Symptoms That can mean serious illness

The following are real life cases of symptoms in Dogs that can mean serious illness that have been treated by Dr. Mike Richards, DVM.

Potential Causes for Pendulous Abdomen
Is Increased Drinking and Urination a Sign of Cushing's Disease?
Possible Causes for Lethargy, Seizure Like Activity and Hyperglobulinemia
Potential Causes for Facial Twitching and Flinching
What Causes Dog Vapors?
Reasons for Blood in Urine
Diagnosis for Breathing Difficulty, Weakness, Bloody Urine
Causes of Shaking and Muscular Weakness in Legs
Possible Uveodermatologic Syndrome
Causes of Intermittent Coughing:
Reason for Dog Drinking Excessively

Potential Causes for Pendulous Abdomen

Question:

First, thanks for answering my first question a few months ago. I've been enjoying this service! Anyway, we just got a new dog. Actually, he's new to us. He was a rescue dog from the pound. The pound said he was anywhere between 6 and 8, while our vet said he's more like 10. Either way, I have a few concerns. We adopted him because we have a dog already who spends her whole day in the house while we're at work. We thought having another dog around might be nice for her. Plus, I really love dogs, and wanted another. My concerns are these: he's got a pot-belly. He isn't fat like other dogs I've seen who are fat all over. His hind and front legs are relatively slim, but his stomach is a round ball, almost like the children you see in commercials for hunger relief. I don't know if dogs have distended bellies when they're malnourished, though. Do they? He's absolutely ravenous all the time, and I have to be very careful when I feed the dogs that he doesn't eat his own food and then the other dog's food. I've started trying to feed them in the morning, take up whatever they don't eat, and then again at night, also taking up what they don't eat in one sitting. I don't know if that's the right thing to do though. Eeyore, the new dog, (a cockapoo, by the way) got taken to the vet Tuesday, who said he might have Cushings.(Our other dog probably has it, too.) His fur is very soft and fine, and his tail has almost no fur on it at all. He doesn't seem to be drinking or urinating much more than a normal dog, so I have to wonder about the Cushings. He does defecate something like 4 times a day, (sometimes even in one walk) which my husband and I found somewhat alarming. He's very mellow, and seems sort of sad, almost. We've only had him three days, so I'm assuming he'll need some time to warm up to us, right? And our old dog is vaguely jealous--any thoughts on how to keep them both happy? Finally, Eeyore has an open sore on each of the lower joints of his front legs, which he licks alot. The vet said they were probably from his licking due to boredom. (He spend 5 weeks in a kennel before we got him.) He still licks them at our place. Is there anything I can do about those? Obviously, this is a pretty rambling letter, and for that I'm sorry. I guess what I want toknow is what you think about his big belly, (are worms a possibility?) what tests I should ask the vet to do (I don't think he did any) how to help him settle in and get to know us, and what you think those leg sores might be. I just want both the dogs happy and as healthy as they can be, given their elderly status. I'd appreciate any help you can give me..

Answer: 

I am hoping that your dogs are getting along better now, because I don't have much advice for encouraging dogs to get accustomed to each other. It does seem to help to set aside a few minutes especially for the dog who has been in the home longer, just to let them know they are special and not being shoved aside for the newer dog.

It sounds like you are describing Cushing's disease and cockapoos are prone to this condition, so I'd have to vote for making sure it wasn't the problem. Other causes of a pendulous abdomen would include malnourishment, diseases that cause protein loss (kidney disease, liver disease, some intestinal diseases), intestinal parasites, ascites (heart failure, liver disease), abdominal tumors and probably some other things that aren't coming to mind right now. Most of these conditions would have other signs associated with them, such as weight loss, poor appetite, tiring readily, unthriftiness --- at least some other sign of illness. Cushing's disease does not always cause increased drinking and urinating, but these are the most consistent complaints that dogs with Cushing's disease are presented for.

The sores are probably acral lick granulomas, which are self-induced sores that usually occur on the lower legs and most commonly the front legs. There are many treatments for this condition, probably because none of them work consistently. We have had some luck lately using Facilitator (tm) a liquid bandaging material that seems to be able to stand up to the licking for a day or two. Using it consistently seems to allow the sores to heal. Some dogs develop these due to allergies and respond to corticosteroid administration but you should rule out the Cushing's disease prior to starting a medication like prednisone for this possibility. A few dogs respond to antibiotic therapy. Topical medications, such as a mixture of Banamine (Rx) and Synotic (Rx) or a local anesthetic like Solarcaine(tm) or Dermacool (tm) will work in some dogs. Changing the dog's stress level and/or boredom level often helps a great deal. Hopefully, as he adjusts to your home, this problem will improve.

Is Increased Drinking and Urination a Sign of Cushing's Disease?

Question:

I suspect my 12-year-old Pomeranian is in the early stages of Cushing's disease for the following reasons:

1. Marked thirst and increased urination.
2. Itching that is not relieved by Advantage.
3. His age.
4. Reading your website!

The doctor took a urine sample that showed a reading of "12"-it needed to be under 13, Dr. B said. (I should've been paying better attention-this mean anything to you?) Had it been 13 or higher, we would've conducted an all-day blood test to measure his reaction to an injection of steroid, something like that... Neither of us wanted to put my dog through it since his symptoms aren't that bad and he's kind of fragile....

I remember that you said such lab work is often inconclusive.

As far as Dr. B's concerned, the matter's settled. But I still have worries. Does diagnosing Cushing's early make a difference in the outcome? I'm thinking if we jump on it now, I'll have an advantage.

Should I wait until my dog's symptoms are more pronounced? (His coat looks great, really-and he'd had a bath the day Dr. B. saw him.) I'm not imagining things: my dog used to pee first thing in the morning; now he wakes me up to drink water. This has been building over the past year, when I had him tested for diabetes. No problem then or now in that regard...

Answer:

I am not sure of the meaning of the lab test. There is a urine test, the rine creatinine:cortisol ratio, which is used to screen for the ossibility of hyperadrenocorticism. In this test, normal is about 13 and dogs with Cushing's disease usually have values greater than 100. This has long been thought to be a very sensitive test, meaning that most of the time it will detect Cushing's disease. It used to be thought that virtually 100% of dogs with Cushing's disease had high urine creatinine:cortisol ratios but more recently, there are studies that suggest that more dogs with Cushing's disease have normal urine cortisol:creatinine ratios than was previously suspected. Some veterinary endocrinologists have questioned the value of this test, due to these newer findings.

Dogs with hyperadrenocorticism also usually have dilute urine. Most dogs have urine specific gravity measurements less than 1.015 to 1.020. Unfortunately, this is also true for a number of other problems, so this measurement is a useful hint that Cushing's disease might be present but does not help confirm the diagnosis.

If a dog has an adrenal gland tumor leading to Cushing's disease symptoms, early detection and early removal of the affected adrenal gland could be life saving -- and actually cures the Cushing's disease. This is the best reason to actively pursue a diagnosis if you want to, even though your vet is probably right that the disease is not present.

There is a small chance that starting treatment for Cushing's disease early, when using selegiline (Anipryl Rx) may help to slow the progress of the disease. This is probably only true for a portion of the dogs with pituitary dependent Cushing's disease and there are endocrinologists who don't think that selegiline does anything at all, so I am not sure how to advise people on early treatment. My current thinking is that if a client doesn't mind the cost and will have enough financial reserve to change their mind and move on to other forms of treatment later, it is reasonable to try selegiline early on. But if finances are a problem, or may be a problem later, I would wait to treat until the symptoms justified it.

I think that it is not very likely that early treatment of Cushing's disease using mitotane (Lysodren Rx), which is effective more often than selegiline at controlling the symptoms of the disease, makes much difference. However, some of the complications of Cushing's disease may be controlled by treatment and so there may be a group of patients who do better over the long term when treated with mitotane early, as well. We have had a few patients live over six years while being treated with mitotane. The average life-span of dogs treated with mitotane is about 31 months, according to "The Textbook of Veterinary Internal Medicine" by Ettinger and Feldman.

Treatment for Cushing's disease primarily controls the symptoms of the disease, except when an adrenal tumor is present and in the small number of dogs in which selegiline seems to control the growth rate of pituitary gland tumors. So most vets feel pretty comfortable just waiting to see if the signs worsen prior to pursuing more tests, when the first diagnostic attempts do not indicate Cushing's disease.

There are several other diseases that can cause increases in drinking and urinating, including diabetes mellitus, diabetes insipidus, hypothyroidism, kidney disease and liver disease. Making sure that these other problems have been ruled out might also be a good idea.

Get additional information on Cushing's Disease in Dogs

Possible Causes for Lethargy, Seizure Like Activity and Hyperglobulinemia

Question:

Last fall, our 13 year old Westie, Button, was acting lethargic so we visited our vet. A routine blood test turned up a high globulin count which our vet warned could be indicative of more serious problems (e.g.multiple myeloma). We agreed to additional blood work and urine tests all which came back suggestive of multiple myeloma. We were distraught and sought a second opinion from an iternal medicine specialist. X-rays were negative for bone lesions and a bone marrow sample turned out normal. The only tests we did not agree to were a CT scan of the head and obtaining a sample of CSF. During this time, a veterinary ophthalmologist noted tortuous vessels in the back of his left eye and that his pupillary response in that eye was absent. At this point we had a lethargic dog with symptoms that did not totally match multiple myeloma according to the internist. Feeling a sense of resignation, I indicated that the last time Button seemed to be "his old self" was when he was on antibiotics which were given early in the treatment of his lethargy. Indicating it couldn't hurt, Button started the maximum daily dose of clindamycin. Within 2 weeks, his activity returned to normal AND so did all of his bloodwork. We began to ween him off the clindamycin when he exhibited a "seizure" in early December. Also, his globulin count rose again. We went back up in our dose of clindamycin and the seizures stopped and the blood work normalized AGAIN. This spring the seizures started to increase in frequency despite the dose of clindamycin so phenobarbital was added to his dosing regimen. He has responded well to the phenobarbital and guess what, his bloodwork is abnormal again. A few more details.....the last 2 times the bloodwork has been abnormal he has also been anemic. There were no obvious signs of bleeding and he responded to the clindamycin. The seizures seem to be stimulated by excitement and are indicated by short "fainting" spells. He also pants quite a bit at rest even in an air conditioned home. We are told that there is no evidence of multiple myeloma symptoms appearing and then disappearing so that diagnosis seems to be shelved. Our vets openly admit that they are stumped. Also, an ultrasound of his belly indicated that there was no evidence of a splenic tumor and his ECG is normal. So....we continue with the phenobarb. and have increased the clindamycin dose to see if again his bloodwork will normalize. Button will be 14 in October and we have tried to maintain quality oflife but continue to wonder if there is something else that we should consider. We would be deeply appreciative if you would comment on this case.

Answer: 

I can think of some disorders that would cause the symptoms you are seeing, but I am not at all sure that they are likely or even possible.

Canine monocytic ehrlichiosis causes hyperglobulinemia (high globulin levels in the blood), lethargy, depression and bleeding tendencies. I have not seen seizures as a listed symptom for this problem. It is treated with doxycycline or imidocarb, usually, but might respond to other antibiotics. Any form of ehrlichiosis could cause problems.

We see a lot of older dogs with dental disease that causes lethargy, depression and appears to be a source of high globulin levels (this is personal observation, not documented by any studies I am aware of). This is very responsive to antibiotic therapy but won't resolve unless the dental problems are identified and treated. We have not associated this problem with seizures, either, though.

Systemic fungal infections will cause hyperglobulinemia but usually cause other clinical signs, like coughing, weight loss, inappetance, lameness or something that indicates a pretty serious problem.

There is a report of anerobic bacterial infection of the central nervous system (Dow, 88) but the dogs affected by these bacteria died quickly. However, the signs seen in them did match what you are seeing -- lethargy, depression, seizures, as well as other symptoms, including paralysis and other severe CNS signs.

Cancers sometimes cause increases in globulin levels and may cause almost any clinical symptom, depending on where they are located and what they effect. Finding cancers can be really difficult. It would be a little odd for antibiotic therapy to make a difference if cancer is the cause of the symptoms but sometimes antibiotics help for reasons other than their antibiotic actions.

Heartworm disease will sometimes cause inceases in globulin levels in the serum and can cause the symptoms seen, although coughing is usually present by the time fainting spells that resemble seizures occur with this disease.

Bacterial endocarditis might cause the depression, lethargy, seizure like activity and hyperglobulinemia and would be responsive to antibiotics. A heart murmur is often present with this problem. There are usually ECG signs associated with bacterial endocarditis but cardiac ultrasound is a better way to look for this problem.

Chronic infections almost anywhere can cause increases in globulin levels and would respond to antibiotics. It seems like it would be easy to find an infection but there are lots of reports of infections in the urinary system, liver, gallbladder, spinal column and other areas of the body that didn't surface until extremely serious signs finally showed up or were found incidentally on post mortem exams.

I don't know if any of these possible differentials will help. I wouldn't be at all worried about using clindamycin long term if it seemed to help. This is a fairly common approach to persistent periodontal disease in dogs so there is a lot of evidence to suggest it doesn't cause problems very often.

Your vets probably thought of these and appear to have been working to rule most of them out. Keep working with them and hopefully some clinical sign that points the way to a diagnosis will appear soon.

Potential Causes for Facial Twitching and Flinching

Question:

I have a 14 year old husky, her name is Amber and she is my best friend. She's always been a strange dog, wild-like in many things, such as circling her food, not eating from your hand, etc, but very sweet. For the past 2-3 years she's been flinching at loud noises, I thought it was b/c she was going deaf. She would also begin to howl in the middle of the night, maybe every couple of months, until someone would let her in, and then she would act very agitated and wouldn't sit or lay down. Then about a year ago, she began to have seizures and was put on phenol barbital. Since then, it seems her mental health has gone down hill. Sometimes, she acts completely crazy, just starts running around, can not sit down, this lasts for at least 30 minutes, it's like she's had some kind of fit or something. After her seizures she would act in a similar manner, very agitated. The other day she was acting particularly crazy, we were outside and when she would walk from a shady spot to a sunny spot she would flinch. And she just kept walking in circles. She looked like she didn't know where she was, or who we were. I took her to the vet and they were very concerned, they thought for sure something was very wrong. The vet was most concerned about how my dog would flinch "violently" when her face was touched, b/c there were no injuries or swollen areas around her face. The vet called me later absolutely astonished that all her blood work was completely normal, no kidney, liver or anemia problems. She also thought that my dog could've had a stroke, but my dog acts like this every couple of months. The vet said since everything looked otherwise normal it was probably vestibular, but from what I've read that is a condition that comes and goes very quickly and like I've said, my dog has exhibited this behavior for a few years. Do you have any idea what could be causing this? Should I be concerned about a possible brain tumor, or can dogs get senile like people? I just want her to be comfortable in her old age. Thanks you so much for your help.

P.S. my dog also drinks water constantly and pants very heavily all the time, we keep her inside where it's cool and she still pants.

Answer: 

There are several possible causes of facial twitching or flinching when dog's faces are touched or when their face is almost touched.

One of the most common causes of this behavior is cancer of the nasal passages or the brain. There is often pain associated with these conditions that may not be evident in any other way, or that may explain other unusual behaviors that you have observed. Sometimes nasal bleeding will occur with a nasal tumor but there may be no externally visible signs even with somewhat advanced tumors. This is more common in older dogs and unfortunately, it has to be a strong consideration in Amber's case due to the signs and her age. The best test for this problem is computerized tomography (CT) or magnetic resonance (MRI) imaging, if it is available to you. Endoscopic exam of the nasal passages can be helpful and even vigorous flushing of the nasal passages and collection of the saline flush can sometimes reveal a tumor.

There is also the possibility that you are seeing focal seizures in Amber. Phenobarbital is usually helpful if that is the case but not always. Hypothyroidism and hyperadrenocorticism have both been associated with focal seizure activity. Hypoglycemia (low blood sugar) can cause brief moments of confusion and weakness but that doesn't seem to be what you are seeing.

Pain from dental problems and from cervical disc disease can make dogs very sensitive around their face and head. Checking to be sure that dental problems are not present is always worthwhile. Cervical disc problems are sometimes difficult to detect but MRI is a good test for this, as well.

Lyme disease and the other tick borne diseases are sometimes reported to cause sensitivity around the face but I don't think this is a common sign of these disorders.

Visual disorders could cause the signs you are seeing, too. Careful ophthalmic exam would be a good idea and if there is any question about visual status evaluation by an ophthalmologist can be helpful.

Routine lab panels would not detect any of the above conditions, except the hypoglycemia.

Liver disorders that lead to encephalopathy (brain inflammation) can cause seizure activity and behavioral changes but this is likely to have shown up in the lab work.

These are the possible problems that I can think of. Sorting through them is probably fastest with the aid of a veterinary neurologist who has access to an MRI machine. If referral is not possible in your area it may be best to look for the hormonal disorders since almost all practices can run tests for these conditions, to check carefully for dental disease and to consider testing for the tick borne diseases if they are likely in your area. Neurologic exam immediately after a seizure (at least within a few hours) can sometimes reveal problems that aren't evident during exams that are not close to a seizure occurrence. Visual disorders can be surprisingly difficult to diagnose but it is still worth a careful exam for these, as well.

Your vet has probably considered all of these possibilities but may not be thinking about referral as an option for diagnostic testing. If you indicate a willingness to seek help at a referral center (if you are willing) that may help your vet make this decision.

Examine some of the other causes of facial twitching in Dogs

What Causes Dog Vapors?

Question:

We have recently adopted a retired racing greyhound (3 year old female). We named her Daisy-Mae. the first time I gave her a bath, she didn't really object, only that in the course of my soaping her up I noticed that she wasn't standing up on her own and that she was staring blankly ahead and being generally in a non responsive state. I carried her out of the shower stall and stood her up outside. It took about 30 seconds of rubbing and talking to her for her to be able to stand up on her own. She was fine after that. I called it "Fear of bath" and that was that. the next time the thing repeated itself and on the third occasion I was prepared and as she begun to wobble I did a sort of awkward chest compression which startled her enough to get her to just stand there and look at me with great surprise. We had EKG and XCR done and everything appears healthy, so, it's the Dog Vapors. Is it? she's scheduled to be spayed next week. Knowing the inherent risk of anesthesia in greyhounds, I'd hate to compound that by ignoring a possible problem. "The vapors" make it sound like a joke, but unless she is the greatest doggie actress alive, then what I see in the bath is really a dog fainting. 

Answer:

I think it would be best to continue to pursue a diagnosis of this condition. The symptoms could easily indicate a heart condition and it was wise to rule out heart disease as well as possible with the electrocardiogram and chest X-rays. In addition to heart problems, I think that it would be a good idea to rule out hypoglycemia, blood parasites (these are common in retired racing greyhounds) and seizure activity, at least.

Babesia and Ehrlichia species of blood parasites are both known to infect the racing greyhounds more frequently than most dog breeds. Serum titers to rule out these parasites may be a good idea. Hypoglycemia is low blood sugar. When the problem is severe, hypoglycemia will usually show up in screening labwork, if blood glucose levels are run several times. In other cases the problem is more infrequent or associated with exercise or stress and harder to detect on routine labwork. In these cases it may be necessary to make a quick trip to the vet shortly after an episode or even to see if she faints while being bathed at the vets, too. Blood could be drawn immediately in that case. Running a general blood chemistry panel and complete blood count would be a very good idea if that hasn't been done.

Once you get through these things, if the problem is still a mystery, it would be worthwhile to videotape one or more of the episodes so that your vet can see exactly what is happening. Since you seem to be able to induce them, it should be possible to get a video.

I would try to have blood work run before surgery, if it has not been done already.

If your local vet can't find an answer consider asking for referral to a veterinary school or large referral center (one with a neurologist and an internal medicine specialist) if you wish to continue to pursue a diagnosis. That would be my inclination in this situation.

Reasons for Blood in Urine

Question:

Both I and my vet are stumped by the malady affecting my 6 year old female golden retriever. About 10 days ago she started urinating frequently. We found blood clots upon two occasions in the urine. She grew increasingly more lethargic and weak. She could hardly stand and didn't eat. Her temperature was 104.5 and she had E.Coli. in her urine. She had a slightly (18,000) elevated white count. All other blood and urine values were normal including liver and renal indicies. After a day on Baytril she continued to decline. The vet hospitalized her and put her on iv. keflex plus baytril. She improved slightly and began to eat. However, her fever remained elevated and she was still weak. The vet then though of possilbe lyme disease and added Vibromycin. Her fever decreased to 101.8 for one day and then rebounded to 103.8. She is eating (1-2 can/day) with coaxing. Her x-rays were not remarkable, she has not hepato or splenomegaly and there are no masses seen. Blood cultures were negative. Her urine is now clean. Auto-immune titers were negative. The vet is now placing her on cortisone. We have not done a bone marrow yet. The other day she did start showing a high number of band cells. We have not done a bone marrow yet. What else could be going on with this dog that we are not thinking of? I would appreciate any advice. Sincerely yours,Irving

Answer:

With blood in the urine there are three likely sources -- from the bladder, from the kidneys and from a clotting disorder leading to generalized bleeding tendencies. Occasionally there is a problem in the urethra or vaginal areas of female dogs leading to blood in the urine but this is less common that the above problems. Bleeding from the bladder usually occurs because of cystitis (bladder infection), bladder stones or bladder cancer. Bleeding from the kidneys can also be due to kidney infection, kidney stones or cancer affecting the kidney. In addition, traumatic injuries may lead to bleeding from the kidneys. There are a number of causes of blood clotting disorders but the most likely one in many areas of the country is ehrlichiosis (infection with the blood parasite Ehrlichia canis). Infection with this will usually respond to treatment with tetracyclines so that may be less likely since this was tried. It may still be worth considering, though. Other possible problems that are fairly common are immune mediated hemolytic anemia and immune mediated thrombocytopenia (loss of platelets). Often, the complete blood cell count is very indicative of a problem with the last two diseases, though.

Bladder cancer does not show up well on X-rays. Neither does kidney infection. Much of the time these conditions just aren't visible at all on plain X-rays. It may be necessary to do one or more contrast studies using dye to delineate a bladder or kidney problem. Putting the dye into the bloodstream and watching it filter out through the kidneys is the best way to see how they are doing. Putting the dye into the bladder directly (through the urethra) is often better when looking for bladder cancer. Using dye and then injecting air can outline some tumors that don't even show up well with the contrast dye.

I hope that she is responding to the medications now and that it is unnecessary to pursue this further. A bone marrow aspirate does help differentiate between some causes of blood clotting disorders and will sometimes aid in finding other disorders as well. It is definitely something to consider doing.

More in-depth information on the causes of blood in Dog urine

Diagnosis for Breathing Difficulty, Weakness, Bloody Urine

Question:

My sister has a healthy 5 year old female retired greyhound named Flippy. Flippy has been lethargic and has had a decrease in appetite for about 2 or 3 weeks but we thought it was due to the hot summer weather (we live in the Boston area). This morning, she had an incident where she could not breathe. It was as if her throat closed up. She then acted very weak. My sister took her to the Vet. The Vet told my sister that there was a toxin in her system.

Several weeks ago Flippy got a hold of an ant trap which she bit through but did not eat the entire ant trap. The Vet seemed to think the ant poison was linked to the breathing incident.

Also, the Vet discovered that Flippy was dehydrated and her pancreas seemed to be swollen. The Vet could not get a clear reading from the pancreas test. The Vet prescribed Amoxycilin and treated Flippy with an IV solution to combat the dehydration.

Flippy seemed fine and my sister took her home to rest late morning and went back to check on her at lunch and found her whimpering and very weak. Flippy urinated blood and seemed to be in pain as she urinated. My sister called the Vet and the Vet told her that Flippy would be better after the antibiotic has a chance to work.

The Vet does not appear to be concerned about this situation and was irritated when my sister called to tell him that Flippy had urinated blood.

Do you think we are doing everything we can? What are you thoughts? Should we seek another opinion?

Answer:

I think it would be a good idea to get a second opinion in this case. It is OK to get that second opinion from your vet if you want. If you schedule a visit your vet should be willing to recheck Flippy and to discuss your concerns. If you can bring a urine sample with you that could be very helpful. The reasons that I believe it is important to consider a recheck in this case are:

1) ant traps may be toxic but a number of my patients have eaten them with no visible effect

2) retired racing greyhounds are commonly infected with Babesia or with ehrlichia and these diseases can lead to bleeding disorders which can cause the signs you are seeing, including blood in the urine or blood colored urine from the accumulation of red blood cell pigments if cells are breaking down.

3) heart failure is also possible with the symptoms seen.

Whenever you are very worried about your dog it is best to have her examined or re-examined. It is a bigger mistake to miss an important problem that is just slow to develop identifiable clinical signs than it is to look at a patient again and find the visit was unnecessary.

Causes of Shaking and Muscular Weakness in Legs

Question:

I have a 13 yr old cocker mix. for about the last year his rear legs have been shaking. his appetite is normal, energy good (though it has slowed in the past year), no problems walking or standing. the shaking does not occur constantly but it does occur more often than not. sometimes it is one leg, sometimes both. my vet ran blood tests and he thinks it could be cushing's. We had my dog (max) on levoxyl though it didn't seem to do much (it did increase his energy level). i have noticed he is drinking more water than normal as well. Any thoughts? pls advise.

A: If I am not mistaken, Levoxyl is a brand name for levothyroxine. This is thyroid hormone, used to treat hypothyroidism. In some dogs, shaking and muscular weakness does seem to be associated with hypothyroidism. Since it didn't work, it does seem logical that there would be another cause.

In an older cocker with an increase in drinking, hyperadrenocorticism (Cushing's disease) does have to be considered, along with diabetes and perhaps kidney failure. Cushing's disease can also be associated with shaking behaviors and it is worthwhile to consider this.

Shaking is difficult to assess. There are a number of possible causes but many times it seems to occur in older dogs without any discernible underlying cause. We usually try hard to make sure this is not from an unidentified source of pain and if we can't find a problem like osteoarthritis or disk disease we pursue other testing based on the overall clinical picture. In your dog's case our next steps would be to test for an eliminate causes of increased thirst as contributing factors -- a general blood panel and the specific testing for Cushing's disease may be necessary.

Possible Uveodermatologic Syndrome

Question:

I have a problem with my buddy Stosh. He is an 11 yr old short hair terrier mix. A little lap dog. He was having problems holding food down, and eating in early february, while developing a white pusy discharge from one eye, that had a droopy eyelid. Also noticed hair on hind quarter getting 'thin', which after reading through other Q&A's might be called bleaching.Took him to the vet. Left blood, stool, exam. No diagnoses. Blood, stool sample, come back 'negative'. Back to vet, getting worse. Perhaps infected tooth below eye. Tooth gets pulled. Surgical center that pulled tooth diagnosed uveitus. Post surgery trip to vet, got meds for uveitus. Drops and pills. No real change. Coat is now totally thinned, he has lost alot of weight, has no appetite. Eyes are glassy, has problems walking.

Answer:

There is a condition "uveodermatologic syndrome" in which uveitis and skin disease occur together (usually affecting mostly the face) but this usually occurs in young dogs of the northern breeds (Akitas, Siberian huskies, etc.). Hormonal diseases may be able to induce uveitis, too. Uveitis also occurs for no discernible reason in dogs.

It is a good idea to make sure a good ophthalmic exam, general bloodwork and chest X-rays are done on any dog with uveitis. It is a lot harder to figure out which infectious diseases to test for but eliminating the fungal, parasitic, viral and bacterial possibilites that are common in your area may be worthwhile.

Most of the time, vets like one disease that explains all the symptoms but that might not happen in your dog's case. Hypothyroidism and Cushing's diseases might cause both the eye and skin signs and dogs with cancer can have almost any set of clinical signs but it is more likely that there is a second disease causing the skin symptoms. There are a lot of possible causes of skin disease. Allergy is the most common cause of hairloss in my practice area, followed by parasitic skin disease -- but then there are a lot of other possible causes.

Keep working with your vet to find a diagnosis -- it may be hard to do but it is worth the effort.

Causes of Intermittent Coughing:

Question:

My mother's dog is half beagle and half dachshund and occasionally has a coughing fit that sounds serious but her vet cannot find a cause. My niece who has worked in vet clinics mentioned a soft palate problem that sometimes exists in dachshunds. Can you tell me something about this problem and if there is anything to be done about it? 

Answer:

I have searched through a veterinary database I have access to and can not find a reference to a soft palate problem in dachshunds. Most of the suspected soft palate problems that have been reported in the veterinary literature seem to be in short nosed dog breeds, like Boston Terriers or Boxers. That doesn't mean that your niece doesn't know something I don't -- but she'll have to get the references for you.

It can be really hard to identify a cause of an intermittent cough. It is possible to spend a great deal of money on various tests to find out that your dog does not have an identifiable problem -- or that he or she is "normal". On the other hand, the only way to figure out what is going on is to start eliminating possible causes, which means that the palate, larynx, trachea, lungs and heart all have to be examined carefully and that tests such as occult heartworm exams, X-rays, ECGs, endoscopy, bacterial cultures and examination under anesthesia may have to be done. some dogs cough because of intestinal parasite migration, so fecal examination will sometimes reveal a clue. I don't mind testing until I find an answer as long as the pet owner is willing and understands that the answer might be "I don't know". Unfortunately, I have lost some clients after several hundred dollars worth of testing didn't reveal a treatable cause of coughing (or itching, or behavioral changes, or ... :)

I guess what I am saying is this: if you really want to know what is going on, keep working with your vet. But be prepared for the diagnostic process to be frustrating and possibly expensive. If you find something important, it will all have been worth it. If you don't find an obvious cause it should be reassuring, too!

Reason for Dog Drinking Excessively

Question:

In the last week and a half, our eight year old poodle is drinking an excessive amount of water, and seems to be wetting herself when asleep.

Before this occurred, she drank very little water, but now as soon as she relieves herself, she comes back inside the house and drinks roughly 4 ounces everytime. She seems to have slowed down in energy also, but the wetting is the problem, it seems to be uncontrollable to her, as she has access to a papered area in the house that she is well accustomed to when it is not feasible for her to go outside. Our Vet in the area is mainly a cow and horse man, I would appreciate your advice in this matter.

Answer:

There are several causes of an increase in water intake and urination in dogs, especially older dogs. The most common ones are probably Cushing's disease, diabetes mellitus (sugar diabetes), kidney disease and diabetes insipidus.

In a female middle-aged poodle the two most likely causes are diabetes mellitus and Cushing's disease. These two diseases occur simultaneously at times, as well.

Diabetes is relatively easy to diagnose. Sugar in the urine and high blood sugar values pretty much confirm diabetes. No special lab tests are required. Cushing's disease is also fairly easy to diagnose but it does require specialized testing. This is a disease in which the adrenal glands produce too much adrenal hormones. The best test for spontaneous Cushing's disease is probably the dexamethasone suppression test. In this test, blood cortisol levels are measured as a baseline. Then dexamethasone is administered at a very low dose. In most dogs, this level will produce suppression of adrenal hormone and the blood cortisol level will drop significantly within 6 to 8 hours. Blood samples drawn at that time should be very low in cortisol. If they are not, then Cushing's disease is very likely. Your vet will have dexamethasone and can run this test.

As a screening test for these diseases, urinalysis is pretty useful and inexpensive. Sugar in the urine would be indicative of diabetes. Low urine specific gravity would hint towards Cushing's disease. If this is a consistent finding on several tests it is even more likely to be present.

The first step is eliminating diabetes mellitus as a possible cause. Then you and your vet can discuss the rest of the symptoms and decide whether to run general bloodwork and possibly the more specialized testing for Cushing's disease (hyperadrenocorticism). 

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