Monday, December 3, 2012

1202. Compliance issues in bladder stone prevention in a British Bulldog

Dec 4, 2012. I phoned the owner of the British bulldog, female, 4 years today as part of follow-up.
An interesting multi-lobed large globular bladder stone was removed by Dr Daniel on Nov 26, 2012 and the stone is being analysed.

"My dog is OK but now passes stools every 2 days, as if she is constipated," the owner said. The dog used to eat like a horse.
"How many cans of S/D do you feed/day?" I asked as this 19 kg dog should be eating 1 and 1/2 to 1 and 3/4 cans per day.
"I feed 2/3 cans/day to prevent her from being fat."
"Do you feed dog treats, bread or other food?" I asked.
"Some vegetables and fruits, but only occasionally," she said.

COMPLIANCE ISSUESOwners don't comply with strictly feeding on prescription diet. They will give some treats, bread and fruits after a while.

Owners don't do that.

1. To prevent struvites, urinary pH = 6.2 to 6.42. To prevent calcium oxalates, urinary pH = 7.1 to 7.73-weekly urine analysis is recommended but no Singapore owners do that. Breeds like Schnauzers and Shih Tzus have a tendency to get urinary stones and reviews of UTI will have prevented costly surgeries.

STRUVITES.  Use C/D after stone removal.  S/D is to dissolve the stones.
CALCIUM OXALATE.  Use U/D to prevent more calcium oxalate stone formation. U/D does not dissolve the stones.
  Check for urinary pH

Nov 19, 2012. Blood in the urine for past 2-3 days. Urine analysis and X-rays (bladder stone).
Nov 26, 2012. Cystostomy to remove the stone. Bladder wall thickened. Dr Daniel put one appositional continuous suture  on submucosal layer and one inverting suture. I advised an additional layer of inverting suture as that would be what I would do. A urinary catheter could be used via urethra to pump saline into the bladder to check whether there is leakage but for 3 layers, I know that the closure is secure.

Nov 19, 2012.  pH 8.0, SG 1.020, Pn 2+, Blood 4+, WBC 30, RBC 720, Bacteria Nil, Crystals Nil   (history of haematuria for past 3 days only).
Nov 26, 2012. pH 8.0, SG 1.019, Pn 3+, Blood 4+, WBC >2250, RBC >2250, Bacteria 3+, Crystals triple phosphate occasional (history of haematuria for past 10 days). The dog was on trimax and medazole oral for 10 days and baytril injection. S/D X6 cans were fed.

Antibiotic sensistivity test not done.

Stone analysis pending.
Oral Baytril 2 days, trimax bid x 10 days
S/D given but owner fed only 2/3 can per day instead of 1 and 1/2 or more.

Dog active, no blood in the urine. Owner is happy.
Need to follow up to ensure compliance with C/D diet and check of urine for UTI and pH = 6.2 to 6.4.
It is time-consuming to follow up but owners don't comply and recurrence due to certain breed can recur again.

1. Switch to dry C/D
2. Give 1 and 1/2 can of S/D per day for 20 kg bulldog till the switch to C/D.
2. No home-cooked rice or vegetables for at least next 6 months 
3. Urine analysis every month.

Whether she will comply is up to her.

X-rays in the previous first report: Blog No. 1186
is at: and the report is reproduced below:

Monday, November 19, 2012

1186. Haematuria in a British bulldog. Durian seed, bladder stone or a botched up spay?

"Could it be a durian seed? My dog rushed and swallowed one yesterday, before I could stop her," the be-spectacled woman in her late 40s was not fully convinced that the X-ray showed a big bladder stone in the ventral dorsal view was really a bladder stone. Her 4-year-old spayed female British bulldog had peed blood in the urine for the past 2 days.

"There is a lot of food in the stomach and intestines," I said. "It is hard to see the durian seed. Definitely, the stone is a large bladder stone. Have you been feeding dry dog food for the past 4 years?"

"No, I stopped after she was over one year old because the other vet advised me to feed home-cooked food to resolve the skin disease problem. I only gave her the dry food in the last 2 days when she passed blood in the urine. Could it be a botched spay operation done by Vet 1 when she was one year old? When she passed urine, I could see the blood in the urine."

"If the spay had not been well done, the dog would be passing blood without any urine every 6-monthly. The blood would not just be present together with the urination." I said.

"I do not see such occurrences," she said. "How about the durian seed? I forgot to tell Dr Daniel about it earlier."

"There may be a durian seed but it is not seen in the X-ray," I said. "The big mass is the bladder stone in the bladder."

I advised antibiotics for 3 days before surgery. The owner brought her trolley and dumped her Bulldog upright inside it and took her home today. The urine analysis and blood test results are pending.


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