Thursday, September 20, 2012

1110. DR SING'S AUDIT CASE. Not eating - Urinary stones in another Miniature Schnauzer


Jul 29, 2012
Miniature Schnauzer, White, Female, 5 years
High fever (40C) and no appetite

Associate Vet (Vet X) palpated >10 stones in bladder

Blood test, urine test, stone analysis

Jul 30, 2012

Jul 30, 2012
Blood test
Total WCC 21.6  (6-17)
N 96%  Absolute 21
L 4%     Absolute 0.82
M 0.4%
E  0.1%
B  0%

Platelets  98 (200-500)
Platelet clumping

Aug 1, 2012 
Urine test
pH 9.0   SG 1.005   Nitrite +, Protein 3+, Blood 4+, Bacteria 2+WBC 180  RBC >2250
Crystals Nil
Casts  Granular cast occasional

Aug 2, 2012 stone analysis
Calcium stone trace
Phosphate stone +
Oxalate stone trace
Magnesium stone +
Ammonia stone +

This case confirms what is known. No crystals inside the urine does not mean no struvite stones.
Alkaline pH + bacteria (urease) + bacteria  leads to formation of MAP (struvite stones).

Sep 20, 2012. Review by me. I asked Vet X to put in writing that therapeutic diet S/D has been advised at least from 1- 3months. If there is recurrence, Vet X cannot be blamed. Advice on monthly
urine analysis. Preferably X-rays 3 monthly.

The children came to buy 2 cans of S/D recently. There need to be more rigorous follow up by Vet X and documentation of advices on medical records in case of recurrence as surgical costs can be very high and owners can be very unhappy when there is a recurrence. Sometimes, they just euthanase the dog to save on costs of surgery.


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