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"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.

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.

REVIEWS FOR URINARY TRACT INFECTIONS
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

CASE STUDY OF THE BRITISH BULLDOG
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.

URINE ANALYSIS 2 TIMES
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.

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

OUTCOME
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.

PHONED OWNER 10.35AM Dec 5, 2012
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.

Monday, November 19, 2012

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

Monday, December 3, 2012

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