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Feeling a little stressed and worried

3K views 30 replies 15 participants last post by  Sweet Girl 
#1 ·
Good morning,

Some may remember all the problems we had with Rayder and diarrhea when we first got him and for months afterwards: coccidia, giardia, clostridium, continued diarrhea despite resolution of all those. His poop finally normalized on Hills w/d and remained ok when I switched him to Royal Canin gastrointestinal fiber response. However, every time I have tried to switch him to a puppy food everything went haywire again and we were back to metronidazole and high fiber food. I had made peace with his not being able to be on puppy food.

Fast forward to now: he is missing his left mandibular fourth premolar and I arranged for a visit with a veterinary dentist to anesthetize him, x-ray the area, and remove the tooth if it was impacted, or just wake him up if the tooth was just not present (the much more likely scenario). In case you don't know, you cannot just leave an impacted tooth because it can cause what is called a dentigerous cyst which can destroy surrounding bone and teeth.

I ran some pre-op blood work on Rayder (the appointment isn't until April, but I wanted to get it over with). In all the previous diagnostics we did on him, including a visit to an internist, blood work has not been done (lots of varied and expensive stool tests, ultrasound, urinalysis, but no blood). The results came back fairly normal, but his protein was a tad low, and in a puppy you would expect it to be on the high side, certainly not below normal, even if it is just slightly. Low protein can cause problems with healing, especially if it were to get worse between now and any possible dental procedure, and given his history of GI problems can indicate a problem with absorption.

I ran a further GI blood panel looking at vitamin b12 which can be low in malabsorption, pancreatic enzymes, resting cortisol (a screening test for Addison's disease which would be super duper weird and rare and unexpected in an 8 month old). At this point I am really glad I got insurance for him!

Those results came back today: low b12 indicating lack of absorption, and his cortisol was super low, despite the excitement of being at the vet and the stress of restraint, blood draw, etc. There is a very good chance he has Addison's disease, plus or minus some other intrinsic intestinal problem. I am doing an ACTH stim test tomorrow which is the definitive test for Addison's. Addison's is low adrenal function and would require that he have some sort of steroid supplementation for life (there are 2 types of steroid they can be missing: glucocorticoid and mineralocorticoid (the worse of the 2) and he would appear to be glucocorticoid (prednisone) deficient if he is indeed addisonian, but could always convert to the other kind in the future). He is also going to have to receive b12 injections. Once all these results come back, I am going to reconfer with the internist to see if anything else (like intestinal biopsies) is indicated.

This is so much for an 8 month old to be facing and I am feeling overwhelmed and guilty and stressed. Thanks for reading this far!
 
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#3 ·
It's great that you are being proactive and catching this before he's symptomatic. You're in a perfect position to be able to care for him.

Our boy lost a premolar at 9 months and the vet suspects it was a baby tooth (I was able to save it) but didn't recommend any further investigation. Is that something I should worry about?
 
#5 ·
If you think it was the baby tooth (which, if there wasn't a trauma I would suspect, given it would take a lot to lose a permanent tooth) and there is no permanent tooth which has taken its place, it is something you should consider looking into. If you are neutering any time soon, you could do an X-ray when he is under for that. We are not neutering Rayder until he is at least 18 months, if at all, so we wanted to confirm if the tooth is there or not before that because dentigerous cysts are not great. The dentist did say that goldens are notorious for missing premolars (I did not know that) but without an X-ray you don't know if it's missing (no big deal) or impacted (she even said she's seen them upside down!).
 
#7 ·
I can understand your feeling stressed, but guilty? Never! If you hadn't been doing the pre-anaesthetic bloodwork, you wouldn't have got such an early diagnosis of Addisons and wouldn't be able to start treatment so soon. You've been a great owner doing everything possible for your dog.
As an aside, I know Addisons can cause diarrhea, so is it possible he may have had this from birth, which may have added to all his intestinal problems?
 
#8 ·
Thank you!

Yes, Addison's can cause diarrhea, and it is certainly possible that it has contributed to all his issues (maybe a bright spot to this will be that we can put him on normal food if we get this sorted out). However, there are some things which don't fit -- the diarrhea has been very responsive to Metronidazole and high fiber food being the main thing, neither of which is a treatment for Addison's, lol. However, the fact that he tends to get diarrhea after stressful or stimulating events totally fits (used to even happen just on walks whereas poops at home were fine), poops got worse as day progressed vs first thing in the morning after a calm sleep. I guess we will see after tomorrow's test!
 
#9 ·
I am so sorry to read about Rayder. As others have said he is lucky to have a mom who is a vet. As for feeling guilty and stressed... well, I think any time any of our fur kids are ill we will find ourselves feeling that way. Even if we, as you obviously are, are very proactive and observant of what is going on with their health, well being and safety. It is a condition which results because we love them dearly and want more than anything to keep them safe and healthy. And the stress which results when they are not is just like the stress we feel when any other family member has problems. Because these dogs are not just dogs to us...they are our furry family members.
You have done everything right and you will continue to do what is best and right for Rayder. i think he is a very lucky guy to have you and I am sending positive thoughts for him and also for you.
 
#10 ·
Sending positive thoughts for Rayder and you. I hope you are able to get his problems sorted out. My boy had an extra tooth (peg lateral?). He had to have surgery at 4 months old to remove that tooth and have a path cut for a tooth that it had impacted. He came through it fine, but the impacted tooth came in a little crooked. Your boy is very lucky to have such a good owner.
 
#13 ·
Good morning,

Some may remember all the problems we had with Rayder and diarrhea when we first got him and for months afterwards:.....

Those results came back today: low b12 indicating lack of absorption, and his cortisol was super low, despite the excitement of being at the vet and the stress of restraint, blood draw, etc. There is a very good chance he has Addison's disease, plus or minus some other intrinsic intestinal problem. I am doing an ACTH stim test tomorrow which is the definitive test for Addison's. Addison's is low adrenal function and would require that he have some sort of steroid supplementation for life (there are 2 types of steroid they can be missing: glucocorticoid and mineralocorticoid (the worse of the 2) and he would appear to be glucocorticoid (prednisone) deficient if he is indeed addisonian, but could always convert to the other kind in the future). He is also going to have to receive b12 injections. Once all these results come back, I am going to reconfer with the internist to see if anything else (like intestinal biopsies) is indicated.

This is so much for an 8 month old to be facing and I am feeling overwhelmed and guilty and stressed. Thanks for reading this far!
Hang in there Sian--

You are a great doggie mom... of course you are stressed and overwhelmed. But you are systematically going through each of the options and I'm sure that you will get to a solution for Rayder- Hugs.

It's always so very hard when you have something like diarrhea, my last girl, Merry had a very sensitive stomach, throughout her life- no steak or human food-- or else we would have the trots. My vet gave me a supply of Metronidazole. And there was one Christmas where it was just a disaster, my Brother-in-law's Uncle was a butcher, old Italian family :) and they were used to giving the dogs bits of everything. He kept sneaking things to my dog ....

In any case I know that you will find the answers to help Rayder and he is in very very good care with you.

Keep us posted
 
#21 ·
Thank you, everyone for your kind words and for checking in on us. The results came back today and they are inconclusive: they are not normal (they are low) but they are not a slam-dunk for Addison's. I am forwarding all the recent info to the internist we saw for his diarrhea to see what he would recommend. The internist at the lab said to simply repeat the test in a few months and see how and if it changes.

To answer a couple of questions/suggestions put forward:

No, I am not treating Rayder myself. I have someone else doing that (even more so now that I am asking the internist's opinion). I agree, it is hard to remain objective and I have always asked for help when it comes to my own pets.

Yes, Addison's would be very rare in a pup his age. Usually young to middle aged females is the typical. There are some breeds, including the Nova Scotia Duck Tolling Retriever, which have a juvenile form.
 
#23 ·
I guess that's potentially good news then, right. And I wasn't suggesting your were treating Rayder yourself - just figuring that if you're like me, you're thinking about it a lot with your "vet hat" on. Sometimes it's helpful just to let all that go and just put your "dog mom" hat on. I went back to your first post and I was thinking again that if you ignore the lab work, and you didn't know about the missing premolar (something that would have never even crossed my mind as a non-vet), is there anything going on now clinically from his appearance or activity that is concerning? If the answer is no, then I wouldn't worry too much. In medicine this happens all the time where something odd is found incidentally on an x-ray or pre-op bloodwork, and it can set you off on a wild goose chase - often leading to further unnecessary test and stress of the patient and family members. I always trust my history and physical exam way more than tests. Tests are only useful to confirm or refute your clinical suspicion. Good luck sian!
 
#26 ·
No, there's nothing that would have made me run the blood work other than the need for it pre-anesthetically. However, the results do fit with/explain his ridiculously sensitive GI tract, so had I been more interested in following that up, we might have got to this point. I think I allowed the specialist's somewhat blasé attitude inform my attitude, even though I feel that a puppy should not be required to eat high fiber food and nothing else in order to avoid diarrhea (and sometimes even on that food).
And you're right, I can't stop thinking of this like a vet, but that's the way I am -- control freak!
 
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