1152. The female
Schnauzer vomits and dribbles urine
"Jurong is too far for
me, I live in Hougang" the owner asked me whether he could
purchase the medication for his vomiting Miniature
Schnauzer in October that had been treated by Dr Jason
Teo in his Jurong clinic in August 2012. This dog had been
X-rayed by Vet 1 at another practice and big urinary
stones were seen in the bladder. Vet 1 advised surgery to
remove the bladder stones.
As the owner had paid over $1,800 to Vet 1 for a similar
surgery 10 months ago, he did not want another surgery and so consulted Dr
Teo at Toa Payoh Vets on a Saturday. He showed me the
August 2012 X-rays from Vet 1 and the bladder stones were several and big.
"Vomiting has many causes," I said. "Your dog's abdomen is
bloated and there is pain in the anterior abdomen as well
as in the bladder. I advise an X-ray and blood test."
"I had done the X-ray in August 18, 2012," the gentleman
said. "Why don't you prescribe me some medication first?"
I understand that he had spent quite a bit and prescribed
him reluctantly. The next 2 days, the dog continued
vomiting some time after drinking water. Urine dribbled
out whenever she sat down. So, was this a sure case of
urinary tract infection involving the kidneys. Infected
kidneys cause toxic blood and therefore vomiting. Urinary
incontinence due to bladder stones irritating the bladder
and infecting it as confirmed by the urine test. Easy
diagnosis.
Yet there was this whole swollen abdomen, as firm as a
full-blown balloon and causing the dog to wince when I
palpated the anterior part as well as the bladder. So
I insisted on an X-ray. Results showed foreign bodies and
gas in the intestines.
Tomorrow is Saturday and my day off. I still need to do
the surgery to remove the "Foreign Bodies" as the dog continued vomiting
and not eating. The IV drips for the past 2 days sustained
her. The blood test showed increased white cell count and
neutrophils and reduced platelets. A bacteraemia causing
vomiting and possibly death would result if the dog was
not operated upon soon.
Unfortunately surgery was the only option and highly risky
in a sick dog with toxic and infected blood. The man has a 6-year-old daughter
who covered her nose when she visited her dog warded at
Toa Payoh Vets. "You can't be a vet," I said. "The kennels
are so smelly to you." She was one of those prettiest
6-year-olds that would grow up to be beauty queens and I
congratulated the father.
"Is it possible her toys and possibly necklaces are thrown
all over the floor and this dog had swallowed them?"
Tomorrow's surgery would provide the evidence. The wife was
most furious, he said to me. I am most worried that the
dog may die on the operating table. The owner knew the
risks of death as the dog had been vomiting for 5 days and
was having a blood borne bacterial infection. The rectal
temperature was 37.6 on admission but today it was 38.5 C
after IV drips and antibiotics. "I will be doing only the
intestinal surgery to remove the foreign bodies," I
informed the owner. "Removing the struvite stones will
prolong the surgery and increase the risk of death on the
op table." He understood and consented to the
surgery.
Nov 1, 2012
Vet 1
Aug 18, 2012
Vet 1
Oct 19, 2012
Toa Payoh Vets
Vomiting
Nov 22, 2012
Toa Payoh Vets
Vomiting again
Nov 1, 2012
Aug 18, 2012
Oct 19, 2012
Nov 22, 2012
Images of
the bladder stone removal
surgery
done by Dr Sing Kong
Yuen in Oct 20 2012
Update on Nov 8, 2012 (3
weeks after bladder stone removal).
No foreign bodies were found in the intestines although there were
areas of black mucosa in the large colon. The Schnauzer no longer
vomits after removal of the bladder stones and medication. She no
longer dribbles urine and is back to normal. As for the left
kidney stones, I advised against nephrotomy (cut open the kidney)
to remove the stones for the time being. The dog should be on S/D
diet for the next 4 weeks.
In the first 7 days after surgery, the dog passed cloudy urine or
blood in the urine once. The owner is a very busy man and I hope
he has time to do the 3-weekly regular urine analysis which he did
not do after the previous surgery. He just fed W/D diet as advised
by the previous vet while the family members fed the dog treats
and other food. No urine analysis was done to check the pH, USG,
bacteria and blood in the urine. No 3-monthly X-rays were done. An
educational leaflet may need to be given to the owner and recorded
in the case files as regards follow ups. This is seldom done by
the vet.
Struvite stones do recur and it is the responsibility of the owner
to do the regular checks so that small ones can be flushed away by
the process of "urohydropropulsion" without any need for surgery.
Once a dog has bladder stones, it is a life-long responsibility of
the owner to do regular monitoring. If not, another surgery when
big stones present themselves!
Update on Nov 17, 2012 The dog had vomited for 2 days and the owner brought her in
for treatment. Blood tests show a high total white cell count
indicating a bacterial infection and urine analysis revealed urate
crystals 2+. After an IV drip and antibiotics, the dog no longer
vomited and ate. "It is possible that the kidney stones had caused
this infection," I said. "The kidney stones in the left kidney
were not removed during my bladder stone removal surgery as
prolonged surgery would have increased the risk of death on the
operating table." The dog had been fed S/D diet since
October 2012. Now it is one month after surgery. Like a game of
chess, the bacteria had check-mated the veterinary surgeon by
causing a blood-borne infection causing the Schnauzer to vomit.
What would be the veterinary surgeon's next move?
Vomited one month ago. Had kidney and bladder stones. I
removed bladder stones, analysed as struvites. No vomiting
for past month. On last Sat, came in as dog vomited.
Warded. Vomited several hours after eating. Why?
Blood-borne infection. Urine has bacteria. Amorphous urate
2+. What's the cause and the solution?
X-rays today.
Spoke to a vet 5 years
older than me and with over 40 years of operating his small
animal practice in Singapore. He said that very rarely did
he encounter kidney stones in dogs. He had operated on one.
"Very painful for the dog, need to give pain-killers
post-op".
"Kidney stones occur in 4% of urinary stone cases, according
to one Australian specialist vet presenting at the SVA 2012
seminar," I said. "This vet said that if the incision of the
kidney to remove the stone is more than 50% of the kidney
length, the kidney would not function normally. If it was
20%, the kidney would be OK."
The X-ray showed the kidney stones to be more distinct. The
dog had been on canned S/D diet for the past month and no
other food. A lot of gas in the intestines. No stones in the
bladder on V/D view. Is there any stone inside the ureter?
This could partially obstruct the ureter and cause pain,
nausea and vomiting hours after eating. The dog still eats
and appears active. IV drips and antibiotics for the past 2
days. Wait and see.
Were the kidney stones of the left kidney URATES instead of
struvites? It is hard to tell. Very rare cases of kidney
stones seen by me for the past 40 years of practice.
Toa
Payoh Vets