If you want to read the first half of Tilda’s story, her diagnosis with primary hyperparathyroidism, you can read those details about our initial reasons to go to the doctor and how we got diagnosed. Read Part 1
Well, our surgery date with Dr. Degner at the Animal Surgical Center of Michigan was on 6/29/2021. Just to quickly bring you up to speed, at this point, we had diagnosed her with hypercalcemia due to primary hyperparathyroidism. Basically, her parathyroid glands were calling for an excess of calcium all the time and the root cause was the parathyroid itself. We were scheduled for a parathyroidectomy. Due to Covid, everything is a little weird, like well, everything. You have your consultation in the parking lot and it was a scheduled day for surgery and consultation all at once. But, I thought the staff did awesome in arranging everything and making you feel comfortable and confident. Communication was really great throughout and I would never hesitate to recommend Dr. Degner and the ASC.
Before the surgery, Dr. Degner explained that there are 2 primary types of conditions that cause primary hyperparathyroidism. The first is the most common and is an adenoma. Basically, a benign tumor that is causing the parathyroid to call for too much calcium. See the one with the tumor and remove it and the problem will be permanently solved, very unlikely to ever reoccur or cause trouble in the future. The far less common cause, of an uncommon condition itself, is hyperplasia. Primary parathyroid hyperplasia is basically a condition of overactive parathyroid glands and will affect all of the parathyroid glands at some point in time. He said we’d hope for the adenoma but wouldn’t really know until the histopath reports came back after surgery.
After her surgery was complete, Dr. Degner called to tell me that she was recovering and I would be able to pick her up the same day. That part was awesome, I thought she’d have to stay overnight. Dr. Degner also shared that she did not present in a typical way, which I immediately knew wasn’t a great sign. With an adenoma, you’d expect to see visually something resembling a tumor or nodule and know which one to remove. In Tilda’s case, he saw one of the external parathyhroid on the left side that was very enlarged, but no visual tumor or nodes. He removed that enlarged parathyroid gland. On the right side, one of the internal parathyroid glands (basically it sits inside of the thyroid gland itself) had a visual nodule of some type and so he removed that one and along with it a part of the thyroid gland. He sent tissues from both sites out for analysis.
Tilda was given an injection for pain that would last 3 days and we were sent home with a bottle of a suspension formula of calcitrol. The calcitrol was to be given in a specific dose every evening before bed. Basically, the calcitrol acts like the hormone that the parathyroid emits to control calcium. Because of her rogue parathyroid glands, the other ones that were still a normal size may have gone to sleep. So, while waiting for them to take back over and do some work, you give calcitrol and slowly wean the dog off during recovery while testing calcium levels throughout to make sure they wake up. After surgery, hypocalcemia (too low of calcium) is a life threatening complication that must be monitored for. She had a slightly larger incision than if she had presented in a typical case, but the incision is still less than an inch long and not painful to her. She should be kept calm for a couple of weeks and the biggest thing is to not have her do any pulling or whatnot on the neck, no tug of war, no slip lead. We are walking with our Brilliant K9 harness and taking it easy.
On Friday, 3 days post surgery, we returned to our local vet for a calcium test and sent the result to Dr. Degner and he messaged back with the new dosage we’ll administer of the calcitrol. We’ll test calcium again in a week and reduce it further, weaning her off it slowly as her other parathyroid glands wake up.
On Friday, Dr. Degner also called me back with the results from her histopathology report. Unfortunately there was no adenoma present anywhere in her parathyroid and so based upon the testing we’ve done, we have a diagnosis of primary parathyroid hyperplasia. This means that all of her parathyroid glands are or will become overactive at some point. We’ll have to continue to monitor her calcium levels throughout her life and if she becomes hypercalcemic again, we’ll have tough decisions to make about what to do going forward. Some dogs have undergone the surgery a 2nd time, but I’m not sure if we would do that again, especially depending upon how old she is at the time that it would be a factor and with the unknowns about if she would have any parathyroids left to do the work and how long they would last before also becoming problematic.
It is definitely not the news we were hoping for. We are going to love the heck out of this dog and have so much fun with her while we can. I want to get her healed up and try to get our RATO title and see how far we can go before she doesn’t want to compete anymore.
I’d be very interested in hearing from any other dog owners with a diagnosis of primary parathyroid hyperplasia in their dogs, of any breed! I’m curious about life expectancy of course, but also about if you had surgery, did you do it more than once and how different doctors might communicate with their people about it. I’ll learn more from my local vet next week when we are there for her calcium testing but I would be interested in connecting with others who have gone through it as well.