Canine senility undiagnosed in many pets

I have written before here about my elderly beagle, Li’l Bit, and her health problems when I finally found a vet to remove a large tumor which other vets had refused to remove due to her age.  Readers of this blog know that I treat my pets as family members because to me, that’s exactly what they are.

I absolutely adore Li’l Bit in particular, as she was a rescue dog found wandering near a major highway.  She was already very old when we got her, and had been severely abused by her former owner, to the point that she had multiple old broken bones and even an abdominal hernia from being kicked, and we took her in and lovingly nursed her back to health in order to make her twilight years as happy and stress-free as possible.  She is an extremely gentle little dog, and like a child to me.

Li’l Bit is strictly an indoor dog, and is treated with kid gloves at all times due to her advanced age.  She only goes outside to potty, or when the weather is particularly nice so I think she will benefit from being outside. Other than that, she is kept inside my home with me, which is temperature-controlled environment with every imaginable creature comfort.  She is not placed in crates or anything of that nature, and my home and lawn are completely pet-proofed to avoid injury, so she has always had the full ability to roam as she pleases.  She therefore knows her way around my house and yard as well as I do, and possibly even better than me since animals have better sensory perception than humans.

We are not exactly sure how old Li’l Bit is, though the vet estimates her age at 17. That is very, very old for a dog, obviously, and to put it into perspective, in “people years” she is nearly 100 years old. She has always been quite feeble since we got her. She never runs, and she never plays beyond getting treats or a belly rub from us.   She has never even intentionally looked us in the eyes because she is so timid, as you can see in the photo.  At the very most she will walk quickly, but she does even that only very rarely.  Usually, she walks very slowly.  At her age and with her background of extreme abuse, of course, none of that is unexpected.

She does still get enjoyment out of life, in that she knows when it is suppertime and becomes quite excited by food. The vet told us long ago to give her whatever she wants to eat, as long as it isn’t harmful (chocolate, small bones, etc) because at her age, it isn’t going to hurt her and can only enhance her enjoyment of life when she obviously doesn’t have much time left no matter what we do. So after dinner each day, we give her whatever “people food” we have left on our plates. That is the only time she shows any excitement about anything, and boy, does that ever excite her!

More recently, she has been engaging in very odd behavior which the vet cannot explain. She has been given multiple full workups, including bloodwork, and they can find nothing physically wrong with her. She does have some blindness and deafness, and she has arthritis, but all of that is common and even expected in a dog her age, especially one who has been severely abused.

She likes to take walks on the leash, though she can’t walk very far.  I take her on a little walk several times a day, and let her determine where to go and when it is time to go home.  Even that has become problematic, though, because she has become increasingly confused by the world around her.

The first warning sign that something was very wrong with Li’l Bit happened about a year ago.

She sleeps in my room at night, and she has always been a very, very quiet dog. She is so quiet, in fact, that I had never even heard her bark once.  That night, however, she awoke with the strangest howling sound I have ever heard from a dog, a sound so strange that it scared the life right out of me to the point that we both sat bolt upright in bed, with me shaking like a leaf and grasping my other half for dear life.  She then began barking like crazy, and walking very quickly around the house, much more quickly than I even thought possible, and was even walking into walls. When I say she walked into walls, I mean that she would walk into a corner of the wall and keep moving her legs as if she were still going somewhere. Try though we may, we could not get her to calm down, or even to notice that we were there. She continued that behavior for almost an hour, with us trying to calm and reassure her the entire time.  Later that same night, she did it again, and then repeated the behavior once again several days later.

We of course checked the property carefully each time, thinking perhaps she heard something outside despite her deafness, but our other dog did not react at all though he is much younger and normally reacts quite vocally to outside stimuli, wanting immediately to be allowed outside to investigate.  Yet not even the motion detector floodlights had been triggered outside our home, so there was nothing there.  So we told ourselves that she had a nightmare, since she had been severely abused prior to the time we got her, and was possibly walking in her sleep and reenacting the abuse by trying to run away from her abuser. I did call the vet, just to be on the safe side, and they said not to worry, that dogs can have “night terrors” just like people do, and given her prior abuse, that was the most likely explanation.

After that happened, however, she started changing dramatically, and her behavior has continued to decompensate severely. Though at first she would come to us for an occasional belly rub or back scratch, she was rarely assertive about getting attention to the point that when she was assertive we were absolutely thrilled, but we would normally have to seek her out to ensure she received petting and physical attention.  We didn’t think a whole lot of that, given that she had been severely abused by other humans.  Honestly, I thought it was normal under the circumstances.

Over time however she became even more distant, until today, she doesn’t seek or even want any attention at all.  Though we do still seek her out to give her attention, she looks at us like she doesn’t know who we are, or what we are doing.  The best way I can describe her now is as if the lights are on, but no one is home.  The one and only thing which interests her at this point is “people food”, but even with that, she gets so confused that we have to literally lead her to the bowl every single time, even though it is always in the exact same place.  Even with our gentle guidance toward the food, she will still try to go in another direction, due to her extreme confusion which seems to worsen when she gets excited.

She used to keep me company during the day as I would work, just basically hanging out in my home office.  Now she sleeps during the day, all day, and stays awake at night pacing the floors endlessly and scratching at her ears, though the vet has repeatedly said there is nothing wrong with her ears.  To be on the safe side since it was such a problem, though, the vet still put her on a course of antibiotics and an antibiotic/antifungal/steroid ear drop.  I always look to see if there is something causing the itching, obviously, and I keep her ears scrupulously clean just to err on the side of caution since a scratch which breaks the skin could result in a serious blood infection if her ears are not kept very clean.  I have found, however, that if I scratch her on her side, on the opposite side of the ear she is scratching, she will stop scratching her ear.  The vet said that is proof that there really is nothing wrong with her ears, and that the ear scratching is just a “nervous tic”.

Though she was house-trained, so that had never been a problem, she also began urinating in the house, in full view of both of us. Based upon my experience with my late Doberman Pinscher, who started doing the exact same thing which I correctly viewed as a cry for help (the vet determined she had leukemia, though even he didn’t suspect any physical ailment until the blood results came back because it was found so early) I insisted upon taking Li’l Bit to the vet for the soiling behavior. At my insistence they did a full workup, including blood work, but couldn’t find anything wrong with her.

The soiling problem continued, and worsened. It got to the point where, when we put her outside to potty, she would stand there staring into space as if she had no idea what was expected of her. We would have to carry to the grass, and even then it was as if she was lost.  No matter how long we leave her outside to potty, she would rarely urinate there, and would instead simply urinate inside whenever the mood struck her, even if she had just been brought back inside.  I scrubbed the floors (obviously) not only for hygienic purposes but also to ensure she wasn’t returning to a scent signature; I spent a ton of money on cleaning agents which are made just for that purpose.  Again, I took her to the vet, and again the vet couldn’t find any physical explanation for the behavior.

Due to that behavior, I have to watch her carefully at all times, and carry her outside immediately after she gets a drink of water to make sure she urinates.  I can’t even just lead her to the door, because she invariably urinates before she gets there.  She doesn’t even bother walking into the grass.  She will simply urinate wherever she is standing at the time the urge hits.  At the same time, I don’t get the impression that she is incontinent, because there is no “dribbling” of urine.  It is more like she has simply forgotten everything she has ever been taught, and is incapable of learning it again.

In the last couple of months, the problem began to include drinking her own urine if I didn’t remove her from it the very moment it occurred, whether outside or inside, even though she has plenty of clean fresh water easily accessible at all times.  Once she urinated in the floor while I was taking a shower, then just laid down in her own urine and immediately went to sleep; luckily I knew to look for urine, and to check on her, so she was only there for at most a couple of minutes, then of course was bathed immediately.  It got to the point where she was defecating in the house as well, and she wasn’t even repeatedly doing it in the same place each time, so she wasn’t following a scent signature and that of course means it wasn’t just a bladder control problem.  Again, it was as if she had simply forgotten that she has to go outside to relieve herself.  None of that is normal behavior, needless to say.

Recently she was outside for a little while, but when we went to let her in, we couldn’t see her.  Our backyard is not an area where our dogs could get lost, mind you.  It’s not small but also not especially large, and it is pretty open with the exception of a gazebo near the house and a line of trees for privacy purposes on the sides and back of the property.  We freaked out and feared she had somehow gotten out of the yard, though the yard is completely fenced in and none of our dogs have ever gotten out.  However, with a dog as old as Li’l Bit, especially with her sight and hearing deficits, getting out of the yard could be absolutely catastrophic, so we were frantic.  We found her in the far back of the yard wandering around the trees, lost even though there are only a few trees there in a straight line, and even when we were leading her inside, she was still clearly confused.

Another time recently she was outside on the patio, standing right next to the house, and I couldn’t get her to understand how to get back into the house, though clearly that’s what she wanted to do.  Just this morning, she was outside to potty and we found her walking around in circles near the garden shed at the back of the property.  We went outside to lead her back in, and she started following us immediately, but she would forget where she was going and just start walking around like she was lost again, even that close to us, and within sight of the house.  The poor little dog became lost with us standing right there three times, in the very short distance between the shed and the house, so we finally picked her up and carried her back inside.

Even inside the house, she gets so lost and confused that she will literally walk around in circles and into walls just trying to find the stairs.  This happens even when she is standing right in front of the stairs, and even when I lead her to the stairs, she seems to not understand that I am taking her where she is trying to go until she is actually upstairs.

Most disturbingly of all, she stares into space, and she has stopped interacting with us on any level, to the point that she shows absolutely no recognition even when we give her attention.  I do not at all get the impression that any of this is due to sight deficit, because she does not react normally to touch either.  Like I said, it’s like the lights are on but nobody’s home, and it’s getting worse whether the vet can find something physically wrong with her or not.

There is clearly something very wrong with my little dog, to the point that I now watch her like a hawk even inside the house, and pick her up and carry her wherever she needs to go because she gets lost even walking into another room.  If it isn’t explained by a physical problem, as apparently it is not given how many times she has been examined by a vet and given complete blood work, it must be explained by something else.

As readers of this blog are aware, I have cared for my elderly grandmother (who raised me, so she is actually my mother) who has dementia.  Time and again, we wondered if perhaps Li’l Bit also has dementia, because the comparisons were obvious.  Time and again, the vet told us that dogs don’t get that disease, and that Li’l Bit is perfectly healthy albeit quite aged, and therefore has only diseases typical of dogs her age, such as arthritis.  There is not even any evidence of kidney, liver, or heart disease, so she is surprisingly healthy for a dog so old.  That’s also what makes this all so confusing for us, in trying to figure out what’s wrong with our beloved beagle so we can help her.

Today, when researching a symptom pertinent to my grandmother’s dementia, I found out completely by accident that elderly dogs (and cats) can indeed become very senile, similar to Alzheimer’s Disease in humans, and that it is likely the explanation for Li’l Bit’s behavior given that she has received repeated complete physicals which came out fine.  Unfortunately, since it was not diagnosed early despite our best efforts to obtain a diagnosis, it appears there is nothing anyone can do to help her, much less to reverse the effects. There are medications available, but they are only effective if given early.  In Li’l Bit’s case, “early” would have been a year ago when we first sought medical treatment for her symptoms.

From the Merck Veterinary Manual:

Cognitive dysfunction or senility has the following necessary and sufficient condition: change in interactive, elimination, or navigational behaviors attendant with aging that are explicitly not due to primary failure of any organ system. This is a potential animal model for the age-dependent cognitive changes that occur in humans. The affiliated behaviors may be associated with Alzheimer’s-like (senile dementia of the Alzheimer type) lesions. The syndrome occurs in both dogs and cats. It is important to differentiate early cognitive dysfunction from old-age onset separation anxiety. Cognitive dysfunction sometimes involves age-dependent changes in dopaminergic function and microembolic events and is associated with deposition of amyloid plaques; however, the presence of such plaques is not sufficient to diagnose the condition. Many dogs and people with extensive plaque formation experience no decrements in cognitive function.

The following clinical signs may be associated with cognitive dysfunction:

1) Disorientation—the dog or cat seems to get lost in the house or confused when outside. The pet may become increasingly distressed within each episode of disorientation early on in the progression of the cognitive changes, and less so as the changes become more pronounced.

2) Alterations in social and environmental interactions—as cognitive decline progresses, affected dogs and cats interact less with their canine and feline housemates, play less, ignore favored toys, and withdraw from clients, often refusing interaction with them. If forced to interact, the animal can become completely withdrawn, or agitated and more distressed, possibly to the extent of becoming aggressive as a means to decrease interaction. When greeted, affected pets appear not to recognize clients. This profound alteration in client interaction and affect is the change that most distresses clients.

3) Changes in sleep-wake cycle—affected dogs and cats may no longer exhibit standard sleep-wake cycles and instead may pace and/or vocalize during the night. Because cats sleep often during the day as a normal behavior, these changes may be most noticeable in dogs, who will sleep during the day when clients are available to interact with them. Increased vocalization that is repetitive and monotonic is the most common complaint of clients with aging cats. The most distressing aspect of changes in sleep patterns for the clients is that they cannot comfort their pets when they pace and vocalize. Early in the progression of the condition, changes may be manifest only as increased time spent sleeping, which may be considered a normal aging change. Unfortunately, we do not know the extent to which this assumption is true, and such knowledge would allow earlier recognition and intervention for cognitive changes.

4) Changes in elimination behaviors—clients often describe cognitive changes associated with eliminative behaviors as a loss of housetraining. It is likely that there are changes in memory and learning associated with true housetraining (eg, the ability to inhibit elimination unless provided with an appropriate substrate) that are affected as a result of cognitive changes, but in general these dogs are not incontinent. The pets either appear to forget to eliminate when taken to their normal locations and substrates, and then eliminate anywhere when the need is urgent, or they have reduced inhibition and will eliminate wherever they are once they reach a certain threshold stimulus. The extent to which cognition is involved in inhibition of volitional behaviors is largely unexplored in dogs and cats but appears to be important in humans.

There are numerous drugs—and the list is always growing for humans—that may be effective in the treatment of cognitive decline. However, there is only one drug, selegiline, that is approved for canine cognitive dysfunction in the USA. All other use is extra-label, and for some of the medications, canine and feline dosages have not been investigated. Treatment with any cognitive enhancer is likely to be lifelong. Because most of these medications are metabolized through renal and hepatic cycles, pre- and postmedication biochemical evaluation is warranted.

In addition to medications, cognitive enrichment and a prescription diet (Hill’s b/d® ) have been shown to improve learning and reduce signs of cognitive dysfunction in aged dogs. In the UK, a dietary supplement is available that diminishes signs of cognitive dysfunction. The earlier behavioral, pharmacologic, and dietary intervention are accomplished, the more likely that the dog or cat will improve. However, at present the course of this condition can only be slowed, not aborted.

I am brokenhearted, needless to say. I just wish the veterinarian had done a little basic research long ago, when I tried to tell her that there is something very, very wrong with my Li’l Bit despite physical examinations saying otherwise.  Perhaps then, though there is no cure, my poor little dog would have been given appropriate treatment early enough to make a difference.  It’s too late for Li’l Bit now though, because at this point, her mind is gone and all I can do is either continue to try to make her comfortable, or euthanize her to end her suffering.  I don’t know what I am going to do, except that I need to consult with multiple veterinarians who actually understand that particular disease.

Hopefully, however, my experience with Li’l Bit will help other pet owners facing a similar situation, by arming them with information which they can then present to their veterinarians in order to get an early diagnosis.