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Zeus was no more than 8-months-old when he presented to us unable to walk. For him, it was no easy task to get him to the clinic, for unlike most puppies, he weighed almost 100 pounds! Most Pet owners have the luxury of being able to carry their puppies to the clinic, especially if they develop sudden paresis (partial loss of movement or impaired movement). They are small enough to be tucked under one arm or resting comfortably in a blanket-padded pet-purse. But not him; he had to be wheeled on a large supply cart generously lent by PetSmart. Zeus was heavy, but his body condition score was two out of nine, small for a Great Dane his age.
Seeing such a large, beautiful Great Dane unable to stand or walk is very frightening for owners and veterinarians alike. The prognosis for a good quality of life for such a large pet that is unable to move to even urinate or defecate in a convenient location is greatly reduced in proportion to their size. It took two people to lift him for the neurological exam, place him on the exam table, and position all four gangly, weak limbs in the kennel. He was down but, fortunately, not out.
The differentials for Pets with paresis are sorted and prioritized based on age and breed. Most of the time when we see Dachshunds and Shih Tzus, we tend to elevate Intervertebral Disc Disease (IVDD) to the number one rule-out. When we see geriatric large breed Pets with a history of hip dysplasia (congenital or acquired deformation or misalignment of hip joint), we gravitate toward severe osteoarthritis with Degenerative Joint Disease (DJD). Smaller breeds with intermittent lameness on one hind limb often are suspected of having luxating patellas (where kneecap dislocates or moves out of its normal condition). However, in this case, Zeus was young, so osteoarthritis or neoplasia (abnormal mass of tissue) was very low on the list of possibilities; he was large with the inability to stand on both enormous rear limbs. The list of most probable differentials was shrinking. Another possibility, spinal trauma from being hit by a car, was also not as likely – he was successfully kenneled in a pen at home. Hope was steadily dwindling. Zeus was weak, unable to stand, depressed and quiet, but not giving us very many clues.
Out came the reference books. The following list of differentials was compiled: Addison’s disease€“adrenal insufficiency (which just so happens to list Great Danes as a breed more likely to present with this disease), tick-borne disease (never rule this out, especially in the Southeast), toxin ingestion (not as likely as he never had access to any known chemicals or garbage), myasthenia gravis (neuromuscular disease leading to fluctuating weakness and fatigability) – the list continued to grow. Bloodwork and radiographs were performed. The likelihood of spinal disease or trauma was immediately, and thankfully, ruled out. Zeus was mildly dehydrated from not wanting to eat or drink but this shouldn’t have caused his weakness. Then, the puzzle pieces started to fall into place. He had elevated potassium, calcium, and phosphorous. His sodium to potassium ratio was 19. He even seemed to get a little better after receiving an IV dose of Dexamethone SP (after bloodwork ruled out possible infection). Later, an Adrenocorticotropic Hormone (ACTH) stimulation test confirmed that our patient had hypoadrenocorticism, or Addison’s disease. Out of all the possible diseases, toxins, and trauma that could have caused his illness, Addison’s was a very welcome diagnosis as it had the best prognosis with treatment. He responded to the medications designed to replace the steroids in his body that he was unable to produce himself. One injection every 25 days or so, and daily doses of prednisone gave him the chemicals his body needed in order to be able to stand, eat, drink, and otherwise function normally.
Within a month, Zeus started to eat better and gained an entire point on his body condition score (no small feat for such a large frame). He was able to walk back into the clinic for his follow-up exams and medications. With adherence to timely injections, one medication a day, and periodic electrolyte and blood panels, Zeus should live a long, normal life.