Episode 5: Recognizing Nutritional Deficiency: 2 clinical examples
Presenting two examples of nutritional deficiency
Not classical nutritional/vitamin/mineral deficiency syndrome Lack of classic signs = “subclinical” deficiency Veterinarians need to increase their level of suspicion that illness may be related to nutritional problems Aspen
Presented 4/02: 13 year old spayed female Labrador retriever-shepherd mix The owner – my brother - noticed weakness and exercise intolerance
Rapid progression over two-three weeks Syncope/collapse episodes with mild exertion Became unable to walk more than a few steps without resting
Diet
Science Diet®
Chemistry Profile, complete blood count and Thyroid hormone level all normal Chest x-rays were normal 5/9/02 Evaluation of ECG via Telemedicine consultation with cardiologist
HR 50 BPM Diagnosed as complete heart block
Possible degeneration, fibrosis, or inflammation of AV node Recommendation: Echocardiogram and possible pacemaker implant
Telephone consultation (Oregon - Ohio)
Recommended treatment
Nutritional support for cardiac function, electrical conductance, muscle function, general nutrition Cataplex® B (Standard Process) L-carnitine (Pure Encapsulations) Vasculin® (Standard Process) Cardio-Plus® (Standard Process) Catalyn® (Standard Process) Calcifood® wafers (Standard Process)
Improvement noticed within several days after starting supplementation Continued progress over initial 4 weeks of supplement use Returned to normal activity level within 4 weeks
8/6/02 Echocardiogram
Anatomically normal heart Normal contractility Severe bradycardia (32 beats per minute) with continued complete heart block
2/25/03 progress exam
Clinically normal 14 yr old dog Repeat ECG: unchanged from 5/02 Aspen running up and down long hill in yard with children Continued supplements as initially prescribed Continued Science Diet
9/20/05 progress exam
Nearly 17 yrs old Stiff and slow moving, nearly blind, hearing loss, developing urinary incontinence Continued bradycardia due to electrical abnormality No syncope Had more stamina than 4/02 prior to supplementation
12/05 euthanized due to deteriorating physical condition, incontinence, arthritis, etc. – no syncope, no heart failure
Gypsy
Presented 8-8-05 - 4 year old spayed female golden retriever mix Consultation concerning autoimmune disease, open wound on rear end, and generally declining condition Owner concerned that Gypsy was dying and wanted to incorporate complementary approaches
History:
Developed severe bone or joint pain at 9 months old Lame, crying when touched Developed immune myositis - diagnosed via muscle biopsy November 2002
Presented as acute-onset muscle pain and inability to open mouth Muscle atrophy developed subsequently Prednisone therapy initiated ( and continued daily since)
4-18-03 Giardia with severe diarrhea and vomiting
Several teeth extracted due to loosening/periodontitis
Seasonal exacerbations of muscle inflammation and dysfunction x 3 yrs.
Approximately October/November 2002, 2003, 2004 Allergic component?
Faithfully vaccinated (yearly)
Last vaccine 3-8-05
Flatulence; owner feels that abdomen is hot and distended; other dog eats Gypsy’s stool
Medications:
Prednisone 10 mg once daily (continuous use since Nov 2002), Thyroxine 0.7 mg twice daily
Blood Chemistries and CBC
AlkP AST ALT GGT P Gluc Amyl WBC Neutr
8/8/05 1430 72 461 80 4.1 144 16.9 83%
5/17/05 2738 75 596 430 6.2 44 224 20.6 83%
4/23/05 2842 75 612 410 5.5 18 248 20.7 86%