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)
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