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Dr. B.
Dr. B., Veterinarian
Category: Dog
Satisfied Customers: 1376
Experience:  I have over 20 years experience in small animal and emergency veterinary medicine
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Hello Dr. B., I have a 13 year old Siberian Husky female

Customer Question

Hello Dr. B.,

I have a 13 year old Siberian Husky female named Endo that has had some sort of degenerative condition (or possibly conditions) since she was about 11. Problem is, noone has been able to figure out what exactly is going on.

As a preface, my dog developed cancer when she was 4 on the dorsal wall of her vaginal canal. It was a low to moderately aggressive smooth muscle cancer that was successfully removed. We found it as a result of a vet visit to investigate some squealing that she'd do when she sat down sometimes (our vet found a lump when he palpated the area). We had also made the decision to spay her, and that was when the vet was able to get most of the tumor (but not all) out. The rest of the tumor was done by specialists a few weeks later. Endo recovered from this surgery very well and had no health problems for 8 years.

Our recent problems started with an increase in thirst and urination 2 years ago (age 11). Everything else about her seemed fine (she's very athletic, and was still acting like a puppy at 11). About the same time, I had to take her to work with me and back every day. I have a hatchback so she'd jump in and out of the car twice a day (in hindsight, I kick myself now for doing that and not getting a ramp sooner than I did). A month or so after the increased thirst/urination started, I started seeing "tremors" in her legs when she was walking around and sniffing, usually when a leg was half down on the ground before she put weight on it. She also got more "clumsy" at times and would trip on her front feet or let her back end sort of "swivel" around a corner. She started chewing on her feet and the front of her legs, and licking them. Her appetite seemed to increase. One afternoon she was standing in the living room and one of her front paws curled under completely and she tried to walk on it like it was "normal" and seemed confused as to why it wouldn't work. A few seconds later (and 2 failed steps forward), she placed it on the ground normally and walked away. (Nothing like this has happened since). I took her to the vet who did blood work and saw her calcium was slightly high (just on the border between normal and high) and some slightly elevated liver enzymes. He did a test for Cushing's, which turned up negative so he felt all we could do was wait to see if the symptoms went away, or got worse.

Her symptoms did not go away, and she was starting to "stretch" and "flex" when laying down - she'd stretch her front legs out straight in front of her, then fold them and bring them in as close to her chest as she could, putting her head down to meet them. Almost like she was trying to stretch and then purposely contracting her front leg and chest muscles. She hadn't done this before, and my mother-in-law as the first to notice it and thought it odd. She also started twitching alot in her sleep. All of this was aggravated by excercise. The more walks we went on, or the more active she was, the more this seemed to happen. So, back to the vet we went. Again, bloodwork was unremarkable, except for slightly elevated liver indicators and calcium on the high side of normal. Her urine was about the same density as pure water this time. We did a test for a specific type of neural/autoimmune disease (I forget the name of it) whose main symptom is weakness after excercise, but that was negative. He referred us to a specialist. A week before seeing the specialist, I was out in the driveway with the my car's hatch open. Seeing the hatchback open and thinking we were going somewhere, she jumped into the back from a standstill, and yelped. She whined for about 5 to 10 seconds, with a rounded back, so I assumed she pulled something. By the end of the day, she seemed fine.

Because of her cancer history, the specialist did an abdominal ultrasound (negative) did some blood tests and told me her PTH levels were elevated and that we could be looking at a Parathyroid tumor, or possibly Pituitary tumor. She suggested an ultrasound and surgery.

We were unable to have the surgery at the same place as the specialist (at the time, we lived 4 hours from her in the middle of West Texas away from everything) so another surgery center in Dallas did the surgery and I stayed at my sister-in-laws. They reviewed her workup and seemed a little surprised that she was having surgery, but assured me that everything would be fine. I unfortunately had a business trip that week so Endo had the surgery and stayed there for a week. The surgeon remove 2 of her 4 Parathyroid glands which he said looked a little swollen, but not badly. The biopsy on them was negative.

When she came home, she wasn't the same dog. She seemed fine, but after a walk, or small amounts of "burst" excercise, she'd suddenly get stiff and sore, sort of picking up her shoulders to move her front legs forward, and bobbing her head up and down. When she'd play (she used to like to run around in circles and yap happily), she'd just pull up suddenly and sit down and start whining. One time, she did this and held up her right leg, then her left leg, and cried and cried. She did stop drinking as much, and her urine was normal. The tremors were still there, however, and the clumsiness, and the chewing on the front paws and legs.

About this time we moved. Our "new" vet had seen her previous to any of this happening, as we had moved away for only a year and a half, and then moved back. I filled her in on all the details. We did a senior panel and her bloodwork was ok, though her liver indicators were now out of normal range but not horribly so, and my vet felt that the mildly abnormal liver indicators were just simply due to age (she was almost 13 by this time). She also felt that Endo probably had back problems, which were being brough on by excercise, and were probably caused by the back pull incident when she jumped into my car, the repeated jumping in and out everday as I brought her to work, and the parathyroid surgery, which requires the dog be strung up and stretched very aggressively, and which requires them to be that way for a few hours.

So, we just started to live with the issues, and here is where our story gets most frustruating: she is still progressively getting worse and worse, with new "symptoms" popping up frequently, and to me, it does not seem to be her back.

In the last three months she has started to "leak". She'll lay down, get up and there will be wet areas on her bed. They are not urine (clean and odorless, more like water). I can only assume it is vaginal discharge. She's been walking with her back legs seemingly held farther apart than normal.

In the last 6 weeks, she has started to pant. It started as mild panting once in awhile, to panting most of the day, to now panting most of the night. In the last 2 weeks her panting has become almost desparate. There are times when her breathing is intensely labored for an hour or two, even while laying down, then it seems to dissipate, and we're back to "regular" panting.

She used to be fine most of the time and experience painful episodes every other week, then it got to every week, then 2x a week, and now it's everyday. Acting "normal" is now the exception. We went back to the vet.

The vet said her lung and heart sounded fine, so she put her on muscle relaxants and anti-inflammatory drugs to treat for back pain, which she still suspects to be the issue. We were to take the muscle relaxants for 5 days (starting on this past Friday) and the anti-inflammatories for 2 weeks. Friday she was ok. The muscle relaxants seemed to put her into a stupor and she slept most of it. However on Saturday, she was agitated, and panting quite heavily again, and Sunday she was terribly distraught. Sunday night, I thought I was going to lose her. Her breathing was extremely labored, her gums were cherry red, and her eyes were wide as saucers. I didn't sleep. In the morning, I didn't give her morning dose of either medication, as it seemed the more she had, the worse she was getting, and within a few hours, she was sleeping quietly, breathing evenly, and not panting at all. I have no idea if that was related to the pills or not, but she's always been extremely sensitive to anesthesias, painkillers and the like, so I stopped giving them to her as a precaution. During all these episodes, she still has a reasonable appetite and regular bowel movements. And, she'll get up and down with no problems, tail held high, and walk outside like nothing is bothering her, then come inside and pant like crazy. The panting and "pain" seem to be intermittent. Which is why I wonder if it's not something else. She also has been very hesitant to let anyone touch her under her belly towards her back legs. She has been "touchy" there since her cancer surgery when she was 4, but she's extremely aggressive about it suddenly, and I wonder if she's in pain back there?

Any additional thoughts?
Submitted: 5 years ago.
Category: Dog
Expert:  Dr. B. replied 5 years ago.
HiCustomer-

I'm sorry your husky is having so many problems. It sounds like she (and you) has been through a lot already.

A few thoughts -

First, if this dog hasn't been tested for the tick borne diseases (Lyme, Anaplasma, Ehrlichia, Rocky Mountain Spotted Fever), that should definitely be done. Which one is most likely would depend on the part of the country you live in. I would be very surprised if this has been overlooked, but I did not see mention of it in your post.

Second, if chest x-rays haven't been done, this should be done. Just because heart and lungs sound fine, doesn't mean everything is fine. Some diseases can't be heard with stethescope.

Third, if this dog continues to have very dilute urine, this needs to be pursued further as this is an important clue. A urine culture should be done (even if the urine tests normal in other ways), further evaluation of liver function (bile acid test), rule out adrenal gland disease with an ACTH stimulation test (I know you said they tested for Cushing's disease, but still need to rule out Addison's disease). If all of these are normal, a water deprivation test and then trial of medication to rule out diabetes insipidus (this is a different type of diabetes than that associated with blood glucose) should be done.

Lastly, if all these things come back normal, I think an MRI of the brain and/or spinal cord of the neck should be done.

All of these tests, with the exception of the MRI, could be done at a regular clinic.

Another thing that you may consider would be a referral to a veterinary college as this is a good way to get opinions from multiple experts when cases are very complicated. They can all put their heads together to try to sort things out when necessary.

I hope this information is helpful. If so, please click Accept. If I can be of further assistance, please let me know. I hope Endo is feeling better very soon.
Dr. B., Veterinarian
Category: Dog
Satisfied Customers: 1376
Experience: I have over 20 years experience in small animal and emergency veterinary medicine
Dr. B. and 4 other Dog Specialists are ready to help you
Customer: replied 5 years ago.

Hello Dr. B,

 

Thank you for your response!

 

She did have a test for tick borne diseases when they originally were doing the workup that showed elevated PTH which - it was negative. She had a chest Xray about a year ago after her surgery by my vet in TX, and that was negative, though we've not had one since.

 

Her urine after the Parathyroid surgery was normal and has been since then (we just did a sample this Friday, and I'm waiting for results, as well as a senior panel bloodwork). She's had small amount of crystals in her urine (since she was 5), but I was told that it was most likely from transports to the labs.

 

I don't think she's had either an Addison's disease test or been tested for diabetes insipidus. Can these tests be done by my local vet?

 

Becuase she's so sensitive to anesthesias (it takes her at least a week to get back to herself and she never seems to get all the way back), I've been hesitant to do a brain/spinal chord MRI, which was suggested by my vet in Texas after her surgery and before we moved back here to Florida. If they were to find anything, like perhaps a pituitary tumor, or a slipped disc, are there any effective treatments besides surgery? I'm not sure she could handle a surgery, especially after our experience with the last one, and there is always that pesky financial consideration. I'd hate to put her through all that and spend $2k - $3k (which is what I've been quoted for an MRI scan - is that pretty typical?) only to find out she needed another surgery I couldn't afford.

 

And thank you for your empathy -- it has been hard on us, especially because of the moves and because she's been seen by different teams of people both in TX and here. I've tried to keep careful notes, but I feel like I'm bound to miss something when explaining this to other people.

 

Thanks for your help. She's a special girl and I appreciate your advice.

Expert:  Dr. B. replied 5 years ago.
HiCustomer-

Thanks for your response -

Tests for tick borne diseases will not detect any change in PTH, so you may double check on this to make sure these tests have been run. Also if the test was done prior to onset of these newer symptoms, it may be worth rechecking.

Same with the chest x-ray - you said it was done about a year ago, but it sounds like this panting and what appears to be painful behavior is more recent than that. If that is the case, this should be rechecked.

Many dogs have crystals in the urine, and it is not a problem. Also, the recent abdominal ultrasound should have picked up if there were stones anywhere within the urinary tract, so I am not concerned about this. I would ask what the specific gravity of the urine is (this is an indication of how concentrated the urine is).

To detect Addison's, we run a blood test called an ACTH stimulation test. It is simple and can be done by any regular vet. Diagnosing diabetes insipidus (DI) is a little bit harder. First, dogs with DI with have very dilute urine (specific gravity usually < 1.008). If your dog's urine is more concentrated than this, this will not need to be pursued any further. If the urine is this dilute, we do a water deprivation test to see if they can concentrate their urine when water is withheld (dogs should be monitored closely during this test to make sure they don't become too dehydrated) and then if the urine remains dilute, a medication is given to see if they are able to concentrate their urine in response to this medication. It is not a difficult test to do, but most likely your vet will need to special order medication for this test.

I know the MRI is an expensive test and I do think the price you mentioned would be very typical for this procedure. I understand your concerns about anesthesia, but know that there are specialists and lots of different types of monitoring equipment that could be used to make this as safe as possible for your dog. It is hard to know whether what you will find is something that will be treatable or not - a pituitary tumor would not likely be treatable, but disk disease often can be treated with medication. I think the main reason to do the MRI is to try to get an actual diagnosis for you so you can make a decision about how to proceed. If they do find a tumor of some type that can't be treated, then at least you will know that you have done everything you can to help Endo.

Another thing you may consider in this case would be to consult with an Alternative medicine specialist, particularly someone who does acupuncture. Acupuncture can be a very effective method of managing painful conditions in dogs and their diagnosis methods are different than in Western medicine and rarely requires any type of sedation. I think this would be worth trying in this case, especially if you decide not to pursue the MRI - sometimes their results are truly remarkable. Here is a website that can help you find someone who practices holistic medicine in your area. http://www.holisticvetlist.com/
Holistic vets are usually very happy to work hand in hand with your regular vet to try to give your dog the best of both Eastern and Western medicine.

Please let me know if you have further questions. I know it is hard to watch the pets we love develop problems as they get older, and I can tell you want only the best for Endo.

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