Sunday, November 28, 2010

257. The dog with white gums - continued

Low red blood cells, low haemoglobin and very low platelet count are life-threatening situations to the dog with the white gums. I followed up by phone call for the next 2 weeks for 3 occasions. The owner was quite happy that the dog was eating 4 times a day and her gums were pinker and would come in for another blood test on the 14th day after the first consultation.

Then on the 14th day (Friday), the dog vomited and so the owner texted me to cancel the appointment. Vomiting is a serious sign. The owner brought in the dog on a Saturday afternoon and she was given the IV drips and treatment. Blood and urine tests were done. "The dog bites me when I carry her," the owner said. I palpated the T/L spinal area and the dog wanted to bite me. The dog had normal rectal temperature and the gums had become pale. She was not eating.

Blood tests indicated that the red cells and haemogolbin levels were back to the low range of normal but would be considered normal. The platelet count was still low but not at 1. It was 120 (normal is 200 -500). A very high white cell count of 27,000 indicated a bacterial infection. The liver enzymes were very high too indicating hepatitis. Serum urea was high but creatinine was below normal. White cells and bacteria and blood were present in the urine tests. A few crystals of calcium oxalate.

Palpation: Spleen enlarged and could be felt like a long rectangular tongue transversing the abdomen. A large painful mass on left side behind the rib, of around 10cm x 4 cm would be the left kidney. Liver enlarged.

The owner visited the dog on Saturday afternoon. The dog seemed OK. No rectal temperature increase. Then on Saturday evening, the dog just passed away quietly at 7p.m. I phoned the owner who came.

"What's the cause of death?" her 2 friends asked me. "It is likely to be septicaemia from bacterial infection. The dog could have inhaled toxic dusts from the neighbour's ongoing renovation (acid and cement dust) for the past weeks." The dog's tongue was cyanotic and white. The spleen and left kidney were enlarged.

The dog had tumours based on ultrasound and these tumours could have spread to all over the body. It is hard to say without a post mortem. Direct Coomb's test was negative but this does not rule out autoimmune haemolytic anaemia. Thyroid function tests were done.

It was hard to save this old dog when she has internal tumours and a toxic dusty environment. Both could result in an autoimmune haemolytic anaemia and thrombocytopaenia.

The owner said good bye to the dog after arranging for cremation. There was not much I could say. She shook my hands and thanked me. This was one of my saddest cases in veterinary medicine as I could not prevent a second recent bereavement in her family.

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