The Yorkshire Vet: Stone me! Smallest of big challenges - Julian Norton
Sometimes, veterinary cases come along in clusters. For farm vets, there might be an unseasonably high number of calvings to attend, maybe due to feeding or weather issues, or the sire to some of the herd being too big. I can still recall winter on one farm when a combination of too much food and a new bull meant that almost all the cows required caesarean sections. The weather was particularly harsh, and the road to the farm was covered in thick snow and ice for several weeks, so even getting to the farm was a challenge, let alone managing the obstetrical difficulties that awaited when we arrived.
And we are frequently faced by a run of foreign bodies stuck inside a dog’s stomach or intestines. Recent days have seen an unusually high incidence of dogs with bladder stones- I’ve seen three dogs in the space of a week with this condition, and another colleague has also had a couple to deal with. To explain, these are stones that develop when crystals in the urine coalesce to form gritty deposits and then grow until they are like pebbles on a beach. In male dogs, they usually get detected at a smaller stage, since the plumbing of a male is more prone to blockages. In females, bladder stones can develop to quite a significant size. In one case many years ago, I removed a whole bag full of smooth, white pebbles from a bladder, which resembled, in size, number and appearance, a quarter pound of mint imperials, that you might have purchased from the sweet shop in the 1970s.
Of course, in nearly all cases, bladder stones need to be removed surgically and the urethra flushed out to ensure there are no tiny remnants lodged. It’s satisfying to diagnose the problem, usually with a combination of abdominal palpation- if the stones are sufficiently large and vet is suitably “old-school”- X-rays and ultrasound. Successful surgery is even more rewarding as the solid stones are dropped with a clatter into a metal kidney dish. But it was my most recent case which provided the biggest cystotomy challenge or, more accurately, the smallest, I have ever had. Milo the hamster had been struggling with blood in his urine for several days after he’d been collected from the hamster shop. It took some detective work from the new owners to identify the blood was in his urine. At first inspection, since it appeared in his wheel, an injured foot was thought to be the cause. After a course of treatment, the blood hadn’t resolved and a colleague had expertly performed an ultrasound scan on her smallest patient. A solid structure was visible casting an “acoustic shadow”- the hallmark of a stone. The next question was, of course, could it be possible to perform this delicate operation on such a small creature? Would Milo survive the anaesthetic? The questions were put on our clinical group-chat. Ever the optimist, I volunteered to do the op. The owners were very aware of the risks but prepared to go ahead. I calculated and recalculated the doses of drugs, concluding that the dose was in fact, “basically, bugger all.” Other colleagues searched the veterinary literature for help with the process. Only three previous reports were discovered. The final one, entitled Cystolithiasis in a Syrian hamster: A Different Outcome suggested the other two outcomes had not been favourable.
It was also the first outing for our new magnifying glasses, which proved to be weird (apparently, I looked like Austin Powers) and mildly sea-sickness-inducing but very helpful. With a bladder smaller than a small marble, I’d need all the help I could get. Half an hour later, against all the odds, Milo’s bladder stone was out, and he was waking up looking for a snack!