Treatment for hyperphagia

My 11-year-old neutered Maltese male has developed hyperphagia. He has gained 1.4 lb (American pounds), from 9.2 to 10.6 lb.in about six weeks, and in that period of time has gone from having been very lively all his life to having a drastically reduced energy level.

More recently he has developed myoclonic jerks which seem to fit those described for Lafora's disease, though I haven't read of appetite changes and lethargy as accompanying the latter. He does seen to be somewhat more sensitive to bright sunlight, and seems somewhat "out of it."

He had a perfect checkup with normal blood and urine screening at his annual checkup in March, and has seen our vet twice since - in May, when his walking began to decrease (though his general energy level didn't seem any different), at which time his weight was normal, and last week, when the weight gain was documented. Diabetes and hypothyroidism were ruled out.

Another symptom of his current condition is that the timing of his bowel movements have changed, and though he has well formed stools, they often smell of chicken, which he has in small amounts daily in addition to his regular food - as he's been fed for most of his life.

He's scheduled for an abdominal sonogram, and I plan to request an MRI of the brain (am wondering about a lesion in the amygdala). I suppose I should wait until these results are in, but he seems to be losing ground rapidly, and would like some help if possible ASAP.

I have just found out that hyperphagia can accompany Lafora disease. Is there any treatment for hyperphagia or Lafora?

Thank you very much
Very truly ours, S. Hyman, by email


Alison Logan, vet, advises...

As an absolute number, your dog might not seem at first glance to have gained much weight. It is only when one expresses the gain as a percentage of the starting weight that this becomes apparent as a truly significant weight gain. A 1.4 pound gain for your dog is a 15% increase in bodyweight, irrespective of whether one is using American or British Imperial pounds.

Hyperphagia is not a term commonly used in the UK. Your reference to American pounds leads me to suspect you are American and it may be that the term ‘hyperphagia’ is used that side of the pond for what we would call polyphagia, or increased appetite. If I am wrong, then apologies!

There are several conditions characterised by polyphagia such as:

- Diabetes mellitus – often weight loss rather than weight gain; often overweight initially; also polyuria/polydipsia or increased urination and thirst (hence pp/pu/pd); characteristically glucose in the urine and a fasting raised blood glucose;

- Cushing’s syndrome or hyperadrenocorticism – over-production of cortisol results in pp/pu/pd and some of a range of signs such as a pot-belly, black heads and inelastic skin on the belly, crusty calcified areas of skin (calcinosis cutis), lethargy and breathlessness, bilaterally symmetrical loss of fur on the flanks without pruritus (itchiness);

- Hypothyroidism – weight gain despite normal appetite because the body’s basal metabolic rate (BMR) is lower than normal so less energy is needed from food for the normal running of the body;

- Hyperthyroidism (rare in dogs) – weight loss despite polyphagia;

- Chronic diarrhoea such that there is insufficient time for efficient digestion and absorption form the intestines as a result of, for example, Exocrine pancreatic insufficiency (or EPI), Small Intestinal Bacterial Overgrowth (SIBO) – usually weight loss in the face of an increased appetite; diagnosed by faecal analysis and a specific set of blood tests;

- Intestinal endoparasites (worms!) – again, the dog is not able to absorb all the nutrients from his food so there is weight loss despite increased appetite; faecal analysis;

- Behavioural – some dogs will quickly learn that, when they demand food, they receive food – this can be attention-seeking behaviour or a way of exerting dominance over the owner – the dog will then gain weight, just as we do if we over-ride our appetite and eat more than we actually need!

- Disorder of the appetite centre of the brain, thought to lie within the hypothalamus - a brain lesion could affect appetite control and also be responsible for other neurological signs, such as the myoclonus you mention.

At a simple, rule-out level, it would be interesting to check on the amount of food your dog is eating, and confirm that he has not found a new source of food which would explain the weight gain such as scavenging under the bird-table or nicking the cat’s food because the bowl is now somewhere that he can access. If your dog is truly polyphagic, however, meaning that his appetite is truly increased, then further investigation is certainly warranted. Diabetes mellitus has been ruled out on blood and urine tests.

The other hormonal causes of polyphagia mentioned above can be hard to pin down because hormone levels vary naturally. Urinalysis can further suggest Cushing’s if the urine is very dilute because of the very marked polyuria/polydipsia; since you do not mention that, I would assume the urine was concentrated within the normal range. It would be worth running the confirmatory tests for Cushing’s (ACTH stimulation) and a full thyroid panel.

That then brings one to Lafora disease. This is a form of epilepsy particularly found in miniature wire-haired dachshund, bassett hound and beagle but also at a lower level in other breeds. The age of onset tends to be from middle-age onwards, progressing slowly so that life expectation may be much as would otherwise be expected. Management of an affected dog is very much by avoiding known triggers. As you mention, bright or flashing lights are a common trigger so wearing doggles and not having a television switched on when an affected dog is in the room can help, for example. Sudden movements can also be a trigger.

There is a DNA test available for miniature wire-haired dachshunds for Lafora disease, performed on a cheek swab.

This is an interesting question with much to consider. Your dog is lined up for further investigation so I hope that a definitive diagnosis is reached, hopefully with curative treatment.

Which treatments tick your boxes?

Hello

Can you help please ?

I want to protect my Collie-Spaniel cross rescue dog, who is approx six-years-old, from both fleas and ticks in a safe way. At the moment I use Advocate obtained from my vet which is costing about £35 for three months treatment and, having spotted a couple of ticks following a country walk, I was surprised to learn that this product does not kill ticks, only fleas and certain other things.

Having looked at other products on the market I see that Frontline have a spot on treatment which is claimed to kill both fleas and ticks, it would also seem to be cheaper to buy.

At the same time I have seen products in my local pet store from both "Bob Martin" and "Johnson" manufacturers, both claiming to deal with fleas and ticks yet costing about a third of what I am paying for Advocate.

Being aware that often you only get what you pay for, I am looking for some unbiased advice regarding the suitability of using an alternative product.

In fairness my dog has not suffered from fleas or had any reaction to the use of Advocate and I have removed any ticks using one of the implements sold by pet stores, but I am wondering if it would be better to have her protected with a spot on treatment for both fleas and ticks.

If so, does the fact that some other products are cheaper, mean that there is more risk of an allergic reaction, or that they are not as good. Also, if I do think about changing product, would you think it safe, once the effective time lapse from the previous spot on treatment is over, to start with the new one, or should I wait much longer.

Any comments would be very welcome and I realise that you may not be able to endorse any particular product.

Thank you.

Peter Purnell, by email

Immunity boost needed!

My long coated GSD has had a runny tummy for a few weeks and is beginning to look rather lethargic. We’ve been to the vet and had the usual antibiotics, but he’s no better. The vet is sure there’s no infection.

Is there an alternative treatment which might help boost his immune system naturally?

Joanne Booker, Woking



Alison Logan, vet, replies...

It sounds to me as if your GSD needs further work-up. I wonder whether you have been back to your vet since being given the antibiotics? If we vets dispense treatment and do not hear back from the owner then we assume the treatment has worked. Without knowledge of his age and diet, it is hard to be specific but there being no improvement would suggest that more investigation is needed, such as blood tests and faecal analysis. Alternatively, or additionally, there may be an underlying food hypersensitivity.

Presumably you have already ruled out obvious things in his diet which could be causing diarrhoea? For example, a table scrap you add to his food may be a trigger. Do you give him the milk from the bottom of your cereal bowl? Milk is a common cause of diarrhoea, and obviously would not respond to treatment with antibiotics. Does your dog add things to his diet of his own free will which upset his intestines? I am thinking of scavenging – the cat’s food, under the bird table, take-away leftovers whilst out on a walk, and so on.

It is not surprising that your GSD is becoming lethargic. Passing liquid faeces means that your dog is not able to derive full benefit from his diet and is therefore missing out on energy and other nutrients. You really need to know what is causing the diarrhoea so that the correct treatment can be initiated. As much as an immunity boost will always help, it would be ideal for your dog if the cause of the diarrhoea could be identified and sorted out appropriately.

Also, being long coated must be posing you problems with keeping his rear end clean. Do please take care during this hot weather because he could be at risk of fly strike, a really unpleasant situation.

A gentle approach to soreness

Please can you help?

My dog has a really sore tummy, it’s red and sort of angry looking. When I look she’s also got some sore, bald patches on her legs. I’ve looked for fleas but can’t see anything walking in her coat. I know if I go to the vets it’ll start getting expensive and I’d like to try something that is just really natural as it looks like it might be an allergy to me – it seems to be slightly worse the hotter the weather.

Where do I start?

Geraldine Williams, Cardiff, by email


Please note: Dogs Today strongly advises that veterinary attention is sought in the first instance so please assume this is the case when providing advice, tips and suggestions.


Alison Logan, vet, replies...

It is very hard to diagnose a skin condition without a full history (such as the age and breed of your dog, flea control strategy, diet, other pets living in house such as cats and their flea control history, nature of your home environment, where you tend to walk your dog) and being able to examine your dog in person. This is what your vet can do and yes, you will have to pay for a consultation but there is no NHS for pets and, in the longterm, your pet’s welfare is paramount. The longer you leave it, the more potential there is for this to develop into a serious problem requiring intensive treatment.

Common things are common. Fleas underlie a large proportion of skin problems, predisposing to secondary skin infections, and are straight forward to sort out. Simply looking in the coat is not sufficient to be sure your dog does not have fleas. You need to run a flea comb (a very fine toothed comb, similar to a child’s nit comb) through your dog’s coat and look not only for fleas but also for flea dirts (small black comma-shaped particles which dissolve red if water is spotted onto them because they contain partly digested blood). Apply an effective flea control product to all your pets regardless of whether or not you find signs of fleas, and ensure good environmental control as well (house, car, caravan etc). Do remember that if your dog is allergic to fleas she may only need one flea to bite so you may not find signs of fleas because the offending flea may have been and gone! If this is so then simply putting effective flea control into place may be sufficient for her skin to settle down.

An allergy to flea saliva is a very common allergy, but a dog with a flea allergy tends to be allergic to other things as well. It may be that your dog was coping until a flea bite took her above the so-called itch threshold. Before investigating inhaled and food allergies, for example, it is so important to rule out fleas. It is also worth remembering that you may find that your dog’s skin settles naturally over the next few weeks as the air-bourne allergens change with the season. If this is so, and then the skin changes recur at a similar time next year then the likelihood is that your dog has a seasonal allergy.

A complication can be a secondary skin infection, following on from skin trauma where a dog has had a good scratch at him/herself. This will usually require medication from a veterinary surgeon. I would therefore strongly advise you to take the plunge and take your dog to be examined by a vet if there is no improvement once you have established strict flea control. There are, of course, other skin parasites and more serious skin conditions which could be the cause of your dog’s problem.

Back to good health

Dear Think Tank

My young Dachshund recently hurt his back, I know the breed are very prone to this so it's not totally unexpected, but what can I do to make sure this injury doesn't create long term problems for him? What is the best way to ensure maximum healing and to encourage healthy joints?

Many thanks
Mary Smith, Reading, Berkshire


Please note: Dogs Today strongly advises that veterinary attention is sought in the first instance so please assume this is the case when providing advice, tips and suggestions.


Alison Logan, vet, replies...

As a breed, the dachshund is certainly prone to back problems. This ranges from back strain (arched back, unwilling to go up/down stairs) through to the other extreme of a prolapsed intervertebral disc (knuckling of hindpaws, difficulty walking on hindlimbs, loss of ability to pass urine/faeces voluntarily). Back strain should settle with rest and pain relief, but at the other end of the spectrum major back surgery may be advised in order to avoid paraplegia

I am assuming that your dachshund made a full recovery, but I would treat this as a warning of potential future episodes. You rightly want to avoid long-term problems and action you can take includes:

- walking your dachshund with a body harness rather than collar and lead

- regular exercise – two or three short walks rather than one long walk, and avoid the common pitfall of a super long walk at the weekend after a week of shorter walks

- maintain ideal body condition, ie avoid your dachshund losing his waistline and carrying excess bodyweight

- avoid jumping up or down – consider furniture, car

- avoid rough play

- balanced diet with particular attention to the joints (glucosamine, chondroitin, omega-3 fatty acids)

If, however, your dachshund has not made a full recovery then I would have him checked out by your veterinary surgeon, especially if you have not had him examined with this problem.

Lafora disease

It was in 2004 that we noticed the deterioration in Sam, our Dachshund. He stopped playing ball and started to lick his back feet and haunches and asking to be carried up the stairs.

From diary entries I can see that the first note about Sam’s ‘oddness’ and his inability to stand on his hind legs was in November 2007. At times his back legs gave away completely.

In January 2008 I wrote that Sam didn’t seem to know what he wanted. Later, he became very unwell and couldn’t stand. The emergency vet gave him painkillers and Sam went to an orthopaedic vet. Sam was an inpatient for five days. Nothing showed obviously on his X-rays.

At this time concerns were raised over his ataxia, a condition that affects the part of the brain which controls balance and which caused Sam to “high step” with his back legs. We couldn’t remember a time when he hadn’t walked like that; it had come on gradually. Sam came home prescribed prednisolone and gabapentin for nerve pain. We soon realised that he seemed to be “jumping” more often, as if being startled. At first we thought just rapid movements alarmed him; then we realised it happened after any slight move, any sudden noise, flickering from the television, the sunlight. He reacted like he’d been slapped in the face.

I noted that Sam seemed to have no traction in his back legs whatsoever in April 2008. In July, he had two vestibular attacks. He was treated again with prednisolone and recovered very well.

He gradually went blind and deaf and started to have difficulty climbing the stairs. Dementia slowly crept up on him. Somewhere during all this, he developed myoclonus, a medical sign of twitching muscles.

Sometimes he would keel over, as if he had tripped or stepped onto something that threw him off balance.

Early in 2010 I was looking at Dr Clare Rusbridge’s website. I read the Lafora disease page and realised that Clare was describing Sam. Then, I watched a video clip, and I knew that, indeed, Sam had Lafora disease. My vets, who had never heard of Lafora disease before, agreed.

None of Sam’s meds needed to be changed; he was on drugs for older dogs, Vivitonin and Aktivait, and the painkiller gabapentin.

At Sam’s age there was no point in seeing a neurologist because nothing would’ve changed. It would have been expensive, and distressing for Sam, to tell us something we already knew. He sadly passed away on 11 November 2010 and his obituary was printed in the February 2011 issue of Dogs Today.

My own vets had never heard of Lafora disease. I have found out more about it, but wanted to make other people aware of this dreadful condition, in the hope that it could help just one more person reach a diagnosis.

Jean Collinson, by email



Clare Rusbridge, BVMS PhD DipECVN MRCVS RCVS and European Specialist in Veterinary Neurology advises...


What is Lafora?
Lafora disease is a disabling progressive neurological disease characterised by myoclonus (jerking), epilepsy and dementia. It is due to excess storage of a toxic starch-like compound called ‘polyglucosan’ within cells – in particularly in nerve, liver and muscle cells. Latest research suggests that there is a problem with the control of the manufacture of glycogen and/or regulation of insulin sensitivity. Glycogen is a polysaccharide (complex carbohydrate) of glucose, which is stored in the animal cell providing the most important source of short term energy.

Is Lafora genetic?
Yes, in the Minature Wireharied Dachshund and Bassett Hound Lafora’s disease is caused by a mutation in the EPM2B (NHLRC1) a gene that encodes malin E3 ubiquitin ligase, a protein involved with carbohydrate metabolism. It is inherited as an autosomal recessive condition. This means that to have the disease the affected dog will have inherited one copy of the disease gene from each of the parents. Both male and female dogs can be affected.

For the breeder of a Lafora dog this means that both the SIRE and the DAM of an affected dog will be either a CARRIER (one copy of the gene and unaffected) or AFFECTED (two copies of the gene). Also ALL of the puppies of a dog with Laforas disease will be either a CARRIER (one copy of the gene and unaffected) or AFFECTED (two copies of the gene). The puppies will only be affected if the mate of the Lafora’s affected dog was also either a carrier or affected. As Lafora’s is a late onset disease it is not possible to select away from the condition by simple breeding practice, e.g. avoiding using affected individuals, and ideally breeders of susceptible breeds should srceen their dogs prior to mating.

Are there DNA tests available?
The genetic mutation was discovered by a Canadian/UK team led from the The Hospital for Sick Children, Toronto and they offer an ‘affected/unaffected’ test in return for a $300 (Canadian dollars) donation to the hospital.
Unfortunately at the current time a test for carriers is not available.

5-10mls of EDTA blood should be submitted to:

Dr. Berge Minassian
Room 6536B
The Hospital for Sick Children
555 University Ave.
Toronto, ON
M5G 1X8
Canada

Tel: 416-813-7721 berge.minassian@sickkids.ca

The disease may also be confirmed by identification of the abnormal polyglucosan (Lafora bodies) in a liver, muscle or nerve biopsy.

What breeds/types of dog are typically affected? Are any other animals affected?
Lafora disease can occur spontaneously in any breed however the Miniature Wire-haired Dachshund, Bassett hound and Beagle are predisposed. Typically first signs are from the age of six-seven years although some dogs start to show signs much later. The Beagle has a more severe version of the disease and the associated epilepsy can be drug resistant. The mutation causing Lafora’s disease in Beagles is so far undetermined. Disease similar to Lafora’s disease has also been also reported in a six-year-old captive-born female fennec fox, cows and a parakeet. Lafora’s disease is a rare cause of progressive myoclonic epilepsy in children. The human form of the disease is typically severe and fatal with affected children developing dementia and status epilepticus; most do not survive beyond their second decade.

What are the signs to look out for?
The most characteristic feature of Lafora disease is a myoclonus typified by rapid shuddering/jerking the head backwards. The jerking movements occur spontaneously and in response to flickering light (including television), sudden sounds and movement especially that close to the dog’s head. These violent jerks can be so disabling that simple activites such as a car journey or walk in long grass can be extremely difficult or impossible. Hypnic (sleep related) myoclonus may also occur. Generalised or focal seizures may be seen in some dogs. The disease progresses slowly over many years and gradually other neurological deficits such as ataxia (wobbliness), blindness and dementia occur.

What treatments are available?
Drugs
Not all dogs with Lafora’s disease require medication however if they have frequent seizures or if the myoclonic jerking is disabling then therapy is advised. In some cases this can be difficult since some dogs do not respond to traditional anti-epileptic drugs like phenobarbital. If the main problem is seizures then I usually start with the antiepileptic drug potassium bromide adjusting the dose to achieve an optimal blood concentration without adverse effects (such as drowsiness or uncoordinated walking). If the number of seizures is still unacceptable then I add phenobarbital again adjusting the dose to achieve an optimal blood concentration without adverse effects. If the seizures are still not adequately controlled with these licensed dog medications then I switch to unlicensed anti-epileptic drugs such as Levetiracetam or Zonisamide. At this stage it is worth considering referral to a specialist veterinary neurologist as they are likely to be more experienced in prescribing these drugs. These “human” second generation anti-epileptic drugs may also be more effective for treating the myoclonic jerks.

Diet
Anecdotally there is some evidence to suggest that dogs with Lafora’s disease are improved on a low glycemic index (GI) diet - in other words a diet which is low in simple carbohydrates. Simple carbohydrates, e.g. glucose and starch, are easily and quickly digested and release glucose rapidly into the bloodstream. There are many proprietary dog food diets that that have a low GI-index and/or are low in carbohydrates (look for a low grain content) and some owners use homemade diets however, remember that before changing your dog’s diet you should seek the advice of your veterinary surgeon. Starchy/sugary treats may aggravate Lafora’s disease and should be avoided.

Other
Some dogs have a problem walking in sunlight and some owners have found that the jerking significantly improves if the dog wears sunglasses (for example DOGGLES). Signs of Lafora’s disease can be aggravated by stress and anxiety and dogs with Lafora’s disease can be more likely to become anxious. Contact your veterinary surgeon for advice. Simple aids include Dog Appeasing Pheromone (DAP) which is available as a spray, a diffuser or a collar. DAP is the synthetic equivalent of the pheromone secreted by bitches to reassure their pups.

Other links
Lafora dogs http://laforadogs.org/ aims to provide central hub for information for owners who have or think that they might have a dog with Lafora’s disease. There is also information on management based on other owners’ personal experience and what is being done to try to reduce the number of affected dogs in the future. More information about Lafora’s disease, its diagnosis and prevention can also be found at www.veterinary-neurologist.co.uk

Legal advice

I'm after some legal ownership clarification. Can you help?

My ex and I had a dog together. When my ex cheated and left me for someone else I took the dog (my ex put up no fight). I have let my ex see the dog every 4-10 weeks since (my ex left 18 months ago). The dog was transferred into my name alone from the point that my ex left. I would now like to move on and stop all contact - my ex has a new life AND a new dog now. This is partly for me and partly for the dog - I have noticed behaviour changes in my boy after my ex's visits, OCD cleaning, angst and sulking. I know he can't tell me what's up but I know something's not right! Thankfully it only lasts a few hours and he goes back to his normal cute, funny and loving self.

Am I running the risk of losing the dog if I ask my ex to stop seeing him? The last things I want are to lose him altogether (or even part time if a dual custody is ordered), or for him to suffer in any way at all.

Please help if you can. Many thanks.

Anon

Barking on the lead

Hello Dogs Today,

I wonder if anyone could offer any advice.

I have a six-year-old Cocker Spaniel that we have had for one year. My problem is that she randomly barks at people and most dogs when she's on the lead, barking and lunging at them. I have been to an animal behaviorist. He advised lots of treats, but she's more interested in barking than eating the treats. She has been on Zylkene for 10 days now, is it too early for it to have started working yet? Off lead she is fine, but on the lead she barks at people/dogs across the road and I cannot even get her to focus on me.

Have you any suggestions please?

Many thanks

Sally Vincent, by email

Nervous disposition

Please, please, please is there someone who can advise me?

I have a small terrier cross (we think Patterdale cross), who I rehomed from a small rescue group in January 2010. Rosie was found wandering the streets and was put in the dog pound. She did not do very well there and the rescue group which was contacted found a foster home for her. An assessment had been done which stated that she was OK with other dogs. When we brought Rosie home she must have been quite traumatised by everything that had happened to her, as she did not bark and was very quiet and withdrawn for about a month.

She is now very settled and is a wonderful little companion. The problem is when she sees another dog she goes into a hysterical panic. There is nothing that will pacify her until she can no longer see the dog. I think she is scared of them because when we pass front gardens where there are often dogs about, she will look up at me, pull away and not want to go near.

I have taken her to training, and have managed to get her to sit and concentrate on a treat while the other dogs move around (which she will not do on a normal walk) but I feel an unhappiness in her and am not sure if I should continue putting her through this ordeal. In all other respects she is so sweet and very obedient - she has a brilliant recall (except when squirrels are around!) and can sit/stay for ages. If she does not actually see the dog i.e. behind a parked car, she hardly reacts, perhaps just a nose in he air. Considering she is very food orientated and will normally do anything for a treat I am at a loss as to how to help her.

I contacted the rescue centre behaviourist who was not very helpful, and I have also tried clicker training and a trainer from amichien bonding (dog listener) without success.

I would very much appreciate any help in this matter.

Maggie Woods, by email

Coughs and sneezes

Does anyone know if humans can catch a cold from a dog who has recently had the kennel cough vaccine?

For the second time in a row, both my husband and I have come down with a bug shortly after our dog has received his vaccination and I wonder whether or not this is coincidental. I understand the vaccine given in the dog's nostrils is live, and assume it may be possible that when our dog sneezes the virus could be passed on, but I would be really interested to know if indeed the kennel cough vaccine could be responsible for making us feel poorly.

Thank you in advance.


Mrs Knight, by phone

To spray or not to spray

I have a seven-year-old Cavalier who keeps barking whenever he goes into the garden because there is a horse on one side of the garden and cattle on the other side – both groups of animals often come up quite close and my Cav starts barking when he sees them.

I am thinking about using a spray collar or some sort of vibrating collar and would like some opinions on them and how effective they are. I don’t know what else to

do and do want to stop my neighbours complaining about the dog!

Maggie, Isle of Wight, by phone

Let slip your ideas!

My husband has just finished re-flooring our dining room and kitchen with reclaimed Oak. It looks beautiful, but my poor dogs are finding it very difficult as they keep slipping!

The youngster – a Labrador-Collie cross – skids around the corner when charging in and out from the garden and my elderly gentleman – a Flat Coated Retriever – finds it difficult to sit comfortably as his feet keep slipping out from under him! It didn’t occur to us until it was finished that the floor would pose such a problem for our dear friends but now we are trying to find a solution!

Can anyone suggest anything? I am loathed to cover the floor up with carpet!!

Gerry Slade, Derbyshire