> We're kicking off a brand new year of real stories with Tiramisu, a beautiful tan and white Pekingese patient of mine. Tira was born in a puppy mill in October 2002. And like all puppy mill dogs, she was not bred from a desire to pass on outstanding genetics -- she was bred to make money.
>
> Tira's human parents had no idea puppies at the pet store they bought her from (and most pet stores) were mill dogs, but thankfully, they were and are 100 percent committed to making their pet's quality of life the best it can be. So when Tira's health problems began, her owners were prepared to do all they could to keep her in the best condition possible.
## Tira's Unfortunate Genetics Start Causing Problems Immediately
> Tira's first congenital (from birth) issue to surface was a common one. Her third eyelid prolapsed when she was just a few months old, and unfortunately, the eyelid was removed rather than replaced by her local vet. This meant she would forever have an eye condition known as KCS -- [keratoconjunctivitis sicca](http://healthypets.mercola.com/sites/healthypets/archive/2010/09/07/diagnosing-and-curing-eye-infections-in-pets.aspx), or dry eye.
>
> Tira's second congenital defect was identified in July 2003, when orthopedic surgeons surgically stabilized her left medially luxated shoulder joint ([page 1](http://mercola.fileburst.com/PDF/HealthyPets/Tira.pdf)). Both of her shoulders were unstable, making normal walking difficult for her. The surgeons repaired the worst shoulder first, with a plan to address the right shoulder when she could no longer bear any weight.
>
> Then in February 2005 when she was two and a half, Tira developed an intervertebral disc prolapse caused by a congenital deformity in her spinal vertebral bodies. This predisposed her to an acute episode of [disc disease](http://healthypets.mercola.com/sites/healthypets/archive/2012/12/10/intervertebral-disc-disease.aspx), where she became unable to use either of her back legs. She had a myelogram ([page 2](http://mercola.fileburst.com/PDF/HealthyPets/Tira.pdf)) that revealed she had disc prolapse at her thoracolumbar junction.
>
> Tira was treated for this condition and did regain use of her rear limbs, but her gait remained abnormal. Unfortunately, It wasn't long before her fourth congenital deformity showed itself.
## A Fourth Congenital Issue Arises
> Tira's seizures started in September 2006, just before her fourth birthday. She had regular episodes of shaking, drooling and loss of coordination through June 2007, when her local vet referred her for additional diagnostic testing.
>
> An abdominal ultrasound revealed a genetic condition known as microhepatica ([page 3](http://mercola.fileburst.com/PDF/HealthyPets/Tira.pdf)). It was discovered that her liver was too small for her body, so when the liver could not keep up with its job of filtering metabolic wastes, the toxins crossed her blood-brain barrier and caused seizures.
>
> In addition to this long list of health problems, Tira had been plagued with urinary tract infections most of her life ([pages 4 and 5](http://mercola.fileburst.com/PDF/HealthyPets/Tira.pdf)).
## My First Visit with Little Tira
> I met Tiramisu in May 2008. My heart broke for this little angel.
>
> Tira's back legs were still uncoordinated from the [intervertebral disc disease](http://healthypets.mercola.com/sites/healthypets/archive/2012/12/10/intervertebral-disc-disease.aspx) (IVDD).
>
> Her left shoulder had unaddressed scar tissue from the surgery and her right humerus was still unstable, causing her to spontaneously fall over and be unable to walk.
>
> She had lots of pain and overworked muscles throughout her body from years of holding herself and moving awkwardly in an attempt to compensate for bad shoulders and a bad back.
>
> Tira had disuse atrophy with reduced range of motion in many joints. She had seasonal allergies, was regularly constipated, and needed her anal glands manually expressed on a routine basis. But it was the unregulated seizures that her mom and dad really wanted to address.
## Tira's Healing Protocol
> I suggested we start Tira on liver support that assists with detoxification, as her too-small liver was overburdened.
>
> I put her on [Alpha-Ketoglutaric Acid](http://www.klaire.com/prod/proddetail.asp?id=V135-06). This supplement assists in the removal of ammonia from the central nervous system, which is one of the reasons pets with poor liver size and function have seizures. I also started her on a blend of nutraceuticals called [MedCaps DPO](http://www.xymogen.com/products/product-detail.aspx?pid=113) that assists with detoxification.
>
> Tira was placed on a novel protein raw food diet, rich in the naturally occurring antioxidants her body desperately needed. Her parents agreed to keep a seizure log and call me immediately if she had another episode.
## Addressing Tira's Musculoskeletal Issues
> We also needed to aggressively address Tira's significant musculoskeletal issues. Because her shoulder joints were deformed, she spent her life shifting weight to her rear limbs and compensating with her mid back.
>
> Surgical stabilization of her left shoulder allowed her to overbear weight on that shoulder, taking the pressure off her right, unstable shoulder joint. Over time, her left shoulder developed arthritis from overuse. This caused her to continue to offload her weight to her rear limbs and compensate through her thoracic spine.
>
> Over time, this stressed her mid spine to the point of crisis, and she damaged intervertebral discs in her back. Because her rear limbs grew weak after this injury, she literally didn't have a (good) leg to stand on. My goal was to control Tira's pain, reduce inflammation, and improve stability and proprioception, as well as muscle tone and range of motion.
>
> We started Tira on a rehab protocol of at-home strengthening exercises, regular chiropractic care, water therapy, laser therapy, acupuncture and oral supplementation with [natural pain support and chondroprotective agents](http://www.kemin.com/products/resources#discomfort).
## Tackling Tira's Chronic Constipation and Urinary Tract Infections
> With regard to her constipation, my theory was that it was secondary to her back pain. I thought Tira might be choosing not to poop as often as she should because it was too painful to assume the normal position needed to effectively defecate.
>
> My hope was if we could reduce her spinal pain and inflammation, she would poop more regularly and the constipation might resolve. Tira's owners agreed to administer a stool softener on days she did not poop on her own and begin the back strengthening protocol I suggested.
>
> I noted that most of her urinalyses showed struvite crystals and an elevated urine pH. I believed these issues to be diet related and by balancing her nutritional status, I hoped the crystals and high urine pH - both of which are precursors for recurrent urinary tract infections -- would resolve.
## Tira Today
> I'm happy to report that Tira responded well to the protocol.
>
> She's had no more seizures. Her body began responding to the [physical rehabilitation](http://healthypets.mercola.com/sites/healthypets/archive/2010/02/03/benefits-of-physical-therapy-for-dogs.aspx), and her quality of life started to improve. Her constipation issues resolved when her back pain was managed and she gained back some core strength.
>
> By March 2009 her Bile Acids (liver function test) were almost normal ([page 6](http://mercola.fileburst.com/PDF/HealthyPets/Tira.pdf)). By fall 2009, they were normal ([pages 7 and 8](http://mercola.fileburst.com/PDF/HealthyPets/Tira.pdf)),_ _indicating her liver was functioning efficiently despite being too small for her body.
>
> Tira's urinalysis was also normal; the recurrent urinary issues were resolved with dietary improvement. Her blood work and urine remained normal and balanced as of August 2012 at her last biannual exam.
>
> My staff and I were delighted to be included by her loving family in the celebration of Tiramisu's 10th birthday this past October. It was gratifying to see that despite having a body far from genetically perfect, Tira is happy, mobile and content thanks to her owners' consistent attention and commitment to her overall well-being.
>
> 
**Related Articles:**
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 _place_holder; [What Never to Do with a "Pushed In" Face Pet](http://healthypets.mercola.com/sites/healthypets/archive/2011/12/20/special-needs-of-brachycephalic-breeds.aspx)
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