Haley is Weak and Wobbly

Wednesdays are usually pretty slow around here. We close early and don't usually schedule elective surgeries, sticking to well pet vaccine appointments, or seeing dogs with itchy ears, cats who got in fights-pretty routine stuff. But it never fails that a patient will come along with pretty vague symptoms but is obviously very sick-just like Haley did today. Haley is a 5 year old, very sweet and ordinarily energetic terrier that had been vomiting last week. She seemingly got better, but is now terribly weak in her hind end, can hardly walk, and is trembling all over. She seems cold, dehydrated and her owner may have seen blood in some vomit yesterday. Yuck. Remember our abbreviation lesson? Haley is ADR-ain't doin' right- for sure!

We started with a physical exam and taking her history. Haley wasn't usually the type of dog to eat things she shouldn't-no rocks or parts of toys or sticks and she hadn't gotten into the garbage as far as her owner knew. Besides, her "partner in crime," Henry, wasn't showing any signs of a problem. There were no medications or toxins out for her to get into, and no one had put out rat or slug bait or changed antifreeze lately. There was no diet change and she didn't get any new kind of treat. Her body temperature was indeed a little low, and instead of eliciting pain or just tension as I do on most dogs, her abdomen was completely flaccid. She was indeed limp in the hind end and her eyes seemed to be sunken into her head. She had a big glob of greenish material in her eyes and her gums were cold, dry and tacky. I thought she was dehydrated, but there had to be more to the story. I thought it would be a good idea to get a blood sample and run a profile to see what was going on in her body.

Getting a blood sample was easier said than done. Haley's veins were practically non-existent! At least her peripheral veins, the ones on her legs, were very difficult to find. We settled for drawing a sample from the larger jugular vein in her neck, and even that wasn't easy. Her cold body temperature and whatever was happening to her body seemed to be shunting her blood away from her periphery and likely to the more vital organs-her heart, brain and such. I sure was glad her owner got her in when she did!

We were able to run a panel on Haley's blood in-house in less than an hour while her owner waited. Her electrolytes were totally out of balance, with a dangerously elevated potassium level and very low sodium. Also significant was the very high phosphorus level and elevated creatinine kinase, the muscle enzyme. These blood results were helping me to understand better what was going on in Haley's body-and more importantly, what we needed to address to help her out. When electrolytes become as out of balance as hers were, it can be due to disorders of the endocrine system-and in this case I strongly suspected hypoadrenocorticism or Addison's Disease.

Addison's Disease occurs when the small adrenal gland stops producing enough of the steroid hormones we all need to help combat stress in our lives-gearing up for the fight or flight response when we face something scary or exciting. Corticosteroids come from the cortex or outer layer of the adrenal gland while mineralocorticoids come from the inner medulla area. The glucocorticoids (including cortisol, prednisone, dexamethasone and others) act on the mechanics of sugar, fat, and protein metabolism. They gear the metabolism towards the preparation of burning - rather than storing - fuels so as to be ready for a fight or flight situation.

The mineralocorticoids (such as aldosterone) influence the electrolytes called sodium and potassium. As a general biological rule, where there's sodium or salt, there's water. When the mineralocorticoids circulate as part of the fight or flight preparation, sodium is conserved in anticipation of blood loss so that there will be extra fluid in the vascular compartment (spare blood). When sodium is conserved, potassium is lost as part of the biological balance. This whole picture of fat mobilization, sodium conservation etc. that is part of the fight or flight preparation is far more complex than can be reviewed here but basically:

Corticosteroid hormones are needed to adapt to stressful situations and without these hormones, even small stresses could lead to physiologic disaster, as I fear is happening to Haley.

We often see these Addisonian dogs at fairly young ages, 4 - 5 years old. Females are more likely to have it, and Standard Poodles and Bearded Collies have breed predilections, but of course, any age, breed, sex dog can be affected. Cats can develop Addison's, but it is extremely rare. It is most likely to come to the diagnosis because of a "crisis" situation-a very sick or shocky dog as Haley is presenting. Older treatments for shock, fluids and steroids, just happened to be the remedy for Addisonian crises, too. Since it wasn't likely to hurt and could be very beneficial, we also gave Haley medications to reduce that dangerous level of potassium. We are also giving her medications to protect her stomach as her owner saw blood in her vomit yesterday. This should hold her steady until we get her resting cortisol level and determine if further testing is needed. We can then start her on a definitive treatment for Addisonian dogs-probably DOCP or Percorten, given once every 25 days or so. She will still need some supplemental corticosteroids, prednisone or dexamethasone, when she is undergoing stressful situations, and it will be essential to monitor her electrolytes carefully as fluctuations can cause the weakness and anorexia Haley showed today.

Haley is fortunate because she has an owner who really knew her normal behaviors and what to watch for-when she wasn't herself, she brought her in for an exam. Others have progressed to full blown seizures and worse before getting diagnosed and getting the help they needed. With all these things that can go wrong in our bodies, isn't it amazing how often they all work so well?

Peace,

DrReneigh

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