When the urine is collected directly from a dog peeing
outdoors, there is the possibility of bacterial
contamination. In this case of one dog who had fits for
the 3rd time 2 days ago, I reviewed the record of one
urine sample collected and tested showing bacteria +++.
However, no antibiotics was prescribed by Vet 1. Vet 1
received the urine sample and handled the case
accordingly. I was not present when the owner came.
I know that the owner works in a human medical
polyclinic and knows what to do when it comes to urine
collection.
She collected the urine "mid-stream", that is, let the
dog pass some urine first and then collect directly the
next flow. The urine was collected in a container
provided by the Lab. She sent the urine in to Toa Payoh
Vets for analysis. As I was not around, Vet 1 took the
responsibility of handling this urine sample.
The urine showed 3+.
Now, in veterinary medicine, each vet has his or her own
interpretation of the laboratory results and come to a
decision on the spot.
Vet 1 judged that the bacteria was not from the urine.
Therefore no antibiotics were prescribed.
In my opinion, I would have prescribed antibiotics for a
suspected urinary tract infection. A bacterial culture
would have been advised too but due to financial
considerations for the owners, I have not asked the
owner.
I asked Vet 1 who stated that the owner did not wish to
have antibiotics.
The owner came today (Sunday) to visit her dog that I
had boarded for observation. He had fits 2 days ago and
instead of a house-call as requested by the owner, I
advised bringing the dog down. Nothing can be done
during a house-call and it costs the owner money .
On this fine Sunday morning, I asked why she did not
want antibiotics when her earlier urine test showed a
bacteria presence of 3+. She said: "Vet 1 said that no
antibiotics were necessary as the urine was
contaminated."
Now there was a difference of reply from both parties. I
needed to investigate what happened, being the licensee
and shouldering the responsibilities of setting a good
standard of care.
So, I called a meeting with Vet 1, the owner and myself
present inside the consultation room to clarify the
matter immediately, as to why the owner did not want
antibiotics. There are some Singapore owners who don't
want antibiotics nowadays and so Vet 1's explanation
would be logical had I not asked the owner's side of the
story. The vet on the spot has to judge. And be
responsible for the judgment.
At the meeting on this busy Sunday morning, the owner
denied having said she did not want antibiotics. "Why
would I reject antibiotics when my dog's urine has
bacteria 3+?" she protested.
Vet 1 said: "It is a mis-communication." It was an
emotional meeting to clear the air as the owner was very
upset over this matter. A dog with three fits is a very
stressful to any owner. This dog had a sudden attack,
ran to her father screaming. Foam spilled out of the
dog's mouth. When the dog was calmed down, the dog
started pooping and peeing all over the apartment. She
phoned me for a house-call but I told her it would be
better to send the dog down for my examination. She had
not told me of the 2nd fit episode.
I had a blood test, urine test, X-ray of the chest and
abdomen done with permission from the owner. I reviewed
the urine test result done some 3 weeks ago and noted
that Vet 1 had not prescribed any antibiotics. Hence,
the situation arose when I found this out.
A vet has to be responsible for his judgment but
sometimes it is a matter of mis-communication on the
spot. The solution is simple for the vet when the owner
is against medical advice. Record this advice down in
the case sheet clearly and if possible, get the owner to
sign: "THE OWNER HAS BEEN ADVISED BUT REFUSED
ANTIBIOTICS."
Sometimes, I do not prescribe antibiotics if I deem it
unnecessary. In one case, I spayed a female dog and had
given an antibiotic and pain-killer injection. As the
spay was a smooth short surgery, I did not deem it
necessary to give antibiotics and pain-killers at home.
However, the owner's wife wanted the medication. The
harassed husband came for them. I prescribed the
antibiotics and pain-killers for the next 4 days.
The husband came for the medication. He gave me a
feedback, saying he wanted to bash Vet 2 up. "Why?" I
asked. He said: "Vet 2 shouted at me from inside the
consultation room when I asked a question how long the
pain-killer injection lasted. Sitting on his chair and
shouting from inside the room. So rude!"
I said: "From my knowledge of Vet 2 over the years, he
has a gentle personality."
Later, I asked Vet 2 what had happened. Vet 2 said that
he was busy consulting and therefore shouted out the
reply.
Much could have been avoided had I prescribed
antibiotics and pain-killers for 4 days after the
operation as I usually do. You can say it was a lapse of
judgment, but I find that dogs and cats who had one
post-op injection of antibiotics and pain-killers do
well.
Sometimes, it is best to prescribe antibiotics as it is
hard to tell whether the infection will set in. In any
case, a dog urine with bacteria +++ definitely requires
antibiotics and failure to give them may constitute an
act of negligence in a court of law if a "reasonable
man" (i.e. a vet) will prescribe antibiotics in such a
situation. Singapore owners are much more sophisticated.
They will check the internet first to do research before
consulting the vet.
In this case of the dog with the 2nd fit, the owner did
not inform me about the incident till Sunday. As to the
cause of the fit, most of the causes are idiopathic,
i.e.. unknown.
However, based on the fact that the dog had urinary
bladder stones removed and had fits just after the
surgery (first episode seen at Toa Payoh Vets and the
owner was informed) a few months ago, there could be a
relationship to urinary stone formation. In the 3rd
episode, the dog had passed blood, blood was 4+, White
cells very high, the pH was 8.0 (alkaline) and struvite
crystals (2+) was detected in the urine.
The owner had fed rawhide as she felt that the dog's
quality of life must be poor, eating SD diet every day.
She had told me that whenever she changed to other diet,
the dog's urine would be cloudy. So she switched back to
S/D and the urine would be clear.
Since she had deviated from the S/D diet and tried other
food, would this be the cause of recurrence of urinary
bladder crystals and high pH? It is hard to say. X-ray
did not show any radio-opaque struvite stones.
More urine and other test need to be done monthly or
3-monthly. But few owners do bother. Till another
episode of fits. In conclusion, it is best (for the
owner's peace of mind) to prescribe antibiotics
post-surgery or when urine samples show high bacterial
count. Owners have to do their part in the
management of fits in dogs. Many causes of fits are
unknown.
In this case, my hypothesis was some imbalance in the
urinary system and infection of the urinary tract
possibly from the raw hide to the blood stream and then
the urinary tract system.
"Has the dog been humping pillows?" I asked when I
retracted the prepuce during my examination together
with Vet 1. On the left and right lateral sides of a
normal penile shaft, two bright red bleeding spots
appeared like "red eyes" of a snake, if you can
visualise. It was a most unusual sight as I had never
seen such an appearance. If one is superstitious, one
would say this was supernatural. A tall tale.
Incredible. Not possible. Gone whacky. But this was a
true observation.
The owner said: "His penis was hanging out yesterday." I
advised neutering to stop the hypersexuality behaviour.
The lady said: "Wait and see."
TOA
PAYOH VETS
