Wednesday, July 26, 2017

3110. Urinary stone prevention diet. Does it work? 3 case studies

CASE 1. BLADDER & KIDNEY STONES
HISTORY
Shih Tzu, MN, born 2006
In Sep 2014, the dog had difficulty passing urine. Vet 1 palpated a "bladder stone" and advised surgery, saying X-rays were not necessary.
The owner consulted me at Toa Payoh Vets. X-rays showed one bladder and 2 kidney stones.



After bladder stone removal at Toa Payoh Vets in Oct 2014, the owner did not feed the prescription diet to prevent bladder stones regularly.

In April 2016, the Shih Tzu passed blood at the end of urination. Soft bladder swelling palpated 
Urine analysis. pH 6.5, SG 1.02, Protein 4+, Blood 4+, White blood cells 900. No urinary crystals.
suggestive of bladder stone or tumour with cystitis. 

X-ray showed more than 2 kidney stones and a soft bladder mass was palpated. 

The owner fed prescription diet regularly and there is only occasional turbid urine but no more blood in the urine or difficulty in urination.




FEEDING PRESCRIPTION DIET RECORD FROM TOA PAYOH VETS


Oct 7, 2014  bladder stone removal surgery

Sep 11, 2015  Urinary S/0 7kg
Dec 12, 2015  Urinary S/0 7kg

Mar 26, 2016  Urinary S/O 7 kg


April 20, 2016. blood in turbid urine. No large stones palpated in bladder.  Cystitis? Bladder tumour or non-opaque stone in X-ray. Switched to Hills' C/D/

April 27, 2016  C/D  17.6 lbs
Owner did not come to Toa Payoh Vets for C/D. 

Jan 31, 2017 C/D  17.6lbs
April 30, 207 C/D 17.6 lbs
Jul 27, 2017 C/D  17.6 lbs.

 Owner says that the Shih Tzu, MN, now 11 years old, has no urination problems and is fed C/D. The other dog, a younger Schnauzer eats commercial food and has no urinary problem. The Shih Tzu consumes the 17.6 lb bag every 3 monthly. 


Conclusion. Difficult to get the owner to do further tests like urine analysis or X-rays as the dog had no problem in 2017. He had been feeding the Shih Tzu solely on the Multicare C/D which is said to reduce oxalate and struvite reccurrence. No other dog food or treats. 

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CASE 2   Miniature Schnauzer, M, N, 12 years. FEEDING OF PRESCRIPTION DIETS
The dog's urine pH is acidified by the feeding of Royal Canin Urinary S/0 as shown in the urine test on July 2017.  In Oct 2016, the pH was 8.0 (alkaline) and it had amorphous phosphate crystals.
However, the dog had dysuria in July 23, 2017 attributed to cystitis.
There was some urethral obstruction at the bend of the urethra during catheterisation, but no big stones are seen on X-rays. The dog has recovered. X rays are shown below. 




  The owner has 2 dogs as in Case 1. So, there may be eating of commercial diet of the other dog affecting urinary pH, causing cystitis. The dog is OK now.

CASE 3.
Shih Tzu, M, 11 years. ATTEMPTED DIETARY DISSOLUTION OF URINARY STONES
The owner attempted to dissolve the urinary stones diagnosed by Vet 1 some one year ago, by feeding Royal Canin Urinary SO. However in July 2017, the dog had great difficulty peeing. X-rays show 2 large urethral stones in the os penis. These 2 stones were flushed back into the bladder which was opened to take out the stones. The dog is OK now.  Stones are sent to the lab for analysis. X-rays are shown below.






Dietary dissolution of urinary stones can be done for struvite stones but these stones must be struvites and must be small.
X-rays of Vet 1 was requested, but the practice said it had no such client. .

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