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Date:   20 December, 2008

 Small animals - dogs, cats, hamsters & rabbits

*10 a.m - 5 p.m (Mon - Sun, except Sat). Dr Sing Kong Yuen. By Appointment Only.

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Tel: 6254-3326, 9668-6469
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Case written: Dec 17, 2008
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS

Dec 17, 2008

What can you say to the owner whose beloved Pekinese died in pain and suffering in front of his eyes? I met him on Dec 17, 2008 and all I could do was listen to his grief on the day his dog died.

Going back in time, around August 2008, the dog had passed >17 urinary stones. I advised surgery and X-rays but he did not take up my advice as he said he had no money for veterinary surgery. He did not ask about the cost nor did I mention it.

The Pekinese could pass out the urinary stones. Sometimes she would exert and strain to pass out the bigger stone. "If only she produces diamonds every 2 days as she produces stones," the owner had a sense of humour. I gave him free consultation and antibiotics a few times as he would not want to bring his dog in for surgery after one visit in August to consult me. There were no large bladder stones palpable but the bladder was full of gas as I felt crepitus inside the bladder. Crepitus refer to a feeling of gas and grinding stones inside the bladder.  There was milk present in the mammary glands of this Pekinese at this time. "The dog has false pregnancy," I showed the milk to the owner.  Normally I would advise spaying the dog to prevent pyometra. But it would be insensitive of me to talk about surgery.    

I did not charge him as I was the one who asked him to get the dog in for a review. All I could help the suffering Pekinese was to prescribe antibiotics and medication to acidify the urine free of charge. "The dog felt less pain in urination after the medication - urination is now not so "rosak (Malay expression for fried?)", the owner told me.

Over the next few weeks, the dog peed out urinary stones almost every day. Sometimes one big stone over 4 mm in diameter, sometimes a few smaller ones. All of the same colour. 

One Saturday in September, the Pekinese vomited and passed a lot of pus in her vaginal discharge. As he brought in the dog on a Saturday when I was on leave, my associate examined the dog and diagnosed pyometra (pus in the womb). The owner took the dog home. He got his dog operated by another vet who charged lower fees.

Some days later, when he saw me, he explained that his wife brought him to Vet 1 who offered a lower fee in view of his financial circumstances. "It is OK with me, " I understood his need to save money in a time of recession. His business was not thriving and his wife might have more confidence in my competitor. This is part and parcel of any business.  

Urolithiasis. Pekinese. Female, 5 years. Urinary stones passed out almost every day. Toa Payoh VetsVet 1 removed the womb. "The dog still passed out dirty discharge over the next 7 days," the owner said to me when I met him outside the Surgery. "Why so many days?"

"Did Vet 1 give you antibiotics after the surgery?" I asked.

"No," he said. "I told Vet 1 you had given the dog antibiotics." But the course of antibiotics was over for some time.

"Why didn't you tell Vet 1 that the dog was no longer on antibiotics at the time of surgery for pyometra?", I had given him antibiotics much earlier to treat the bladder infections.

The owner did not reply. I gave him antibiotics free of charge to clear the infections. Now, this infection was more likely to be due to bacterial infection of the bladder as the infected womb was removed and there would be no more purulent vaginal discharge due to pyometra.

Vet 1 had done a good job of removing the womb. He had presumed that the owner had antibiotics from me and therefore did not prescribe any to save veterinary costs for the owner. 

The infection cleared soon after. "The taxi fares to Vet 1 cost a lot," the owner said to me as he was working around my Surgery. "I have to bring the Pekinese to Vet 1 to remove the skin stitches."

I removed the nylon stitches from the skin for the dog. I understood that the owner needed to save money as his business dropped drastically due to the melamine scare. He was selling products associated with milk and melamine contamination of his products existed. "Did your dog eat ice-cream in the past?" I asked him. "No," he said. "My dog eats home-cooked food.

"How about dry dog food," I asked.

"My dog eats home cooked food.

Ice-cream was one of the products in Singapore banned for melamine contamination in August. Children in China produced urinary stones after drinking contaminated milk. Some dogs died eating dry food contaminated with melamine some years ago. Yet this Pekinese did not consume either of the above mentioned products. She produced urinary stones without fail for 5 months, on a daily basis.  

The owner collected the stones and gave some 50 stones.  One day I asked him, "What did Vet 1 advise about the stones?" He replied,  "Vet 1 says that there is no point having bladder surgery to take out the stones since the dog will continue producing stones." This was a difference of opinion from mine. I advised removal of the stones and prescription diet. But I cannot guarantee that urinary stones will not re-form again. 

Then one day in December, the owner phoned me at night. "My wife took the dog to Vet 1 as the dog could not pass urine. The large stone was stuck inside her. She vomited many times.  She came back from Vet 1 and the dog is still screaming. Can I pay you half your surgical fees and pay the other half later when you operate tomorrow?"

"With vomiting, the dog's kidneys would be infected. In addition, the dog would have toxic blood. It is best you get her to Vet 1 immediately to get emergency surgery immediately." This was now a very high risk anaesthetic case. It was better that the dog be handled by Vet 1 who had done some treatment earlier but had sent the dog home after removal of the stone. There must be more stones being stuck.  

I did not hear from the owner after that phone call. I presumed his wife had got the dog to Vet 1 for treatment. Around 2 weeks later, on Dec 16, 2008 I met him and asked what happened to his dog.

"I went back to Vet 1 that night after I phoned you. Blood gushed out as Vet 1's "nurse" inserted an instrument into the dog. She pulled out the stone from the dog. The dog screamed in pain." He was distressed in seeing his dog suffering. "The vet gave an injection."

"What happened after the injection?" I asked.

 The owner tilted his head to the left, rolled out his tongue. He was still grieving. I could only provide a listening ear. I did not know what to say. There was something missing in the management of this case by the owner. He did not blame the vets.

In retrospect, a charity like the British  People's Dispensary for Small Animals (PDSA) would provide the funds to get the dog  operated early.


5 months of passing >100 urinary stones. Toa Payoh Vets

Removal of the stones may prevent  crystallisations and formation of more and more stones inside the bladder.

The stones would be analysed.  A prescription diet should be fed.

Follow-ups and X-rays every 3 months would be best but all these cost money.

The dog may or may not produce more stones once the bladder is cleared of stones.  Nobody can predict whether the dog will produce stones after surgery or not.  Vet 1 had done his best but the best is not good enough when a beloved pet dies.

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