Addisons

[Aidan3]

We recently lost our lovely old boy to cancer. Very shortly after that, our GSD (turning 10 in Jan) became quite sick. Loss of appetite, some vomiting, lethargy, stiffness, drinking over 4L of water per day, hunched or tucked over in the back end, some tremors and clumsiness, and generally depressed.

I took her in for tests, which included urine, blood, ultrasound with a specialist and x-rays. The blood test revealed high calcium, and again a few days later (I had her tested again). The x-rays revealed quite advanced bone growths in her spine, so she is probably in a lot of pain.

After a shot of methodone and some Rimadyl, she picked up very quickly. Her appetite didn't recover very well, and I've not been able to walk her for very long, but the excessive drinking slowed down and she seemed brighter.

Then she started to go downhill again, and went off her food for a couple of days. I gave her some Rimadyl on Sunday morning, but then she didn't eat. Later that evening she vomited bile. I took her to the vet yesterday and he did a thorough examination, gave her some Metacam and a shot of antibiotics, told me to fast her for 24 hours then resume Rimadyl plus a course of antibiotics.

I tried to feed her tonight and she turned her nose up at the usual things. She had thrown up earlier several times,then went looking for cat food (bypassing the dry food, she was looking for canned food). I got her a can of cat food and she ate a little, I also hand-fed her some raw lamb liver. She would take the softest bits if I cut them up into small pieces, but if she had to chew she would spit them out and leave them. She seemed otherwise quite keen, and after a while she ate some cooked beef that I had left near her bed earlier. I will give her a thorough dental exam tomorrow with daylight. I had noticed a little blood near her bed in the morning.

But now I'm wondering, with the full blood panel would something not show up that would suggest an ACTH challenge test for Addisons? Or might something come up that would rule it out?

We don't really have a diagnosis. It could be all sorts of things. It's the fact that it flared up so soon after losing Django that concerns me, suggesting some possibility that it's stress related. Her behavioural history is also interesting. She began life quite normal and sociable, then she would go through periods of quite severe aggression and anxiety. Then she would settle down again, until something set her off again. These periods lasted a few weeks at a time.

Sorry if this is really poorly written, I'm kind of just throwing it all out there to see what comes back.

I guess what I really want to know is:

1. is there something in a full blood panel that would rule out Addisons?

2. is there something in a full blood panel (that didn't show up), that would suggest we should run an ACTH challenge?

I do trust the vets I normally see, however, I've not been able to see my normal vets. They have been consulted and kept informed by the vets that I did see (in the same practice).

[Rappie]

Hypoadrenocorticism can present with a range of signs - from 'classical' through to 'atypical'. Sometimes it's easy to diagnose and sometimes it isn't

Typical changes on a blood panel include abnormal electrolyte levels (low sodium, high potassium, often causes a significant change in the Na:K ratio), mild non regenerative anaemia, sometimes a low blood glucose. There might also be an absence of a stress leucogram (a pattern of white blood cell changes), which in a sick dog might suggest Addison's. There can be a bradycardia (slow heart rate) noted due to abnormal potassium levels, and a small heart or hypovolaemia on chest rads.

High calcium can be associated with Addison's but also with other disease, including malignant causes like anal gland tumours and lymphosarcoma.

[Aidan3]

Thanks Rappie. Everything in her bloods came back normal except calcium. I had them check her anal glands four times.

So there are a lot of 'mights' and 'cans' in your post. In the absence of any of those things do you think it's worth pushing the idea with my vet based purely on lack of diagnosis and presentation of symptoms? I'm not worried about looking neurotic, if that helps

[Rappie]

Thanks Rappie. Everything in her bloods came back normal except calcium. I had them check her anal glands four times.

So there are a lot of 'mights' and 'cans' in your post.

That's an old habit from the first degree I started (forensic science) - "Never speak in absolutes", but unfortunately there aren't always straight answers.

Persistent hypercalaemia is a concern - the list of differentials if it is 'real' is fairly short. Neoplasia, primary hyperparathyroidism, renal failure, hypoadrenocorticism. Ionised calcium can be tested to help differentiate causes but it can be tricky to do as it needs to be run quickly. If it were Addison's chronic stress wouldn't help (as you've pointed out) but the clinical signs of weakness, polyuria and polydipsia, inappetance, vomiting etc can all be related to the increased calcium level. At the risk of stating the obvious, her response to pain relief suggests that pain is a signficant issue for her and with the other clinical signs and hypercalcaemia I would (without the benefit of seeing either the patient or the rads!) wonder whether a bone lesion (rather than simply spondylosis or chronic changes) is a possibility. Even if this is not the case, I would be inclined to give more pain relief but avoid NSAIDs in a dog that is PU/PD, vomiting and inappetant.

These situations are always challenging, but as the saying goes - absence of evidence is not evidence of absence. Normal test results doesn't mean she is ok, just that the things covered in the tests are not abnormal. Feel free to PM me if you like.

[JulesP]

Just wanted to say sorry about your doggies Aidan2

The seeking out of cat food is something that I have noticed in my dogs that have felt very poorly. I think because it has a stronger smell.

[Aidan3]

Just wanted to say sorry about your doggies Aidan2

Thanks Jules, I realise I made a huge mistake only having two dogs and letting them become such a big part of my life. I'm going to get 12 dogs and only give them 5 minutes each per day, ugly dogs too (but not so ugly I feel sorry for them), with no personalities.

The seeking out of cat food is something that I have noticed in my dogs that have felt very poorly. I think because it has a stronger smell.

Yeah, and it belongs to the cats

[JulesP]

Yeah, and it belongs to the cats

True!!

I had hysterics when I lost my first border collie at 15yo and his slightly younger friend looked like she wanted to go too. So I know how you feel. I got a puppy and that perked Fern up enough for her to live for another 3 years.

[Aidan3]

Ionised calcium can be tested to help differentiate causes but it can be tricky to do as it needs to be run quickly.

Hmm, we could do that. Full lab at the clinic I go to.

At the risk of stating the obvious, her response to pain relief suggests that pain is a signficant issue for her and with the other clinical signs and hypercalcaemia I would (without the benefit of seeing either the patient or the rads!) wonder whether a bone lesion (rather than simply spondylosis or chronic changes) is a possibility. Even if this is not the case, I would be inclined to give more pain relief but avoid NSAIDs in a dog that is PU/PD, vomiting and inappetant.

Yes, that's a big problem for us and I'm in two minds about it. On one hand, Rimadyl appeared to work very quickly but then her symptoms started to return. Correlation but not causation, I have to wonder? In any case, I can only give it to her if she eats. Fortunately she ate a bit more liver and cat food this morning, enough for me to feel safe to give her 50mg of Rimadyl so I'll see how she responds to that. She had her breakfast in two parts, the first part nearly came back up but she kept it down. A bit later she ate more on her own, without my prompting.

These situations are always challenging, but as the saying goes - absence of evidence is not evidence of absence. Normal test results doesn't mean she is ok, just that the things covered in the tests are not abnormal. Feel free to PM me if you like.

Thanks Rappie, very kind of you And thanks for your help so far.

[Aidan3]

I got a puppy and that perked Fern up enough for her to live for another 3 years.

I'd take another 3 years quite happily, even if I have to carry her outside every morning. I don't think she'd like a puppy though.

[Aidan3]

I had a big chat with my awesome vet. She went off and looked back over her entire case history (10 years), did some research, and agreed that an ACTH stimulation test was the way to go. Booked in for tomorrow. I don't want to get my hopes up, but at least we'll know one way or another.

[Rappie]

I don't want to get my hopes up, but at least we'll know one way or another.

Exactly. Saves trying to guess