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Date:   27 May, 2009    
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Toa Payoh Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures

Can a home-cooked diet dissolve large urinary stones in the bladder?
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: November 12, 2006
Case updated: May 28, 2009

"It is best that you do not advocate surgery to be done by me," I advised my ex-nurse. "Your boss may infer that you are drumming up business for me. He is a really nice gentle giant from overseas. Courtesy and discretion may prevent him from telling you and hence offending you."

Her boss' 3-year-old female Miniature Schnauzer had been passing blood in the urine for some months. Jenny had felt a hard "stone" in the bladder. This woman with over 20 years of dog experience had instantly diagnosed bladder stone.
She scheduled a surgery after getting quotations from me and elsewhere. She is one of those rare employees who cares about her boss's business - the need to minimise expenses for her boss.

I suggested X-ray of the bladder to confirm it. It could be a bladder tumour but the hardness and crunchiness of the stones would lead to one diagnosis - bladder stone. 

Since I do not have the X-ray machine, I asked her to get it done at another practice. An X-ray is important to check whether there are any other urinary stones in other parts of the urinary system, other than the bladder.

The other vet recommended a home-based diet to get the bladder stone "dissolved." So, I did not hear from Jenny for some time after the X-ray nor did I attempt to solicit business from her by following up. Sometimes, I do lose cases to the competitor when sending the dog for X-rays. 

2 months later, Jenny phoned me to get surgery done and that was how I cam to know what transpired after the X-rays.

"Stones felt like a figure of 8" Jenny said when she palpated the bladder. "How could such large stones dissolve when the home-cooked food is fed?" 2 months of home-cooked food and no stones dissolved.

Reddish blood, bright and red stained the backside of the Miniature Schnauzer every day.

Jenny's boss had accepted the medical advice of the vet to dissolve the stones using home-cooked food.

But the female dog kept passing blood in the urine. Jenny decided finally to operate. So, I told her that she had a conflict of interest in the sense that she was my ex-nurse and now the other vet had given a separate opinion to the owner who was her boss.

"How in the world can such a large bladder stone disappear?" Jenny was skeptical and must have been very fed up with having to care for this dog as well as being distressed in seeing blood in the urine for so many months. "The dog is still passing blood in the urine everyday!"

The conflicting veterinary advices had postponed the operation by more than two months. What to do now?  It was not a normal situation for any dog to pass blood in the urine every day for so many months. 

Ultimately, it is up to the owner or the care-giver to decide. If this was my dog, I would opt for surgery rather than try medical dissolution of the struvite stones.

An infected bladder over time would lead to infections of the kidneys or death. That would not be good for this dog.

Jenny decided to get the stones removed. It was better late than never as this dog could just die in time to come as the bladder ruptures or the toxins from the bacteria in the bladder spread to the kidneys, liver and other organs.

Follow up:  Feb 4, 2007.
Four months after surgery, the dog was normal despite a delay of more than 10 months of passing blood in the urine before the surgical removal of the bladder stones. 

Now she does not pass blood in the urine. She can control her bladder and does not dribble urine or is incontinent.

She had been on dry food from puppy hood. Home-cooked food was advised to prevent recurrence. Stones were not analysed but the structure of the stones were indicative of struvite bladder stones formed in an alkaline urine environment by urease-producing bacteria.

Follow up: May 28, 2009.
Jenny said that there were no urination problems in the Miniature Schnauzer. No prescription diets or regular urine tests for bacteria or stones in the bladder were done on this dog as most Singaporean dog owners don't believe in spending more money than necessary.  The dog urinated normally everyday. That was the outcome desired by the owner.   

tpvets_logo.jpg (2726 bytes)Toa Payoh Vets Clinical Research
 

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All rights reserved. Revised: May 27, 2009

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