Billy’s Story

Billy at the shelter

This website includes a timeline which outlines the key health related events in Billy’s life. In this section, “Billy’s Story”, we hope to delve a little more deeply into the specifics of his health problems and explain how we came to our conclusions throughout this website. We adopted our husky mix Billy from Pets Unlimited in San Francisco at the approximate age of 3 years. Pets Unlimited had rescued Billy from the Sacramento shelter where he was scheduled for euthanasia (Billy was deemed “unadoptable” by the Sacramento shelter because of his extraordinary fear of everything). Billy had been neutered before arriving at Sacramento; in fact they seemed to think he was a girl and named him “Trish”. On the way back to Pets Unlimited the shelter manager and Vanessa Getty (benefactor to Pets Unlimited at the time), upon realizing that Trish was a male, decided to call him “Billy” after Mrs. Getty’s husband! Once at Pets Unlimited, Billy was evaluated, treated for kennel cough, vaccinated, and chipped. Once home with us, our own vet evaluated Billy and concluded he was underweight, but otherwise young and healthy. He also advised us that Billy was the most frightened dog he had ever examined.  An excellent article from the San Francisco Chronicle describes the situation at the Sacramento shelter at the time Billy was there. Many dogs like Billy were left in a drop box at that inhumane Sacramento shelter when they were surrendered – many times for multiple days and in sweltering heat!

Adopting Billy out was problematic for Pets Unlimited. He did not warm up to potential adopters and essentially cowered in his cage. If you approached him, he would roll over on his back. His message was loud and clear:  “Please don’t hurt me!” His overwhelming fear of practically everyone and everything created havoc with his bathroom habits. This was because Billy was too afraid to allow someone to watch him going to the bathroom. Although Billy understood what was desired of him in terms of going to the bathroom outside, many times he held it hoping for a more opportune time when he would be alone. This would cause the occasional accident.

As it seemed no one was interested in actually adopting Billy, Pets Unlimited was now offering Billy up for adoption along with his buddy and kennel-mate, a gregarious Dalmatian named Romeo. It was a package deal. Surely, no one could resist Romeo. And, to get Romeo, they would have to take Billy home too. Still no one was interested. After our extended initial visit to Pets Unlimited, where we spent over two hours trying to get Billy familiar with us, we returned for a second visit the very next day. We expected that Billy would remember us and be happy to see us. Billy happened to be outside the shelter with a volunteer who had just taken him for a walk. When we called out to him by name, Billy lunged – in the opposite direction!  Billy couldn’t get away from us fast enough! The volunteer was devastated. Certainly it looked like Pets Unlimited had lost a potential home for Billy. Imagine their surprise when we asked if we could adopt Billy without Romeo!

We chose to share our home with Billy because despite his aloof and fearful behavior, we saw within an intelligent, gentle creature – capable of much more. When we got past his fear and anxiety, he did become a truly remarkable dog who was beloved by many. He was the big dog who the little dogs loved and trusted. He was the dog at the park that people trusted their small children with. He had the softest mouth imaginable when he took a treat from you. People who had spent their lives fearful of dogs were not afraid of Billy. We now recognize that many of the dogs being euthanized or relegated to a lifetime of shelter living are not inherently aggressive or vicious – they are just scared. Some dogs deal with situations that scare them by running away. Other dogs have learned if they lunge and snarl at the source of their fear, the potential threat usually goes away. The literature regarding  behavior modification for a variety of issues (e.g., separation anxiety, fear of other dogs, fear of other people, touch sensitivity, fear of loud noises) was somewhat helpful. In retrospect, we recognize they failed to address the heart of the matter, i.e., the dog’s endocrine system (hormones). In the near term, we found that by taking Billy to the beach every morning for long runs in the sand, we had better control of his fear/anxiety.  In fact, extreme exercise seemed to be our best defense against the variety of emotional issues exhibited by Billy. Ocean Beach, with its miles of sand, smells and experiences, became Billy’s “happy place”. We concluded that many of the undesirable behavior traits found in Billy could be offset through exercise. We came to believe dogs, like humans, have a release of endorphins (i.e., hormonal secretions conferring a sense of euphoria from the pituitary gland in the brain, through vigorous exercise). We have now found scientific studies which confirm that dogs also experience a “runner’s high”.  The “high”, however, is believed to come from the release of endocannabinoids (eCBs) during moderate to high intensity exercise. Walking, such as on a leash, is not sufficient intensity of exercise to stimulate release of eCBs.166 Not everyone can run far enough or fast enough to give their dog adequate exercise to provoke the release of eCBs, but certainly most anyone can play fetch with their dog. Billy did seem to get the same effect from a game of fetch with a frisbee, stick or ball. The videos on Billy’s timeline which show him playing fetch at Lake Las Vegas give you a pretty good idea as to how those hormonal secretions, be they endorphins or endocannabinoids, can confer a sense of happiness and well-being in a fearful dog.

A healthy and happy Billy

In a little over 3 years (at age 6) Billy became the handsome, confident dog you see in the photo on the right. Granted, he was still terrified of fireworks/loud noises and did have separation anxiety, but overall he seemed like a healthy and happy dog. Knowing what we do now, we believe that three years of a stable, reduced stress lifestyle had allowed Billy’s adrenal glands to recover from the stress of his experience at the Sacramento shelter. Our conclusion in hindsight: young, healthy adrenal glands can produce sex hormones to compensate for the sex hormones lost by neutering.

Unfortunately, it wasn’t long before problems started with Billy’s health. First he became less active, and some of his beautiful fur started to thin. We took Billy to the vet and he concluded Billy’s thyroid gland was not producing enough thyroid hormone. So we began thyroid supplements which would continue for the rest of  Billy’s life. We also advised the vet that Billy had noticeably been favoring his right front leg.

Billy was prescribed Metacam, an anti-inflammatory, that acts much like ibuprofen for people. The Metacam did not help. About 3 months later, Billy became totally lame on his front right leg. Our vet sent us to an orthopedic specialist. It turned out Billy had fractured one of the bones (the coronoid process) that was a part of his right elbow. Billy had surgery to remove the fractured bone, and he was soon back to running and playing at the beach. However, after his surgery, some of the fur shaved off in the location of the surgery never grew back. The surgeon and our primary care vet had no idea why. In hindsight, we recognize that low thyroid is the first sign a dog can no longer compensate for the hormone imbalance brought on by neutering. Further, the stress of an injury or surgery can exacerbate the imbalance.

Almost one year later (age 7), suddenly Billy was unable to sit properly, or get up from a sitting position without great difficulty. We went back to the orthopedic specialist, and Billy was diagnosed with a tear of his cranial cruciate ligament in both knees. We had tried to protect his joints by running him almost exclusively on the softer sand at the beach.  Because his exercise was so important to his mental and physical well-being, we were very concerned that Billy continued to have so many orthopedic problems. The orthopedic specialist didn’t have any suggestions as to how we could do better for Billy. Billy had TPLO surgery on both knees – one after another. This is a complex surgery where they actually shorten one of the bones to flatten the angle (TPA) of the bones in the knee joint. The steep TPA before surgery is what predisposes the ligament to tearing,67 and shortening the bone that grew too long flattens the angle in the knee and allows the repair to be successful long term.  We discovered much later the bone in question grows too long when dogs are spayed or neutered at an early age while their bones are not yet fully developed.61 Please refer to our section “Cranial Cruciate Ligament Tear” under the Orthopedic heading of this website for more specifics about excessive TPA and it’s remedy, TPLO surgery.

With each TPLO surgery, although he was treated very well by the specialist and his staff, Billy’s recovery was quite painful, and each recovery lasted 8 weeks. Once again, the fur shaved in the surgical field did not grow back, and subsequently his skin in the bald areas turned black. The vets had no idea as to why. When Billy was 8 years old, we did a biopsy of one of the bald areas, and the biopsy showed the problem was endocrine (hormonal) in nature. What we didn’t know then, but was most certainly true, was these three surgeries had pushed Billy’s hormone imbalance to a point where he would never recover. This set the stage for endocrine disease and/or diseases brought on by a defective immune system. Our primary care vet, in consideration of Billy’s symptoms, recommended testing Billy for Cushings disease.

Cushings disease is a very rare disease in humans, and it is characterized by an overproduction of cortisol (a cortisone-like hormone) by the adrenal glands. It is a disease that we are seeing with increasing frequency in dogs, and the veterinary community seems to have no explanation for this trend.73 We believe spay/neuter and the hormonal chaos it creates is directly responsible for the uptick in Cushings disease.  Why would the veterinary community think that removing sex organs that are an integral part of a dog’s hormonal system would NOT lead to hormonal imbalances/problems? Billy did not test positive for Cushings. Our primary care vet reached out to veterinary endocrine experts and advised us the endocrine “experts” at the time were recommending 12 mg. of melatonin daily to enhance the regrowth of Billy’s fur. We started Billy on melatonin.

HPIM1051Billy’s back legs seemed to be doing very well, but his elbows continued to give him pain. Billy’s fur was now falling out on other parts of his body in addition to the shaved areas which never grew back (see the back of his neck in the adjacent picture). We kept Billy on the melatonin because we were told it could take at least 4 months and possibly much longer to see results. We were also advised melatonin had few, if any, side effects. Billy had injections of hyaluronic acid (HA) and cortisone in his elbows, and they seemed to help to some degree.  We were told by friends that perhaps acupuncture could help Billy’s elbows, so at age 9 we took Billy to a holistic vet.  The holistic vet told us she did not feel Billy had Cushings, and instead opted to change his diet to address the fur loss. She also provided acupuncture to try to address the orthopedic pain. At the end of four months, it was clear Billy’s elbow pain and fur loss were unimproved. The holistic vet told us that she now thought Billy did have Cushings. She recommended more acupuncture with an emphasis on resolving Cushings. We found her explanation disconcerting. We also found the theory that Billy had Cushings very odd because Cushings patients have an excess of cortisone-like hormone. If Billy already had too much of this cortisone-like hormone, and cortisone is what they injected into his joints to make them less painful, why did Billy have so much pain in his elbows in the first place?

We decided to keep Billy on his new diet and we did not return to the holistic vet. Billy still had pain in his elbows, and when he was about 10 years old, we took him back to the orthopedic specialist for injections into his elbows of HA and cortisone. He improved some, but about 6 months later you could actually feel a grating when you bent and straightened his front legs. Billy had bits of bone and calcium floating around in his elbow joints, and they caused him pain when he flexed at the elbows. We wanted to have the orthopedic specialist go in and flush all of the debris out of his elbows (much like they do for people). However, Billy’s liver enzymes were elevated and the vets did not feel it would be safe to put him under anesthesia in this condition.

There can be many reasons for elevated liver enzymes. Our primary care vet ordered an ultrasound to check Billy’s liver. There were no tumors or visual abnormalities. The most likely culprit was the anti-inflammatory medications Billy had been taking for years to help his knees and elbows. Consequently, the vet put Billy on Tramadol, a pain reliever which acts on the brain instead of working directly on the area of pain and inflammation like anti-inflammatory medications do. He also put Billy on Denamarin (its principal components are silybin and SAMe) which is utilized in dogs to help their liver heal, and bring down elevated liver enzyme levels. We learned three important lessons from this episode:

First, the Denamarin was very successful at helping the liver to heal. After 6 weeks of treatment with Denamarin, Billy was cleared to have his elbow procedures.

Second, SAMe is believed in humans to raise levels of neurotransmitters in the brain.  Denamarin certainly had an effect in Billy’s brain. When we discontinued Billy’s Denamarin, within a short period of time he became fearful of planes flying overhead.  We live in Pacifica, and flights from SFO come over our house at all times during the day and night. It seemed every time we took him out of the house to go to the bathroom, a plane would fly over and he would stop peeing or pooping and run home. In fact, it even became a serious problem inside the house, where the noise from a plane overhead would send Billy into a panic-stricken search for a safe place to hide. The vet had no idea as to what could have caused this change in behavior. We tried to go through Billy’s daily living and account for any changes we might have made. We finally concluded it might be the Denamarin. We started Billy on Denamarin again, and within 24 hours, the problem with the planes had completely disappeared. In retrospect, the SAMe in Denamarin is theorized to mimic progesterone in the dog’s brain. Progesterone is a calming hormone found in males and females. There have been reports in studies of pregnant dogs who are turned in to shelters that after giving birth, if the dog is immediately spayed they can actually become “psychotic”. It is believed that progesterone is at a high level during the pregnancy, and the abrupt withdrawal of progesterone by the spay procedure creates hormonal chaos in the dog’s brain. Our abrupt withdrawal of the Denamarin could have had a similar effect.

Third, within Billy’s liver enzymes, all the abnormalities could be explained except one – his GGT level. We specifically asked our vets what could account for this elevated GGT. The vets had no answers. Years later, in our research, we found that in humans, elevated GGT is a harbinger of a patient developing Type 2 diabetes.94

Billy exhibiting excessive fur loss

On Thanksgiving Day in 2010, we noticed at the end of Thanksgiving dinner, Billy was scratching at his tummy. We looked at the area and saw a mass of red bumps. It was clear he either had a bad infection or an allergic reaction which had caused hives all over his chest, stomach and abdomen. The next morning they were still there, and he was very uncomfortable. Our vet’s office was closed, and neighbors had been suggesting we see another local vet for a second opinion for Billy’s long standing unresolved problems. We were put into the new vet’s schedule that day, and she thought Billy had been bitten by a spider and had an allergic reaction. She also wanted to test Billy for Cushings again. The tests for Cushings were again negative, and this new vet suggested that Billy had Atypical Cushings, and should be treated for that. Further, the meds she gave him for an allergic reaction actually made Billy’s stomach worse. The obvious conclusion was that this was not an allergic reaction, but an infection. The new vet refused to change her diagnosis and wanted to give him an even higher dose of allergy medication. We declined, and brought Billy back to our regular vet the next day who gave him antibiotics. The problem started to resolve immediately. However, this infection proved difficult to eliminate entirely. We tried a second type of antibiotic, and it still did not clear completely. Our primary care vet felt that treatment for Atypical Cushings was unwise, but also referred us to a veterinary dermatologic specialist. The specialist did not believe Billy had Atypical Cushings, and had no answers for the loss of fur, the endocrine issues in his skin or the chronic skin infections Billy experienced.

Billy had no new symptoms over the next year except for the chronic elbow pain and chronic skin problems outlined above. However, when Billy was 12 1/2 years old, we noticed Billy seemed to be drinking excessive amounts of water, urinating frequently, and eating more food. He had lost several pounds and was noticeably thin. We brought him to the vet and advised him we thought Billy had exhibited the classic symptoms of diabetes. Absent an attack of pancreatitis, the vet told us it was highly unlikely that Billy had diabetes. However, upon testing, Billy did have seriously elevated blood glucose which confirmed a diagnosis of diabetes.

When the pancreas cannot make enough/any insulin, a dog has Type 1 diabetes, just as in humans. Blood tests indicated Billy’s pancreas was producing a normal amount of insulin and his pancreatic enzymes indicated he had a healthy, functioning pancreas. Type 2 diabetes occurs when the pancreas makes enough insulin, but the cells cannot respond normally to the insulin. In this case, the cells have “insulin resistance”. Despite the assertions of our vet and the medical literature that dogs do not develop Type 2 diabetes, Billy appeared to have Type 2 diabetes. At that point in time, Billy’s blood glucose level (BGL) was averaging close to 400 despite our best efforts to control his diet, provide him regular exercise, do frequent testing of his BGL and inject insulin at doctor-recommended doses. A BGL of between 80 and 100 is considered normal.

Now that Billy’s chronic problems were no longer just cosmetic, our vet started a battery of tests to try to identify the source of his unexplained constellation of symptoms. Billy’s thyroid levels were normal with supplementation. An abdominal ultrasound was normal – no abnormalities noted in his adrenal glands or liver. Our vet felt he had taken Billy’s care as far as he could, so he referred us to a canine Internal Medicine (IM) specialist.

The IM specialist tried to prescribe different types of insulin to see if we could improve Billy’s blood glucose levels. No improvement. She seemed content to leave things as they were, and told us that was all we could do for Billy’s diabetes. Dissatisfied, we then started our own research online. We tried to learn as much as we could about diabetes in dogs, and oddly enough references to Cushings  disease as well Atypical Cushings kept coming up in our searches. We joined a Cushings chat group, and realized the dog guardians were all basing their care for their dogs on hormone panels that had been performed at the University of Tennessee. For those whose dogs also had diabetes it seemed the approach to improving the diabetes was to treat the Cushings/Atypical Cushings. In order to treat the Cushings/Atypical Cushings we needed to rule out an adrenal tumor or a pituitary gland tumor. Our primary care vet had ruled out an adrenal gland tumor. So, we asked the IM specialist to send Billy for an MRI to see if he had a pituitary tumor. The MRI showed no tumor in Billy’s pituitary gland, but the radiologist concluded he had a left middle ear infection. The IM specialist prescribed an antibiotic ointment to place in both of Billy’s ears on a daily basis, as she claimed an ear infection in one ear often spreads to the other ear.

At our request, the IM specialist also submitted samples to the University of Tennessee for a hormone panel. The hormone panel showed Billy still did not have Cushings. Rather, Billy was afflicted with hyperestrinism (i.e., too much estrogen). In fact, Billy had 6 times the normal amount of estradiol (the most potent form of estrogen found in the body) for a male dog. But equally, if not more disturbing, was that Billy had absolutely NO testosterone – extremely bizarre considering Billy is a male. It was at this point that a light went on in our heads. Was all of this because Billy was neutered?

Billy (age 13+) was still receiving antibiotic ointment in both of his ears – it had been over 6 months. The IM specialist had been telling us that if we could eliminate the ear infection, his BGL should improve. Billy’s BGL was still averaging between 350 and 400 despite frequent testing and trying different combinations of insulin. The IM specialist had not made any recommendations regarding Billy’s excess estradiol, other than keeping Billy on his 12 mg. daily dose of melatonin that he had been taking since he was 8 years old. Clearly, the melatonin was not working!  We decided to research humans, rather than dogs, to try and find answers as to what we could do to lower Billy’s estradiol, as there was no plan forthcoming from the IM specialist. At this point, it is important that we clarify the situation. It was dire. Status quo was unacceptable and could yield no other possible outcome than Billy’s imminent death. Clearly, we needed to take control of the situation. Thorough and relentless research through the available medical databases was in order.

Our research led us to our first big surprise:  excess estradiol in a male can cause insulin resistance79 – the hallmark of Type 2 diabetes. We needed to find another, more effective way to reduce Billy’s estradiol. We found that women who suffer from estrogen sensitive breast cancer must reduce the estrogen/estradiol their body makes because the estrogen/estradiol “feeds” the cancer.  Many of these women take anastrozole (an aromatase inhibitor like melatonin but stronger) to lower their estrogen/estradiol levels.96  We also found that anastrozole had been tested in dogs with few or no side effects 98 (as a means of assessing its safety for humans). We asked the IM specialist to prescribe anastrozole to reduce the amount of estrogen/estradiol in Billy’s system. She complied, and Billy began his daily doses of anastrozole along with his insulin injections. We enrolled Billy in a local pharmacy’s pet prescription plan which made the anastrozole very affordable. We stopped melatonin supplements.

The research on human males also indicated that low testosterone makes the prognosis for Type 2 diabetes much worse. Billy’s hormone tests showed he had no testosterone, so we asked the IM specialist to provide Billy with testosterone injections to bring him to a normal level of testosterone for a male dog. The IM specialist refused, saying that it would be dangerous to do so as Billy may become “aggressive” (further discussion of this will be provided below).

Billy’s “ear infection” had not improved as he continued to show discomfort by shaking his head. Also, Billy had now lost his hearing completely in both ears. Our own research led us to suspect the ear antibiotic ointment had caused his deafness. However, the IM specialist assured us otherwise. Desperate, we found an ear specialist who was willing to open up Billy’s eardrum and get direct access to the problem area. The ear specialist determined that there was no infection in Billy’s ear but rather a tumor which he biopsied. The biopsy came back inconclusive. He also compounded a solution for us to put in Billy’s ears to hopefully help restore his hearing. He advised us that the antibiotic ointment prescribed for Billy by the IM specialist had indeed caused his deafness. We were then referred to a surgical specialist for evaluation to remove Billy’s middle ear tumor.

Billy resting post surgery

Billy (age 13+) had surgery to remove the tumor in his middle ear. The biopsy of the removed tumor was labeled as an adenocarcinoma (cancer). However, the lab seemed to have some doubts; they had two pathologists evaluate it, and they commented it was an unusual type of tumor. They said, “we suspect there is potential for an invasive growth pattern”. We were forced to rely upon studies on humans to get more information about what we were facing, as canine references did not discuss this type of tumor in the detail we required. We did find relevant information in the human cases to conclude this was probably not a cancerous tumor, and that these types of tumors in this location often were misinterpreted as cancer. The cell types and presentation in the studies matched closely what Billy’s pathology report showed.18

We were referred to an oncologist for follow up treatment. The oncologist recommended removal of Billy’s outer ear on that side (just in case the tumor had spread) and 18 sessions of radiation, with general anesthesia for each session. What the oncologist did not discuss was the language in the biopsy report that indicated the pathologists were unsure of their diagnosis. The oncologist also did not discuss the horrible side effects of head/neck radiation that we were fully aware of through our own research. We declined treatment because we strongly believed through our aforementioned research that the tumor was slow growing, benign and quite possibly related to Billy’s estrogen excess. Further, the idea of subjecting Billy to the entirety of what the oncologist proposed left us with the belief that Billy would have died in the process of this treatment – the result of an infection from the open sores that would develop throughout the inside of his mouth from the radiation. Fortunately, our instincts proved correct. Had Billy’s tumor actually been an adenocarcinoma (a very aggressive form of cancer) he would have died within 8 months. Instead he lived another 2 1/2 years and died of other causes.

Billy was now 13 1/2 years old and the ear specialist’s treatment had successfully restored Billy’s hearing. We were thrilled! We were back at our primary care vet, and we asked him about hormonal supplementation for Billy in addition to his anastrozole and insulin. He indicated he would be willing to try growth hormone (GH) supplementation. He had been thinking it might help for some time, but a side effect can be diabetes, and that seemed too great a risk. Now that Billy had diabetes, that was no longer an issue. Billy was started on growth hormone. It definitely helped his energy, and his muscle mass. His back legs had been weakening recently, and the GH really helped Billy’s ability to exercise. He also achieved a little regrowth of his fur. Most importantly, Billy seemed to feel better.

Billy’s vision had been deteriorating over time, and there was a very visible clouding in his eyes that made the pupils almost invisible. Our vet told us Billy had cataracts and that this was a common problem for people and dogs with diabetes. We brought Billy to an eye specialist who confirmed that Billy had cataracts in both eyes and that he was almost completely blind. We were told that many dogs adapt to blindness better than one would expect, but for Billy it just heightened his anxiety. For a dog who tended to be fearful, not being able to see perceived “threats ” was intolerable. Although we were advised the risk of surgery at his age and with his diabetes was of great concern, we agreed it was a risk worth taking. The specialist agreed to perform cataract surgery on both of Billy’s eyes. The surgery was a resounding success! Billy’s vision had been restored.

Billy at age 14

Billy is now 14 years old. His BGL is still way too high from his diabetes and was averaging about 299 with insulin injections since he started anastrozole (down from almost 400 at initial diagnosis). The diabetes continued to take its toll. We felt we were losing him. The GH had not benefited Billy’s BGL. As we did with the IM specialist, we showed our primary care vet the research that indicated  testosterone supplementation would bring down Billy’s BGL. Our primary care vet agreed to terminate the GH and give Billy testosterone injections instead. He had some concerns regarding aggression and testosterone supplementation. He also knew Billy was declining and that we would be careful with Billy so as not to put any people or dogs in jeopardy should Billy react badly to the testosterone – as was the conventional wisdom.

Billy-T at OBDOG-EC Meet at Ocean Beach Sloat on Friday  May 15 2015 2015-05-15 013
Billy enjoying life at the beach

Billy (age 15) had realized significant improvements in his BGL through his monthly testosterone injections. His BGL was now averaging 233 with insulin, anastrozole and testosterone. The testosterone had begun to restore hormonal balance, and his BGL continued on a downward trend. In fact, we found we needed to reduce the dosage of Billy’s thyroid hormone supplement.  This was entirely consistent with the findings in case studies of patients whose adrenal hormones were abnormal. In these patients, adrenal hormone replacement therapy returned the thyroid levels to normal without the need for thyroid hormone replacement.105 

Billy’s cognitive decline had been reversed. He was more alert, more aware of his surroundings and was less fearful.55 For example, Billy was no longer frightened by fireworks/loud noises. We knew he heard them because he did react, turning his head and rotating his ears to try to figure out where the sound was coming from. However, he no longer ran to hide and he was not shaking uncontrollably in fear. Billy was now inclined to approach people he did not know. Billy even had an improved appetite. Contrary to the vet’s concerns, the testosterone had made Billy more relaxed and friendlier to new people and dogs. We and our vet were amazed and taking great pleasure in the improved quality of life Billy was now experiencing! We concluded that the veterinary community had it all wrong. Low testosterone might very well be responsible for the myriad of fears (i.e., those brought on by loud noises, new people/dogs, separation, etc.) exhibited by many male dogs, as well as “fear aggression”. Perhaps many of the male dogs who were considered unadoptable, or were surrendered, could have benefited by testosterone supplementation?

Unfortunately, Billy still had persistent pain in his elbows. For the past several years he had periodic HA and cortisone injections as well as cold laser treatments in his elbows. Before giving Billy a new medication for pain, a blood test was performed which showed elevated liver enzymes. Billy had an ultrasound performed on his abdomen to check out his liver. A large mass was discovered on his liver. If surgery was not performed to remove the mass, Billy’s liver function would continue to decline rapidly, causing a painful death in the not too distant future. This was a decision that could not be put off, because as his liver function declined, so did his blood’s ability to clot. Our perspective was simply this: if Billy did not survive the surgery, it would be an expensive euthanasia, and he would not suffer. However, the surgeon believed he could remove the tumor, and that Billy’s blood would clot adequately. The surgeon also advised us, in his experience, the liver values and the patient’s comfort would improve immediately after surgery. We believed if Billy survived, he would have quality of life for some time.

Billy recovering from liver surgery

Billy (age 15+) underwent surgery to remove the mass on his liver and, as it turned out, his gall bladder had to be removed as well. The surgery was successful. Billy’s liver values improved almost immediately. Billy’s BGL continued to improve from the regimen of insulin, anastrozole and testosterone (and perhaps the improved liver function) and was now averaging in the mid to high 100’s! We couldn’t have been happier! The tumor itself weighed 3.5 pounds and was benign. The surgeon indicated he had been seeing these tumors with greater frequency but was unsure as to their cause. Based upon our research, the tumor appeared to have been caused by excessive estrogen. Once again, there was nothing in veterinary literature to address this situation. However, there were historical references in human medical literature which documented liver tumors histologically consistent with Billy’s found in women who were given early birth control pills that were high in estrogen. Subsequently, the estrogen levels were reduced in birth control pills, and the liver tumors did not appear in women studied. Billy recovered well from the surgery.

We would like to redirect for a moment the discussion about Billy’s health to address a question we suspect you have been asking yourself as you read about all of Billy’s health problems–just how much did all of this cost? The costs were extremely high, perhaps into 6 figures. We never wanted to add them up, because we did not want to deny him care because of the cost. This is a decision many families are making every day all over the world because of spay/neuter. Many families do not have the resources to provide comprehensive care to their canine family members, and that is truly heartbreaking. Please refer to our “Hidden Costs of Spay/Neuter” page for a in-depth explanation of the financial aspect of this situation.

Unfortunately, after enjoying about 6 months of improved health from his liver surgery and ongoing testosterone supplementation, Billy’s health took a turn for the worse. The diabetes was taking its toll. Despite its recent improvement, his BGL had been so persistently high for so long, there was damage done we could not reverse. We began to notice signs that he was having peripheral neuropathy91 – probably related to the diabetes. Billy also struggled with laryngeal paralysis which made his breathing more labored during exercise and caused him to have difficulty swallowing. We had no ability to adequately address these new issues, and Billy (almost age 16) passed away on his own terms – peacefully, with us at home.