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Dr.Fiona
Dr.Fiona, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 6273
Experience:  Small animal medicine and surgery - 16 years experience in BC, California and Ontario
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My 15 year old Wheaton Terrier has had some signs of dementia,

Customer Question

My 15 year old Wheaton Terrier has had some signs of dementia, he wanders into corners and just stands there. He is also losing control of his legs, they will slip out from under him. Last night he collapsed completely and stayed in his bed all night and most of today. He rallied a bit and did het up and walked to the door to go outside which he did with some help. He hasn't had a bowel movement since last night. His nose is cold and he is not panting. Is the end near? Is this an emergency or should I just let him rest comfortably? I had fed him twice today and he ate well. Is not too interested in drinking.
Submitted: 5 years ago.
Category: Dog Veterinary
Expert:  Dr.Fiona replied 5 years ago.
Hi there,

Welcome to Just Answer! I would like to try to help you and your dog bit need a bit more information in order to better assist you.

Has he been trying to have a bowel movement, or not?

Is he on any medications at all?

Fiona
Customer: replied 5 years ago.
He doesn"t seem to have to move his bowels. He takes 10 mg. fluoxetine, .4 mg soloxine and 50 mg. carprofen. Also a derm cap ES (945 mg ) He weighs approx. 30 lbs.
Expert:  Dr.Fiona replied 5 years ago.
Hmmm...

Could you please go lift his lip above his canine tooth and check the colour of his gums?

Are they a nice bubble gum pink like your own, or lighter?

Have you looked in to treatment for the dementia?



Customer: replied 5 years ago.
His gums are pink with black splotches. I haven't asked about treatment for dementia.
Expert:  Dr.Fiona replied 5 years ago.
Ah... and how long has he been on the carprofen?
Customer: replied 5 years ago.
over a year
Expert:  Dr.Fiona replied 5 years ago.
Hi again,

From what you are describing, it sounds like your older Wheaten Terrier dog has a couple of issues combining together to cause his current problems. These sound like
1. Cognitive Dysfunction Syndrome, and
2. Arthritis

Let me explain a bit more about each.   

CDS is an age-related mental decline that happens in older pets and that isn't caused by a specific medical condition such as a tumour, organ failure, or hearing or vision loss. Dogs with CDS typically exhibit some of the following behavioural changes that interfere with their normal enjoyment of life:

Disorientation. Dogs with CDS may wander about aimlessly; appearing lost or confused in the house or yard; staring into space or at the wall, as though they have forgotten where they are.

Many dogs will show Decreased responsiveness to family members. They may have less interaction with the family, decreased enthusiasm when greeting, or not seem to recognize familiar people. They may turn away when being petted.

Dogs with CDS may have Abnormal sleep and activity patterns. These dogs may sleep more during the day, and stay up at night barking or pacing.

Some dogs with CDS have a Loss of housetraining. They may urinate or defecate shortly after coming in from outside, and seem to forget where they are and that indoors on the carpet is NOT the place to urinate!

Now, not every dog will show every symptom, but given how many of the symptoms your boy has, this would be right at the top of my list of things that I would be considering! CDS is a diagnosis of exclusion - which means when we rule out a lot of other things, then we are left with CDS.

If your old boy has CDS, there are steps both you and your veterinarian can take to manage the condition and help restore the relationship between you and your dog. The following treatment options are available:

1. There is a medication called Anipryl that is quite effective at treating CDS. Unfortunately, it is not cheap. There is now a generic option that is not as expensive. This medication (Anipryl or the generic L-deprenyl or selegeline) is the most effective treatment. Here is more about it:
http://www.petplace.com/drug-library/selegiline-hcl-anipryl/page1.aspx


2. Many dogs improve on a prescription food (available through your vet) called B/D. It stands for Brain Diet. You might want to consider changing your dog to the B/D diet as it is very helpful in some dogs. Make the food change gradually, over 2-3 weeks so as to avoid gastrointestinal upset.

Here's a link:
http://www.hillspet.com/zSkin_2/owner/prescription_diet/mini_site_index.jsp?JSESSIONID=HYS4eiDkJTkHQSfKPocHkRWIx63sKGLS13aryi3211G5wiVpCv3e!494534170!167846932!7005!8005&FOLDER%3C%3Efolder_id=2534374302046069&bmUID=1201197752243&bmLocale=en_CA

3. Try a DAP diffuser as it helps some dogs greatly. This is a device you can plug into an electrical outlet and it sprays a dog pheromone to relieve stress.
Here's a link:
http://www.healthypets.com/dapdogappher.html

And, here is more information about CDS:
http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2549

http://www.petplace.com/dogs/dementia-senility-cognitive-dysfunction/page1.aspx

http://www.peteducation.com/article.cfm?cls=0&cat=1276&articleid=1095


Your dog also sounds like he has arthritis, which is what I assume he is taking the carprofen for, and what is likely leading to his hind legs slipping out from under him.

What is most likely for your boy is that he is developing Degenerative Joint Disease of the coxofemoral joints (hip arthritis),which is unfortunately something that dogs are very prone to.

If he came in to the clinic to see me, I would perform a thorough musculo-skeletal exam on him, which would certainly include flexing and extending his hip joints to check for pain and feel for crepitus (a grinding, crunching feeling when moving the leg in the hip joint). I might suggest x-rays of the hips to be able to see exactly what is going on in there. And if everything supported DJD in the hips I would talk to you about treatment.

My treatment plan for early DJD is as follows:

1. Be lean!

Every extra pound that a dog carries on sore joints just makes the problem worse. So, the single most effective thing you can do to help a dog with sore joints is to make sure he is slim - even a little bit on the skinny side of normal. It is just going to make him so much younger! Check to see how much he weighed when he was 2 years old. Has he gained since then?

2. Try glucosamine.

This supplement is very safe, and is helpful in the majority of dogs. For a 60-80lb dog, I usually suggest 500mg given 3 times daily. It usually takes 6-8 weeks on this supplement to see improvement. Here are some links:
http://www.glucosamine-arthritis.org/glucosamine/glucosamine-product-guide.html
http://www.peteducation.com/article.cfm?cls=0&cat=1276&articleid=1176
http://www.peteducation.com/article.cfm?articleid=670


3. Improve muscle mass with swimming.

If your dog likes to swim this is such a great exercise because it builds up the muscles around the joint, which stabilizes them, but causes none of the strain in the joints that running does.


4. Consider prescription medications.

Your veterinarian has a selection of very effective and safe medications to treat the pain and inflammation of arthritis.

Some common nonsteroidal anti-inflammatory drugs (NSAIDs) that might be prescribed are:
Rimadyl:http://www.petplace.com/drug-library/carprofen-rimadyl-novox/page1.aspx (this is what he is already on)
Metacam - http://www.petplace.com/drug-library/meloxicam-metacam/page1.aspx
Etogesic - http://www.petplace.com/drug-library/etodolac-etogesic/page1.aspx
Deramaxx - http://www.petplace.com/drug-library/deracoxib-deramaxx/page1.aspx

Other options to consider are:
Tramadol - http://www.petplace.com/drug-library/tramadol-hydrochloride-ultram/page1.aspx
Gabapentin (which can be given together with Tramadol) - http://en.wikipedia.org/wiki/Gabapentin


Of these, I would have to say that my favourite is Metacam. I have had SUCH good results with it, and can only think of one dog that had vomiting on it, out of several hundred dogs that I have had on this drug.

6. Cartrophen

This injectible drug is a polysulfated glycosaminoglycan (p-gag) and I have used it in hundreds of patients. I have never had one vomit! In an exhaustive study of 70 000 dogs, exactly TWO dogs vomited, and one had diarrhea upon injection. I have found improvement in about 80% of dog that have been on this medication and strongly recommend it.    
More about it here:
http://www.drugs.com/vet/cartrophen-vet-can.html

http://www.arthritis.au.com/htm/vet_01.htm

7. Also, many people with joint pain report that a warm compress is soothing, and your dog may appreciate that too.

You can do this by making a wet towel compress. Place a small wet towel, folded into a zip-lok bag (unzipped!) and heat for about 2 minutes in the microwave. Remove and press all the air out. Make sure it is not too hot! You may want to put another towel around it, and then gently place over your dog's sore area.

8. Provide your dog with a padded bed large enough to stretch out on so he can sleep in luxury!

9. To help your dog to get up the stairs at night, I would recommend using a "sling" that you can make yourself.

Take a long bath towel, and fold it 3 or 4 times lengthwise, so that you have a long and thin shape. Put this under his belly, as far back as possible, so it is under his hips. Now, bring the ends up over his back so that you can hold the ends above him. With this, you can lift almost all his weight by using this sling, and thus really help him up the stairs. He can walk himself, with you right beside him taking his weight on the sling to help him. This is a really good way to help him up stairs or up into the car - or any time he has to go UP!


For further information about hip dysplasia, I will give you these links: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1916
http://www.sniksnak.com/doghealth/chd.html
http://www.workingdogs.com/vchipdysplasia.htm

For further information about arthritis I will give you these links:
http://www.placervillevet.com/arthritis.htm
http://www.canismajor.com/dog/arthrit.html
http://www.drsfostersmith.com/pic/article.cfm?aid=537



Although I cannot diagnose your dog over the internet, I hope that I have given you a direction to explore with your vet. My own dog had CDS, and I saw a dramatic improvement in her mental health about 2 weeks after starting her on the Anipryl (and later I switched her to the cheaper version selegeline) and B/D. I really hope that a trial of this medication and food under your vet's supervision might bring back the dog you know and love!

It does not sound as though this is an emergency as your dog is eating normally. However, I do think you should get him in to see your veterinarian this week to evaluate him further. Your boy is certainly a senior citizen, and so I worry more about him than I would about a younger dog as there are likely to be multiple issues.   

If this has been helpful, please "Accept" my answer and leave feedback.

If you have more questions, just click on reply and I will still be here to provide more information if you need it.

Good luck with your dog! I know how hard this is, I've been there too with my own dog!

   
The above is given for information only. Although I am a licensed veterinarian, I cannot legally prescribe medicines or diagnose your pet's condition without performing a physical exam. If you have concerns about your pet I would strongly advise contacting your regular veterinarian.


Best wishes to you and your senior dog!
Fiona
Dr.Fiona, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 6273
Experience: Small animal medicine and surgery - 16 years experience in BC, California and Ontario
Dr.Fiona and 2 other Dog Veterinary Specialists are ready to help you
Customer: replied 5 years ago.
Thank you for your help! Do you think the other medications for arthritis you mentioned would be better than the carprofen? I will take him in to the vet tomorrow and ask about Anipryl and B/D. I really appreciate your comments. I wasn't sure what was going on because before this episode of collapse, he was doing OK with minor episodes of his legs slipping out from under him. I thought he had a stroke or something and you reassured me.
Expert:  Dr.Fiona replied 5 years ago.
You are very welcome! Thank you so much for the generous bonus! :-)

Carprofen is a great drug! But every dog is different, and sometimes a different drug will produce better (or worse) results. The only way to know is to do a therapeutic trial - which means coming OFF one NSAID drug for about 2 days before starting another.

You could talk to your vet about trying a different NSAID, or you could talk about adding in another pain killer on top of the NSAID. For example, you could add the tramadol on top of the carprofen to see how that helps your dog. This is what I usually do in dogs like your boy so that I don't have to take them off the drugs that are so helpful to them.

Best wishes,
Fiona
PS you do NOT need to hit accept again even though the system will prompt you to do so!

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