More Opinions - Same Plan of Action

Stella had her appointment with the Oncologist today.  An abdominal ultrasound was also performed.  As I stated previously, she was due for her annual abdominal ultrasound in August but in light of the 3^rd Mast Cell Tumor discovery and removal we decided to bump up her appointment.  We informed the oncologist about Stella’s torn ACL, possible neurologic defect associated with her spine and our recent appointment with the orthopedic surgeon (at this same facility).

Good news – the ultrasound was “clean”.  THANK GOODNESS!

Dr. F. was pleased that the ultrasound was clean but was concerned about the seizure episode that Stella had recently (described two posts ago).  She asked us to describe exactly what happened that day and why we thought it was a seizure.  After our description she agreed it was indeed a seizure and then asked us the following questions:

 

• Had Stella ever had a seizure or similar episode before, to our knowledge?

We had not witnessed an episode like this before however we described to Dr. F. about two occurrences when Stella was a puppy. Once when she was a few months old and another time about a year later Stella had, what looked like to us, two “fainting” episodes where she suddenly collapsed and regained her composure within seconds (described in a very early post).  Both times our veterinarian (at the time) could not find anything wrong with her.  Based on our description of events surrounding these "fainting spells” Dr. F. believes they are unrelated and that Stella truly fainted.
 

• During the seizure was Stella vocalizing or attempting to vocalize?  No.

• During the seizure did Stella appear to be conscious?

Stella’s eyes were open however they were glazed over. She looked as if she were in a trance and was completely unresponsive to our voices or movements. 
 

• During the seizure was Stella moving her legs and/or paws; also called “paddling”?  (Dr. F. demonstrated this and it reminded us of when the dogs “run” when they are sleeping)

Stella was not moving her limbs in that motion but she was pushing her head into my chest as I sat on the floor with her as if she could not get close enough.  Although I was holding her tightly it seemed like she did not realize this and kept pushing into me vigorously.

• Could Stella have possibly gotten into anything or ingested any human medication?

We are very careful about not leaving chemicals of any kind anywhere where the pets can get to it.  I suppose we can’t say with 100% certainty that we didn’t possibly drop one of our pills on the floor but neither of us recalls having done so or spilling a bottle or even missing a pill.  Occasionally teenagers in our neighborhood throw something over our privacy fence but we never leave the dogs outside by themselves (as we have a growing coyote problem) and when we see the dogs start to hover over something we immediately tend to it – it is usually a candy wrapper, apple core, that sort of thing.  Squirrels as well often times drop something in our yard as they’re attempting to carry it up a tree.  To our knowledge we never saw Stella eat anything outside, except the usual twigs and grass; incidentally we do not fertilize our lawn. 

• During the seizure was Stella drooling?  No.

• During the seizure did Stella urinate or defecate?  No.

• Did Stella seem confused after the seizure?

Immediately following the seizure Stella seemed somewhat confused or dazed like she couldn’t figure out what just happened.  After several minutes she was acting like her normal self; wanting dinner, etc.

• Prior to the seizure had Stella hit her head at any time?  No - not to our knowledge.

During our appointment Dr. F. consulted with the neurologist and together they examined Stella; we were not present during this examination.  According to Dr. F. the neurologist was pleased with Stella’s response to stimulus, her eye movement, her energy and her cheerful Pug self.  They did notice Stella slightly drag her back right paw from time to time as they walked her around the facility.  We had not noticed this but Dr. F. said it is very slight and is typical of dogs with a neurologic deficit (her torn ACL is on the left).  As I sated in the previous post the orthopedic surgeon stated this deficit could be a pinched nerve or compression along the spine and could “work itself out”.  I recall years ago when I had a Greyhound he too had a neurologic deficit and would walk directly on top of his knuckles, so much so that they bled…..poor thing :(    Both doctors, along with the orthopedic surgeon, agree that this possible neurologic deficit is unrelated to the seizure.  And the oncologist stated seizures are unrelated to MCT’s.

For now, the plan is to watch and wait; just as with her knee and neurologic deficit.  The doctors agree that if Stella has another seizure we are to bring her back at which point they will do an MRI of her brain and spine.  If Stella should have multiple seizures in one day, such as in the middle of the night or on a weekend, we are to go to the emergency room immediately for anti-seizure medication until the neurologist can see her.

The biggest concern with seizures is the possibility that Stella will have what is called a Grand Mal seizure – which in laymen’s terms would be “the mother of all seizures”; a BIG one where she may lose consciousness or injure herself. 

I know there may not be any way for us to detect if Stella’s has another seizure when we are not at home but we asked Dr. F. what signs to look for if she should have a Grand Mal seizure.  Dr. F. responded that dogs will typically urinate or defecate during a Grand Mal seizure; of course having two dogs this could happen anyway.  Dr. F. stated that in the case of a Grand Mal seizure Stella would release urine and/or feces without trying and may be laying in it when we find her or will have it on her body – as opposed to a dog who will naturally squat and then walk away from it.  She said we may find vomit on Stella or she may appear extremely lethargic.  She may also be unconscious.  She said if Stella has a Grand Mal seizure we WILL at least suspect it as “something” will not be right.

As always we will watch Stella closely and try not to worry too much – fat chance on the latter.  As instructed by the orthopedic surgeon we will take her for easy walks as much as she wants, trying not to tire her “bum” knee.  If everything remains quiet we will see the oncologist for a check-up in 6 months.
Don’t get me wrong - as much as we worry and as paranoid as we feel at times,  we don't let the worry consume us and we do enjoy every moment with our girls and their lives are as full as can be…..as are their bellies! 

 

 

Plan of Action? Wait and see...

We took Stella to see the orthopedic surgeon today.  Dr. G. examined her and confirmed that she has a partial tear in her left ACL.  He observed the way she walked, sat and her overall physical behavior and stated that she “looked good”.  Upon physical manipulation however he discovered a possible secondary issue – of course.  We’ve had this type of maneuver done with our dogs in the past; while in a standing position the dog’s paws are individually flipped knuckle side down.  Most dogs will immediately flip the paw right side up or will pull their paw away from the person.  Stella flipped her paws back, except the back right paw took about 5 seconds.  Dr. G. let her walk around a bit more and then re-flipped each paw; the back right took 5 seconds again.  As I said, we’ve had this happen before so we knew what it indicated; confirmed by Dr. G, a neurological issue, specifically an issue somewhere along her spine.

We described to Dr. G. the seizure episode that Stella had last week.  He told us that the seizure activity is unrelated and is a THIRD concern.

Because of the possible glaucoma issue mentioned by our regular vet the other day, Dr. G. wants Stella to see her ophthalmologist to rule that out as the cause for some of the unusual behavior; perhaps her equilibrium was off.  Assuming her eyes are fine he wants to proceed with a conservative approach. Because Stella is almost 9 years old, is not super-active, is a couch potato, not limping, walking well, has a good appetite, etc. we will wait and see what presents itself first, if anything.  If she should start limping or show signs of pain with walking we are to bring her back to him for a possible MRI and/or surgery.  If she has another seizure we are to make an appointment with the neurologist – if necessary, we will make an appointment with the neurologist at this same facility to keep the continuity of Stella’s specialized care under one roof.

Incidentally, Dr. G. said Stella’s ACL will not heal itself.  The goal is to not let it get worse.  In the state that it is in now it may be tolerable to her; we also have no idea how long it has been this way.  He also stated that the neurological deficit could heal itself if it is something minor in nature.  He told us to watch Stella for pain or injury but let her decide if she wants to go for walkies, if she wants to take the little doggy steps up to the couch or would rather be lifted, if she wants her bowl elevated, etc.  She will be our guide as to what steps to take next.

So to sum up the current events, Stella has:

• a torn ACL
• a possible neurological deficit
• had one seizure that we’re aware of
• a possible glaucoma issue
• had a third Mast Cell Tumor removed a few weeks ago

We were able to get an appointment today to see Stella’s ophthalmologist and drove there after our appointment with the orthopedic surgeon.  We were told that Stella’s eyes look fine – well, as fine as Stella’s eyes can look.  Dr. S. told us that her eyes are exactly what he expected and unchanged from her last appointment less than a year ago.  He also informed us that there is no such thing as “borderline glaucoma” for dogs – there is for people but not for dogs.  He said dogs either have it or they don’t, period.  Their eye pressures are either normal or through the roof.  Being a defined specialty we certainly can’t fault our regular vet for being concerned and suggesting we get Stella’s eyes checked.  At least we now know her eyes did not play into any of the odd behavior.  ONE thing to scratch off our list.

We tried to schedule Stella’s abdominal ultrasound for today to save a trip but was unable to coordinate this with the oncology section.  After her 3^rd MCT removal a few weeks ago we discussed with the oncologist having her ultrasound sooner rather than waiting the full year (August).  Dr. F. is fine with this as it does not require anesthesia and is of no harm to Stella.  We recalled the conversation from 2011 - that if an MCT appears on one of her organs Stella would start chemo immediately.  I can’t stand the thought that something may be growing inside her and we wouldn’t know for 4 more months.  The ultrasound is scheduled for April 15.