29. High BUN - Fundamentals and Technicals in Veterinary Surgery

March 26, 2010 05:58:01 pm
SMS to Dr Sing

Hi Doc Sing, I am the owner of the Silkie terrier with kidney problem who came tis afternoon...Tkns god he is willing to finish 1/3 of the can food. I will monitor closely & email the amount of water he drunk to u weekly...Thank You so muz on ur advice & helpfulness of ur staff to my dog...Thank You
Saturday, March 27, 2010. Handphone call missed. I returned call to owner.
"My dog is feverish," the young lady said. "I feel that his belly is hotter than my other dog." I advised her to use the thermometer to check the rectal temperature. "What should the normal temperature be?" she asked. "From 38.0 - 39.0 deg C." She said, "My dog's temperature was 38.4 deg C." So, there was nothing to worry.

History:
Vomiting occasionally for the past years, according to the owner. Vet 1's blood test showed that the blood urea nitrogen (BUN) way above normal, at the high end. An earlier test showed BUN was high but not that high. So, the owner who consulted me as I treated the puppy when he vomited and that was 5 years ago. Vet 1 referred the owner to another vet for ultra-scan of the kidneys, possibly for kidney tumour. What she was worried was whether the dog was in the end stage of kidney failure since the BUN had peaked.

So, she phoned me and wanted to fax over the reports. "The dog must come to Toa Payoh Vets for examination," I said. "Reading reports cannot enable me to give you correct and proper advice." In fact, it is unprofessional to advise on a serious kidney failure dog based on technical reports and no history or prior examinations of any creature or person. When the dog was presented, he was as active as a normal dog. He had excellent appetite and was not vomiting daily or every few days. Definitely he was not at the end stage of kidney failure.

Fundamentals and Technicals
I just finished listening to the audio "A Maniac Commodity Trader's Guide For Making A Fortune - A Not-so-crazy roadmap to riches" by Kevin Kerr. The commodity trading advisor, said that the use of fundamentals and technical (charts) are important if one is to succeed in trading. His website is http://www.kerrtrade.com/

For this silkie terrier, the fundamentals will be the health and lifestyle of the dog himself. The technicals will be the blood tests, X-rays, ultra-scans and others. The technical reports of blood test indicate a very high BUN and therefore imminent kidney failure. Yet the dog himself does not look as if he was going to pass away the next few days. I advised monitoring water intake, bouts of vomiting and switching to a low protein diet for the next few weeks before jumping to the conclusion that this dog was dying of chronic kidney failure. Ultra-scans are useful but expensive.

If kidney tumours are detected by ultra-scan, would the cure of surgery and/or chemotherapy be effective and would it be worse than the disease? Singapore does not have veterinary specialists in dog kidney transplant. So, what could this young lady do in the event of the detection of kidney tumours besides depleting her savings? It is possible that this dog of 5 years has a congenital kidney disease but presently, he is not at the end stage of kidney failure. Is there a cure? Unlikely unless the kidneys are infected and the infection is cured by antibiotics.

In conclusion, this case shows that both the fundamentals and technicals of the profession must be studied together to be successful in giving correct advices of a case in the interest of the sick animal as it is in commodity futures trading.

I am not interested in commodity trading as I don't have the passion for it and time to learn about a new business. I read it to learn about the best practices of another industry as some best practices are applicable to veterinary medicine and surgery.