4016. Vet case study. GATSBY. A 13-year-old Bichon Frise woke up lethargic and recumbent. Why?

HOOK

This 13-year-old much loved by the young man who bought him as a puppy in Perth Australia. The dog is walked every morning for around an hour, but today, he just would not want to go out. He was very lethargic and laid down on his side, under the dining table as if he was "dying". 

USE some 2-minute footage of the video below as hook.

His Body Condition Score 4/9 is good. Occasionally, he has this retching sound in the morning as if he tries to clear his throat. Appetite is excellent.

He goes for morning walks of half an hour daily for the past few months. However, on Nov 17, 2019, he was lethargic and recumbent under the dining table. He was OK yesterday after the walk.Nov 27, 2019.

 
Gatsby's blood tests showed slight anaemia and elevated liver enzymes. No bacteraemia and no fever. Monocytosis. Thrombocytosis.  

Monocytes: High levels of monocytes may indicate the presence of chronic infection, an autoimmune or blood disorder, cancer, or other medical conditions.This may occur as a result of a virus or an infection, such as tuberculosis. It may also be linked to specific lymphomas and leukemias.

Monocytes

Monocytes are often found in higher numbers during a stress response and also during inflammation. They are involved in the immune response and remove dead and damaged cells as well as microorganisms.

Thrombocytosis is defined as increased number of circulating platelets.

Fundamental causes The fundamental causes responsible for thrombocytosis in dogs are:

• It may be a temporary response to epinephrine release.
• It may be a reaction to a disorder or disease in another part of the body e.g. liver disorder in Gatsby and slight anaemia in this dog.
• It may be a sign of an underlying disease in the bone marrow e.g. blood cancers. 

In some conditions, the spleen is present but either it does not function properly or it is shrunken and the total platelet count is sometimes increased in these conditions.

Some cancers can cause an increased total platelet count either by causing damage to tissues, causing blood loss or by erroneously producing a cytokine that stimulates the bone marrow to produce platelets. 

“There are typically five types of white blood cells—neutrophils, lymphocytes, monocytes, eosinophils, and basophils—that we look at in a leukon, which is a white blood cell profile,” . “Knowing the levels of each of these cells in the body helps us to understand what type of process might be going on.”

Liver disorder - ALT enzymes are above normal. X-rays show slight
enlargement of the liver. Edges of liver are still sharp, not rounded as in severe
liver disorder.

Total red cell count is low. Haemoglobin is on the low side of the range.
Mild anaemia is present in Gatsby

Nov 27, 2019
Gatsby's X-rays

Heart is not enlarged. Retching usually in the morning could be due to clearing
of the throat or lungs of mucus. Nothing was vomited out.
 

No tumours or inflammation in the lungs

Liver is enlarged. Liver enzymes are elevated.

TREATMENT
A cause of chronic inflammation would be the periodontal disease.

Periodontal disease in dogs is an inflammation or infection that results in the weakening or loss of support structures of the teeth. Periodontal disease happens when food and bacteria accumulate along the gums and form plaque, which turns into calculus (also known as tartar).

ADVICES TO DOG OWNERS

Give your dog chew toys and perhaps consider dog food specially formulated to address dental disease. You can also provide your pet with chew treats treated with enzymes that help reduce the formation of tartar and calculus. The chews do not take the place of brushing but is a great supplement and a treat for your pet. Yearly dental examination and scaling by your vet will help prevent periodontal disease.

In this case, the dog had dental scaling some 4 months ago, but no tooth brushing. The periodontal disease is now present.   

OUTCOME
Many old dogs do suffer from heart diseases. The signs include retching, coughing after waking up, loss of energy and stamina during walks, short of breath and lethargy. X-rays of a serious case of heart disease in a Shih Tzu are as follows:

The heart is much enlarged

Fluid due to heart failure is present in the lungs. Hence the lungs
are black as in a normal dog (see Gatsby's normal lungs).

Iron tablets and heart medication to help the heart were given. The dog recovers his normal self 2 days later. He goes for  his morning walk, has good appetite and barks when strangers come to the door.

UPDATE:

Gatsby was on heart medication. He led a normal life and would walk when taken out.
In 26 May 2023, Gatsby died in his sleep at the age of 17 years. He was cremated.
The life span of a Bichon Frise is said to be 12 - 15 years. Gatsby lived to a ripe old age.