Why did this ter­rier stop eat­ing and be­come dull?

Fingal Independent - - LIFESTYLE - PETE WEDDERBURN

Janie is a ten year old spayed fe­male cross bred ter­rier. Onemon­day evening re­cently, she sud­denly seemed un­der the weather. She was duller than usual, and sig­nif­i­cantly, she had re­fused to eat all day. Her en­thu­si­as­tic ap­petite was nor­mally one of the most re­li­able fea­tures of her per­son­al­ity.

When I ex­am­ined her, there were no specif­i­cally ab­nor­mal find­ings, but be­cause this was such an un­usual turn for her, I de­cided to carry out a rou­tine blood pro­file in our in-house lab­o­ra­tory. Within twenty min­utes, our au­to­mated anal­yser had as­sessed her blood count and in­ter­nal bio­chem­istry. This showed my that ev­ery­thing was more or less nor­mal, but it also pointed out a cou­ple of key, low grade ab­nor­mal­i­ties: she has one slightly raised liver enzyme, and one marginally el­e­vated kid­ney pa­ram­e­ter. These tests ruled out se­ri­ous, life threat­en­ing is­sues, but they did hint that there was some­thing go­ing on un­der the sur­face.

At first, a virus or a mild up­set stom­ach seemed pos­si­ble. I gave her a sim­ple treat­ment us­ing med­i­ca­tion to take away any feel­ings of nau­sea. If Janie didn’t perk up by the fol­low­ing morn­ing, we’d need to carry out fur­ther tests to look into what was go­ing on.

The next day, she was no bet­ter: she was still lethar­gic with no in­ter­est in eat­ing. And she had vom­ited overnight, de­spite the anti-nau­sea med­i­ca­tion.

This time, there were a few other key find­ings: her tem­per­a­ture was be­low nor­mal, and her heart rate had dropped from the nor­mal rate of around 100 per minute to just 40 per minute.

She was now show­ing clues of some­thing more sig­nif­i­cant and spe­cific go­ing on. I took an­other blood sam­ple, and this time, I de­cided to do an­other in-house test: the mea­sure­ment of so­called elec­trolytes in her blood.

Elec­trolytes are dis­solved chem­i­cals in the blood­stream that are nor­mally kept within cer­tain pa­ram­e­ters: dif­fer­ent dis­eases can cause el­e­va­tions and de­pres­sions of their lev­els, and these ab­nor­mal­i­ties can have far reach­ing ef­fects on the body’s me­tab­o­lism. With some ill­nesses, the spe­cific changes in cer­tain elec­trolyte lev­els can be enough to con­firm a di­ag­no­sis.

So I mea­sured Janie’s cal­cium and chlo­rine lev­els: they were nor­mal. I also mea­sured her sodium level - and it was lower than nor­mal. And her potas­sium level was higher than it should be. To most read­ers, this will all be gob­blede­gook, but any vets read­ing this will be say­ing “Ah­h­hhh”. The com­bi­na­tion of signs shown by Janie (dull­ness, in­ap­petance, vom­it­ing) along with these changes in elec­trolyte lev­els are suf­fi­cient to make an al­most def­i­nite di­ag­no­sis of the cause of her prob­lem: Ad­di­son’s Dis­ease.

This con­di­tion, also known as Hy­poa­d­reno­cor­ti­cism, hap­pens when the adrenal glands (lo­cated be­side the kid­neys) stop pro­duc­ing enough nat­u­ral steroid hor­mones to keep the body func­tion­ing nor­mally. The cause is usu­ally be­cause the dog’s own im­mune sys­tem at­tacks its own adrenal glands, de­stroy­ing the hor­mone-pro­duc­ing ar­eas. No­body knows ex­actly why this hap­pens, but it can oc­cur in any an­i­mal, of any age. Pa­tients are usu­ally young (four or five years old) but any age of dog can be af­fected. There’s a ge­netic el­e­ment to the prob­lem (it’s more com­mon in some breeds, like Labradors and Cairn Ter­ri­ers). Fe­male dogs are af­fected twice as of­ten as males.

Janie was a clas­si­cal ex­am­ple, and her di­ag­no­sis was fairly straight­for­ward. How­ever the con­di­tion is known as “The Great Imi­ta­tor” be­cause it can re­sem­ble other dis­eases, such as early kid­ney or liver dis­ease, can­cer, and many oth­ers. It’s one of those sit­u­a­tion where vets need to care­fully note all of the var­i­ous as­pects of the case, keep­ing the pos­si­bil­ity of Ad­dis­ons Dis­ease in the back of their mind if it is ever even re­motely sus­pected.

The signs of ill­ness plus blood test re­sults are enough to make a pro­vi­sional di­ag­no­sis (as in Janie’s case), but to be ab­so­lutely sure, a spe­cial test known as an ACTH Stim­u­la­tion Test needs to be done: this mea­sures the ac­tual lev­els of cor­ti­sone in the blood stream. Only spe­cialised lab­o­ra­to­ries can do this test, so it takes a few days to get a re­sult.

While we were wait­ing for Janie’s re­sults from this test, we started her on treat­ment for Ad­dis­ons Dis­ease. It can be a fa­tal con­di­tion if left un­treated, and even in the un­likely event of the di­ag­no­sis be­ing wrong, treat­ment would not cause her any harm in the in­terim.

She was given im­me­di­ate in­tra­venous flu­ids and cor­ti­sone, as well as tablets to con­trol her elec­trolytes, and af­ter just a few hours, she im­proved dra­mat­i­cally. She be­came brighter, more en­er­getic, and when of­fered food, she scoffed it down rapidly. Her heart rate speeded back up to 100, and she was sim­ply a much hap­pier dog.

Two days later, as ex­pected, the blood tests con­firmed for sure that she was a clas­sic case of Ad­dis­ons Dis­ease.

This is a com­plex con­di­tion when you get into the de­tails. There are ac­tu­ally two steroid hor­mones pro­duced by the adrenal glands: the cor­ti­cos­teroids (cor­ti­sone) and the min­er­alo­cor­ti­coids (these con­trol the elec­trolyte lev­els). Once the di­ag­no­sis has been made, treat­ment is sim­ple.

Janie will have to stay on tablets for the rest of her life, to re­place the two types of hor­mones which her body now lacks.

Ad­di­son’s Dis­ease can be a tricky con­di­tion to di­ag­nose

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