A few years back, a concerned owner brought her dog, Tucker, to see me for a rather unusual problem - night terrors. Tucker, a 40 pound neutered Beagle, was no spring chicken. At almost 13-1/2 years old, he had enjoyed a good life but, for the last few months, had begun to show extreme anxiety at night from about midnight to daybreak. During that time, his owners described him as clingy, pacing, wide-eyed, panting, and barking for a good proportion of the time. If he did fall asleep for awhile, he would often wake up in a panic, leaping to his feet and might start pushing doors or other objects with his snout. His owners were extremely concerned about him and no one in the house was getting much sleep. Something had to be done. First, they had been to their local veterinarian who had prescribed an assortment of drugs to try and help Tucker get through the night. Tri-cyclic anti-depressants, like amitriptyline and clomipramine had not helped much but the sedative drug, acepromazine, at least helped a little. Tucker had always been a tad on the anxious side and had a history of what his owner's called panic attacks but his present condition was beyond the pale. Clearly something had changed. In desperation, his owners had tried disciplining him, tying him on a short leash, and even putting him outside. Nothing worked.
Now a lot of veterinarians presented with a case like Tuckers, might immediately spring to the conclusion that he had so-called canine cognitive dysfunction, the canine version of Alzheimer's disease. I considered that possibility, too, because sleep disturbances are a feature of canine cognitive dysfunction but Tucker was showing none of the usual signs apart from this. In fact, he was more focused than disoriented. Another possibility I considered but dismissed for lack of compelling clinical evidence was partial seizures which can sometimes manifest this way. That left my third possible diagnosis as some medical condition that had come along to plague him, making him uncomfortable or even frankly painful, particularly at night. But what might that medical condition be, I wondered. Clinically, there wasn't much to see. In the consulting room, Tucker looked and behaved like an older dog though, as I mentioned, he was seemingly very aware of everything going on around him. He also seemed to have a little difficulty in getting up and down, perhaps a sign of arthritis. Again, not an unusual finding in a dog of his age and unlikely to cause this degree of angst. I decided I would take him to our wards to get a blood sample to check out the functioning of all his organ systems but, as I went to leave the room, the owner made a comment that caught my attention. She mentioned something about him having difficulty defecating sometimes and I thought about this as I led Tucker down the corridor. So, as well as taking blood, I also engaged in the relatively unusual measure (for me) of giving Tucker a rectal examination. Tucker tolerated this procedure with great patience but when I touched his prostate gland he screamed. I stopped touching the gland and he was silent. I touched it again, he screamed. I had found something painful, something unusual, and something that might account for his distress. I brought him to another room in the hospital where the medicine resident helped me sedate him, catheterize him, and collect a cell sample from his prostate gland using a technique known as a prosthetic wash and, with his owner's permission; I took him to our X-ray department for a radiograph of his posterior abdominal region. The findings were positive. The prosthetic delivered suspicious-looking cells that indicated that he probably had a prosthetic tumor. In addition, his rectum was seen to be reflected upward by presumably an enlarged prostate gland.
The good news was that we had found something that could account for the problem, the bad news is that it wasn't necessarily easily treatable. The definitive treatment was with piroxicam, a non-steroidal anti-inflammatory drug, used to treat painful inflammatory conditions but also supposedly having some activity against certain types of prostate cancer. In addition to this, we treated Tucker with anti-anxiety medication and sleep aids. Though at no time did we underestimate the gravity of the situation.
The early news was good in that Tucker appeared to do very well on the medications we prescribed. He started improving within a week or two of the appointment and, according to his owner, regained much of his youthful vigor as his night terrors gradually subsided. Sadly though, all we were able to do was to buy Tucker a little extra quality time as this improvement began to fade over time and, ultimately, his owners, after considerable thought and anguishing, decided that it was time to have his dispatched to the happy hunting grounds.'
Tucker's is not the first case in which we have seen medical problems manifest as nocturnal anxiety in an older dog. In fact, it's probably about the twelfth time. The causes have been various, ranging from a brain tumor to a retrobulbar tumor of the eye, an abdominal tumor, bone tumor, and some other excruciatingly painful orthopedic or neurological conditions. In some cases, something can be done to completely reverse the problem - as was the case when the retrobulbar tumor was removed. In other cases, the underlying condition is relentless and progressive, only allowing us to treat palliatively - as seemed to be the case with Tucker. The moral of this sad story is that if you encounter an older dog that is displaying anxiety at night when he is separated from his owners by the physiological state of sleep, though he may be able to cope during the day, it is always wise to consider underlying medical problems as possibly causative. While this sundowner-type syndrome can be a sign of canine Alzheimer's disease, it is a syndrome and not a specific condition, so some lateral thinking is required.