1221Singapore veterinary education shih tzu corneal injuries eye ulcer

EDUCATIONAL TIPS FOR VET UNDERGRADUATES
I write this case of contrasting urine colours for vet undergraduates who may be struggling to remember so much information for their 4th year examinations. I hope the following cases will bring veterinary medicine alive to students who unfortunately don't have the opportunity to see many interesting cases (being students)!

More details of the following cases are at:
Urine tests for 2 dogs - shivering and leaking urine Part 1

Dog 1 - Miniature Schnauzer, 2 years, male, not neutered. Dog was groomed one week ago but the house-call groomer prohibited the owner to see. However, he recommended one "shampoo" for the dog. The daughter applied directly onto the legs the "shampoo" to make the hair silky and not tangled up. However the dog licked off the "shampoo" and started shivering and vomiting after 1 day.

Dog 2 - Shih Tzu, 10 years, male, recently neutered and repair of right perineal hernia. 4 days ago, had fever and urinary tract infection was diagnosed. Dog was given medication of antibiotics.

Complaint
Dog 1 - Shivering for 2 hours yesterday. Vomited twice after consultation.
Dog 2 - Cannot control bladder. "Bites when backside is touched" the mother said. Tongue pale. Vomited once after consultation during hospitalisation.

Presenting signs
Dog 1 - shivering
Dog 2 - urinary incontinence

Coincidental cases. Mum and young adult daughter

DOG 1
Miniature Schnauzer, 2 years male, shivers for 1 hour yesterday. Working daughter brought in the dog. Why? Had a history of shivering after tick wash. A home groomer had come 2 weeks ago to the apartment as the dog had tick infestation frequently. But the groomer refused to let the mum and daughter watch.

"He never humps or climbed our legs when we are around," the daughter said. I noted that the penile tip is red and inflamed. Slight pain in the right ear horizontal canal and L/S spinal area. Allergy to shampoo or environment? Excessive ear hairs trapping dirt and "ticks" inside the ear canal? Head shaking for the past 3 months, the daughter volunteered the new info. Fits of unknown cause? Distemper encephalitis? So what is he problem?

The urine was orange brown in colour.

DOG 2

Two dogs' urine test analysis - ingestion poison, prostatitis, urinary tract infection, toapayohvets - singapore

The mother brought in the dog. "A vet cannot predict whether the dog will die or not." I said. "Blood tests and urine tests are important in the aid to diagnosis." The daughter messaged from the school while she was in clinic. The Shih Tzu keeps licking penile area. Urine incontinence. Had been treated for UTI and right perineal hernia repair.

The mum said: "The Shih Tzu had been taking the antibiotics and medication for the past 4 days. Yet he is not OK. Why?" the mum asked. I said: "I need to do blood test and urine test again." I used a catheter to collect the urine. It was light yellow in colour.

I took pictures of the two urine samples in bright sunlight as they were contrasting in colours.

"I thought he had died," the mum said. The Shih Tzu, male, neutered, 10 years old was motionless. He had a right perineal hernia repair and then neutering 2 weeks ago on 5.8.10 and went home on 16.8.10. He was Ok for a few days at home. Then he stopped eating for a few days and collapsed as if he had died pm 20.8.10.

20.8.10:
Bladder felt firm and enlarged. Urine was collected by catherisation. Urine test indicated a Urinary Tract Infection. He had a high fever and was given antibiotics and sent home. The dog went home the next day but came back again on 23.8.10 as he could not control his bladder and "bites when his back is touched."

23.8.10
I found that he had a high fever and was pale. He was licking his private parts and urine kept leaking out. I noted that the urine was chalky white in colour.

Palpation: Bladder felt firm and a painful hard globular lump was felt in the bladder area. It could be an enlarged bladder wall, bladder tumour or prostrate enlargement.

2. I emptied the bladder using a catheter and syringe to draw out the urine. 15 ml of urine came out. Then I palpated the bladder. A little amount of urine came out but a rounded lump of 3 cm x 3 cm was distinctly felt. This was the enlarged prostate and the dog reacted painfully..

3. Rectal digital palpation when the bladder is emptied. This confirmed that the prostate was enlarged.

Diagnosis: I diagnosed this as prostatitis and enlargement. Also epithelial cells seen in urine test.

BLOOD TEST
23.8.10 Creatinine was below normal. Red cell below normal. Total White Cell above normal. Neutrophils 97% (Absolute 17.2 x 10^9/L), Lymphocytes 2.5% (Absolute 0.45X 10^9/L). During the first evening of hospitalisation on 23.8.10, I noted that the tongue was pale. The mother noted that too.

URINE DIPSTICK TEST ON 23.8.10
"Kidney failure," my 2nd assistant based his diagnosis on the

Acute prostatitis in an old dog. urine test - low specific gravity and high white blood cells, singapore

very low specific gravity of the urine seen on the urine dipstick. "It should be 1.020 in the dog." I was surprised by his remarks. However, it is good that he is free to express his diagnosis and share his knowledge.

The low SG meant that the kidneys were not functioning and therefore my assistant declared kidney failure to me. The owner was not present as such news could cause considerable worries.

Is this a case of an acute kidney failure? I advised the owner to have the urine tested 24 hours later. The Specific Gravity was confirmed low at the first collection but was normal when checked by urinalysis 24 hours later. The dog went home soon and had no kidney disorder as at August 30, 2010.

URINALYSIS BY THE LAB
23.8.10 Colourless, slightly turbid. pH 6.5 (5-8), SG 1.005 (1.005 - 1.030). Protein - trace. Blood 4+, White blood cells >2250, Red blood cells 20, epithelial cells 0, Mucus Threads Occasional, Bacterial Occasional. Possible haemolysis of RBC in urine.

24.8.10
Vomited white froth overnight. "His tongue colour is pinker today," the mother told me. "At 7 pm yesterday when I saw him, his tongue was very pale." Another urine test was taken. Owner was advised that an X-ray or ultrasound scan might be required. "The dog had never been sick for the last 7 years," she said. Now there were some veterinary expenses and worries. The dog is still incontinent and more work need to be done.

CONCLUSION
"Can a dog die of UTI?" the mother asked me.
"A dog can die of UTI or any infection if he is not treated," I replied. "Older dogs are more likely to die when they are sick as they have lower immune system. Your dog is 8 years old and is considered an old dog." As at August 30, 2010, both dogs are alive. No complaints from the Shih Tzu owner. The Shih Tzu would be given clindamycin antibiotics for 10 days.

See: Urine tests for 2 dogs - shivering and leaking urine Part 1

See: An interesting bladder urinary stone case at:
A Chihuahua takes a long time to pee