I asked intern,
Michelle to write down
the following rather
than being an
observer. She has just
completed her A levels
and is waiting for the
A-level results and
wants to study vet
medicine. So, I spent
some time on this case
with her to make vet
medicine alive for her
when I am free as she
does not really
benefit from case
studies as she is not
in Vet course yet.
The Pug had a
complaint as follows:
Not able to pee
normally for past 2
days. "But he pees
normally at one big
lot yesterday," the
lady who loves pugs
wanted to consult me
as she had a black pug
seen by me some 18
years ago. The black
pug had passed away
from old age and she
never had such
problems for the 3
pugs she had. Now,
this pug that does not
look like a "pug"
because he had a
longer body and not
broad chested had
dysuria (difficulty in
urination). He had
been operated on by an
expensive vet one year
ago ($2,000 for the
whole urinary stone
surgery case etc).
"The vet removed the
kidney stones," the
lady told me but had
no medical records
from the vet.
"Are you sure it is
kidney stones?" I
asked her as she was
satisfied that the dog
had recovered and that
was what mattered. The
dog had been on S/D
diet for one month and
C/D diet for 3 months.
Then only home-cooked
food for the last 8
months. Dysuria
occurred 2 days ago.
So she consulted me as
she surfed the
internet.
I was in charge of
this case working
closely with my
associate Dr Vanessa
Lin.
PALPATION OF BLADDER,
URINE TEST AND BLOOD
TEST
1. Empty bladder. So,
I asked the owner to
let me keep the dog
till his bladder is
full and I can collect
urine for analysis of
urinary stones and
crystals as well as
other tests. There is
no point
catheterisation at
this stage to collect
urine as the bladder
was emptied recently.
Blood was taken. An IV
drip was given to get
some urine produced.
2. URETHRAL
OBSTRUCTION
Dr Vanessa told me
that the catheter
could not be passed
through for more than
10 cm, i.e.. beyond
the os penis. I
advised X-ray and a
spasmogesic injection
to be given to relax
the bladder muscles.
She gave the
spasmogesic injection
and did the X-ray
before 5 pm. She used
a smaller
hard-catheter and
could get the urine
out (around 20 ml in a
collection bottle) for
laboratory analysis.
I checked the pug at 6
pm with the owner who
came to visit. The pug
was put on the floor.
He was very happy. He
lifted his leg and
peed around 20 ml of
dark brown urine. The
nurse matron
apologised but I said
it was OK and a common
incident. The intern
mopped away the urine.
The following is
Michelle's case report
is as follows:
3) Pug with
difficulty urinating
Catheter could not go
through; obstruction
in the urinary tract;
small bladder stone
detected using x-ray
Urinated at 6.30pm;
dipstick test:
pH 7.0
WBC 1.00+
Blood ±
Colour of urine:
orange-yellow
Protein 2.00+
Specific gravity:
1.015
"The dipstick results
are not as accurate as
urine analysis," I
told Michelle. "The
urine test report will
be in tomorrow and
compare the results."
ADVICE FROM DR SING
Each vet has his or
her own method of
treatment. For me, the
diagnosis is urethral
obstruction behind the
os penis (based on
catherisation mainly).
"The X-ray showed some
opaque sand behind the
os penis," I said to
the owner. "What
happens is that it
causes pain and so the
dog has dysuria. After
the pain subsided, the
sand particles go back
to the bladder and so
the dog could pee a
large amount of urine
at one go. Till the
next episode."
"What is the
treatment?" the lady
asked me. "The dog
can't be peeing with
difficulty now and
then."
"Be patient," I said.
I advised a low dose
of prednisolone and
let Dr Vanessa Lin
know about this
approach. Pred brings
down inflammation and
let the sand particles
be passed out. This is
my rationale for the
treatment but each vet
will have his or her
own approach.
Antibiotics for the
next 2 days. The dog
would drink water and
urohydropropulsion can
be used to flush out
the sand particles.
This would be tried
first before another
bladder surgery which
the owner was not keen
to do. This case may
not need the bladder
surgery but the owner
must be patient for
dietary and medical
treatment. This is
where many owners want
fast results. Bladder
surgery would resolve
the problem fast but
there is the owner's
wish not to have it.
It would not cost her
$2,000 but economics
do play a great part
for the owner.
This is Day 1. The pug
had passed urine at
6.30 pm with some
difficulty (leg held
up for more than 60
seconds). Will wait
and see.
Dr Vanessa phoned the
previous vet and was
told that the urinary
stone removed was 95%
struvite. As every
urethral obstruction
case is different and
every vet has his or
her approach, my
management of this
case may differ from
that of my associate
vet. The urinary
pH on dipstick is 7.0.
So, a vet could argue
that the urine is not
alkaline.
Struvites stone form
in alkaline ph but a
pH 7.0 on urine
dipstick shows neutral
pH.
Dietary and medical
management, instead of
surgery may be
possible in this case
as detection is early.
The first vet had said
it was not necessary
to monitor the dog
after surgery
though the owner had
asked him whether it
was necessary as she
is a nurse matron.
"Maybe to save the
owner some
inconvenience," she
said to me. "Almost
100% of Singapore
owners don't come for
review 3 months after
surgery and
regularly," I said to
her. So, vets don't
bother to ask them to
do it.
Will update when urine
test pH and crystal
results come in today.
TOA
PAYOH VETS
