Monday, June 17, 2013

1469. Trust & Audit of case - shih tzu with blood in the urine (haematuria).

Medical opinions by vets differ on how to handle a haemturia case in a dog. Some vets give medication and wait and see if any more recurrences happen. This is to reduce medical costs for the owner.

Some owners are reluctant to do further investigation when their older dog has blood in the urine as illustrated by this case.  In the end, the total medical cost is higher owing to more consultations.

Shih Tzu, M, 6 years 

1.  Mar 6, 2013 - Vet 1. Haematuria.  Urethral obstruction.  Unblocked bladder. Urine analysis and advised radiographs pending urine test. Differential diagnosis was UTI or stones. No X-ray was done.

pH 7, SG 1.024, Blood +, Bacteria Occasional, Casts granular occasional, Crystals Nil

2. Mar 24, 2013 - Dr Sing Kong Yuen (myself).
Fresh blood in urine for past 2 days. No blood in urine since Mar 6, after medication.
I advised X-ray of kidney and bladder and urine analysis when there is blood in the urine after medication. I recorded "Thick bladder wall", prostate OK.

3. Jun 2, 2013 -Dr Daniel
Recurrent haematuria & diarrhoea. Dr Daniel recorded no crystals in March 2013 urine test. Advised X-ray.

Jun 4, 2013 - Dr Daniel
X-ray and urine test done.
pH 8.0  SG 1.015, Blood 4+, WBC >2250.Bacteria 2+, Crystals Amorphous phosphate +

Cystotomy to remove one bladder stone by Vet 1.
Stone analysis:
Magnesium, calcium, phosphate +ve

Any advice on prevention?
No crystal in the urine does NOT mean no urinary stone
X-ray at first consultation of haematuria in the older dog would benefit the owner and the dog especially in cases of recurrent haematuria earlier. However economics dictate the owner's decision for X-rays. 

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