Neurologist Re-check #2

Today was Stella's 2nd check-up with the Neurologist - 2 months since her official corrected diagnosis: seizures secondary to immune-mediated encephalitis.

Blood was drawn again for routine bloodwork and once again we all anticipate everything will come back normal.

Dr. P has taken Stella off Prednisone.  She will remain on Levetiracetam 250mg tablets, 3x a day.

We noticed the other day that Stella's right ear was starting to droop lower than her left and her head was also slightly tilted.  Dr. P examined her ears and said she had a very slight ear infection (which we will tend to with our normal ear cleaning routine at home) but that he thinks the ear droop is just muscle or nerve related and doesn't think it's anything to worry about.  He also said the head tilt was not worrisome to him either and that "it just makes Stella look cuter"  :)

We were told Stella can resume vaccinations as scheduled but that she should not receive more than one vaccination at a time - they should be scheduled for different visits a few weeks apart.  Dr. P also said we should not give Stella heartworm preventative and flea preventative on the same day; again, spacing them a few weeks apart. 

Stella will have her next recheck in 4 months.

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.

Spinal Tap Results

Got a call from the neurologist’s assistant today stating that Stella’s CSF tap (Cerebrospinal Fluid) results were normal; no meningitis or other viral infection.  We were told there was an abnormality but that it is linked to Stella’s protruding discs as the neurologist indicated would probably happen.  I asked the assistant how we are going to proceed going forward and she said we would need to speak with the neurologist on Monday as she is off today.  For now, we are to keep Stella on the Gabapentin 100mg until further notice.  We informed the assistant that we are giving Stella Gabapentin twice a day as opposed to the prescribed three times a day due to our schedule and the fact that two of the doses would be fairly close together.  She confirmed with us that it is better to give the doses only twice a day rather than have two of the doses be only a few hours apart.

Meanwhile we have noticed the Gabapentin is making Stella fairly loopy.  She seems disoriented and has not been as animated.

Later in the day I called our regular vet to get her opinion on treatment options.  Dr. A said she wants to defer all of Stella’s neurologic care to the neurologist.  Once the neuro has the treatment course that is right for Stella she, our regular vet, will maintain the treatment from that point with medication dispensing, follow-up bloodwork, etc.

We will speak with the neurologist on Monday (7/1) and find out the treatment course and suspected diagnosis.

 

Another seizure...and then another...

Yesterday (6/26) we came home from work it and was a day like any other.  Stella greeted us at the door and then ran off to grab a toy (her strawberry ice cream cone) and then proceeded to tease me with it so I would mock scold her “hey, that’s MY ice cream…”; something we do every single day.  She and her sister, Betty, went out into the yard to relieve their bladders and then “walkies” was announced and they came running to put their harnesses on.  We noticed Stella was walking a bit slowly but it was very humid and we know she has that torn anterior cruciate ligament (see previous post).  We decided to cut the walk short and went back home; we had walked 2 blocks total.

As we walked in the door we proceeded to take off their harnesses as usual and the girls went to the water bowl.  Unfortunately both of us were in different rooms for just a moment when I walked back into the kitchen to find Stella “coming down” from what appeared to me to be another seizure.  She was completely disoriented, staring at nothing in particular and trembling.  I sat down on the floor and she immediately cuddled herself into me.  I held her and talked to her with a soothing voice all the while she trembled and stared off.  She was unresponsive to me saying her name and would not look at me.  Several minutes later I tried to move away from her but she was aware enough to know that I had moved and then slid herself back in between my legs.  As a test, I tried to give her a treat;  she smelled it in my hand but seemed confused as to what to do.
 

We remembered what the oncologist told us in April when we reported Stella’s first seizure (at least the first one that we know of).  Dr. F. had consulted with the neurologist at that time and we were told if it happened again we were to go to the emergency room.  At that moment it did not appear that Stella was in imminent danger so we chose to drive the 40 minutes to the specialty hospital’s emergency room rather than the one 5 minutes away from our house.  The specialty hospital is where Stella sees the oncologist, the orthopedic surgeon and where the neurologist is.  To keep continuity with all of Stella's health issues we feel it is important to try to keep all of her care at one facility if possible.  When we arrived Stella could walk, but very clumsily.  We explained what happened to the ER technician and she then took Stella to be examined by the Emergency Room physician.  10 minutes later they called us into a room.  The ER physician walked in with Stella bouncing next to her eating a cookie and then she proceeded to eat two more cookies.  She seemed back to normal.  From the time we noticed her behaving oddly to this time it had been approximately 1 hour.  The ER physician stated that all of Stella’s vitals were normal and because she appeared to be fine she did not want to give her any medication.  She stated that we could leave Stella at the hospital overnight where they would monitor her and the neurologist would see her in the morning or we could take her home and play it by ear.  Since Stella was bouncing about we decided to take her home.  The rest of the evening she seemed like she was 95%, just a little bit off, and she slept quietly throughout the night.

Today (6/27) at 5am, 12 hours from the seizure, we walked into the room and again saw her coming down from another apparent seizure.  She was standing and appeared to be frozen in mid walk with one paw up staring at the wall;  she looked like a statue.   Again I sat on the floor with her and she collapsed into my arms just wanting to be held. 

With both seizures she did not lose consciousness, she did not pee, vomit or defecate, and she did not attempt to vocalize.

We immediately put her in the car and drove back to the specialty hospital emergency room.  When we got there the ER physician (a different one) stated that he thought Stella appeared normal but we insisted to him, as her owners, we KNEW she was not normal and would need to see the neurologist.  We also discussed the fact that the neurologist had consulted with the oncologist in April and was the one who recommended an MRI should a series of seizures occur. 
 

Since we didn’t have a formal appointment and because Stella was seemingly not in immediate danger we were told to leave her at the hospital and the neurologist would see her at some point during the day and call us.  We were assured that until the neurologist saw her she would be monitored by the staff.
 

We told the ER physician that we indeed wanted Stella to have the MRI but wanted to be called PRIOR to anything being done to her outside of a physical exam.  We also told the ER technician this before we left.  The reason for this, explained in detail in an earlier post, was because we had a dog that had an MRI that showed a catastrophic event; the dog had no hope and would die within weeks.  Instead of calling us first, the surgeon chose to have our dog woken up and THEN called us to tell us the bad news.  So instead of giving us the option of having him put down while he was still under anesthesia, he was woken up and we then had to have him put down an hour later.  It was such a horrifying and infuriating experience.  We swore we would NEVER let that happen again and so we make our wishes CLEAR before signing off on anything. 
 
Luckily this was early in the morning and Stella had not eaten anything since dinner last night so she was good to go for an MRI or any procedures requiring anesthesia. 
 

Later in the afternoon we received a call from the neurologist’s assistant.  She stated they were about to start the MRI.  I asked if Stella was under anesthesia yet and when she replied “yes” I got a bit upset and told her we specifically asked to be called FIRST.  The assistant stated she was never told this and was very upset with the staff.  I told her the reason why we wanted to be called and said the bottom line was we just wanted to be clear that Stella is not to be woken up if there is a catastrophic finding; we were to be called first.  She said she understood and we told her we would head back to the hospital so we could speak with the neurologist when the MRI was finished.  A minute later the phone rang and it was the neurologist herself calling to apologize that they did not receive our instructions.  Dr. C. reiterated that what they would be looking for on the MRI would be any abnormalities in the brain, like a brain tumor.  She explained that dogs with Epilepsy are typically diagnosed before the age of 3 and that later in life it can often times be caused by a brain tumor or other abnormality.

We headed to the hospital and when we arrived they had just finished the MRI.  Incidentally, this was the first time meeting the neurologist.  We had spoken to her on the phone only; she was recommended to us by our regular vet and the oncologist. Dr. C. told us that there was no tumor activity and that the MRI was negative for any abnormal findings; thank goodness.  She also said they performed another abdominal ultrasound (which, oddly, we don't recall them telling us they wanted to do) and that her organs remain free of Mast Cell Tumors (just as with the last ultrasound  in April) and there was nothing alarming to indicate seizure activity.  She did however state that Stella had a “disc protrusion” in her neck.  Dr. C. believes this protrusion, although pressing on her spinal cord somewhat, was not likely to cause the seizures.  She also stated that they would not perform the surgery to repair these discs as the more pressing issue is the seizures and it should be addressed first. She explained that because Stella had not gotten into any toxins or had any head injuries there was a possibility of a viral infection such as Meningitis.  To test for Meningitis they would need to perform a Cerebrospinal Fluid (or CSF) collection; also known as a spinal tap.  Unlike with humans the spinal fluid is not collected through a puncture in the lower back, but from the neck and brain stem area.  Dr. C. explained that the risk was fairly high in doing this type of procedure because of the location of the needle puncture.  We asked if something were to happen to Stella as a result of the tap, would it appear days or weeks from now or would she know right away.  Dr. C. stated they would know right away as it would be obvious while they had her on the table. 

We discussed the situation in detail with Dr. C. getting her opinion on whether or not we should pursue the tap.  We had to make this decision fairly quickly as Stella was still anesthetized.  In the end we decided that because we still do not know what is causing the seizures, the neurologist said it was the obvious next step to take, and given the fact that she was already anesthetized and would possibly save her from anesthesia an additional time (good golly this dog has had a lot of anesthesia in her lifetime) we would allow the tap to be performed.  Also, Dr. C. said Stella should have no pain from the tap afterwards.  
 

One other thing we discussed was the fact that IF something horrible did happen at least Baby Girl was under anesthesia and wouldn’t feel anything, even if we had to let her go.
 

A short while later Dr. C. came into the waiting area and said everything went well and we should have at least preliminary results by tomorrow.  She did however warn us that the results may not come back as 100% normal because of the disc protrusion but that the results should still be able to tell us whether or not Stella has a viral infection.

In the meantime, Dr. C. has prescribed a pain medication, Gabapentin 100mg.  This medication although meant for pain (if Stella's disc issue should bother her) is known to possibly help prevent seizures when given at a high dose.  We are to give Stella this medication (pills) three times a day.  The technician explained to us that the medication can make Stella "loopy" and should it make her too loopy we can reduce it to twice a day. 
 

We waited several more hours for Stella to recover from the anesthesia and then took her home where she has been sleeping soundly after her big eventful day.

 

 

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.

 

 

 

 

 

 

Another Setback??

Sigh…..where do I even begin?

It’s a long story but I’ve always felt it’s important with this blog to be as detailed as possible; the better you can compare the possible circumstances of your dog’s life to my Stella.

On Friday, March 22 we took the girls for their usual walk.  We noticed Stella was walking really slooooowww.  No limp, just really slooooowww.  She seemed fine in every other way so we chalked up to her just not feeling like going for walkies that day.

Saturday morning (3/23) when I woke up she did not bring me a toy.  Every day when I wake up or come home (whether I’m gone for minutes or hours) Stella ALWAYS brings me a toy.  She pretends to want to play tug-of-war but she really just wants to taunt me with it.  We will “fight” over the toy and, of course, she always wins – happy little girl.  This has been going on every single day for as long as I can remember.  This day there was no toy and Stella in fact did not even rise from her dog bed to greet me.  I went to her and noticed that her belly was trembling, almost vibrating.  She had eaten that morning and did her usual “business”.  Nothing else seemed amiss.  We decided to watch her closely and not jump the gun.  But the fact that this was a Saturday around 9am was at the front of my mind as I knew our vet’s office would close at noon for the weekend and if Stella got worse we would end up in the emergency room.  A few hours later there was no change – her belly was still trembling, she was very withdrawn and had no typical Pug animation to her face.  We took her to the vet.

Our vet examined her and found Stella’s blood pressure, heart rate and respiration rate were normal.  She also had no fever.  Dr. A. decided to take some abdominal x-rays thinking that Stella might have a blockage.  Although Stella had “gone” that morning (and the days before) and did not appear on x-ray to have a blockage there was still a lot of stool in the colon so Dr. A. suggested that Stella may be constipated.  She sent us home and told us to watch her and watch for the usual “sick symptoms” like vomiting, confusion, etc.

Later that day Stella seemed worse.  It was dinnertime and she wanted to eat but could not reach her food bowl, just inches from her face.  She did this sort of chicken dance jerking her neck trying to reach the bowl.  It appeared she could not bend her neck.  We hand fed her and she ate a full meal.  A little while later we noticed her gait and her stance was somehow “off”.  Something did not look right with her rear left leg.  We massaged her entire body but she did not seem to have any pain.  Again, we decided to wait it out.  We went out for a few hours and when we returned Stella seemed somewhat better as her face was more animated and she didn’t seem so withdrawn.  Still her gait appeared off to us and when we offered her a treat on the floor, she wanted it but still could not pick it up – this time she did not even try.

Sunday (3/24) still no toy.  Stella’s condition seemed unchanged since the night before.  We raised her food bowl on a box and she was able to eat by herself.  We noticed that when we attempted to give her a treat she was super gentle and somewhat shy about taking it; it wasn't that she did not want the treat, it was as if she wasn't sure it was there.  Normally, Stella practically takes all your fingers off trying when given a treat of any kind.   Regular bowel movements today, normal appearance, normal amount. 

Monday morning (3/25) she was improved and could now reach her bowl but we raised it on a box anyway in case there was some healing injury involved.  Monday afternoon when we arrived home from work she finally brought me a toy and her face was back to being animated.  Her gait was still off and we knew she just wasn’t 100%.  She also kept wanting to sit and did not want to walk around much. Again, regular bowel movements, normal appearance, normal amount.

Tuesday (3/26) she was the same as the day before but we discussed the approaching weekend and how we did not want to end up not being able to see our vet and having to go to the emergency room if something should happen.  We decided we would let our vet re-examine her just to be sure. We attempted to go for a walk but she was still walking really slowly so we came right back home. 

Incidentally, Stella has been very timid the past 4 days with taking the "doggy steps" up to the couch, so we have been giving her "elevator" rides.

Wednesday (3/27) Dr. A. re-examined her.  Her opinion was that Stella’s walk looked “normal” but we told her it was a dog-owner thing, something only the dog’s owner would see and we were certain something was not right.  Because of the chicken dance thing Dr. A. decided to pursue that first and see if Stella had a neck or spinal injury – it appeared she didn’t.  Dr. A. then tested the pressures in Stella’s eyes and found that they were high.  In her opinion, borderline glaucoma.  She also told us that Stella appeared to be almost blind in her right eye but this is something we have known for years.  In one of my very early posts I explained how Stella was kicked in the eye by a littermate and later when she had eye surgery (to close off the eyelids because of the exaggerated bugginess of her  eyes) our veterinary ophthalmologist told us that Stella probably had very little vision in that eye.  Dr. A. then examined the rest of Stella’s body and suddenly exclaimed “oh my goodness, Stella’s left ACL (anterior cruciate ligament of the knee) was torn in her opinion.  Dr. A. believes that 1) Stella’s balance being off was due to the pressure build-up in her eyes.  Pressure build-up can cause vertigo and a headache (what to us would feel like a migraine) and 2) her gait was off due to the ACL being torn.  It seemed odd to us that Stella seemingly had no pain (in the knee) and no limp but then again she has always been a tough little trooper.  So our instructions were to see both the ophthalmologist and orthopedic surgeon; the same orthopedic surgeon that performed Stella’s neck surgery in 2011.  Meanwhile Dr. A. gave us pressure-relieving eye drops so we could tend to the knee issue first.

By the way, how does an 8 year old, 25 pound couch potato tear her ACL???

We made an appointment with the orthopedic surgeon for Tuesday 4/2.  Maybe she won’t need surgery?  I’ve read where sometimes adult dogs under 30 pounds that are not super-active sometimes do not have to have surgery.  But I’ve also read that not having surgery can sometimes cause other issues like bone spurs and debilitating arthritis.  Enough internet searching for now, we’ll let the expert give us the proper information.

The next day, Thursday (3/28), we came home from work and the usual happened – Stella brought me a toy, taunted me with it and I proceeded to mock scold her for stealing MY toy.  I was careful not to let her run around like usual to not stress her knee any further.  She then went out and did her business and we had her come back in the house so as to not run around the yard.  I then went to the bathroom sink and while I was standing there I felt Stella walk between me and the sink cabinets – something Pugs do all the time to sit or lay on their owner's feet.  This time was different – I felt Stella slide down and when I looked down her arms were extended in front of her, her legs extended behind her, her chin on the floor;  she was laying flat on the floor, spread eagle.  I could tell her eyes were open and bent down to see if she was ok.  She managed to sit up at the same time I sat on the floor and started to nuzzle into me. She kept pushing her head into me like she couldn’t get close enough.  It reminded me of a shy child who is introduced to a stranger and they bury their face into their mother’s side; she was doing just that.  I soothed her and held her tight as her entire body trembled, all the while she was pushing her head really hard into my chest.  Trying to talk to her I noticed her eyes were open but she wasn’t responsive to my voice.  She would not look up at me and appeared to be in a trance-like state as if hypnotized; her eyes were completely glazed over.   I held her and comforted her and in less than 2 minutes whatever this episode was, I’m assuming a seizure, was over.  She got up and walked away and went to sit on the dog bed.  Within 5-10 minutes she was her normal self again.  The rest of the night she was fine – no residual “after effects” that we could see.

The next day, Friday (3/29), she still seemed fine and we went to work.  I contacted our vet and asked if the episode was indeed a seizure and she responded that it sounded like it.  I also asked if it could be caused as a result of sudden pain from her knee or the pressure building up in her eyes – she responded no, a seizure would not happen in those circumstances.  She also pointed out that although Stella’s eyes were open it did not mean she was “conscious”.  Dr. A. was very upset by this new incidence and stated that our “game plan” would now have to change.  She stated that this seizure and figuring out why it happened should take precedence over all else.  She said Stella had some sort of brain or vascular event.  As this was a Friday afternoon we were in that situation again where no one, specifically a neurologist, would be able to see her until the weekend had passed.  The neurologist is at the same specialty facility where Stella would see the orthopedic surgeon and also where her oncologist is.  As we already have an appointment on Tuesday 4/2 to see the orthopedic surgeon Dr. A.’s advice is to watch Stella closely.  If she should have another seizure we are to bring her to the emergency room immediately, otherwise we should report this to the orthopedic surgeon who will coordinate her care at that point. 

This past week Stella (and her sister Betty) has been gated off in the house so she cannot jump on furniture or otherwise hurt herself.

Meanwhile today is Sunday 3/31 and Stella seems better now than she has in a week.  The only thing noticeable to us is that her gait and stance are slightly off.  Still no limp and seemingly no pain, just off.  She is back to eating with her bowl on the floor and wants to run around but we have to restrict her.  Her personality is her usual happy silly self.

The panic in me is starting to rise.  Why did she have a seizure?  My baby girl has been through so much in her life, especially in the last two years, and she just had a third Mast Cell Tumor removed a few weeks ago.  Could this event be something catastrophic……the thought is unimaginable.