I can’t believe how fast time is flying. Only two weeks ago, I was enjoying a thrilling new experience of getting a photo shoot of me and my dogs at Saint Kilda dog beach.
I finally got to meet one of my fellow bloggers and utilised her photography talent to the maximum.
I really can’t thank you enough Vicki for being such a good sport during the whole photo shoot. It was just a great and very fulfilling experience for both of us. I absolutely enjoyed reading Vicki’s blog on our photo shoot experience and she simply describes the whole event so well that I don’t need to add a thing to it. She took so many amazing photographs and her a few of my personal favourite:
Posing with my favourite boys (Lewi our cat was the missing family member)
A wonderful profile picture. Too bad the boys weren’t looking in the same direction.
‘Shepo’ flying up in the air to catch his ball.
‘Punchkin’ proving to be the next hover dog.
My boys happily parading back with the successfully retrieved ball.
Last weekend I was on emergency call and as always I was kept fairly busy. My entire weekend on call was packed with difficult and interesting case; they ranged from a horse with colic to a blocked cat and a blocked dog to even a dog with snakebite. I shall however focus on discussing only one of these cases as it continued well into the middle of the week.
As soon as I received the call from ‘Ernie’s owner, I knew he had to be seen immediately.
‘Ernie’ the 12-year-old male de-sexed Dalmatian was dribbling urine. He had been examined the day before and was sent home on antibiotics but had deteriorated overnight. He was so lethargic and constantly trying to urinate to no avail. On examination, I found he was very sore and was guarding his private part. He made it clear that I would not be allowed to pass a urinary catheter while he was conscious. I quickly decided it was best to give him a premedication containing a combination of pain relief and sedative.
This was followed with me juggling another few consultations until I finally got an opportunity to go back to examine ‘Ernie’. At that stage, he appeared quite sedated but was still not refusing me trying to catheterize him. I deemed it necessary at that stage to proceed with a full anaesthetic. Even under full anaesthetic, I struggled to pass the urinary catheter. I kept rubbing against a very gritty structure (suspect urethral stone referred to as a ‘urolith’). I took radiographs of his abdomen and could see a suspect bladder stone but nothing showed up in his urethra on x-rays.
Sometimes the bladder or urethral stones are not opaque (visualized on x-rays).
After multiple unsuccessful attempts at catheterization, I called Ernie’s owner and advised her I had to perform abdominal surgery and try to flush out the urethral stone/s retrograde (pass the catheter the other way around via his bladder).
We positioned ‘Ernie’ on his back and were about to start scrubbing his abdomen up with antiseptic in preparation for surgery. I suddenly felt an urge to attempt to catheterize him one last time. And voila, success… I was able to pass the urinary catheter with a tiny bit of force and drain his much distended bladder. I sutured the catheter in place and we aborted the surgery.
I then did a full urinalysis on his urine to determine the type of crystals he may have. I could not see any crystals but simply lots of sludge. I updated his owner and explained ‘Ernie’ will most likely still require surgery to remove the bladder stones as they will ultimately lead to further urethral obstructions. ‘Ernie’ made a great recovery. I knew he was ready to go home as soon as he reverted to his usual ‘whinge bag ways’ which is clearly illustrated in the video footage below:
Sunday afternoon, I sent him home with an indwelling urinary catheter as it is important to leave in the catheter for at least 24-48 hours afer insertion. I booked him in to see me again on Monday in the late afternoon. Monday afternoon arrived and ‘Ernie’ was back for his revisit.
Needless to say ‘Ernie’ or as I like to call him ‘Ernito’, was not at all impressed to see me again.
Me attempting to help ‘Ernie’ feel less uneasy about seeing me again.
Liver treats finally working their charm on ‘Ernito’
His mom reported he was doing well at home and easily urinating through his urinary catheter. I pulled out his urinary catheter and emphasized the importance of closely monitoring his urine output for the next few days.
All was going smoothly until I received a call from his owner two days later on Wednesday around 12 o’clock.
She informed us ‘Ernie’ was struggling to pee again.
She was already on her way to the clinic and was well aware he would require surgery this time around.
I gave him a premedication as soon as he arrived and started him on a low rate of iv fluids. We then proceeded with what we often consider quite an easy and routine surgery. I could not pass the urinary catheter and it was proving to be blocked in the same exact spot I struggled with only 4 days before. I opened up his abdomen and put in a stay suture in the apex of his bladder to allow me to externalize his bladder.
Suddenly I found urine gushing out of the bladder as my suture had ripped through the bladder wall.
I was utterly shocked at what had just happened. Obviously his bladder wall was just so friable. I called in my vet colleague Liz to scrub in and help me repair the damage. We emptied his bladder outside of his abdomen to prevent further contamination of his abdominal cavity. I then extended my bladder incision (cystotomy) to facilitate an appropriate examination of the inner workings of his bladder. I discovered his bladder was full of tiny stones and that only a few had formed into larger ones. All these larger stones were impacted in the neck of bladder ; which is a very narrow and difficult spot to access.
At this very moment, I had a rude awakening. I just knew that this surgery was going to take much longer than I expected. We had to pass in the urinary catheter normograde (via his penis) well knowing that we can’t pass it far enough because of the stone lodged in his urethra. We then started infusing the urinary catheter with large amounts of flush to help dislodge the urethral stone and the bladder stones. This process had to be repeated several times until we eventually managed to successfully flush out all the stones in the trigone area of the bladder.
I started to celebrate the removal of all these bladder stones forgetting about the urethral stone that was yet to be addressed. I had again under estimated the rest of the surgery. Usually you should be able to easily flush it out retrograde. I passed the urinary catheter retrograde (vie the cystotomy site) and for the life of me, I could not get this stone to budge. We had to keep trying to flush it through both methods normograde then retrograde then vice versa. After 1.5 hours of doing so without any sign of progress, you could only imagine how frustrated and deflated I was feeling.
I mean ‘Ernie’ had been under anaesthetic for almost a total of 3.5 hours which was far too long.
Don’t ask me how but miraculously the stubborn urethral stone finally moved and we flushed it back into the bladder and pulled it out of there. We then passed the urinary catheters both ways and flushed the bladder several times to be %100 sure we got rid of all the stones. I then sutured up the bladder and tested it for any leakage. We then thoroughly lavaged his abdomen with warm saline to get rid of any contamination (urine or bladder stones) and I finally closed ‘Ernie’ up. I have to thank my colleague Liz for her support and assistance throughout this complicated surgery!
The critical period was the next 12-24 hours. We had to warm up poor ‘Ernie’ as he was hypothermic. We had him sandwiched with a bear hugger (bag filled with hot air) and heat mat. We also wrapped him up with lots of warm bedding. When he first woke up, he felt very nauseous and did a big vomit. We had to put drape his head over a towel to prevent him aspirating any of his vomit. My colleague was on afterhours duty and monitored ‘Ernie’ for the first 4-5 hours post surgery. I could not sleep without checking up on my darling ‘Ernito’. I did a total of 3 checks over the course of the night and early morning during of which I had to give him more pain relief and cut down his fluid rates.
The next morning, he was still feeling very sorry for himself.
After all, we had probed and prodded his urethra intensively over the course of a couple of hours.
Check out the picture of both his bladder and urethral stones.
The urethral stone covered with so much blood is the one that created most havoc.
They may appear like tiny stones but they are big enough to plug your urethra!
The following day, we sent those stones for free analysis to the hill’s science laboratory. We highly suspect they are urate crystals but we could be wrong. Dalmatians are predisposed to urate crystals because of their unique composition. I will wait to see his results before delving into a discussion on this particular type of crystal.
As far as I know, ‘Ernie’ is recovering well at home. I will be calling his mom tomorrow to check up on his progress.
Morale of this story is you should pay attention to your dog’s urination habits. If you don’t, it may cost you his/her life!
Related articles
- Is your male cat struggling to pee? (rayyathevet.com)
Dr Rayya's Online Veterinary Journal 
March 26, 2012 at 6:04 am
Wow, what an ordeal! Thanks for showing us the stones; they are impressive. I’m glad Ernie is on the road to recovery. I also enjoyed the photos from your shoot, especially the portrait shot. I don’t mind that they’re looking beyond…gives the photo more of candid feeling. Have a great week!
March 28, 2012 at 9:27 pm
Thanks so much. Glad you enjoyed the photos! I totally agree, the stones were quite impressive and that’s why I had to show them to you all 🙂
March 26, 2012 at 6:19 am
I’m glad you had your photo shoot BEFORE the surgeries! And those stones do not look small.
March 28, 2012 at 9:28 pm
I am glad the stones significance was portrayed in the photographs 🙂
March 26, 2012 at 6:23 am
I’m glad you were able to get the stones out (they look pretty big to me) and Ernie is on the road to recovery.
Some people look at me funny when I discuss the habits of my dogs but watching them closely and knowing what is their normal is the only way to know when things are not normal!
Great post 🙂
March 28, 2012 at 9:29 pm
Misty, ignore people that stare at you when you are closely watching your doggies doing their business. You are being a good mom no matter what they think :-). Ernie is doing well so far so it is great.
March 26, 2012 at 6:47 am
Hi,
Not a good day for you at all, but well done getting all the stones out of poor Ernie, hopefully now after he heals he will be back to his normal self and enjoying life once more.
I love the photos of your dogs having fun at the beach, dogs just seem to love frolicking around on the sand and running in and out of the water. 🙂
March 28, 2012 at 9:31 pm
Hey Mags. It sure was a battle getting each and every one of these horrible stones out but it had to be done. Ernie is recovering slowly but steadily which is a great relief.
My dogs sure love the beach and we miss living close to one. They will happily run down to the beach before I even join them 🙂
March 26, 2012 at 7:16 am
So pleased that you finally had a day off work Raaya … and it looks like you had a great time at the beach with your dogs. Fantastic photos.
The good news is that Ernie continues to recover really well. He enjoyed a trot down the drive to feed the horses yesterday, a hearty bark at the dog next door, a half hearted chase with Lucy and lots of effortless piddling.
Thanks Raaya for everything you have done to help Ernie. Your compassion, dedication and passion are inspirational.
March 26, 2012 at 9:13 am
Hooray.
March 31, 2012 at 1:21 pm
🙂
March 28, 2012 at 9:33 pm
Hey Fiona. It was great seeing you & Ernie this week and I am happy that he is well on his way to fully recover from his ordeal. I am sure he is getting very well looked after at home and that’s why I sent him home earlier than I usually would. He just loves to be with you and I know you will give him the BEST POSSIBLE GERIATRIC WARD CARE :-)…
Take care & see you next week.
March 26, 2012 at 7:38 am
holy cow, those are huge stones!! I can’t imagine all that, what a crazy experience! poor ernie! I’m so glad to hear he’s recovering well *whew*
March 28, 2012 at 9:35 pm
Hey Julia. I know, poor Ernie was riddled with these horrible stones. I am sure he will be feeling 20x better now.
March 29, 2012 at 2:07 am
at least! I’ve heard about the excruciating pain of passing them when they are too small to see, I can only imagine how much he was hurting. one more thing to watch for, I’m learning so much from your blog!
March 26, 2012 at 7:39 am
I wonder what causes these stones to form. Any ideas?
March 26, 2012 at 8:58 am
Besides the fact that it was a male Dalmatian (incredibly prone to stones, world-wide apparently as America gets this all the time, too) those look like calcium oxalate stones. Typically, those will form with there’s issues with the pH of the urine. Dog urine needs to maintain a pH of around 6.5. Too acidic or too basic and crystals will form (often secondary to a bacterial infection, although it can be a sort of chicken-and-egg situation where it’s hard to determine if infection causes crystals or if crystals caused infection.)
The crystals can then start to ‘lump’ together, forming these large stone deposits.
My poodle is prone to struvites, a high-protien-diet-induced stone that, thankfully, can be dissolved with diet. Oxalate stones, however, have to be removed and cannot dissolve.
I’m sure Rayya could expand on that… it’s been a while since I’ve been active in the field.
March 28, 2012 at 9:38 pm
Hey Lyle. Absolutely terrific and very well written answer.
I don’t need to expand on it any further. 🙂
March 28, 2012 at 9:37 pm
I still haven’t received the results of his stone anaylsis.
We highly suspect they are calcium oxalates but they maybe a different type.
Lyle had done a terrific job at answering your question.
I will be posting a blog about stones/crystals later on and will discuss that indepth then.
March 29, 2012 at 1:11 am
Yes, that was a good response from Lyle. Interesting about high protein diets. We’re changing what we feed our dog.
March 26, 2012 at 8:53 am
Those look huge to me!
March 28, 2012 at 9:39 pm
They are for a urethra! 🙂
March 26, 2012 at 9:10 am
My gosh! Those stones are enormous! Poor guy! I’m so glad you were able to give him some relief. I love your posts. I learn something every time!
And the photo of you and your husband is adorable!
March 28, 2012 at 9:40 pm
Hey Heather. It makes me smile to hear that my posts have helped impart some knowledge. Thanks for the compliment on the photo 🙂
March 26, 2012 at 10:22 am
So glad he is okay! Your Dr. Life is so crazy – I love animals so much but could have never been a doctor! Iwould have fainted! ha! I am crazy because I have to take my cat, Safari for his dental on Tuesday morning and I get like a nervous wreck because of the anesthesia – scares me! He will be 11 in May and this will be his second one – he has great teeth but one little tooth has a tiny absess on it so I know it needs attention! Thank God for docs like you!
March 28, 2012 at 9:42 pm
Hey Sherri. I am sure ‘Safari’ will have a smooth dental & recover very well. You have every right to worry, it goes to show how much you care about your furry friend. I usually get my colleagues to put my pets under anaesthetic if needed and prefer not to watch as I become a very paranoid owner myself :-).
Thanks for your lovely comment.
March 26, 2012 at 5:47 pm
Assume one of your next blogs might be about diet and how to prevent the stones. Really feel for that guy – what a good job you did! Love the photos from the beach 🙂
March 28, 2012 at 9:44 pm
You are absolutly right. I will have to blog all about diet & how to prevent stone. Let’s wait for the results of Ernie’s stones. Glad you liked the photos 🙂
March 26, 2012 at 6:16 pm
Well done – amazing dedication. Love your photos too!
March 28, 2012 at 9:44 pm
Thanks heaps Jo 🙂
March 26, 2012 at 6:49 pm
Such stunning shot of you all and the boys are just too gorgeous for words! I can see they are well loved. 🙂
Poor Ernie! He is blessed to have a wonderful vet like you to take care of him. Great job there! Those stones are terrible and painful.
Thanks for a lovely post and for sharing your wonderful experiences. 🙂
Have a wonderful day!
*hugs*
March 28, 2012 at 9:45 pm
Hey Sonel.
Thank you for your wonderful comment. I am glad you can see how much I spoil my handsome boys :-).
Ernie is recovering well and that’s all that ever matters.
Take care.
March 29, 2012 at 12:11 am
I am very glad to hear that Ernie is doing so well Rayya and you are very welcome. Your boys deserve to be spoiled and they are gorgeous! 🙂
March 27, 2012 at 12:20 am
I think those stones look HUGE. I wouldn’t want to pass them myself, never mind my poor punkin!!!
I’m pretty cautious with my babies, but it’s good to know what to look for.
Thanks Dr. Rayya!! Oh and I love the pictures of your two guys. 🙂
March 28, 2012 at 9:47 pm
Hey Jodi.
No I wouldn’t want to pass any of these stones either, yawzaaa that would be painful! Definitely worth keeping a close eye on your Sampson’s urine flow.
Glad you liked the pics :-).
March 27, 2012 at 1:21 am
We’re glad to hear Ernie is doing better!
Bella and DiDi
March 28, 2012 at 9:50 pm
Great to hear from you. Ernie is doing so well now :-).
March 27, 2012 at 2:31 am
I am very glad you like the photos and loving animals in the name of the animals and I thank you very affectionate greetings from Spain
March 28, 2012 at 9:51 pm
Olaaaaaaa 🙂 Thank you so much for your very lovely comment.
March 27, 2012 at 11:04 am
Great work. Look as large as some problem stones for humans. Calcium Oxalate I bet. The Cephus and Langston are impressed.
March 28, 2012 at 9:52 pm
I am happy to hear that The Cephus & Langston are impressed :-). I definitely think they are calcium oxalates, just waiting for the report now.
March 27, 2012 at 8:16 pm
I’m glad everything turned out alright in the end for Ernie!
March 28, 2012 at 9:52 pm
Thanks Barb. So am I 🙂
March 27, 2012 at 8:25 pm
Phew! I was on tenterhooks as I read this post. Poor Ernie! Well done Dr. Rayya. Tall person had a kidney stone last year and said it was extremely painful. Luckily it passed.
March 28, 2012 at 9:54 pm
Bassa…I bet you offered tall person lots of support during that very painful ordeal of passing a kidney stone! 🙂
March 28, 2012 at 2:54 am
You and your hubby and your boys are picture perfect!!!!!!!!!
March 28, 2012 at 9:54 pm
Thanks Nicoleeeeeeeeeeeeeeeee :-)…So sweet as always!
March 28, 2012 at 7:03 pm
I love reading about your work! As a VA who has little time to practice because of my animal welfare work, I live vicariously through your blogs. This one in particular strikes a cord with me as I teach a 2 hour course and cover emergency situations such as this. We go with the 24 hour rule…if it changes in color, amount or smell and doesn’t right itself in 24 hrs…emergency!
March 28, 2012 at 9:56 pm
Hey Janice. I feel very flattered to hear that you live viraciously through my blogs :-). I bet you impart very practical and amazing information during your 2 hour course. Education is the key to everything!
March 29, 2012 at 9:32 am
That was an interesting case. And beautiful pictures of you and your dogs.
March 29, 2012 at 6:42 pm
Hi Rayya – you will be pleased to know that Ernie’s appetite has fully recovered today. Am now a bit concerned about Lucy who has been eating the same diet as Ernie for the past 11 years. Do you think she may have developed bladder stones too? .. or am I just being a paranoid dog owner?
March 29, 2012 at 10:08 pm
Hey Fiona.
That’s terrific news about Ernito’s return to his full appetite! With Lucy, it is worth bringing me in a urine sample to test. Fortunately female dogs are at less risk of blocking up but if she develops recurrent bouts of cysitits (excessive and frequent urination), we will need to address that further. It is good to be cautious and important to learn from each experience and that is exaclty what you are doing. I am sure Lucy is okay! 🙂
March 29, 2012 at 10:36 pm
It sure was an interesting case :-). Thank you so much for the lovely compliment 🙂
March 30, 2012 at 12:58 am
I’m so happy for Ernie that you could help him to get rid of the stones. Imagine the terrible pain he must have had, that poor dog.
Your photo’s are really amazing, you all look very handsome 🙂
I learnt a lot of this story. Thank you for sharing, Raya 🙂
March 31, 2012 at 1:28 pm
Thank you so much for your lovely feedback. Poor Ernie was definitely in a world of pain but not anymore! Glad my story was able to impart some new information for you 🙂
April 5, 2012 at 2:04 am
Hi Rayya! I just nominated you for a Versatile Blogger Award. Click here for the Rules http://yashikibuta.wordpress.com/2012/04/04/versatile-blogger-award/
April 6, 2012 at 12:17 am
Wow thank you so much. I really appreciate it 🙂
June 11, 2012 at 10:58 pm
i have got a japanese spitz puppy and her name is trasy, 1 month old ans very much active but i have noticed that she has some hearing problems, i have done many tests for checking her hearing ability, i am from Nepal and there are no good vets and veterinary here. Yesterday i took her to the vet and he said that she’s just 1 month old and she might progress later, Her mom Cindy’s no more, she was 8 years old and gave birth to total of 3 puppies including Trasy, other two are normal and respond when i make noise but Trasy doesn’t respond.. and when she’s asleep she doesn’t get distracted to any sound? I love her very much.. so my question is that is the vet’s saying right( some puppies may dvelop hearing ability later)? i don’t think so but would like to ask you.. 😦
June 14, 2012 at 9:37 pm
Hey Sherry
You obviously love your japanese spitz puppies very much. I highly suspect that Trasy may be deaf purely based on your history and I don’t necessarily think she will gain her hearing over time. Some puppies are born deaf and can still live very happy and long lives. It is important to train her using hand signals since she can’t hear you.
So long as she is happy and healthy and eating well. There isn’t much you can do to help fix her hearing. I am not aware of any procedures they do in pets to help them hear. Maybe in the near future there will be, who knows!
Take care and enjoy your lovely puppies.
Cheers,
Rayya
August 4, 2012 at 8:46 pm
thts great to know…..plzzz carrry on…..and an request plz post on large animals toooo
August 4, 2012 at 9:51 pm
Thanks for stopping by. I will definitely strive to do a post on large animal cases if I come across one 🙂
January 19, 2016 at 9:37 pm
Hey Dr Rayya, I really want to say thank you for sharing your knowledge on the internet and also for saving those animals.may God bless your knowledge and give you more wisdom to it.