TOA
PAYOH VETS
Yesterday, I had a case of a Cavalier King Charles, female, 6 years passing smelly cloudy urine. She yelped occasionally when she peed. So I asked the owner to send me a sample of the urine.
On March 2, 2013, she collected the urine in the clean pee tray and sent it to me. Urine analysis show pH=6.5 which is acidic and calcium oxalate crystals 2+. Bacteria was "occasional" and there was no blood in the urine.
I advised X-rays which showed no stones but I could see radiodense cloudy urine inside the bladder, suggestive of calcium oxalate crystals which are radio-dense. I palpated the bladder confirming no big stones or bladder pain at that time.
I turned the dog upside down on the examination table and discussed this case with Dr Daniel. I noted that she had unusually enlarged nipples as if the dog had given birth a few times. You can see the enlarged nipples on the lateral view of the X-ray below. "She had never given birth," the lady owner in her late 30s said to me.
White cloudy
discharge appeared
at the vulval area
but the owner did
not want to see it.
"This could be
pyometra," I said to
Dr Daniel who
disagreed. He
thought it was just
white turbid urine.
The dog could be
incontinent but the
owner did not
complain about
incontinence or
leaking urine. She
said that the dog no
longer came into
heat although it
usually happened
around February. I
palpated the
abdomen. The dog did
not experience any
abdominal pain but I
could few swollen
uterine horns of
around 2 cm in
diameter.
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This dog lived in a
house with a garden
and sometimes the
owner might miss the
bleeding as the dog
cleaned herself well
by licking. This
would account for
her swollen vulval
lips.
"So what to do now?"
this was what the
owner wants to know.
She was a busy lady
and all those
technical
information did not
interest her.
"Put the dog on U/D
diet for 3 months
and don't feed any
treats or food.
Monitor the urine 4
weeks later to check
for the presence of
calcium oxalate
crystals. Monitor
amount of water
being drunk daily."
As to why the dog
"yelped"
occasionally when
peeing, this was a
mystery. This was
the complaint. Not
difficulty in
urination or blood
in the urine as in
the 2009 case. My
hypothesis was that
the female stone had
great difficulty
passing out the
calcium oxalate
stones via her
urethra. As she
strained to pee out
the stones, there
was great pain and
so she "yelped"
during urination
onto the grass.
But the X-rays (2
views) showed no
large stones and so
I had no evidence.
If stones were
large, it would not
be passed out as the
diameter of the
urethra in this
female dog would be
around 3-4 mm. But
the stones were
smaller and must
have been urinated
out.
The owner ordered a
packet of the dry
U/D diet and drove
home in a hurry as
she was tired and
although the
children were grown
up, she had lots of
things to do.
Monthly monitoring
of urine every 4
weeks for the next 6
months and regular
X-rays of the
bladder and kidney
are strongly advised
but sadly, rarely do
owners comply.
UPDATE
ON MAR 9, 2013
The owner phoned me
as her dog would not
eat the dry U/D diet
at all.
"Shall I buy some
cans of U/D to mix
with the dry food?"
she asked.
"No need," I said.
"Give 90% of the old
food and 10% of U/D.
Increase U/D amount
daily till she eats
all U/D."
"I thought you said
to switch all to U/D
immediately?"
"Some dogs eat U/D
immediately and so I
had said to switch
directly to U/D to
prevent formation of
the calcium oxalate
stones. How's
Pappy?"
"She is OK" the lady
replied.
Evidence-based
medicine using
X-rays and blood
tests are still the
best practice to
educate the owner.
As to how U/D will
prevent calcium
oxalate stone
formation, the owner
did not ask.
Basically, it
alkalinises the
urine, preventing
formation of the
oxalate crystals and
therefore preventing
oxalate urolithiasis
in this dog. Her
urinary pH was 6.5
during urinalysis. A
4-weekly urine test
will monitor the
success of
prevention but not
many owners have
time for such
important matters.
How many Singaporean
senior citizens send
their stool sample
for colon cancer
screening even when
the bottles are
free? Very few do.
Updates will be on
this webpage:
sinpets.com/links/20130305calcium_oxalate_crystals_king_charles_toapayohvets.htm
Read a case of
calcium oxalate
stones in
2009.
2009
case: Calcium
oxalate urethral
obstruction in a
Chihuahua
Recurrence of Urate
urolithiasis
asiahomes.com/new1/20130221urate_stones_
recurring_toapayohvets.htm