Neurologist Re-check #1

Stella had her follow-up visit with the Neurologist today.  We reported that the past 2 weeks have been great. Baby girl is back to her normal self :)

Dr. P drew some blood for routine bloodwork which we all anticipate will be normal.  He is also taking her Prednisone down to 5mg.  He has asked us to not vaccinate Stella at this time until she is given the "all clear" and he wants another re-check in 2 months.

We told Dr. P that we are trying to give Stella her pills as close to 8 hours as possible but due to our work schedules we have been giving them at 6:30am, 4pm and 9-10pm.  Dr. p said this was just fine.

The diagnosis on her discharge instructions reads: recheck for epilepsy secondary to immune-mediated encephalitis.


 
As I stated before I do not want to go into detail about what transpired with the first neurologist that caused the serious communication breakdown and I am glad that we stuck with our gut instinct and sought the second opinion, however seeing Stella today, 2 weeks later, and the fact that we came so close to doing the unthinkable makes me very emotional.  All we want is for Stella to have the best life that she can - the thought that it was almost cut short ......I can't even explain how heavy it makes my heart.

Meanwhile we celebrated Stella's 9th birthday last week!!!

Knee & Neck - I Forgot to mention......

In all the chaos from the past few months I forgot to mention that Stella's partial torn ACL (back left) does not appear to be bothering her anymore.  She is walking fine.  But because we know it's there we try to give her an "elevator" lift onto the couch and our bed as much as possible so she doesn't have to use the doggy stairs - man alive our pets are spoiled!! 

Also, that chicken dance jerking neck thing she did a few months ago while attempting to eat has not happened again.  Perhaps whatever issue she was having with her neck was minor and healed itself as the orthopedic surgeon stated it might.

Oh and that issue she had with not correcting her back right foot when it was flipped over seems to have corrected itself.

Let's hope the seizures work themselves out as well.

2nd Neurologist's Opinion

When we made this second-opinion appointment we were told not to feed Stella after midnight in case anesthesia was administered if the neurologist wanted to do an MRI.  We were also told to stop all medications after midnight.  Should Stella have a seizure during the night that we found alarming we were told to go to the emergency room.

Our appointment was in the late morning.  Stella skipping a dose of the Phenobarbital made her less catatonic and a little more steady on her feet.  When we met with the second neurologist, Dr. P, we explained all that that had transpired over the past 6 days.  We told him that if he agreed with the current diagnosis of idiopathic epilepsy and agreed that this current treatment plan was our only option that we would seriously have to consider doing the unthinkable.  Just typing these words makes me cry - but we had a long discussion about Stella’s quality of life and we could not bear to let her live out her life in this current state.

Dr. P, noticing how emotional we were, said “I know you’re worried, but don’t jump ahead, let’s take this one step at a time”.  He then sat back and listened to us intently all the while watching Stella’s manner and her every move.  At one point we noticed Stella had that same tremoring that she had been doing for days, as if she was really cold.  He watched her and said “those are seizures”.  So even with the powerful medication she was still having seizures and they were, alarmingly, more frequent - OMG.

Dr. P said the first thing he would like to do was to flush her system and rid her of the Phenobarbital as much as possible.  He wanted her to stay at the hospital while they slowly flushed her system through an IV.  Meanwhile he stated he wanted to look at the actual MRI images for himself.  We told him we would go to the other hospital and pick up a copy of the images on CD and bring them to his office for review – we agree to regroup in 3 hours. 

3 hours later we returned and Dr. P came into the room with a smile and said “you are going to be pleasantly surprised”.  He opened the door and in walked Stella – walking on her own!  She was not 100% but appeared to be at least 90% OUR STELLA!  We asked Dr. P what he did and he said all they did up to that point was flush her system.  He said neither he nor his staff witnessed and “major” seizures, just the smaller “trembling” kind - which he stated was not necessarily worrisome at this point.

After reviewing the MRI images and having spent the last few hours with Stella Dr. P said his opinion based on all details of the past week was that Stella did not have just Idiopathic Epilepsy.  He believes she has Idiopathic Encephalitis (inflammation of the brain of unknown origin) which is causing the seizures.  He believes she should be on a low dose anti-seizure medication.  He has prescribed Levetiracetam (Keppra) 250mg tablets for the seizures (half a pill 3x a day) and Prednisone 10mg tablets for the inflammation.

Dr. P wants a follow-up visit with Stella in two weeks.

We left the office feeling hopeful - Stella walked herself to the car!



 

 

 

My Opinion on Second Opinions

I just wanted to take a moment and throw in my two cents about seeking a second opinion.

I am a firm believer in educating oneself as much as possible when making decisions.  Not only doing as much research as possible but also seeking opinions from experts as well as from family and friends.  People will differ with their opinions but I find that helpful because different perspectives will give you insight into things you may not have even thought of and the more information you have the better the choices you can make, the less second guessing you will do and the less regrets you will hopefully have. 

Unlike with a home or a car many people seem to be apprehensive in seeking a second opinion when it involves a doctor, whether for themselves or their pet, because they worry about hurt feelings or insulting a professional.  They feel an awkwardness will ensue and relationships may be irrevocably broken.  My opinion is that true professionals will encourage you to make an informed choice.  If someone is insulted or offended by your desire for a second opinion you probably do not want to do business with them anyway.  Professionals should always want what is best for you or your pet and that should be the bottom line for everyone involved.  In my experience I find that if I seek a second opinion or sometimes multiple opinions, regardless if I agree with all or some or none of them, the more confident I feel about the choices I make. 

In Stella's case we would still need to bring her back to the specialty hospital to see the Oncologist so the fact that we may ultimately decide against having their Neurologist treat her may seem, to some, a potentially awkward situation.  To us, we are comfortable with the knowledge that we are dealing with professionals and do not anticipate that seeking a second opinion elsewhere would pose any problem.

I guess I'm just trying to say do whatever is necessary for you to feel good about your choices.  Educate yourself, write down and ask hard questions, but also know that often times there are no right or wrong answers and sometimes you just have to go with your gut instinct. 

And one last thing……..if you don’t like that last haircut you got (and paid for), go to someone else.  Don’t even think twice about hurting someone’s feelings – you’ll look ridiculous…..literally.

 

Follow-up with Neurologist - Seeking a Second Opinion

We are extremely upset and feel completely lost and broken.  Yesterday, it had been 5 days since Stella started on the powerful seizure medication (Phenobarbital).  We had waited all this time to finally speak with her Neurologist, which we understand was unavoidable and just bad timing.  Unfortunately we have had a serious communication breakdown with the Neurologist and the conversation we had with her last night has left us extremely uncomfortable.  We are very concerned about Stella’s current catatonic state and condition and we are now left wondering if she is on the right treatment plan.  I won’t go into details about our conversation with the Dr. C. but suffice it to say that we have decided that we need to seek a second opinion.

 

We have made an appointment for this Thursday, two days from now, with another Neurologist.  Incidentally this second Neurologist is one we have gone to before years ago with two of our other dogs.  When Stella started having seizures we felt it was important to keep all of her healthcare under one roof, at the specialty hospital, and at the beginning we did not know if the seizure activity was related to her cancer issues and wanted to be close by to her oncologist so we made the decision to see the Neuro at this same facility.  As I stated in a previous post – all the veterinarians contributing to her current health issue (Oncologist, Neurologist, our regular vet and the ER vets) all agree that this seizure activity is a completely unrelated to her cancer history.

For the next two days until we see the second Neurologist we will abide with the suggestion of the first Neuro that we reduce the Phenobarbital dosage to half her current dose.

We are hopeful that the second Neurologist can provide more clarity with Stella’s condition and can lead us on the right path….whatever that may be.

Meanwhile Stella's condition remains the same; very worrisome.

Seizure Treatment Plan - Day 7

Same as yesterday. Same alarming appearance and behavior.  Still catatonic but maybe just a tiny bit less being off the Gabapentin.  Still having those shivering bouts.

Appetite poor and we're still worried she may drown in the water bowl.  Still unable to walk properly,  still needing to be carried to the grass to relieve herself.

 

One more day until we can speak with the Neurologist......so worried......

Seizure Treatment Plan - Day 6

Stella’s appearance and behavior are still alarming to us.  She is catatonic and seems extremely depressed.  We worry that she could possibly drown in the dog water bowl because her legs are still so unsteady and she continues to fall face-forward so we picked up the bowl each time we left the room.  She has little interest in eating or drinking but it appears it is because she is confused and cannot focus.  She has been lying on a kitchen rug for most of the day.  At times her eyes are open but she is completely glazed over.

A few times today I sat on the floor with her and she was shivering as if she were sitting out in the cold snow – although we have the air conditioning on it is set at the same temperature as for the past month.  Maybe this is just a result of the powerful drugs? 

Still two more days until we can confirm her treatment plan with the Neurologist.  We feel so startled by Stella’s current catatonic state that we have made our own decision to stop the Gabapentin and just give her the seizure medication.  She is completely non-functional, depressed and we cannot stand to see her quality of life diminished in this way.  If stopping the Gabapentin does not help with her catatonic state we have discussed the fact that if the Neuro tells us her current condition is likely permanent we will opt to discontinue the seizure medications altogether even if it means she continues to have seizures and it shortens her life.  We cannot and will not allow this to continue.

 

Seizure Treatment Plan - Day 5

We called the hospital this morning to inquire when we could pick up our Stella.  They stated that she had just been giving the last of the loading dose of Phenobarbital and was pretty zonked out so we should not pick her up until late afternoon.

We arrived at the hospital around 4:30pm and were given Stella’s discharge instructions by an ER technologist.  When she could not answer some of our questions she sent in an ER vet to speak with us.  We were told to give Stella ½ tablet of Phenobarbital (full tablet =64.8mg) twice a day.  We were told this medication schedule is very stringent; we need to stick to a strict schedule, making every effort to keep it at the exact same times every single day and to not skip a dose.  We were told this is extremely important for the medication to be effective.  We were also told to continue with the Gabapentin, three times a day.  When we asked why Stella would need to be on both medications the ER vet was unsure and said that until we spoke with the Neurologist we should continue to give it to her. 

With all the different medications Stella has been on the last two weeks we asked if it was ok to still give her the monthly Heartworm  medication and Frontline protection for fleas & ticks.  The ER vet stated she ‘thought” it was ok but since she seems unsure we will hold off for now.  We do not live in a wooded area and Stella does not come into contact with wild animals and with all she has been through we haven’t taken her for walks so she is seemingly safe in her own fenced-in backyard.

When the tech brought Stella out to us in the waiting area we were quite startled at her appearance.  She could walk but kept turning her front paws over as if waking on her "wrists" and then would stumble and land on her face.  She would stand herself back up but it took several seconds and then she would fall on her face again.  Luckily being a Pug she is not far from the ground (and her face is already flat!).  Hopefully this is just a reaction to being loaded with powerful drugs and once she is on s steady medication  regimen this will wear off.

When we arrived at home, we decided that until Stella could walk properly, we would line our kitchen with small rugs so she would hopefully have more balance and not slip on the tile.  We also will carry her to the grass portion of the yard to protect her from hitting her face on the concrete patio.

*Because we have had dogs with various issues with walking, whether sick or injured, we have numerous rubber-backed bath rugs that we keep for these such circumstances.  I highly recommend that all dog owners have these on hand if you have wood floors or tile – but I hope you never have to use them.  Also the rugs are easily washed in the washing machine and easy to store on a shelf.

The rest of the night Stella was seriously disoriented, more like catatonic.  Maybe Baby Girl will be better tomorrow after a good night’s sleep in her own home.  We have doggy stairs for the girls to get up in our bed at night but we are worried Stella may fall so we will have her sleep in the kitchen to keep her safe - her sister Betty will keep her company.

Incidentally, we have decided her stringent medication schedule will be at 6am and 6 pm every day.

**HELPFUL SUGGESTION – if your dog is ever in a situation where they are in the hospital overnight receiving IV fluids be sure to line your car with WATERPROOF pads.  We have a heavy duty canvas car hammock for the girls in the backseat.  It keeps them confined to the back seat are and yet they won’t get tangled in seatbelts or leashes.  We also keep soft blankets on the hammock for them (spoiled spoiled spoiled).  Even though we let Stella relieve herself prior to getting in the car, once on the road she passed out and as her body relaxed all the fluids from the past 15 hours(!!!!) just seeped out everywhere; right thru multi layers of blankets and even through the thick “waterproof” canvas.  I have a “Dog Recipe” that I use to remove pee and vomit and it does work however one of the steps requires baking soda and although the smell is out of the car I cannot get the baking soda out of the grooves of the pattern of the fabric on the seat.  It looks like a bag of flour exploded!!!!

This “recipe” is the best method I have ever found and works to get the pee and vomit smell out of carpeting and upholstery.  If you would like it, leave me a comment.


 

Seizure Treatment Plan - Day 4

Stella had 3 full doses of Gabapentin yesterday; it is making her even more disoriented. 

At 12:15pm today she had yet another seizure.  Again, lasting about 20 minutes.  Less than one hour later she had another.  This last one was the “worst” one she’s had so far.  At one point, as I held her tightly, her entire body seized into a hard rock; it felt like she had turned to stone.  This lasted for just a few seconds and I felt her muscles relax and then she just sat there shaking.  We made the decision that 5 seizures in less than 48 hours was too much (I believe it is called a “cluster”) and we decided to go back to the ER.  Although this was in the middle of the day, the “regular” hospital was closed as this is Independence Day. 

By the time we arrived in the ER it had been one hour since Stella’s last seizure began and she was just coming down from it; this was the longest one yet.
 

ER vet examined Stella and came back to us to explain what he thought should be done.  He stated that there was no more waiting to put Stella on anti-seizure medication.  When we asked about the possible live damage or failure he explained that we were at a point where we needed to think about her overall well-being versus just the liver.  He stated that although anti-seizure medication CAN cause liver damage it doesn’t mean it will happen.  If Stella continues to have seizures, the seizures WILL cause brain damage.  So tending to her seizures now takes precedence over what MAY happen to her liver.
 

The ER vet told us we should leave Stella in the hospital overnight so that he can start loading her with Phenobarbital; the anti seizure medication.  We asked why we could not do this at home and he responded that although we could go home with Phenobarbital pills they would give her a loading dose thru an IV so that it gets to her system immediately to hopefully stop the seizures sooner.  He stated they would monitor her closely throughout the night and we could pick her up tomorrow afternoon.  He told us the Phenobarbital would make her really loopy and he expects that she will sleep most of the next 24 hours.  We proceeded to ask a gazillion questions about seizures and Epilepsy.  The ER vet was very patient and tried to answer as many questions as possible but pointed out he is just there to stabilize Stella.  All the neurologic and treatment questions should be posed to the neurologist.  We knew this of course but you know how it is when you’re worried and scared and given so much information to process; your brain doesn’t stop to pause and your mouth just keeps going. Incidentally, the neurologist will not be back in the office until Monday 7/8, four days from now so hopefully Stella will be stabilized until we can speak with her about future plans.
 

Later in the evening we called the ER to check on Stella.  The ER vet said that Stella is responding really well and remains alert.  He said he was surprised as most dogs usually “pass out”  from the heavy medication but he also pointed out that there were a lot of Pug Lovers working on the shift and they were giving Stella a lot of attention.  There’s nothing Stella loves more than adoring fans!!



 

Seizure Treatment Plan - Day 3

This morning Stella had another seizure; the duration was about 20 minutes. We called the ER (it was very early in the morning and the “regular” hospital section was not quite open yet).  We spoke with an ER vet and inquired whether or not giving Stella just two doses of Gabapentin per day as opposed to the prescribed three might be the cause of this additional seizure.  We have only been giving her two doses per day because our schedules would make two of the doses just a few hours apart which is not recommended.  ER vet stated she was unsure but that we needed to do whatever we could to try to give Stella the three doses a day as close to eight hours apart as possible.  She asked if we could have someone come into our house in the middle of the day or if we could set an alarm clock to give her one in the middle of the night.  Once Stella is on the Gabapentin three times a day, should she have another seizure, we should bring her back to the hospital/ER.

 

We discussed what we needed to do to make this happen.  We have decided that we will have to come home from work during our lunch time each day to assure Stella gets the pill three times a day.  Luckily we only live 15 minutes from our workplace so it is just a matter of scheduling.  If this is what it takes to get her back to normal, then this is just what we’ll have to do.  This regimen started today.

 

Later this evening, approximately 12 hours from this morning’s seizure, Stella had another one.  Again, lasting about 20 minutes.  As usual, I sat on the floor with her and held her as she cuddled into me, shaking and looking scared.  As with the other seizures she was unresponsive to our voices or movement but remained seemingly conscious – I say “seemingly” because her eyes remain open, whether or not she is actually “conscious” during the seizures we do not know.  

 

Four hours later I walked into the room and it appeared to me she may have just finished another bout of seizure activity.

 

As of this writing, Stella is sleeping quietly on our bed next to her sister Betty.

 

By the way, we find it interesting that Betty (nor the cat) has any reaction whatsoever to Stella’s seizures.  I wonder what they think?  Do they know just to leave her alone?  Are they aware of what’s happening?

Seizure Treatment Plan?

Spoke with the neurologist’s assistant again today (who, in turn spoke to the neurologist on our behalf).  She states that the treatment plan for now is to keep Stella on the Gabapentin 100mg and wait.  The suspected diagnosis is “Idiopathic Epilepsy”; “Epilepsy with no known cause”.
 

We are to continue with the Gabapentin and if another seizure should occur we are to call.  The neurologist wants to wait as long as possible before putting Stella on anti-seizure medications because they are very powerful and can be damaging to the liver  We were told it can cause liver failure.  If we are lucky the Gabapentin will be enough to stop further seizures since Stella’s are considered relatively “mild”.
 

Stella remains fairly disoriented.  We are hopeful her body will adjust to the medication and she will return to her silly, joyful, Puggy self.