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