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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 24363
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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I have a nine year old female Akita and she has been to the

Customer Question

Hi, I have a nine year old female Akita and she has been to the vet several times in the last 3 months and they cannot figure out what's wrong. Her blood test was normal other than low thyroid (she is currently on thyroid medication) urine test had very slightly high white blood count, ultrasound of her abdomen normal, chest xray normal. However she is very lethargic, decreased appetite (but still eating and drinking) appears to have normal bowel movements, but she seems to be in pain and disoriented. She also has a constant clear runny nose, and goopy eyes. Not sure what else to check for at this point. Her saliva seems sticky and foul smelling as well. ANY ideas what this could be? Thanks!!
Submitted: 8 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 8 months ago.

i understand your frustration at this time. Can you clarify for me what you're seeing that implies disorientation? Disorientation suggests a change in mentation (mental status) as would be seen with encephalopathy (brain disorder).

Customer: replied 8 months ago.
Thanks for getting back to me! At times it seems she doesn't know what to do with herself, just standing in the middle of the yard or not knowing where she wants to go. As clearly I can't ask her I'm not sure if she is confused or if she is just in pain moving around.. sometimes I will try to direct her such as to her bed, and one time she yelped when I touched under her front legs and snapped at me (very unusual, I'm thinking it must have been painful.) She also circles a Lot before she will lay down
Expert:  Dr. Michael Salkin replied 8 months ago.

Yes, I see how that can be difficult to evaluate. When such extensive testing is performed yet nothing untoward is found, I look to the central nervous system (brain/spinal cord). A change in mentation would support a disorder in that area. Her constant clear runny nose and goopy eyes aren't pathognomonic (specifically indicative) of any one disorder but I would consider a viral infection - which could also involve her central nervous system. Distemper is such a virus but not likely in a regularly vaccinated dog. Sticky, foul smelling saliva suggests dehydration and I would also carefully examine her oral cavity for inflammation. Her yelping and snapping when you touched her and her excessive circling could suggest the pain of myelopathy (spinal cord disorder) - another indication of central nervous system involvement. Lots of conjecture at this time.

Can you upload a copy of her most recent test results to our conversation? I understand that you might not have a copy at home but her 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 dropbox.com/ I not only review the test results but also note which tests should have been performed but weren't.

Customer: replied 8 months ago.
I can scan those to you tomorrow. Thanks so much!
Expert:  Dr. Michael Salkin replied 8 months ago.

I'll watch for them. You're quite welcome. Please stay in this conversation rather than opening up a new question.

Customer: replied 8 months ago.
I've attached the recent medical files, thanks for reviewing!
Expert:  Dr. Michael Salkin replied 8 months ago.

Thank you! I don't see her CBC and biochemistries but I see that they were reviewed and found to be "essentially normal" except for the slightly decreased T4 which I believe to be due to non-thyroidal illness. I'm familiar with the facilities she has visited and can tell you that she has received excellent care. Please discuss her recent symptoms - particularly her possible confusion - with her internist. I suspect that a cerebrospinal fluid tap and analysis and MRI are going to be recommended rather than endoscopy once the internist hears of her reaction to your touching her and her alteration in mentation.

Please continue our conversation if you wish. I have to leave my computer for a few hours but I promise to reply as soon as I return if need be.

Expert:  Dr. Michael Salkin replied 8 months ago.
Hi,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Michael Salkin
Customer: replied 8 months ago.
Hi there, our vet wants to retest her thyroid levels this week, however she's been on nsaids which I'm told can affect the test. They recommend going off it for three days before the test. If her thyroid is normal they are going to send her to a neurologist. She has not had any sensitivity to touch other than that one time. She is still seeming to be slightly confused and lethargic, and we've also noticed she has not barked in some time (weeks or maybe longer). Her nose still runs constantly. Just wondering what are possible neurological conditions and is there treatment? Thanks!
Expert:  Dr. Michael Salkin replied 8 months ago.

Yes, the NSAID carprofen can decrease T4 and fT4. Deracoxib and meloxicam don't affect them. I wonder if barking hurts her head? Her runny nose puzzles me. Is there a tumor in the sinus or nasal cavity? Brain tumor is the most common of the brain disorders at her age. Barring surgery, only anticonvulsant or antiinflammatory (steroidal) therapy is available.

I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience.

Customer: replied 8 months ago.
Hi there, my dog has now had another blood test (as they scheduled her for a brain MRI) and the neurologist said her blood work indicates Addison's. They are doing another test and I don't have the details as to what indicated that, however I have read that Akita's, as Pacific Rim breed, can be falsely diagnosed with Addisons. Also I'm wondering if her symptoms really fit? Something new at her neurology exam was that her abdomen was very painful upon palpitation. The doctor thought that was because of a groin strain. Any insight to this would be helpful. Thanks!
Expert:  Dr. Michael Salkin replied 8 months ago.

Yes, Akitas have a higher potassium in their red blood cells and if hemolysis (destruction) of those cells occurs, the serum potassium level rises (hyperkalemia). Addison's is often diagnosed by noticing that the serum sodium:potassium ratio is less than 23:1 which can occur with hyperkalemia. When a question exists if Addison's truly exists, an ACTH stim test can be performed. The symptoms of Addison's are classically vague - nondescript gastrointestinal discomfort (weakness, lethargy, anorexia, vomiting, e.g.), mainly, but an acute, life-threatening crisis can arise as well. A painful abdomen has a remarkably long list of possible etiologies...including Addison's.

I'm pleased to hear that an MRI will be performed. Please continue our conversation if you wish.

Customer: replied 8 months ago.
The MRI has been cancelled until this is further investigated. We are of course hoping it is not brain tumor so hoping this brings up some other cause that is more treatable. Thanks again
Expert:  Dr. Michael Salkin replied 8 months ago.

You're welcome. Keep me posted, please.