Wednesday, August 12, 2020

3395. INTERN SHYAN. A Silkie Terrier has high cholesterol levels and liver disorders


13 Aug 2020. Silkie Terrier, FS, 11 years. 6 JULY 2020. The dog came in for consultation on a large subcutaneous elbow tumour on the left fore limb. Dr Daniel did a blood test. The pre-surgery blood test showed high liver enzymes, low total white cell count and high cholesterol levels. The low total white cell count is not a good risk for anaesthesia. He advised weight control and prescribed therapeutic diet, Hills Canine I/D low fat. A second blood test was taken 5 weeks later. The dog had lost 2 kg. The owner was worried. The total cholesterol levels were lower but not in the normal range. The total white cell count was normal. The owner did not decide on surgical removal of the elbow tumour. ***The liver enzymes increased more than twofold on 13 Aug with the ALT being 1383 U/L compared to 503 U/L on 6 Jul. High cholesterol level is likely due to too many dog treats given daily for years from one year of age. She was given 20 grams of dog treats (3 strips per day) for the past 8 years. Now the dog may have fatty liver disease. The owner decided not to operate to excise the tumour. FOLLOW UP BY DR SING KONG YUEN ON 23 SEP 2020. Around last week, the dog vomited two days and had no appetite. She had fever. She was sent to a vet hospital. An ultrasound revealed the gall bladder "was leaking". The dog was operated and is recuperating now. No further details from the owner. It was probably cholestasis due to liver damage (hepatocellular cholestasis) or bile duct obstruction (obstructive cholestasis).



13 Aug 2020. Silkie Terrier, FS, 11 years. 6 JULY 2020. Dr Daniel Sing. The dog came in for consultation on a large subcutaneous tumour on the left fore limb near the elbow. Dr Daniel did a blood test. The pre-surgery blood test showed high liver enzymes, low total white cell count and high cholesterol levels. The low total white cell count meant this dog was not a good risk for anaesthesia. The dog stopped eating treats. He was given a therapeutic diet - Hills Canine ID low fat. The owner had difficulty feeding this diet to the dog---hence little was eaten.

13 AUGUST 2020. Dr Sing Kong Yuen. A second blood test was taken 5 weeks later. The total cholesterol levels were still high. ***The liver enzymes were twice as high as on 13 Aug with the ALT being 1383 U/L compared to 503 U/L on 6 Jul. High cholesterol level is likely due to too many dog treats given daily for years from one year of age. She was given 20 grams of dog treats (3 strips per day) for the past 8 years. Now the dog may have fatty liver disease.

On enquiry, the owner said that the dog had stopped eating treats. He was given a therapeutic diet - Hills Canine ID low fat. The owner was taught to feed the Hills Canine ID low fat in small amounts till the dog gets used to it. The owner decided to wait and see as the left fore leg tumour was not growing larger. No further news from the owner.
TELEPHONE FOLLOW UP BY DR SING KONG YUEN ON 23 SEP 2020. Around last week, the dog vomited two days and had no appetite. She was sent to a hospital. An ultrasound revealed the gall bladder was leaking. The dog was operated and is recuperating now. No further details.


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                                                         6 Jul 2020                  13 Aug 2020        Ref Range
Total cholesterol (mmol/L)                        20.7               17.9                          (3 - 6.6)
Triglyceride (mmol/L)                                1.2                  2.7
   
ALT (U/L)                                             503                    1383           (less than 59)
AST (U/L)                                             45                         135           ((less than 81)

Total White Cell Count (x10*9/L)               3.6                    6.2         (6.0 -17.0)
Neutrophil  %                                     58.7                            78.7                         
Neutrophils  Absolute     (x10*9/L)    2.11                           4.88
               

Lymphocytes %                                    21.2                    11.2%                
Lymphocytes Absolute (x10*9/L)          0.76                   0.69

Platelets (x10*9/L)                                566                      481               (200-500)

Urea (mmol/L)                                    5.9                        4.2                    (4.2 - 6.3)
Creatinine (umol/L)                             54                         42                   (89 - 177)                     


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Thur 13 Aug 2020

TP 40213   Silkie Terr, FS, 11 yrs

The lady owner saw a large dark blue left elbow tumour 2 cm x 1.5 cm x 1 cm on 6 Jul 2020.
Consulted Dr Daniel.

Pre-op blood test done on 6 Jul 2020.

1. High cholesterol
>20.7 mmol/L (3-6.6)

2. High level enzymes
ALT  503 U/L   (less than 59)

3 Low White Cell count. 
3.6 x 10^9/L  (6-17)

N,L % normal (59%, 21% respectively), but absolute numbers lower than normal.
Monocytes 16.9% high (3-10%) but absolute number normal.

Platelets 566 x 10^9/L (200-500)


Pre-op blood test done on 13 Aug 2020.
Pending



DIET  Fish4Dogs and JerHigh 


OWNER'S WORRIES
1.  Drastic drop of 2 kg bodyweight from 7 kg on 2 Jul to 5 kg today.  Owner stopped JerHigh feeding 3 strips a day for the past 8 years and feed vegetables and home-cooked food. 

2.  Dog not eating the Hills ID low fat canine kibbles. 
 CP 25.9%  Crude Fat 7.4%

compared to Fish4Dogs Finest Salmon Complete (Small bites). CP 26%, Fat 12%


CONCLUSION
1. Stop feeding excessive JerHigh said to be 20g/3 days usually. 




2. Weight loss drastic. BCS 3/9 thin. Top of lumbar vertebra visible.
3/ Feed ID in small amounts---powdered till 100% in 4 weeks.
    Peservere
4.  L elbow tumour to be operated. Teeth had dropped. Thick tartar crust.

5. Liver Zentonil  continue

Diet management - ID low fat according to weight wanted,  i.e. 6 kg. Now 5 kg thin. .
Weight monitoring
Excercise
No dog treats
Home cooked food and vegetables some.


 FOLLOW UP ON 23 SEP 2020

FOLLOW UP ON 23 SEP 2020 BY DR SING KONG YUEN
Recently around 17 Sep 2020



Vomiting 2 days, fever, not eating. 

Ultrasound - gall bladder leaking (owner said).   Surgery done. 

Went to hospital for operation. Likely cholestasis - gall bladder distension.



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This video is part of Dr Sing Kong Yuen's training programme for veterinary students Chloe and Stefanie on a case of pre-surgery assessment of a dog with a large tumour near the left elbow. The owner consulted Toa Payoh Vets as she discovered a large subcutaneous tumour near the left elbow one month ago. A pre-surgery blood test showed that the dog was unfit for anaesthesia and surgery owing to: 1. low total white cell count, low lymphocytes, low neutrophil 2. liver disorder - high liver enzymes 3. high cholesterol level. The dog was prescribed Hills' low fat I/D (7.4% fat) which is less fattening compared to the old diet (12%). She was deprived of dog treats. Today, the owner came for a review and a second blood test. The dog had lost a lot of weight of weight as the dog disliked the new diet and was not given dog treats. ADVICES FOR TODAY 1. High total cholesterol levels. The dog was given around 20 grams of dog treats per day since she was one year old. Now she is 11 years old. For the past month, she was not given dog treats. Strict dieting using Hills' low fat ID was advised by Dr Daniel. The owner is again taught how to mix the slimming diet slowly to get the dog to eat it. NO dog will eat a new diet which is given 100% immediately. Exercise is recommended. 2. Liver disorder. High liver enzymes is usually due to a fatty liver disease. Reduce fatty food and feed liver supplements like Zentonil. The commercial food had 12% fat while Hills low fat diet has 7.4%. The owner needs to give an appropriate amount to reduce the dog's weight but not to underfeed her. There is a food amount for desired bodyweight guidelines on the bag. 3. Left forelimb tumour is large. It was noticed only last month and hence may be cancerous. However the blood test showed a high risk of anaesthetic death as the total white cell count was low. A second blood test will be done today.

 


 4. The owner has to decide whether to get the surgery done or not if the 2nd blood test is not normal. 

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