[This is Susan here - I think Renae will be posting another case later today or tomorrow.]

One night a few weeks ago, it was cold here. Really cold. There was a lot of snow as well. A big St. Bernard named Beethoven came in to our ER that night. Normally an outdoor dog, he had a thick, heavy coat. But it was too cold even for him that night, and his owners had brought him indoors earlier that evening. That’s when they noticed something was not right with him.

He seemed agitated, and he resented his owner handling him – he even went so far as to try to bite her. This was unusual for him, as his owners described as normally a happy, friendly dog. They also noticed he seemed to have some intermittent limping, especially in his hind legs, and at times yelped as if he might be in pain. At one point he seemed disoriented and started falling into a wall. He was trembling at times too. So they brought him in to see us.

On first look, Beethoven did not look that sick. He did seem a bit agitated, but sometimes it’s hard for us to tell because we don’t know an animal’s normal demeanor. Being a big boy (who outweighed most of us), he was a bit hard to handle, as he resented our manipulation of him as well.

On exam, nothing really stuck out to me. His temperature was a little high, but not too bad. He was panting a lot, but dogs that don’t want to be here in our ER do that a lot. He didn’t seem to have any obvious lameness, but occasionally lifted his legs, and at one point almost seemed slightly lame on front leg. I couldn’t get him to act painful when I manipulated his joints, but he was agitated enough that it was hard to tell.

Beethoven had what I jokingly refer to as a ‘nebulopathy’. Some condition that was nebulous – hard to pin down. And I hate nebulopathies. They are usually a real pain to sort out. And a nebulopathy at midnight on a busy night is always a challenge.

So I talked to his mom. I didn’t have much to go on, but something was not right with him. So I suggested getting some bloodwork on him, which is usually the place we start our search for the cause of a nebulopathy.

We drew the blood (a chore in itself, because he was hard to hold – he just didn’t want us handling him). I waited impatiently for the results. And there it was: the level of calcium in his blood was dangerously low (hypocalcemia). The symptoms of hypocalcemia are agitation, rapid panting, sometimes itching of the face, trouble walking and a stiff gait, tremors leading to seizures, high body temperature and death if untreated.

The most common cause of hypocalcemia is eclampsia. This is a disease where a nursing mother dog loses too much calcium in her milk, and her blood calcium drops low. We see this with some frequency in the ER. But Beethoven is a 9 year old castrated male dog, so eclampsia couldn’t be his problem. There had to be another reason.

Some more diagnostic tests in the next few days showed that Beethoven had an uncommon disease called primary hypoparathyroidism. This condition is caused by a malfunction of two glands in the neck called the parathyroid glands. These two glands function to keep the calium level in the blood normal. When the glands don’t do their job correctly, the blood calcium drops too low.

We threw a catheter in Beethoven and gave him some intravenous calcium (this has to be done slowly and carefully, as giving it too fast can actually stop the heart). He responded nicely, and within an hour, he turned from an agitated, grumpy dog into a funny, sweet big boy. Now he is on medication to keep his calcium normal.