Ziggy makes full recovery after tests and surgery

Ziggy is a 6 year old Schnauzer who is just very laid back! He came to us for further investigation of an electrolyte abnormality. A high calcium level had been found on a blood test and had been making him feel a bit off colour.

High calcium is a relatively uncommon problem, it can show up in a number of ways, including generally being slightly unwell, drinking a lot & diarrhoea. There are a number of potential causes and all of them are serious. They include various cancers (lymphoma, anal sac tumour & parathyroid gland tumour) kidney failure, adrenal failure and rat poison. Excessively high calcium is toxic to the body and can cause irreversible kidney damage. It is important to find the problem and correct the calcium level.

A thorough physical checkup showed that Ziggy was very healthy however we found a small lump inside his anus next to his anal sac. Blood tests ruled out kidney failure and adrenal failure as possibilities and since rat poison works by causing kidney failure, this was ruled out as well. Our next step was then to remove the anal lump and have it examined. His calcium remained high and the lump turned out to be tumour unrelated to his anal sac. To continue the search we x-rayed Ziggy's chest and abdomen looking for signs of a lymphoma but found nothing. We did an extensive ultrasound scan of his abdomen and again found nothing.

The next step was to measure his parathyroid hormone level. This is a difficult test to do as the sample must be transported frozen to a human hospital in Sydney. A tumour of the parathyroid gland will often cause a high reading, but a normal reading does not rule this out. Parathyroid glands are very small and lay embedded in the thyroid glands at the top of the neck. The hormone they produce keeps the body's calcium level up. A low calcium is even more dangerous than a high calcium as it results in muscle tremors, seizures and cardiac arrest! Ziggy's result came back in the high part of the normal range.

Since this did not rule out a parathyroid tumour we had to continue the search. The next step was to see if we could image the thyroid glands with ultrasound and locate any parathyroid gland abnormalities. The parathyroid glands themselves are very small and are usually not able to be seen, however when we scanned Ziggy's R thyroid there was a nodule at the front of the thyroid, right where the parathyroid is situated. (see image)
It appeared that we might at last have found the problem. Surgery is required to remove the nodule and careful monitoring of the calcium level must be done to prevent any rebound drop which might occur. The nodule was successfully removed (see photos) and Ziggy's calcium reduced back to normal and stayed in the normal range. Testing of the nodule confirmed it was indeed a parathyroid tumour and that it was benign. This was good news and since Ziggy's calcium continued to remain in the normal range we could therefore be confident that we had cured the problem.

This small innocuous nodule had been producing an excess of parathyroid hormone which had been causing the high blood calcium. It had taken a lot of testing, xraying and scanning to track down, a delicate operation to treat but now Ziggy could look forward to a normal life again.
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