. Euthanasia was not acceptable to the wife. After my injections, the dog was active for the next 2 days. He walked 15 minutes in the morning exercise. Then he became restless and paced. He started to breathe fast. These were not good signs.

I examined him again 2 days before his passing away. He was having a sore throat and back pain, probably from being ataxic and falling on his sides against the walls. I gave him a low dose of diazepam sedative IV so he could have rest for the night. I explained this action to the owners (husband, daughter and son-in-law).  The dog did not sleep soundly as the dosage was low. His breathing was fast. 2 days later, he passed away.

From the perspective of an outside vet who had not seen the case at the beginning, his opinion was that diazepam caused his rapid breathing and killed him. The dog's life was ending when he first c collapsed at the dog-sitter and suffered from hypothermia and whole body tremors. Surprisingly, he revived after treatment and went back to the dog-sitter the very next day. He was eating for the next 7 days and the dog-sitter actually took videos of him eating on the last day he was to go home. The owners were given the video clip and had shown to me. The dog collapsed again just on the day the owners came back from Japan to take him home. The husband brought him to me for treatment the following morning. I gave him the injections but he was not back to eating as before. He was pacing, restless and breathing fast. The prognosis was poor. The wife spent the last few days with her beloved dog who passed away at home. The husband texted to me the sad news.

The husband was appreciative and thanked me saying that his wife got to spend some days with her beloved dog at home, after returning from Japan.

This is a situation whereby the vet giving the sedative could be accused of killing the dog. Without sedation, the dog was restless and pacing the whole night. With sedation, he had some rest. His failing health was attributed to something affecting his brain. No MRI imaging of his brain was proposed as this would cost a few thousand dollars, I told the son-in-law.

This dog had not been able to recognise the owners for the last 6 months and was circling to the left. His mind was not normal. But he had good appetite and was much well cared for.

As to what caused his head tilt to the left, I was not the vet to examine him earlier and so I do not know the possible cause or advise a solution. 

However, Schnauzers have hairy ears and ear infections which may rupture the ear drum and cause infections in the middle ear and head tilt. Early detection of ear infections and sometimes surgery to open up the lateral ear canal or remove the vertical canal when the Schnauzer is young may prevent middle ear infections leading to head tilts.

The surgery is called lateral ear canal resection or vertical ear canal ablation.





    

1189. Make a difference in being "kind to pets" - share your knowledge in an e-book

An e-book needs to be concise and edited to help the read. Articles and correspondences in emails and comments on social media may contain too much repetition. Hence I propose you write an e-book "How owners provide good care for dogs with heart and kidney failure"

Your experiences with various owners on how to treat kidney and heart failure at home, after visit to the vet will be extremely welcome by owners. Most owners do not know how to give home nursing and most dogs do not accept medications. So, your in-depth research of your dog as well as other owners will be most useful in the e-book. Just these 2 diseases - heart and kidney failure from the owners' perspective.

Vets are quite busy and need to  keep medical and consultation costs down/ owner and reduce waiting time. There are only a limited number of working hours and if one owner takes 60 minutes to ask questions including examination (as had happened in some of mhy cases), this may not be practical. Other owners have to tolerate 2-3hour waits and get fed up or go elsewhere. It is best for owners to read up on their pet diseases and list down the questions and email to the vet.

I know that facebook and facepage are more popular. However, to succeed, I need to spend time updating regularly. I have focused on youtube and blogger.com.  

Pl send me actual links in your facebook and facepage as I can't access them.

Make a difference in being "kind to pets" when you are young. Share your knowledge in an e-book.

Best wishes

1188. Feline urethrostomy

https://www.youtube.com/watch?v=2KcuW-trvPI

1187. Kidney stones - Intense abdominal pain in an old poodle

Sunday May 3, 2015

The 12-year-old poodle is much loved. 2 years ago, she had a bladder stone removed. I advised that the few specks of stones in the left kidney can be dissolved by S/D diet. However, the owner did not come for reviews for the next 2 years as the dog was fed home-cooked food. The left kidney now has large stones.

Kidney stones do occur in dogs but are rare compared to bladder stones. In this case, the dog was free of blood in the urine for 2 years after removal of the large bladder stone. I had advised S/D diet to remove the few specks of stones in the left kidney (as seen in the X-ray).

I did not do hard sell as this may antagonise the owners.  The owner did not follow up after bladder stone removal for the next 2 years. Now the dog has acute abdominal pain and kidney failure. Singapore does not have the machine to break down the bladder stones using sound waves and in any case, it would be very expensive. The dog was in great pain and had kidney failure. No operation to remove the left kidney is advised as the dog would die on the op table.

In retrospect, if the owner agrees, the dog would be on S/D diet for 3 months. X-rays and urine test. 

1186. The 13-year-old Beagle X has diarrhoea many times for the past 4 days

Sunday May 3, 2015

"His right eye has pus and is very red," the young man said. "He has diarrhoea 3-4 x/day for the past 4 days!"

The old Beagle had circum-anal tumour removed by Dr Daniel some 3 weeks ago. He did not come back for neutering as the male hormones could cause a recurrence of the circum-anal tumour.

"Could the tumour cause the diarrhoea?" the young man asked.

"It is possible if it is cancerous and has spread into the intestines," I said.

"I would like the tumour tested for cancer."

"It is too late as you did not want it tested after surgery as we don't keep it."

"What is the cause of diarrhoea?" the young man asked. "We feed the same dry dog food,"

"The dog was boarded earlier than 4 days ago and could have eaten other food upsetting his stomach. It could be viral infections from other dogs in the boarding house, causing gastro-enteritis."

The dog would be given IV drip, antibiotic and anti-diarrhoea for the next 24 hours.

1185. An investment banker's Schnauzer keeps scratching ears non-stop

Saturday May 2, 2015

"It is the cost of the ear surgery," the investment banker had not turned up for the surgery in 2014. The dog had frequent head shaking and ear scratching for the past 2 years. So he brought the dog in for treatment of ear irrigation and medication. I explained to him that the best solution would be to do ear surgery to open up the side wall of the ear canal. 

This Schnauzer has very hairy ear canals and so there was no drainage and ventilation. The continuous scratching and vet treatment over the last 2 years added up and would cost more than the surgery.

I showed him the video of a Schnauzer after ear surgery at:
  https://www.youtube.com/watch?v=tQKGWCS-mzo&feature=youtu.be

"The Schnauzer needs some maintenance of the horizontal ear canal when his ears feel itchy," I said to him. "But there will be much less scratching every time, causing ear swelling and pain."

An appointment for surgery is made on May 12, 2015 and this time, the banker intends to keep the appointment. It seems like a hard sell to advise ear surgery. It seems expensive at $900 for 2 years at this time, but I advise surgery when it is needed by the dog to save the dog many weeks of head shaking and ear scratching. In some cases, chronic otitis externa lead to infections of the middle ear and head tilt after the ear drum had ruptured and bacteria goes into the middle ear. It will be too late.      

1184. A hardy hamster

May 1, 2015

Two brothers in their early 20s brought in a hardy hamster on this bright morning of Labour Day. The hamster weighs 33 g and has two black ulcerated tumours. One below the chest at 2 cm x 2 cm and the other below the left armpit at 8 mm x 6 mm.

"Why didn't you get the tumour removed when it is small?" I asked.

"We asked a vet and he said to leave it alone," the elder brother said that the tumours were present for around 2 months and could be cancerous. As the hamster exercised, the lower part of the tumour got worn out and became infected and now blackened.

I checked the thin hamster's teeth. He had short teeth indicating that he was still eating to survive.
"He had lost a lot of weight," I said. "He does eat judging by his short front teeth being worn out, but he lost weight due to the stress and the tumours sucking up the nutrients." 

The elder brother googled " hamster tumour surgery" or something like that and found Toa Payoh Vets. Now, the hamster is so thin, the anesthetic risk is very high. If he can survive the anaethesia, he would be OK with the chest tumour removed first as the left armpit tumour is large too. There would be insufficient skin to stitch up if both tumours are removed. In any case, the chest tumour can be sliced off in 2 seconds as it is now loose under the skin.

Vets who do not wish to operate on hamster tumours may do the owner a service by referring him to another vet who does it. 

 

 

Webpage
http://www.sinpets.com/F6/20111009unacceptable-veterinary-advices-hamster-tumouors-singapore_ToaPayohVets.htm


1183. **How to treat kidney failure in an old cat

May 1, 2105

Most Singapore owners do not comply with instructions on home treatment of the cat with kidney diseases.

CASE
Fatty, female spayed, 10 years old.

April 29, 2015
Anorexia 3 days. Not drinking 3 days. Diarrhoea (dark chocolate stools) 4 days.
Fever 40.5C.


I review the medical records today

HISTORY
Feb 2, 2015. 
Mastectomy. Left mammary gland 1 (MG1) tumour with left axillary lymph node enlarged. Histology -  Invasive ductal carcinoma (malignant tumour).  Blood test - Urea 5.3 (7.2-10.8), creatinine76 (71-160).  No leucocytosis. Platelets low  60 (300-800).
However, the cat had been vomiting for the past 2 weeks and the "left" kidney was painful on palpation.

Feb 28, 2015. Vomiting. Treated by Dr Daniel.




Mar 7, 2015
Has vomiting for the past 7 days. Thin but no fever. Kidneys painful on palpation.
Blood test - kidneys normal.  Urea 7.3 (7.2 - 10.8), creatinine 93 (71-160). Total white cell count 2.3 (5.5 - 19.5). Neutrophils 24% (35-75), Absolute 0.55 (2.5-12.5). Platelets low 78 (300-800).
Tiger Balm ointment smell in apartment.  Not to use Tiger Balm ointment which might have been inadvertently rubbed onto the cat.

PRESENT CONSULTATION
Apr 29, 2015
X-rays as kidneys are painful on palpation and enlarged with the cat growling during palpation.
Kidneys enlarged  No blood or urine tests to reduce medical costs. Given drip + baytril before going home.
Advised dialysis 200 ml Hartmann's Solution/day, next 4 days. Fortekor 5 (1/2 tab/day),, Baytril and Prescription K/D for 5 days.

FOLLOW UP
May 1, 2015
Cat is his normal self. No diarrhoea. Eating the usual Friskie dry food.
Did not accept Fortekor and K/D.

CONCLUSION
Although the blood test did not show kidney disorder so far, it is possible that the kidney failure has just started. Probably the cancer cells had gone to the kidneys, causing pain and enlargement. Owing to the need to reduce medical costs, no further are done to check on the kidneys.

I advised crushing the Fortekor dose into 4 portions of powder. Mix with honey and feed the cat. The K/D is to be fed by hand at 5% till 100% or switch to the dry K/D. The owner had given one SC drip. It is difficult to do it.  Wrap the towel around the cat to prevent clawing.

VIDEO