Be Kind To Pets, Vet case studies, Photography tips, Travel Stories: 3151. A 14-year-old female Labrador Retriever with multiple skin lumps and passing blood in the urine again. Two final videos.

Create 2 videos as they have separate topics

VIDEO 1.

A 14-year-old female Labrador Retriever has so many large fatty lumps. What to do?

HOOK

HOOK IS VIDEO FOOTAGE AS FOLLOWS:

0:00 - 0:23. Use audio in the video footage. "Today is 10 Sep 2020, This 14-year-old female, not spayed Labrador Retriever...."

1:14 - 1:31. (Narrate as you show various locations of the multiple skin lumps). The dog is underweight and has multiple skin lumps - armpit area, chest area, back area, using the following footages:

2:58 - 3:10 armpit area lumps
5:30 - 5:38. lift up dog to see more lumps under the body. Owner said that the lumps appear after feeding her dog duck mean. That was around 5 years ago.

6:30 - 6:46
7:00 - 7:14

BKTP

TITLE:

SINGAPORE SETTING....

Short video clip of singaporeans working, buses, apartments, street scenes etc but NOT the same as your previous one.

"5 years ago, the lumps appeared after I fed her duck meat," Tan said. "I consulted a vet. He said to wait and see. If they grow much bigger and cause her irritation or lameness, he will remove them."

Today is 10 Sep 2020. The subcutaneous lumps have had increased in numbers and sizes. The dog had a fever 7 days ago and is underweight. Were the multiple skin lumps the cause of her poor health? Dr Daniel had taken blood and urine for examination.

Are they really lipomas or the cancerous cells like liposarcomas, mast cell tumours or soft tissue sarcomas? Vet 1 had not performed any biopsy on these fatty lumps.

Lipomas are non-cancerous fatty lumps under the skin. They appear in the older dogs and on any part of the body. The cause is unknown. Older and obese dogs are said to be more likely to develop lipomas"

Most vets advise observation instead of surgery to remove the lipomas. When these lipomas are large and irritate the dog or causing the dog to be limping, they are removed. However, the best practice is as follows:

1. PHYSICAL EXAMINATION.
A physical examination is not good enough to diagnose that the lumps under the skin are lipomas.

2. CYTOLOGY, FNA, BIOPSY. It is important for the vet to use cytology to diagnose lipomas. Cytology is the examination of the cells under the microscope.

The vet collects the cells by using a fine needle to aspirate the cells (FNA) and transfer the collected cells to a slide to look under the microscope.

Alternatively, the vet uses a biopsy punch to take out a sample of the lumps for the laboratory to check the cells.

CONCLUSION.

Why do some dogs develop lipomas? Not much is known. Older dogs and certain breeds past middle age and are obese develop these fatty lumps.

"This Labrador Retriever was never fed dry or canned dog food," Ms Tan told me. "She eats only home-cooked food!".

"Did you give her a lot of fat and sausages?" I asked. "No," Ms Tan said.

"Did you feed her RAW DIET" as her total cholesterol is high, at 8.5 mmol/L. The normal range of values are 3.4 - 6.5 mmole/L."

"Yes" she said. "I feed her raw diet since she was a young dog."

Not all dogs with high total cholesterol levels develop fatty lumps. Hence, the presence of high total cholesterol is not a useful indicator.

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Lame on right hind (Video).

BEST ADVICE FROM DR SING KONG YUEN

1. SURGICAL EXCISION AND HISTOLOGY by removing and sending the fatty lump to the laboratory to determine whether they are cancerous or not is my best advice to owners. This is because I had some cases of the Labrador Retriever misdiagnosed as lipomas when they are cancerous liposarcomas, mast cell tumours or soft tissue sarcomas.

2. OWNERS HAVE NO TIME. Many owners in Singapore do not have their lipomas checked YEARLY. The vet should use FNA or BIOPSY unless the large fatty lumps irritate the dog as they become ulcerated and infected or cause lameness.

Example of one case study.

By then, such lumps may be cancerous mast cell tumours or soft tissue sarcomas that have had spread. The large fatty lumps in right hind leg could be a cause of limping on the right hind leg. Ms Tan would have to decide on whether X-rays of the left hip to check for hip arthritis. Large lipomas at the righrt knee joint area can impede movement but Ms Tan has to decide on surgery to remove them.

(Always narrate any text on any slide)

FINAL VIDEO:

5 Oct 2020.

Dr Sing Kong Yuen's comments on A labrador retriever with multiple skin lumps

An excellent educational video, very well created.

1. The hook draws the viewer to learn more.

2. The use of animations, illustrations, subtitles and images were co-ordinated, making sure viewers do NOT fall asleep. Be aware of copyright infringements as some animations appear to be copyrighted materials. It is best NOT to use them. You can always draw your own illustrations by hand. Not as nice, but free from Youtube warnings and removal of the video in the future.

3. Monotonous narration. The narrator needs to vary the tone - louder and softer voices to keep the viewer more focused on certain key words like a much louder voice for "What is a lipomas?"

4. The pacing is good. Not to slow and not too fast narration. Keep up good editing.

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VIDEO 2.

A 14-year-old female Labrador Retriever passes blood in the urine for the 4th time.

HOOK

Use same footage as in Video 1. The footage is 0:00 to 0: 40 only.

The owner consulted Dr Daniel 4 days ago as her dog had passed blood in the urine for the 4th time. The dog was losing weight. What can be done to help this beloved companion?

TITLE

HAEMATURIA IS THE PRESENCE OF BLOOD IN THE URINE.
(IMAGE OF BLOOD IN THE URINE - TEST TUBE FOR URINE TEST)

Haematuria is not normal in any dog, young or old. What is the cause and solution for this 14-year-old female Labrador Retriever?

SINGAPORE SETTING....

Short video clip of singaporeans working, buses, apartments, street scenes etc but NOT the same as your previous one.

CAUSES AND LABORATORY TESTS

INFECTIONS - BLOOD AND URINE TESTS
1. Upper urinary tract infection
2. Lower urinary tract infection.
Pyometra (infection of the uterus) in the older female not-spayed dog is common condition.

UROLITHIASIS - URINARY STONES - X-RAYS AND ULTRASOUND
1. Upper urinary tract. Kidney stones.

2. Lower urinary tract. Bladder and urethral stones.

RENAL NEOPLASIA

1. Upper urinary tract
2. Lower urinary tract. Bladder cancer.

Dr Daniel performed a blood and urine test on 6 Sep 2020.

Findings showed bacterial infections in the blood and urine.

EXPLAIN THE TABLES - BLOOD TEST AND URINE TEST - SEE BELOW

Of great concern is the very high liver enzyme levels in the blood test. This indicated liver disease such as hepatitis and/or neoplasia.

No X-rays or ultrasound were performed as thhe owner wanted to wait and see.

TREATMENT

Dr Sing Kong Yuen recommended a therapeutic diet, Hill's l/D (IMAGE) to be fed as sole food for the next 3 months. No more home-cooked food or BARF Diet.

What is BARF Diet?

BARF is an acronym that stands for Bones and Raw Food, or Biologically Appropriate Raw Food. Some dog owners believe that adult dogs thrive on what canines ate before they became domesticated - Raw, meaty bones and vegetable scraps.

As the owner did not feed dry dog food, this eliminates the possibility of the dog developing urinary stones in the kidneys and/or the bladder. The stones irritate the lining of these organs and cause bleeding. Blood in the urine in this dog is likely due to a urinary tract infection.

FOLLOW UP ON OCTOBER 10, 2020.
VIDEO FOOTAGE (Attached in email to you).

The dog is not passing blood in the urine and is eating 110% of the therapeutic diet and had gained weight.

"How do you know that your dog has gained weight?" Dr Sing texted her.

"Her stomach" is visible. See the video footage sent by the owner. Footage emailed to Shyan. This stomach was present for the past 5 years. The owner will monitor if the swelling increases in size.

Another blood and urine test will be done on 30 October 2020.

BLOOD TEST (Shyan to put the data in a table)

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BLOOD LIVER ENZYMES ARE ELEVATED, SHOWING LIVER DISORDERS

4 Jul 2018 VET CLINIC 1
ALT 168 U/L Normal Range (10-125)

6 Sep 2020 TOA PAYOH VETS

ALT 788 U/L Normal Range (less than 59)

AST 259 U/L (less than 81)

COMMENTS; High liver enzymes indicate a liver disorder and/or infection.

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BLOOD TEST

6 Sep 2020 TOA PAYOH VETS (Shyan to put data in a table)

Total white cell count 29.0 x 10*9/L (6-17)

Neutrophils 96.1% (60-70%) Absolute 27.9 x 10*9/L (3-11.5).

This dog has leucocytosis and neutrophilia as evident in the increase in the total white cell count and neutrophils. This means that the dog's immune system is producing more fighters to get rid of the bacteria. The bacterial infections of the urinary tract lead to urinary tract infection and the presence of blood in the urine.

Most likely, the liver has been infected. Hence the increase in liver enzymes. (Show above table).

COMMENTS: Total white cell count and high neutrophils indicates bacteraemia which is the presence of bacterial infection in the blood circulation. The dog had fever and weight loss.

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URINE TEST.

BLOOD, BACTERIA AND WHITE CELLS IN THE URINE, SHOWING URINARY TRACT INFECTION

4 July 2018. VET CLINIC 1 URINE TEST

Reference Range

pH = 8 (5-8)

SG 1.010 (1.005-1.030)
Protein 3+ (Negative)
Nitrite 2+ (Negative)
Blood 3+ (Negative)

Prescribed antibiotics

2 Aug 2018 VET CLINIC 2 URINE TEST

pH = 8 (5-8)
SG 1.024 (1.005-1.030)
Protein 3+ (Negative)
Struvite & Bacteria Present (Negative)
Blood 1+ (Negative)
Prescribed antibiotics, acidurin and omeprazole

Latest urine test

6 Sep 2020 TOA PAYOH VETS URINE TEST

pH = 7 (5-8)

SG 1.020 (1.005-1.030)
Protein 4+ (Negative)

Ketones 2+ (Negative)

Urobilinigen Normal. Bilirubin Negative. Glucose Negative

Blood 4+ (Negative)

White blood cells over 900 (/uL)
Red blood cells over 1800 (/uL)

Bacteria +
No casts or crystals. No crystals do NOT mean that the dog does not have urinary stones like struvites.

Findings: Urine test confirmed a UTI with haematuria. This is a urinary tract infection with bacteria present in the urine. How serious is the UTI?

Let's look at the blood test specifically, the total white cell count and neutrophil %. These values are high confirming bacteraemia. This means that the blood circulation has bacteria organisms which have had infected the liver as well as the urinary tract.

COMMENTS: Blood, bacteria, proteins and white cells inside the urine - urinary tract infection

URINARY pH IS ALKALINE

4 July 2018. VET CLINIC 1 URINE TEST

pH = 8 (5-8)

SG 1.010 (1.005-1.030)

2 Aug 2018 VET CLINIC 2 URINE TEST

pH = 8 (5-8)
SG 1.024 (1.005-1.030)

6 Sep 2020 TOA PAYOH VETS URINE TEST

pH = 7 (5-8)

SG 1.020 (1.005-1.030)

No casts or crystals. No crystals do NOT mean that the dog does not have urinary stones like struvites.

From the 3 urine tests, the dog has an alkaline urine which favours the growth of bacteria. The bacteria causes urinary tract infection. In Vet Clinic 2, the urine contains struvite crystals. In Toa Payoh Vets' urine test, the urine does NOT contain crystals. The absence of crystals does NOT mean that the dog does not have struvite stones in the bladder or kidneys.

CONCLUSION

The present solution is to do a feed trial for 3 months.

The therapeutic diet (Hill's L/D) is recommended as the dog has liver disease.

Liver Care This dog's liver is the largest internal organ with many functions, including the digestion and conversion of nutrients, the removal of toxic substances from the blood and the storage of vitamins and minerals. The liver has can repair and regenerate itself. Good nutrition plays a vital role in this process.

Hill's® Prescription Diet® l/d® Canine is a complete and balanced food that provides all the nutrition your dog needs.

It is formulated to help protect vital liver function

How it works:

Moderate levels of high quality protein
High L-carnitine & L-arginine levels
Appropriate level of zinc
Low copper
Clinically proven antioxidants

How it helps:

Helps reduce liver workload allowing liver tissue to regenerate
Helps maintain normal fat metabolism in the liver
Helps avoid nutrient deficiencies commonly related to liver issues
Supports a healthy immune system
S+OXSHIELD^TM: Formulated to promote a urinary environment that reduces the risk of developing struvite & calcium oxalate crystals

The owner needs to be educated to feed this therapeutic diet for around 3 months to help the liver to recover.

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Acidification of the urine:

Will this diet acidify the urine to stop bacterial infection, I have no data presently. If this dog does not suffer from liver disorders, I will recommend Hill's C/D which is proven to acidify the urine.

The urine needs to be checked once in 2 months for the next 3 months.

URINE TESTS

As you can see from the urine test, ketones were present in the urine.

6 Sep 2020 TOA PAYOH VETS URINE TEST

pH = 7 (5-8)

SG 1.020 (1.005-1.030)
Protein 4+ (Negative)
Ketones 2+ (Negative)

The urinalysis came back with no glucose but some ketones present in the urine. Ketones are acids that are a byproduct of fat break down. When enough of them built up in the blood, it becomes poisonous to the animal.

This type of fat break down usually occurs when the animal can’t use glucose as a form of energy due to a lack of insulin.

If the dog has a high amount of glucose and ketones in the urine, she will be suffering from diabetic ketoacidosis (DKA) – a potentially fatal condition if not corrected quickly. However, the urine has no glucose and therefore, there is unlikely to be diabetic ketoacidosis. Another urine test in one month's time will be done.

As the owner was busy and did not come to collect the diet, Dr Sing Kong Yuen delivered the dog food personally. The dog's liver can recover as soon as possible but it needs the therapeutic diet.