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Dr. Deb
Dr. Deb, Dog Veterinarian
Category: Dog
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Experience:  I have been a practicing veterinarian for over 30 years.
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My 12 years old female Husky Laïka (75pounds) ate 6 ounces

Customer Question

My 12 years old female Husky Laïka (75pounds) ate 6 ounces of marzipan. About 6hours after she had diarrhea and vomit. @4 hours after she became completely lethargic with very high fever (40.7°C). We brought her in emergency to the vet, was misdiagnosed, operated and died 12 hours after the operation. Is that normal? What we should have done to save her life?
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Deb replied 1 year ago.

Hello Evhen, I'm Dr. Deb.

I recently came online and see that your question about Laika hasn't been answered. I'm so sorry that you've had to wait for a response,but if you still need assistance, I'd like to help if I can.

First, let me express my sincere condolences to you and your family on your loss; I'm sure you must be devastated.
I do have a few questions to ask, however, if you don't mind:

1. Can you tell me what the ER vet felt was going on which is why surgery was done?
2. I'm assuming the marzipan didn't contain xylitol?
3. Was bloodwork done prior to surgery? If so, what were the results?
4. What was found during the surgical procedure?
5. How did she behave during the 12 hours prior to her death?

There may be a delay after I receive your answers since I have to type up a response to you and I may be offline at the time you respond. But I'll get back to you as soon as I can since I'm on the computer some part of every day.

Thanks for your patience. Deb

Customer: replied 1 year ago.

Thank you.

I asked the hospital to send me all the tests. I will send them to you as soon as received them.

They found a lump (tumor) attached to her liver.

The blood test showed abnormal counts (of ?).

After the surgery (Dec 18), she started to bleed and had a cardiac arrest around midnight (about 7 hours after the surgery).

The surgery was done around 5pm Dec 18. She had 2 cardiac arrests at around 8:15am Dec 19. I rushed to the hospital and told them to let her go. Laika died in horrible pains at 8:20am, Dec 19.

Customer: replied 1 year ago.

How can I send you a pdf file?

Expert:  Dr. Deb replied 1 year ago.

Evhen:
I'm sorry that I was off my computer when you responded back; this sounds like a pretty horrible experience for you, your family and, of course, for Laika:(

It's not always easy to send files but this LINK walks you through it. I would be interested in knowing what the results of her blood tests, especially if a coagulation panel was done.

I'm sorry for more questions but I'd like more clarification, if possible, so that I can better respond to why she might have died:
1. I'm assuming that an ultrasound was done? Otherwise, how was a liver mass detected? By palpation or x-ray?

2. How was she misdiagnosed? Was a liver mass not found when surgery was done?

3. What did the surgeon find?

4. Where was the source of her bleeding? From her incision site? Internally?

I'll continue to be off and on my computer most of the day but I'll apologize in advance if we keep missing each other. Deb

Customer: replied 1 year ago.

















































Clinic:



065 Centre vet. D.M.V,




Fax



***-***-****



Phone: ***-***-****



Clinician:



Dre Lefebvre, Claude




Fax:





Phone:



Patient:



Yakimiw, Laika 170683



Species: Canine





Breed:



Siberian Husky



Sex:



Spayed Female



Age: 12 years







- -iz



-;;ZNAWA., ",; J:1AI;Ire14- !,•'1



...., 'ALAI ? .1.



,.



,-t.,



.e• ..- T



..:.-t..4;:.f, ,.f:lt 4,-11, ,t5ki,•'



Collected Date: 2014-12-18 Reception Date: 2014-12-18

Clinical information:

1 Procedure: Fine needle aspiration

C27721-14-1 CA EC1-Cyto 1 with MD foie Fine needle aspiration) B 5 L

C27721-14-2 CA CSTAT-Cyto Stat Other OD 0 L










Lam



414



SOURCE:

Masse hepatique.

DESCRIPTION :

5 lames sont soumises pour analyse. Elks sont moderement ou tres cellulaires et demontrent une population relativement homogene de cellules polygonales d'apparence hepatocytaire qui forment des amas cohesifs de taille variable. Les amas sont legerement desorganises et un entassement cellulaire Leger a modere est note. Les cellules exhibent une anisocytose et une anisocaryose legeres, mais un ratio N :C augmente. Leur cytoplasme est granulaire et legerement basophilique. Leur noyau est rond et it contient une chromatine granulaire, ainsi qu'un ou deux petits nucleoles ronds proeminents. Les cellules demontrent une vacuolisation cytoplasmique variable. Quelques amas sont associes a des granules d'hemosiderine. On apercoit aussi un faible nombre de cellules himatopoletiques individuelles qui sont eparses sur la majorite des lames et presentes en nombre legerement plus grand en peripherie. Il s'agit de quelques megacaryocytes et de precurseurs granulocytaires neutrophiliques et eosinophiliques. L'arriere-plan contient une quantite moderee de sang et plusieurs noyaux d'hepatocytes nus.

INTERPRETATION :

Compatible avec un hepatome ou un carcinome hepatocellulaire bien differencie.

COMMENTAIRES :

On observe presque uniquement des hipatocytes sur les lames. Ceux-ci demontrent quelques criteres cratypie mineurs qui ne sont pas suffisants pour suggerer un diagnostic cytologique de carcinome hepato-cellulaire. Il pourrait done s'agir d'un simple hepatome, mais la possibilite d'un carcinome hepato-cellulaire bien differencie ne peut pas etre totalement exclue. Une vacuolisation cytoplasmique et une hematopoIese extra-medullaire secondaires non-specifiques sont presentes. L'examen histopathologique de l'architecture tissulaire serait indiquee si vous desirez exclure la possibilite d'un carcinome bien differencie.

Sebastien Overvelde, DMV, MSc, Diplomate ACVP

Final

(GMT-05:00) Eastern Time (US and Canada) Page 1 / 2
































Clinic: 065 Centre vet. D.M.V.




Fax:



***-***-**** Phone: ***-***-****



Clinician: Dre Lefebvre, Claude




Fax:



Phone:



Patient: Yakimiw, LAIKA 170683



Species: Canine



Breed:



Siberian Husky



Sex: Spayed Female



Age: 12 years











































BIOCHEMISTRY






HEMATOLOGY



Test



Results



Reference



Units



Lab



Test



Results Reference Units Lab



Glucose Urea (BUN) Creatinine Phosphorus Calcium Sodium Potassium Na/K Ratio Chloride Total Protein Albumin Globulin A/G Ratio ALT

AST

ALP

T. Bill (Total)

D. Bil (Conj.) Cholesterol Amylase Lipase CK Hemolysis lcterus Lipemia



4.8 13.8 203 1.1 2.85 143 4.3 33 103 71


33


38
0.9
2787
1479
3566
5.5
1.8
9.4
911
898
129
+++
Normal
Normal



3.5


t 3.2


t 44


0.8


t 2.20
142 4.0 28

+ 108
55 27 24 0.7


t 18


+ 16


t 5


t 0


0


t 3.4


337


t 138


10



­­­­- ­­-• ­­­­• • - - - ­­• -



6.3 11.0 133 2.0 2,80 152 5.4 37 119 75


39

40 1.5 121 55 160 5.13 3.42 8.9 1469 755 200



mmol/L mmol/L umol/L mmol/L mmol/L mmol/L mmol/L

mmol/L g/L g/L g/L

ILI/L IU/L IU/L umol/L umol/L mmol/L IU/L IU/L IU/L.



M11 MIL Mn MIL MTL MTL MTL MIL MIL MIL Mn MTL MTL MTL MTL 7.411 MTL Mn MIL MTL MIL MIL MIL MIL MTL



WBC RBC Hemoglobin Hematocrit MCV

MCH

MCHC RDW Platelets Nucleated RBC % Reticulocyte Reticulocyte

Differential:



7.6 4.9 ­17.6 x10E9/L MR

5.7 5.4 ­8.7 x10E12/L MIL

127 4' 134 - 207 g/L MTL

0.33 4, 0.38 - 0.57 UL M71

58.0 4, 59 ­76 fl MIL

22.2 21.9 ­26.1 pg

383 326 ­392 g/L MTL

17,3 10 ­19 %CV Mn

237 143 - 448 x10E9/L MIL

2 /100

0.4 MTL

22.8 10 - 110 X10E3lul Mn

Degree of bone marrow response (10E3/uL): Normal if non-anemic < 110 Inadequate if anemic < 110

Mlid 110 -150

Moderate 150 - 300

Marked > 300

% abs.



Neutrophils Bands Lymphocytes Monocytes Eosinophils Basophils Metamyelocyte



89.0 6.8 2.9 - 12.7 x10E9/L

6.0 0.5 + 0.0. 0.2 x10E9/L

1.0 0.1 4. 1.1 . 5.0 x10E9/L

3.0 0,2 0.0 - 1.2 x10E9/L

0.0 0.0 0.0 - 1.5 x10E9/L

0.0 0.0 0.0 _ 0.1 x10E9/L

1.0 0.1 x10E9/L



Morphology:

WBC MORPHOLOGY

Left Shift Present

Lymphopenia Marked

Toxic Neutrophils Mild

RBC MORPHOLOGY

Anemia Mild

Polychromasia 0-1 /100X

PLT MORPHOLOGY

Clumped Platelets Present
Normal

PLT ASSESSMENT



Teats requested: W2, reINRBC, ATYL, %ATYL, MAST, MMYE, MYE, END, %BND, %,MMYE, %MYE, %MAST, UNCC, %UNCC

Tests to follow:



(GMT-05:00) Eastern Time (US and Canada)

Page 1 / 2




























Clinic: 065 Centre vet. D.M.V.





Fax: ***-***-**** Phone: ***-***-****



Clinician: Dre Lefebvre, Claude





Fax: Phone:



Patient: Yakimiw, LAIKA 170883



Species: Canine



Breed: Siberian Husky



Sex: Spayed Female



Age: 12 years





Platelet Count Adequate

Comment Manual Differential performed. RP



haste requested: W2, refNREIC, ATYL, %ATYL, MAST, MMYE, MYE, BNC, %BND, %MMYE, %MYE, %MAST, UNCC, %UNCC

Tests to follow:



(GMT-05:00) Eastern Time (US and Canada)

Page 2 / 2




Detailed Lab Results








































































































































































































































































































Patient: 6322

Client: 6573 Evhen Yakimiw



Patient: Laika Sex: Female sterilised


Species: Canin Breed: Husky



Age: 13 Yrs. 8 Mos Weight: 0.00 kilogram:



Lab ID: INCLINIC IDEXX VetLab In-clinic Laboratory


Template: Hematology

Staff: Dr. Annie Bedard Status: Posted

Req ID: 11000 - Thursday 18/12/14 09:51:55







Test



Results




Reference Range



Low



Normal High




HCT



= 35.4 %



L



37.0 - 55.0



i



I_



-r



J



HGB



= 12.6 g/dL




12.0 - 18.0



t,.. ....____A-




1



1







_.





MCHC



= 35.6 g/dL




30.0 - 37.5




E-



L E



i



WBC



= 6.95 x1 0^9/L




5.50 - 16.90






_A



[.



'AL



---1


____



LYMPHS



= 0.28 x10^9/L



L



0.50 - 4.90







I C_



if



1



I



%LYMPHS



= 4.1 %









MONOS



= 0.40 x10A9/L




0.30 - 2,00







%MONOS



= 5,8 %









NEUT



= 6.14 x10^9/L




2.00 - 12.00





,




%NEUT



= 88.4 %









EOS



= 0.10 x10"9/L




0.10 - 1.49



C






%EOS



= 1.4 %









BASO



= 0.02 x10^9/L




0.00-0.10



F






%BASO



= 0.3 %









PLT



= 251 K/uL




175 - 500






1



Retics



= 157.4 KfuL



H



10.0 - 110.0



E.






%Retics



= 2.7 %









RBC



= 5.77 x10^12/L




5.50 - 8.50



-

r_---



---ill


-



-T


-



Ti



MCV



. 61.3fL




60.0-77.0




_._i UI




..._____



1




MCH



= 21.9 pg




18.5 - 30.0




IL



1L--



i



RDW



= 18.9 %



H



14.7 - 17.9



1::::"----



..L_________




.... __I



__II__ __



MPV



= 11.0 fL









PDW



= 20.8 %









PCT



= 0.28 %









Clinic Comments: PCV: 38% TP: 8.6g/dl




Detailed Lab Results

Patient: 6322 Patient: Laika Sex: Female sterilised Age: 13 Yrs. 8 Mos

Client: 6573 Evhen Yakimiw Species: Canin Breed: Husky Weight: 0.00 kilogram!









































































































































Lab ID: INCLINIC IDEXX VetLab In-clinic Laboratory


Template: Chemistry


Staff: Dr. Annie Bedard


Status: Posted

Req ID: 11000 - Thursday 18/12/14 09:52:55



Test



Results




Reference Range



ALB



39 g/L




22 - 39



ALKP



1533 U/L



H



23 - 212



ALT



U/L




10 - 100



BUN/UREA



= 10.7 mmol/L



H



2.5 - 9.6



Ca



2.82 mmol/L




1.98 - 3.00



Chloride



114 mmol/L




109 - 122



CHOL



7.78 mmol/L




2.84 - 8.26



CREA



164 umol/L



H



44 - 159



GGT



< 0 U/L




0 - 7



GLU



5.42 mmol/L




3.89 - 7.95



PHOS



1.08 mmol/L




0.81 - 2.20



Potassium



= 4.6 mmol/L




3.5 - 5.8



Sodium



153 mmol/L




144 - 160



TBIL



14 umol/L




0-15



TP



76 g/L




52 - 82



GLOB



37 g/L




25 - 45



Na/K



33





OSM calc



= 309 mmol/kg





BUN/CREA



= 16





ALB/GLOB



= 1.1






Client YAKIMIW (170683) Sexe: CENTRE VETERINAIRE DMV

Nom du patient: LAIKA Poids: 2300 54ave LACHINE, QC H8T

EspOce: Chien Age: 13 Ans 3R2

Ram Docteur: (###) ###-####/strong>

Test Resultats Valeurs Usuelles BAS NORMALE ELEVE

SNAP Pro (18 decembre 2014 14:00)

AP_spp EC-EE HW Lyme

Expert:  Dr. Deb replied 1 year ago.
Evhen:
Thanks for the additional information; this is very helpful.
My interpretation of the test results is as follows:

She had significant elevations in all of her liver enzymes. She also had issues with her kidneys. She was mildly anemic and although her platelets were within a normal range, they were at the low end of normal.

The aspirate of her liver was inconclusive although cancer was mentioned as a possiblity.

A clotting profile wasn't done which would have been a good thing to do prior to surgery, although I'm somewhat at a loss to understand why surgery was contemplated in the face of these values.

If this were my case (and I realize that everyone practices differently), I would have considered Leptospirosis ( http://www.petplace.com/dogs/leptospirosis/page1.aspx) since this organism can target both the kidneys and liver at the same time.
Cancer would have been on my list of rule outs, given her age and the mass on her liver.
I would have suggested an ultrasound to evaluate her internal organs and I might have submitted testing for Leptospirosis (but would have already started her on antibiotics pending the results).
I might have run a bile acids test to further evalute liver function.

In all honesty, this is not a dog whom I would have taken to surgery or even contemplated surgery for until or unless my patient was very stable. Problems with both her liver and kidneys would have put any patient at an increased risk for adverse anesthetic reactions. In addition, since a coagulation profile wasn't done, it's possible that clotting would be an issue with an unhealthy liver.

Given all of her abnormalities in her blood work/urinalysis, I would expect complications after a surgical procedure..or let me rephrase and say I wouldn't be surprised if they developed.
If she started to spontaneously bleed, then she may not have had sufficient Vitamin K or clotting factors produced by her liver to keep up with the loss and to cause clotting.

It's also possible that she went into DIC (Disseminated Intravascular Coagulation) which is usually fatal, unfortuantely. (http://www.petplace.com/dogs/disseminated-intravascular-coagulation-in-dogs/page1.aspx)

Once her body started to shut down, I honestly don't know if there would have been any way to save her. Even if she had been given Vitamin K injections, it likely wouldn't have been enough to prevent hemorrhage.

I know that hindsight is 20/20, but she clearly had issues with more than one organ system. If this had been Leptospirosis, then she might have responded to antibiotic therapy although not all dogs will; some will die from this condition.
If she had cancer, then it was also a matter of time before it would disseminate and she would decline even further.

I hope this helps although I suspect you're still in a state of shock over her sudden loss; I can't say that I blame you. Deb

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