The Geriatric Dog

Older Irish Setter with Possible Hypoglycemia (Low Blood Sugar)

Q: Dear Dr. Mike,

I also have a 12 1/2 year old small field variety Irish Setter. She has developed mild seizure type behaviors-no falling, salivating or loss of consciousness. I watched for a few days and it seemed to be near mealtime (I feed twice daily) --mostly mild tremors and standing very still to get it together after a 20 second spell. So I read up on hypoglycemia. At her age, the insulinomas could be a factor. If I do the complete blood panel you recommend, will we just see possible right conditions for these tumors? How would you be sure? If you elect not to operate on a dog of this age, what is the usual course of medication?

I have started slipping her a MilkBone from time to time and when I return to work, I think I'll leave a small bowl of food in her crate during the day.

Again, many thanks. Ann  

A: Ann-

At first, it can be hard to find hypoglycemia (low blood sugar) when a problem like an insulinoma is present. After the signs become more established, it is usually possible to identify the low blood sugar within a few blood samples taken at various times during the day. Fasting for a few hours will usually cause hypoglycemia in patients with insulin secreting tumors and can be helpful when the diagnosis is hard to make. When a sample does have a low blood sugar value and clinical symptoms suggest recurrent hypoglycemia it is a good idea to run an insulin level and glucose level on the same blood sample. If the blood sugar is less than 60mg/dl and the insulin levels are above normal for the laboratory running the testing, there is a very high probability of an insulin secreting tumor.

It is important to remember that there are other possible problems that could lead to the signs listed in your note, such as vestibular disorders, seizure disorders, liver problems, heart disorders and probably a number of other things I'm not thinking of at the present time. A good physical exam, general blood chemistry panel and complete blood cell count might be a good starting point to discovering the cause of the signs you are seeing. If the blood sugar is low on the panel and there are no signs of other possible causes, such as liver disease or other cancers, then an insulin secreting tumor would be much more likely.

Surgical removal of as much of the tumor as is possible is the preferred  treatment for insulinomas but there are medical options. Administration of prednisone, or other corticosteroids, helps to increase blood sugar by interfering with the actions of insulin and stimulating sugar release from the liver. It is usually necessary to administer prednisone twice a day to keep blood sugar elevated. Diazoxide (Proglycem Rx), is also used to help increase blood sugar and can be used long term. There has been some use of octreotide (Sandostatin Rx) for this condition, according to "Saunders Manual of Small Animal Practice, 2nd ed." by Scherding and Birchard.

I hope that this helps some in understanding what might be happening.  It would be a good idea to have your vet check your Irish setter to see if it seems necessary to start the diagnostic process for this condition and the other things that can look like it at times.

Mike Richards, DVM

Older Dog Problems in Springer

Q: Riley is my 11 yr old Springer Spaniel. I don't know if you can make any recommendations with what I am going to describe but here goes anyway.

In the last few months, although he runs and plays and eats well every day. At night when he is sleeping, he moans and moans. He also has accidents even though I put him out many times a night.

I realize he is arthritic as he has more and more trouble jumping up on the bed, but it doesn't slow him down playing with his ball. He's rather do that than eat.

The other possible concern is his lower fang teeth. They are about half their original size and you can see the pink in the middle.

I don't have much money but I don't want him to be in pain. Any help will be greatly appreciated.

Sincerely,

Sally

A: Sally--

It is hard to be sure of the cause of Riley's restlessness when he sleeps, but it is possible that this could be due to pain from arthritis. There is no reason not to try a pain relief and/or anti-inflammatory medication. Aspirin is the least expensive of these medications and is pretty effective at both pain relief and anti-inflammation. It causes gastrointestinal irritation in some patients and use should be discontinued if there is any sign of GI problems, especially lack of appetite and vomiting. The dosage is 10mg/lb every 12 hours. Another good choice would be glucosamine and chondroitin, which is usually dosed at 1 tablet per 25 pounds per day, of the usual 500mg glucosamine / 400mg chondroitin tablets. These are available over the counter. Two very effective medications that are prescription only, carprofen (Rimadyl Rx) and etodolac (Etogesic Rx) would also be good choices but are more expensive. If pain relief did not resolve the problems, it would be necessary to consider a visit to your vet to explore what might be happening, as this is a very non-specific sign.

Urine leakage when dogs are asleep is most commonly associated with incontinence but can occur due to disorders that increase the volume of urine, such as diabetes or hyperadrenocorticism (Cushing's disease). It can also occur when there is a stronger need to urinate, due to prostate disease, bladder infection, bladder stones, bladder cancer or other urinary tract disease. It is pretty important to try to rule out these conditions to the extent it is possible to do so, prior to assuming that incontinence is the cause.  In male dogs, it is sometimes hard to control incontinence. If no underlying problem, such as a problem with nerve innervation to the bladder is found, a combination of administration of testosterone and phenylpropanolamine will often help control the incontinence.

If the teeth wear down slowly they will usually produce a protective dentin layer as they wear and they are not painful in this case. There is a chance with the pink color that a problem is present. Many pet owners can discern pain in this situation, noticing things like a reluctance to drink cold water, not picking up toys anymore, eating differently --- things that indicate that the dog is trying to protect the affected teeth. It is probably OK to wait a reasonable length of time for a routine visit to occur where you can ask about the teeth but it would be good to have these teeth checked by your vet when it is convenient to do so.

I wish that I could help more with the night time moaning problem.

Mike Richards, DVM

Most Common Causes of Coughing or Altered Respiratory Sounds in Older Dog

Q: Dear Dr. Richards I am writing for two reasons. First, I want to thank you for this great web site. I found it by accident a few weeks ago when I was looking for information concerning my dog's new medication. The information I found on your web site was so useful I decided to subscribe. The first issue of your digest I received was great. I really found the article on medications useful. My dog and other pets have been quite ill this past year and sometimes my kitchen counter looked like a drug store; it was great to finally have such useful information concerning medications.

The second reason I am writing is to ask a question concerning my dog. He is a very nervous dog.  We found him 13 years ago; he had been thrown out of a car and although we will never know exactly what happened to him before this time, we do know that it left him incredibly nervous and very frightened whenever I try to give him any kind of medical care. Removing a pricker from his fur can cause him to run a hide. So taking him to the vet can be a nightmare; he is very hard to handle at the vet and whines and cries for days after each visit. Because of this I am always very reluctant to take him to the vet. I try to make my visits as brief as possible and go with as much information as I can so that I can help my vet as much as possible to diagnose him quickly and without  the least amount of stress. That is why I am writing. Any infomation that you could provide concerning the condition I am about to describe would be very, very appreciated.

My dog is 14 years old shephard/lab mix. He is a dibetic, has I.B.D., has lost most of his eye sight and late this summer suffered terribly with allergies. A couple of months ago he started with somewthing that sounds a bit like a cough or maybe more like he is clearing his throat loudle. It happens occasionally after he drinks (he has always coughed if he drinks a large amount of water at one time) or at certain times during his walk. Usually about a block away from my house at almost the exact same spot he will cought; then he'll cough about a block later and sometimes about a block after than. But sometims he does not cough at all. I spoke to my vet very briefly about this problem bdrling my last visit and he tested his lungs; he said his breathing was a little raw but nothing to worry about. He felt his thrat and by pushing on his larynx he was able to make him make the sound I had been hearling. He told me that to test for the problem he wound need to sedate my dog, inject fluid into his throat and then withdraw some of the fluid for testing. He was hestitant about doing this test because he did not want to sedate my dog. He can react very unpredictably to medication and because of his age and other conditions he felt that sedation could be risky. He told me to keep and eye on him and get back to him. He then said a couple of things that really bothered me he mentioned that diabetiics can have problems with blood vessels then he told me to remember that my dog wasn't eternal.

Apart from this "cough" my dog seems fine. He eats well, enjoys long walks, has had no weight loss and just generally seems fine. But I'm not sure what to do. I fear it could be something quite serious based on my vet's comments. But I don't want to put this dog through more tests the last two years have been very difficult (he almost bled to death from an ulcer, was at the vet weekly during the winter for ulcers on his eyes and this sumer was on one medication after another to try to stop the allergies) especailly if they could be life threatening, if it is not necessary. So I just don't know what to do at this point. Could you give me some idea of the type of tests my vet may suggest to diagnose this condition? Could you possibly give me an educatid guess as to what my be causing this problem? Are there any other symptoms that I might not be aware of that I should be looking for that I could tell my vet about to help hi diagnose my dog better?

Thank you in advance for taking the time to read this very lenghty message. Any suggestions, advise ect. would be very appreciated. We love this dog very much and will do anything to help him.

Rennie

A: Rennie-

The most common causes of coughing or alterations in respiratory sounds in older dogs include:

laryngeal paralysis (pretty common in Labs, based on the ones in our practice) collapsing trachea  (usually affects small breed dogs sometimes affects bigger breeds) chronic bronchitis heart disease (more common as dogs age and in heartworm endemic areas) cancer (lung cancer is not especially common in dogs, upper airway cancers  are an occasional problem) allergic bronchitis (there is not a strong correlation between allergic bronchitis and allergic skin disease but this would be a consideration due to the history of allergies) fungal infections  (coughing is a major sign of some fungal diseases, these occur in specific geographic areas such as the Southwest and Ohio River valley most commonly -- not too likely as the problem) lung parasites (dogs can get lung worms. This is not a common cause of coughing but  it is one that can occur)

I probably forgot several differentials for coughing.

Depending on what was found as we went along, the diagnostic process might include chest X-rays, heartworm testing if it seemed necessary based on the area and history of heartworm prevention medication usage, a complete blood cell count, examination of the larynx under anesthesia, cardiac ultrasound examination,  electrocardiogram, tracheal or bronchoalveolar lavage (the fluid injection into the trachea/bronchi/lungs for culture of bacteria and examination of collected cellular material to help rule in or rule out cancer, fungal infections, bacterial infections and inflammatory disorders like allergic bronchitis).

Almost all of these tests are invasive or would involve sedation or anesthesia in an uncooperative or frightened patient. Given the history of stress related problems after veterinary visits, it is important to assess the need to know for certain what is going on, especially as far as assessing what you will do if you find out any of these conditions is actually present.

Of the problems listed, the most likely to be the problem are probably laryngeal/pharyngeal problems such as laryngeal paralysis or polyps or tumors in the upper airway, allergic bronchitis, chronic bronchitis ( diabetes can make it hard for dogs to fight off infections they would normally control), heart disease and cancer. Of these, the most treatable conditions are the two forms of bronchitis and heart disease. I think that might be why your vet is thinking of doing the tracheal wash or bronchoalveolar lavage first, since finding a treatable condition would make the testing worthwhile. I think that if sedation is necessary it would be  a good idea to get chest X-rays at the same time.

Bronchoalveolar lavage and tracheal wash are invasive procedures which would almost certainly require anesthesia in a patient who was very frightened at the vets. With your dog's history it may be reasonable to attempt treatment without doing the testing but you have to accept that the odds of choosing the correct treatment are less without the diagnostic information. Sometimes that is a reasonable compromise but it can make future testing a little more difficult since it can have some effect on the outcome of future testing by altering the disease process and masking the initial cause.

Heart disease is often responsive to therapy and when coughing is present there are usually visible signs of associated problems, like pulmonary edema, heart enlargement or tracheal elevation on X-rays. We can sometimes take X-rays of nervous dogs without sedation or anesthesia and sometimes we have to resort to those measures. Again, if anesthesia is necessary for any part of the examination procedure it might be best to do all the invasive testing at one time and collect a database to make decisions from.

I think that I would probably base the choice on whether to proceed with testing on the course of the coughing and the perceived severity of the situation. A mild cough that is not interfering much with activity in a fourteen year old dog is less important than one that is accompanied by tiring easily, giving up on daily walks or other exercise, weight loss, loss of appetite or other signs that a serious problem is present. For the mild cough,  I would tend to try therapies aimed at common problems in a patient who I thought the examination procedure would be extremely stressful for. For a cough with any of the more severe signs, I think it is better to consider a more complete work-up and in a patient who did poorly at our office, I would do all the testing I could at one time.

The questions I would want to know the answers to are 1) how frequently does the cough occur?  2) Under what circumstances does it occur, such as only in the morning, only after exercise, after eating, after drinking water, randomly, etc   3) Are there changes in appetite or daily routine since the coughing started?  4) Is the cough productive (does phelgm get expelled) or non-productive?  5) Are there other respiratory sounds that have increased, such as wheezing or snoring?  6) Is the cough gradually worsening or does it seem to be about the same frequency and just staying around chronically?  7) Has your dog been on any trips and if so where to?  Or, have you been on trips and boarded your dog? 8) Any new pets in the household  9) Do you suspect a weight loss?  10 ) Does your dog tire more readily than in the past or does he lag behind on walks or quit walking entirely? 11)  Are there any other problems, like fainting, that are associated with his cough?

I hope this helps some.  I know how hard it is to care for a pet that doesn't like to be handled.  One of my dogs was almost the worst patient we have had in our clinic and it was always hard to decide when she was ill enough that we just had to do something about it and when it was best to hope that she would get better on her own so we didn't take a chance of making things worse by stressing her too much. Lots of times I took a wait and see approach to Shasta's problems because of her personality.

Mike Richards, DVM

Senility and Other Geriatric Problems

Q: Dear Dr. Mike, We have spent a lot of time and money with our vet and emergency vet trying to figure out what is wrong with our Yorkie. He has cataracts and does not see well, yet at time he appears to get disoriented in a crowded space. He can no longer control his bladder through the night. He has bad gums and therefore he has lost several teeth. He howls as if he is in pain and runs around rubbing his face (both sides) on the floor. We thought he had an abscess but the vet says no. At times, he is very tender usually in his hind quarters. He has thrown his hip out  before but not during these episodes. We have given him baby aspirin and at times it appears to help. Sometimes holding him close and stroking him will settle him down. Other times nothing helps. After a bad episode last night, we took him back to the vet today and were told that he had Alzheimer's. I know this is a guess as they did no blood work, x-rays etc. they did give him all his shots that were due. Can you help???????? Thank you Chris    

A: Chris-

At present, I do not think that there is enough evidence to be sure that dogs have a disorder that can really be directly compared to Alzheimer's disease. On the other hand, dogs do have a form of senility that is termed cognitive dysfunction, which is also the category of disorder that Alzheimer's disease is considered to fall under in humans. L-deprenyl (Anipryl Rx) is approved by the FDA for treatment of this condition in dogs. It may be worth checking into this medication because it is reported to help with problems such as loss of housetraining and bouts of confusion. It is also approved for use in treating uncomplicated Cushing's disease, which can lead to increased drinking and urination. Pfizer manufacturers Anipryl and has some good information on canine cognitive disorder that they would be almost certainly be happy to provide to your vet.

It would be a good idea to check for problems leading to oral pain. A lot of Yorkies have really bad periodontal disease as they age and they seem prone to bone resorption around the teeth. When the teeth are loose and the gums inflamed there can be a lot of pain. It is also possible that renal disease may be leading to calcium/phosphorous imbalances and loss of bone density so general labwork to rule out kidney disease would also be worthwhile. Pawing at the face is a sign of pain and I think finding out why this is happening would be worth a good diagnostic effort. If it is necessary to remove all or most of the teeth he will still be able to eat and to function and would still be more comfortable if they are the source of the discomfort.

Mike Richards, DVM  

Cortisones and Older Dogs

Q: Dr. Mike, Do you have any advice on using steroids for older dogs (14 1/2 yr old mini poodle). "Benji" collapsed and still has no use of all legs. My vet did all tests and there is nothing showing the reason for the loss of his muscles. Is steroid usage recommended for older dogs? Thanks for any info you can shed on this. -Debbie

A: Debbie- I use cortisones in older dogs pretty frequently. I prefer to know why I am using them, if at all possible, but I'd be lying if I said I never tried cortisones just because I couldn't think of anything better to do at the time. It can be really hard to determine the cause of problems in an older dog with paralysis, especially if there is an injury to the spinal cord without evidence of disk disease or some other visible problem. As long as I feel pretty sure that there isn't a reason not to use corticosteroids I think it is reasonable to use them on the suspicion of a spinal injury. Searching for a diagnosis is important in any age dog and making sure there is not a problem in which they shouldn't be used applies to any age dog, too. I do not know of any specifically age related problems with corticosteroid use.

Mike Richards, DVM

Surgical Risk for Older Dog

Q: Dear Dr Mike, Our 13 yr old German Shepard mixed female went in for her annual shots and during the examination the vet found 3 masses in her mammaries; one involving the gland. The dog is in good health; the only evidence of age seems to be arthritis in her hind quarters this started several months ago. We have been treating it with buffered asprin as needed. Since she was not spayed, the vet recommended that we have the masses removed and spay her at the same time since these tumors are normally hormone related. The vet took a blood to test for both heartworm and for pre-surgery testing. The blood test came back with high levels of alkaline phosphates indicating cushings disease. The vet indicated that cushings disease slows healing, so it would be necessary to put her on medication for several months prior to the surgery. The vet recommended that we take her in to a local animal hospital for more extensive bloodwork and for x-rays of the abdominal & chest areas. The x-rays of the chest area are to determine if the tumors have invaded her lungs. I have two questions; I have heard that surgery on older dogs is extremely risky and this dog has had no prior surgeries, so her sensitivity to anesthetic is unknown. Also, at her advanced age would the tumors significantly cut her life expectancy, since the normal life expectancy in this breed is 15-17 yrs? Of course, the quality & comfort of her remaining years is also important. Thank you, Vickie

A: Vickie- I have never really understood the logic behind thinking that older animals are more susceptible to anesthetic problems. Personally, I would much rather anesthetize a twelve year old dog with no previous history of anesthesia than a six month old one with the same history. Just the fact that the dog lives to be twelve or thirteen years old is a good sign that its body works well and is not likely to have a serious hidden defect that would lead to sensitivity to anesthesia. The veterinarians who claim that older animals are at an increased risk of anesthetic complications believe that as a pet ages it is more likely to accumulate problems such as heart valve insufficiencies, kidney damage or liver damage which make anesthesia a greater risk. I have repeatedly asked veterinarians which patients die most frequently from unexplained anesthetic crises and virtually all of them have lost a patient during a spay procedure, an ear crop or some other pediatric surgical procedure and very few can remember an incidence of anesthetic death in an older pet. Surgical deaths are more common in this age range because the surgeon is less likely to be doing a routine procedure on healthy tissue but I strongly question the assumption that there is an increased risk of anesthetic death in an older patient with normal clinical signs other than a problem such as mammary cancer. Particularly if the better anesthetic agents are used.

It is probably best to take lung X-rays and be sure the tumors haven't metastasized prior to surgery. Canine mammary tumors are benign most of the time but it is still a worthwhile precaution.

Mammary tumors grow unpredictably in size in dogs. Some stay small for long periods of time and other grow so rapidly that it kills the tissue around the tumor and necrotic abscesses form. In most cases, your dog will enjoy a much higher quality of life without the tumors. Since mammary tumors seem to enlarge under the influence of the reproductive hormones it is best to spay a bitch at the time  of mammary tumor removal. While there is no sure way of knowing it is very likely that tumor removal could extend her lifespan.

Rises in alkaline phosphatase levels can occur for a number of reasons and Cushing's disease is only one of them. If this is the only abnormality on labwork it probably wouldn't deter me from doing surgery but a more complete workup is not harmful and may be helpful.

Again, age is not a major factor in anesthetic safety. Preanesthetic examination and labwork are likely to uncover any hidden problems that may impact on anesthesia such as kidney disease or diabetes that are more common in older dogs. As long as the exam and tests seem normal there should be no significant increase in risk in anesthetizing an older patient.

Mike Richards, DVM

Multiple Health Problems - Older Golden (Part 1)

Q: My 9 year old golden has several health problems:

(1)Osteoarthritis in hips & spine (x-rays show bone spur on vertabrae at end of rib cage, hips don't look bad) - he's taking Rimadyl (150 mg per day)...no miraculous improvement - has difficulty getting up & groans when he lays down, walks slowly, some instability (younger dog knocks him down when trying to play)

(2) Chest X-ray shows some cardio-pulmonary problems. He had Heartworm when I got him seven years ago & was treated successfully, but has enlarged right ventricle (sp?) & breathes hard all the time (is on animophyllne which helps with the panting somewhat). We did a geriatric panel before trying any other meds for either problem nd it was fairly normal with the following exceptions: Alkaline phosphatase: 156 (H), AST: 21 (L), Cholesterol: 391 (H), and Lipase: 652 (H). The vet suspects A-Typical Cushings. He was on & off prednisone for years for flea-bite allergies & then the hip problems. I will be taking him to a cardiologist in a few weeks to get a better fix on what's going on with his heart & lungs, but was hoping you could give me some information on the blood work results & what A-Typical Cushings is (I've looked up Cushing Syndrome, but the symptoms don't fit my dog at all).

Thank you, Mary

A: Mary- High cholesterol levels seem to correlate pretty well with hypothyroidism. It might be worthwhile to run just a little more labwork and check for this, too. Going to see the cardiologist is probably a good idea, too. Although Rimadyl is relatively new it has been a very good medication for degenerative joint disease in our patients. Therefore, I am suspicious that osteoarthritis is not the primary cause of weakness or apparent pain when Rimadyl doesn't work. Checking to be sure there is not a neurologic defect might be a good first step in looking for alternative possibilities. In goldens, cancer is a major problem and has to be considered whenever there are unusual combinations of symptoms. I hope that your dog is doing better now.

Mike Richards, DVM

Multiple Health Problems - Older Golden (Part 2)

Q: Dr. Richards, Thank you very much for replying to my original questions. Max's T4 level is low normal (1.8)...are there more specific tests that can be done to diagnose hypothyroidism. My vet has mentioned it as a possible problem occassionally but then dismissed it because the blood work was within normal ranges. What is the standard treatment? (I have a 18 year old hyperthyroid cat on tapazole...so I'm used to dealing with the opposite problem). Also...specifically, how does hyperthyroidism cause the high cholesterol readings? Would it also be responsible for the high Lipase reading? (I am a pre-vet student, so I'm always interested in this stuff).

Secondly, we have done hip, chest & back x-rays...nothing suspicious (as far as tumors, etc). We are considering an abdominal ultrasound (his liver showed as slightly enlarged on the x-ray), but to be honest I am waiting to save up the $200.00+ for that. His gait favors his back left leg and there is some atrophy on that side upon palpitation, but as I mentioned before...his hips don't look bad under X-ray. ???? We have tried some alternative things...acupuncture (no more noticeable improvement than with the rimadyl) and just the other day, a vet who is certified in veterinary chiropractic did an adjustment on him (he was the demo dog for a lecture) and , believe it or not, I did see an improvement (he jumped right into the back seat of the car without any help). I don't know...your mention of cancer concerned me. He is otherwise happy...eats well (is a little overweight), sleeps fine, urinates & takes in slightly more water than he used to, normal stools. What would we be looking for, or how can we check for cancer or neurological problems? I am, of course, working on this with my vet, but always looking for suggestions in case we might be missing something. Although I like & trust my current vet, he seems to not be very motivated to get to the bottom of these problems. I know the dog is 9, but if there is something going on that we could be treating to make him more comfortable & possibly give him some more quality years of life, then I want to be doing it. Thank you again for your time and the assistancce you have already given,

A: Mary- Currently the most accurate way to test for hypothyroidism is to check the free T4 value and the thyroid stimulating hormone (TSH) levels in the same serum sample. If the free T4 level is low or low normal and the TSH level is high there would be a higher suspicion of hypothyroidism. Your vet is probably right, though. It may not make a lot of sense to spend more on testing for hypothyroidism with these levels when there are other problems to consider.

I don't know why the cholesterol level rises when hypothyroidism is present. If I find a good explanation of this I'll try to remember to post it online.

Cancer can be hard to definitely diagnose. Persistence in looking for it and good physical examination are the keys. I'm sure your vet will continue to check for signs of this in future visits. Neurologic signs are similar in that they can be difficult to discern at first but tend to gradually get worse, especially with conditions such as degenerative myelopathy. If there is a neurologic disease more definite signs of it will almost certain appear as time goes on.

Mike Richards, DVM    

Geriatric Dog Developing Problems

Q: Dear Dr. Mike: I am happy to read your website in hopes of finding an answer to my dog's problems. He is a neutered 14 year old English SheepDog/Terrier mix. He has been remarkably healthy dog for his entire life. Recently, about two months ago, he started to gag as though he were about to throw up his dinner. He doesn't reguritate any substance. Its like the dry heaves. He does this mostly during the evening hours. The vet suggested a possible food allergy and a change to lamb and rice formula food. I have done that within the last two weeks to no avail. He still retches on occassion.

Secondly, he has a rectal tumorous growth which seems like a perianal adenoma according to your description. I was told initially that I could leave the mass alone to see if it increased in size. It has increased in size over the last six months. I am sure it must be removed at this point.

Thirdly, I came home from a road trip last week to discover he had a lump under the skin on his left flank near his groin. The vet says its a sebaceous cyst. He says it must be removed surgically and will not respond to antibiotics before that. The surgeries and treatments could cost up to $650.00. The dog is in good health and his energy for an old dog seems good. My question is, is there a way to treat the animal without surgery and/or what happens if I don't address these symptoms as they present themselves? Am I creating a problem? Is this the beginning of the end of my dog's life? I look forward to your suggestions. Thanks for your help. Stewart

A: Stewart- There are a lot of possible causes of the gagging/retching behavior, unfortunately. It can take pretty extensive testing to figure those problems out but starting with a thorough physical exam is always best. Heart problems may be apparent on exam or there may be palpable lymph node enlargement or something else to explain the symptoms. X-rays may reveal collapsing trachea problems, chronic obstructive airway disease, hiatal hernia, lung tumors or other causes. This problem requires an examination and labwork by your vet if a diagnosis is to be made.

It is easy to find opinions for and against operating on sebaceous cysts. Sometimes we recommend doing this and sometimes we recommend a "wait and see" attitude, depending on the size, location and appearance of the cyst. We take a lot of these off with local anesthetic and a sedative but this cyst may be too large for that based on your description. I recently read somewhere (and I can't remember where) that about 40 or 50% of sebaceous cysts would resorb but that the smaller they were the more likely that would be the case. As far as I know, the only choices are to remove the cysts or ignore them. There is no medical treatment that I am aware of that has been consistently successful.

I tend to remove perianal adenomas a little more quickly than I did in the past. Neutering your dog is a very good idea if that has not been done and these are indeed perianal adenomas. It just seems like I have seen more of these go on and become problems due to infection or sudden rapid growth that I remember in the past so I am getting conservative about them. We have even removed a few of these using local anesthetics but it does take just the right dog to consider this, given the tumor location.

Your dog is definitely in the geriatric category at this time and you are going to see more and more minor to major problems that accumulate with age. Figuring out how far to go with medical and surgical care is always trickier when you are trying to balance in the estimated recovery time, cost and potential lifespan in a sort of risk/benefit ratio. I know of no good way to do this. If I could predict with great accuracy how long my geriatric patients would live I think it would scare me. That is something we can only guess at.

Mike Richards, DVM

Protein Intake in Older Dogs

Q: Dr. Mike: I have two senior dogs 8 years and 13 years (Keeshond and Sheltie). I'm very confused by the labeling of most dog food companies. I am currently feeding a food with a 22% protein level. Both dogs are doing wonderfully on it, but I've heard that older dogs should be on a protein level of 15% or 16% to prevent kidney problems. However, going to the pet store to compare protein levels, most are listed as xx% minimum. Now what does minimum really mean? I guess if it says 16% minumum I could really be getting a food with over 22% protein. So, my question: What is your opinion on protein levels in food for older dogs? Thank you.

A: I will try to look into this question in more detail but this is my current impression of the information I have seen.

There is no evidence that I am aware of that shows it is possible to prevent renal deterioration by limiting protein intake in dogs.

That might sound odd, given the marketing hype for reduced protein foods. There is a lot of evidence to show that dogs with kidney failure do feel better when fed lower protein diets. There is a purpose for these diets. It just isn't possible currently to determine if lowering the protein really helps prevent kidney disease. The only study I know of relating to this showed that lowering protein levels did not have a significant effect in preventing renal disease.

I would not change from a diet that is working well in an effort to find a lower protein diet unless one of your dogs actually developed renal failure. Even then the situation is murky -- but at present it still seems reasonable to recommend that when creatinine levels or BUN start to stay high. The recommended amount of protein in that case is about 2 to 2.2 grams of protein/kg of body weight/day according to Allen et al in the July 1990 issue of the Compendium of Continuing Education.

Unfortunately you are correct that stated minimums may not have as much correlation with actual protein content as you would like. I think that you may need to look for one of the prescription diets with min/max levels to be sure of the amount of protein but you may be able to find this information on other foods as well.

Mike Richards, DVM

Elderly Cavalier King Charles Spaniel - Just Want to Make Comfortable

Q: Dear Dr Mike, Our dog is a twelve year old Cavalier King Charles Spaniel. She is nearing the end of her life and I would love to make her as comfortable as possible. My vet doesn't think it is time she left us just yet but sometimes I wonder - she seems to be in a lot of pain. She cannot walk on one of her back legs and the vet says it is a mixture of spine problems and arthritis in her knee. She is a diabetic and is on insulin twice a day and has been stable for 1.5 years. She also is on Renitec for her heart once a day and Furosemide to control water on her lungs. She takes one quarter tablet a day of that. Because of the furosemide she doesn't seem to be able to take any non-steroidal anti-inflammatory drugs for her arthritis etc. They make her vomit and give her diarrhea (she has had episodes of pancreatitis in the past and is on a strict diet of chicken, brown rice and vegetables, moistened with jellied chicken stock). She really needs some sort of pain relief and I was wondering if acupuncture could help her. I have seen a programme about a vet who administered acupuncture on a dog for spinal problems and the dog got a lot of relief from it. If so then we need to find someone locally who can administer it. The other thing I was a little worried about was that the furosemide may be depleting her of essentials such as potassium (you can't feed a dog bananas and tomatoes)! Will the brocolli and carrots I give her most days be enough? I am very grateful for any consideration you could give to my questions. Thank you.

A: Furosemide (I think that is the generic name of the diuretic you are referring to) is less likely to deplete potassium in dogs than it is in people. Unfortunately, I don't know the potassium content of broccoli and carrots so I can't tell you if they would supply potassium in adequate amounts to help if a deficiency did occur. Still, for the most part this doesn't seem to be a problem in dogs. Cavaliers often have heart valve problems and the majority of them are probably being treated for chronic heart failure by the time they are twelve years old. Cavaliers also seem to be prone to degenerative joint disease and we have seen some spinal problems in them, as well. In general, we have had good luck treating these problems with aspirin but I have been fortunate and have not had to deal with interference from pancreatitis yet in a CKCS. We are awaiting approval of some new NSAIDS in the US that are supposed to cause less digestive disturbance than the current ones. I am not sure of the spelling but carpofen is the one that seems to be getting the best reviews. Maybe that is already available in New Zealand? We use hydrocodone to control pain when that seems necessary but it has no anti-inflammatory properties and so we combine it with something that does. Again, I usually use aspirin so that still leaves a problem in your case. Still, if pain relief alone seems worthwhile at this point, it might help. I don't know much about accupuncture as a therapy but it seems very unlikely to cause harm to me and so I see no reason at all not to give it a try. I do know that some vets really feel it is beneficial. Several of my clients have tried it with their pets and their feeling have been mixed. Some thought it was great and one or two saw little response. That happens with all treatments, so I'm still waiting for a bigger sample or a study of a large number of animals to get a better feel for the success of acupuncture. Incidentally, my family also has a Cavalier. He is only 9 years old and so far, is doing well. We feel lucky!

Mike Richards, DVM