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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 23776
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My 10-year-old standard poodle is having a complex health

Customer Question

My 10-year-old standard poodle is having a complex health emergency. A couple of weeks ago, over about 24 hours, she became quite listless, and had difficulty getting out of bed. We noticed her eyes were very dry and crusted and she was a little awkward on her feet. When we got her to the vet, they diagnosed facial paralysis, she had no blink reflex and had difficulty eating and drinking. She also had high liver numbers. She was x-rayed and her heart was given an ultrasound and no abnormalities were found. (No brain scan.) After a couple of days at the vet, getting IV fluids, we took her home and over the next few days (on two antibiotics, prednisone, and amlodipine (she'd spiked some very high blood pressures while at the vet)) she has learned to eat and drink better, the drooling subsided, but she is still unable to blink her eyes. The drops we give her 3x day help with that. All in all we thought she was on the mend. Then she started getting pitting edema in her hind legs, first one, and a couple of days later, in the other. Globulin tests showed polyclonal, so it's not likely a hidden cancer. No sign of autoimmune disease. Liver enzymes improving slowly. Nothing on the screen for tick diseases. She's now on Plavix, just in case she has some clotting abnormality somewhere, but it seems odd that there would be high liver enzymes and then bi-lateral edema in just her hind legs if it's a clot problem. (She has had high liver enzymes before, but never this high, and never symptomatic.) We've stopped the antibiotics.
Any thoughts? As may be clear, this has been a very expensive illness for a dog who has never been ill before, and we don't know what's going on. It's difficult to make decisions on such expensive care ($10,000 and climbing) when she's still getting around and wagging, but we don't have a clue about what's happening next.
Submitted: 7 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 7 months ago.

I'm sorry that your question wasn't answered in a timely manner. This is a difficult case to jump into the middle. Can you upload a copy of all of Gracie's test results to our conversation? I understand that you might not have a copy at home but Gracie's vet can give you one which you can scan into your computer and then give me file link or you can photograph the pages and upload them by using the paperclip icon above your message box (if you can see the icon) or by using an external app such as

I'm particularly interested in her serum albumin and differentiating a pitting edema due to hypoalbuminemia from lymphedema usually caused by neoplastic cells obstructing lymphatic channels. Please tell me if imaging has been performed. X-rays of Gracie's chest? Ultrasound of her abdomen?

The pathogenesis of facial paralysis in dogs in unknown but in humans a similar condition (Bell's palsy) is associated with herpes simplex virus infection. Histopathologic studies reveal active degeneration of large- and small-caliber myelinated fibers but inflammation is absent.

Expert:  Dr. Michael Salkin replied 7 months ago.
Hi Jeff Wiggins,
I'm just following up on our conversation about Gracie. How is everything going?
Dr. Michael Salkin