TOA PAYOH VETS
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Date:   23 November, 2012  

Focus: Small animals - dogs, cats, hamsters, guinea pig, turtle & rabbits.

The Schnauzer vomits and dribbles urine
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
23 November, 2012  
TOA PAYOH VETS 
Be Kind To Pets
Veterinary Education
Project 2010-0129

Friday, October 19, 2012

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
tpvets_logo.jpg (2726 bytes) 5742. Kidney stone Nov 2011? Vet 1 did not extend the X-ray area to the kidneys in this first occurrence tpvets_logo.jpg (2726 bytes) 5742. Kidney & bladder stones. Aug 2012. tpvets_logo.jpg (2726 bytes) 5743. Kidney & bladder stones. Oct 2012. I would be removing the bladder stones soon tpvets_logo.jpg (2726 bytes) 5755. Kidney stones. Nov 2012. No bladder stones
Nov 1, 2012 Aug 18, 2012 Oct 19, 2012 Nov 22, 2012
tpvets_logo.jpg (2726 bytes) 5742. Kidney view not shown  tpvets_logo.jpg (2726 bytes) 5743. Kidney & bladder stones tpvets_logo.jpg (2726 bytes) 5745. Kidney
 & bladder stones
tpvets_logo.jpg (2726 bytes) 5759. Kidney stones. No bladder stones
 

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?

 

1194. Follow up. The Schnauzer vomits again - bladder stones & kidney stones

 
Thur Nov 22, 2012

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.
tpvets_logo.jpg (2726 bytes) 5755. Kidney stone Nov 2012. Vomits one month after my bladder stone removal surgery tpvets_logo.jpg (2726 bytes) 5759. Kidney stone Nov 2012. No bladder stones

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.

Urine analysis revealed amorphous urates 2+ in urine pH 6.0, USG 1.017, blood 3+, bacteria 2+

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.

 



Other articles:
The vomiting Schnauzer has kidney stones too
The Tibetan Spaniel panted continuously for 3 days. Urinary bladder stones seen. 

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