My 10 year old beagle in November had an ear infection that caused him to develop facial paralysis. He seemed to be doing well and was eating normally. We are concerned because he has started trembling a lot and his eating habits have changed dramatically. He went from eating everything in sight to being extremely picky. Multiple blood work, x-rays, various veterinarians (even specialists) and no one can tell us why he is trembling and seems painful. Sometimes he cries out in pain when we pick him up and sort of scrunch him. An x-ray showed a narrowing of his thoracolumbar vertebrae, but they were uncertain if that was the cause. He seems to tremble more around meal time, but it can occur anytime. He is currently on Previcox once daily and Tramadol as needed. The tramadol seemed to help, but lately not so much. He is arthritic and has had bilateral cruciate repairs in 09. The arthritis pain was helped with the previcox, so we are concerned something else could be causing pain. Once he shook so much that he threw up and had diarrhea.
Some history: Fletcher has had a high ALP since he started NSAIDS while being diagnosed with his cruciate injuries. He is a little on the chubby side (40 pounds) but has always been healthy, happy , and active up until the paralysis. He does not seem to have any vestibular issues (no circling, disorientation, etc.)
We were wondering what sort of ideas you might have that we could take to our vet. We are just going around in circles trying to figure out how to make him feel better. He has been to the vets so much for this, and we still have no answers. Any ideas would be much appreciated. Thank you for your time.
Dr. Marie replied:
Aw, the poor guy. It sounds like he has been through a lot. Pain can be such a difficult thing to figure out in dogs. It sounds like your vets have been very thourough. Yet, we still do have cases like this where we do everything we can and no one can come up with a solution.
One thing you could ask your vets about is something called "Beagle Pain Syndrome". It doesn't fit exactly but it is a possibility. It is a condition that can cause excruciating pain in Beagles. While it usually starts to affect younger dogs, it can happen at any age. The condition is a little hard to diagnose. It is generally treated with steroids. However, with elevated ALP levels, this might pose a bit of a challenge. Still, it's worth asking your vets if this is a possibility.
If the problem is due to back or neck pain then most of the time there is not much we can do other than medications. Sometimes one particular NSAID will work better than another, so you could ask your vet if switching types could be helpful. If it is in your budget you could ask if surgery is a possibility. The next step would likely be to have a myelogram done. This is a special test where they inject a dye into the spinal column and take some xrays. This really should confirm if there is a disc problem and whether or not surgery would help.
I wish I could offer more. I hope things improve soon.
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Thank you for your reply. We tried switching him to Metacam several months ago to see if we could control his arthritis pain better with it. He was doing alright on it, but after about 3-4 weeks on it, he started to lose his appetite. We did give it to him in some foods that were not the best for him, but they were all he would eat. The trembling and decrease in appetite seemed to start after trying the Metacam, so we switched him back to Previcox. His appetite picked up somewhat, but it is not how it used to be. He wants to eat, but when it comes time to eat he just won't.
We were looking over his medical history and noticed that in 2012 when we had an ultrasound of his liver done, his gallbladder was enlarged. The veterinarian told us that if it was not bothering him at the time to leave it alone. In 2013, he went in to see a different veterinarian for trembling and being painful. Before seeing Flethcer, the doctor thought his blood work may he indicative of gallbladder issues and that the trembling was from the pain associated with digestion. Once he saw him, though, the doctor determined that he had back and neck pain. Is it possible that a change in his diet, like getting Metacam and antibiotics in fatty foods, could have caused issues with his gallbladder?
He was diagnosed with idiopathic vestibular disease and idiopathic facial paralysis by a specialist in March. Is facial paralysis painful? Could he be experiencing some sort of nerve pain from this paralysis? Is there anyway to even determine that? Thanks again for your time. I am sorry to write so much, we are just so worried about him.
Dr. Marie replied:
We don't tend to see a lot of gallbladder related pain in dogs, but it's probably not impossible. However, there really should be some obvious bloodwork changes that would go along with this type of problem. If the vet was able to determine that there is neck pain then this is the likely problem as it's not common to have two sources of pain. Still, it's worth asking your vet if it is worthwhile to repeat some blood tests or even the ultrasound.
I wouldn't say that vestibular disease and facial paralysis are associated with pain. I suppose there is some kind of obscure possibility of a brain tumor but I think that the chances like this are extremely small.
I think that the most likely explanation is back/neck pain which certainly can be frustrating.
As an aside, I am currently dealing with the aftermath of a bulging disc injury and even though I am on some excellent medications I still have a significant amount of pain. My reason to tell you this is not to garner pity but to say that as a human who can express to my doctors exactly what kind of pain I am having I still have to deal with it daily. I would imagine that the situation is even worse in dogs because they don't have the sensibility to know that they should avoid certain types of movements that could cause them pain and they can't do exercises like we can to help the back repair.
Still, there could be other options if it is a neck pain issue. You could ask your vet about trying Metacam along with a stomach protectant like famotidine and this could possibly help.
I wish I could offer more!
Have you seen with facial paralysis where the muscles on the face atrophy and affect the muscles around the cervical vertebra? Many times he has visited the veterinarian and they press on his muscles and move around his head and check for back/neck pain and he doesn't cry out. Not too long ago he was prescribed Gabapentin for possible nerve pain but not being too familiar with the med I didn't want to try it. Have you seen good result with this drug and nerve pain? Even this morning he likes to open the doors with his head ( they are left slightly open for him ) and cried. It's hard to treat him for pain because it doesn't seem like the previcox helps all 24 hours and the tramadol sometimes helps and his appetite is not so great. We are now thinking about alternative medicine and acupuncture hoping it may help. He's going in on thurs. for another second opinion. Thank you again . Erin
Dr. Marie replied:
I can't say that I have ever seen this happen before.
If there is potential nerve pain then Gabapentin can be an excellent drug and it's certainly worth a try.
Hope things look up soon!
We wanted to give you an update on Fletcher. His blood work showed hypercalcemia, so we had a malignancy profile run. It showed that he has primary hyperparathyroidism. He will be going to see a specialist for our next step in his treatment. Have you ever encountered any dogs with this condition? Thanks again for all of your time. Hopefully we can get Fletcher feeling better now!!
Dr. Marie replied:
Ah...very interesting! I have had a couple of cases of hyperparathyroidism. One went untreated because of cost concerns and that dog did not do well. The second had surgery to remove one side of the parathyroid. That dog did amazingly well. What we thought was arthritis in her hips cleared up completely within a couple of months of having surgery.
Hope things improve!
Hi Dr. Marie,
I just wanted to let you know that Fletcher had an ultrasound that showed two parathyroid nodules. He had the two affected glands removed on July 1st. He had to be hospitalized for several days afterwards because he became hypocalcemic. He was home for 3 days and was rushed back in to the vets because he was having seizures. 3 more days in the hospital and he was home again. Last night, we just rushed him back in for seizures again. He is on calcitriol and calcium supplementation 3 times a day, but his body is not responding to the therapy. The doctors tell us it will take time to get him regulated and hopefully we will bring him home again tomorrow! I was just wondering if you have ever seen anything like this before or how other dogs responded after having parathyroid glands removed. It has been so stressful and scary for him and us. Our other dog, I think, is taking it worse than all of us combined! Thanks again for all of your help.
Dr. Marie replied:
Thank you for the update. I can't say that this was a diagnosis that I was thinking of! But, I have actually seen a similar case. I had a dog who had very bad hip problems that was cured once we realized that she had a parathyroid problem and removed the parathyroid glands.
Hope things work out well.
Hi Dr. Marie,
I just wanted to give an update on Fletcher. He passed away in August from a suspected brain tumor. We were completely devastated. When he started having seizures and his calcium levels were normal, we knew something was up. After a scary seizure, we took him to the emergency animal hospital and the doctor informed us that he probably had a lesion in his brain. He passed away 4 days after that diagnosis in my arms after having cluster seizures. We feel like we were given the run-around by the specialists. When we mentioned the possibility of a brain tumor before we had the parathyroid surgery done, the doctors assured us that Fletcher would be fine once his calcium levels were normal.
I wish I would have listened to my gut instead. I would have taken him for an MRI and done whatever I could to make his final months comfortable for him and I never would have put him through that terrible ordeal. After reading up on the symptoms of brain tumors in dogs, I can't believe that they didn't even want to consider the possibility. Even before he started having seizures, he had warning signs that were never addressed.
I want to stress to your readers to always listen to your gut when it comes to your animals. You see them everyday and know when something isn't right. If I had listened to mine, Fletcher wouldn't have been put through that horrible surgery and the subsequent hospitalizations for hypocalcemia. Thanks again for your time and input, we really appreciated it.
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Dr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.
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