What the vet said

Cora’s Vestibular Disease, Part 2

Read Part 1 here.

Last Sunday (August 16), we got home from a day away to find Cora not quite herself—she didn’t seem certain that it was us coming in the door, and she was a little unsteady on her feet. I also noticed her head tilt was worse than usual. Because of our experience with her vestibular disease in January, I knew what to look for, so I got her in good light and, sure enough, saw the nystagmus (rapid eye movement), which was diagonal again. It was then that I realized her head tilt was to the left, not to the right as usual.

She really wanted to join us on the walk but wasn't able to walk much, so she rode.

She really wanted to join us on the walk but wasn’t able to walk much, so she rode.

She saw the vet the next day, and vestibular disease was confirmed. However, this time, there was no sign of an ear infection, which was more worrisome to the vet. It was suggested we see how her symptoms changed over the next few days. The following day, as last time, she was moving in circles in the backyard. Over the next several days, new symptoms that were different from before appeared gradually—confusion about how to get out of the house; Parkinson’s-like movements when eating, drinking, or sniffing the ground; and circling that she seemed unable to stop.

By Friday, the vet recommended a consultation with a neurologist and possibly an MRI.

We got in to see Dr. Campbell at Toronto Veterinary Emergency Hospital on Monday. Cora was doing so much better by then, and I honestly expected him to send us home with no further investigation. But he found that she was painful in her neck. With only slight pressure, her neck spasmed. His concern was a tumour on her brain stem because neck pain is common with that. The MRI was booked for the next day. When he learned that our vet had removed a pellet from her cheek a couple years ago, he said he’d do X-rays first to be certain there wasn’t any other metal in her head.

Cora's head had to be shaved for the spinal tap. It looks as though she had three needles there.

Cora’s head had to be shaved for the spinal tap. It looks as though she had three needles there.

Sure enough, she has another pellet embedded deep in the tissue of her neck (no wonder she is so wary of people!); however, the vet felt it was deep enough to make the MRI safe to do. Cora’s neurologist was in emergency surgery during her MRI, so the radiologist on staff looked at her results, and I got a call at 3:05 p.m. telling me that her brain and ears were normal, so they were also going to MRI her neck and do a spinal tap. I was thrilled to get the news that nothing showed up in her brain (well, except a brain).

However, then when I met with the neurologist at 5:30 p.m., he started by telling me they’d found something small at the base of her brain stem, the site he’d expected to find something, based on the vestibular symptoms. I was confused and told him about the call I’d received. It turns out that the nodule or whatever it is is SO small that the radiologist didn’t see it until the neurologist pointed it out. They can’t be sure of what it is or whether it’s cancerous, though, so we don’t actually know much more than we did. He said we’ll have to judge the prognosis simply by Cora’s clinical symptoms over time.

So it wasn’t exactly the news we were hoping for, but it’s also not nearly as bad as we feared. There isn’t a definitive sign of brain cancer (woohoo!). The spinal tap results we’ve received thus far have been “normal,” but we’re waiting on the pathologist to look at the cells in her spinal fluid to be certain.

The head tilt to the left is just as cute as her head tilt to the right was. :)

The head tilt to the left is just as cute as her head tilt to the right was. :)

The best part of the call from the neurologist yesterday was his pronouncement of the diagnosis “geriatric idiopathic vestibular disease.” Idiopathic means “unknown cause,” so he’s not relating it to the tumour. (The second best part of the call is his assurance that our insurance company will cover the cost, which was substantial, and if it doesn’t, he’ll follow up with whoever he needs to talk to to get coverage!) Cora received amazing care at TVEH, with both her neurologist and vet tech recognizing just how sweet a dog she is. Both were saddened by the pellet in her neck, and as I left there Wednesday, the vet tech pet Cora’s bald head and said to me, “This girl really melts my heart.” Really, how could she not?

If we’re to judge by Cora’s clinical appearance, I’d say she’s healthy. Since Friday, she’s continually improved, walking straighter, not shaking as much when her head is down, and seeming much less confused. Whereas I thought maybe her head would at last be straight, which it hasn’t been since her first vestibular episode, it seems the left-leaning tilt may remain, and that’s okay. After all, it’s just as cute as her right tilt was.

Cora’s Vestibular Disease, Part 1

I haven’t had much time to post here in the past year, but last week I got a terrible reminder of one of the reasons I started this blog in the first place—to have a record of issues we go through with the dogs.

One morning at the end of January this year, Cora scared the bejeezus out of us by being, well, spaghetti-like. She was unable to stand, and whenever she tried, she just fell down, limp as could be. She had the will to walk and do everything her brothers were doing, and she still wagged her tail, but she seemingly had no control over her body. We thought she was having a stroke. It was terribly frightening!

Fortunately, the symptoms began the day that one of our vets was to come to our house to give Dusty acupuncture for a cruciate ligament tear we were treating through conservative management (another blog post I should’ve written). The vet examined Cora off the record, suggesting we get her to the clinic for a full “official” exam, and pointed out her nystagmus—the darting of her eyes. He felt fairly certain Cora had geriatric vestibular disease. The word disease in the name knifed fear into my heart—would she live out her days unable to control her body? He then told me that when his dog had it, it lasted about two weeks and resolved itself. Phew!

Vestibular disease, I learned through many Facebook friends whose dogs had gone through it, is not all that uncommon in senior dogs, and, more important, it’s not a death knell. Essentially, it’s an episode of vertigo. Cora was dizzy, as evidenced by her eye movements (nystagmus), which in her case started out as diagonal, not back and forth or up and down, and through her poor sense of balance. Most often, vestibular disease is considered idiopathic, meaning that there’s no known cause—it’s just age related.

However, because Cora has had ear infections on and off since we adopted her, the vet assumed an ear infection could be causing her symptoms, and sure enough, examination showed inflammation (despite regular ear cleanings!), so she prescribed two weeks’ worth of antibiotics.

Cora’s condition worsened a bit on the second or third day, when she started circling in the backyard. Our vet was a little worried by this because vestibular symptoms should only start improving after the first day. The circling happened on and off for a couple more days. But we waited it out because other things were normalizing—her nystagmus wasn’t noticeable to the naked eye, she was able to walk around the block, and she wasn’t vomiting or avoiding food (quite the opposite, as usual).

Cora rocking the head tilt.

Cora rocking the head tilt.

By the time she finished the antibiotics, Cora seemed mostly back to normal. She was safely jumping onto and off of furniture, going on our long walks and keeping up, and being as energetic and kooky as usual. Two main symptoms remained: her head tilt, which the vet had warned might never go away, and a bit of a lazy eye—both on the right side.

Then a day or two after she finished the antibiotics, Cora’s symptoms worsened again. I don’t remember exactly what was going on, but the vet decided to put her on antibiotics for another four or six weeks.

Once that course of antibiotics was done, Cora was back to normal (yay!), except for the head tilt and the lazy eye, both very cute qualities, we think. 🙂

And then in August …

The Way Each Day Ends

Algonquin ParkLife’s truths don’t get much more basic than this: no matter how my day is going, I always know it will end with my hands on the dog’s dick.

This is the side of pet ownership no one tells you about, the harsh reality of aging, illness, or injury, when they’re dependent on you in ways you never foresaw. My 13-year-old Westie, for example, is dependent on me to catheterize him daily. Sometimes twice.

Let’s start at the beginning. About 12 years ago, a man with whom I worked asked around the office if anyone could take a male, year-old West Highland Terrier. He had been bought as a gift for their son by the parents of an adolescent boy, a latchkey kid as we used to say. The kid, apparently, went home each day from school and ignored Angus (because it is law that every Westie be given an appropriately Scottish-sounding name), who was left in a crate for hours on end. My colleague was friends with the parents.

Laddie

Laddie

On a whim I, with a Scottish background and a fondness for the Westie on Hamish McBeth (whose name was Jock) and without one lick of experience as a dog owner, said I would take him. Hey, free Westie, right?

A few days later, I came home from an errand to find my boyfriend and my new dog peering out the back door at me. The latter was a foot high, was fringed in spiky white fur, and had an oversized dark nose pressed against the patio door glass. He had the biggest, pinkest ears I’d ever seen. My first thought was, “Oh, lord, what have I done?”

I had no idea what to do with a dog. I loved animals, but until then I’d stuck to cats. I didn’t even particularly like dogs. A couple of my friends had them, and they seemed like high-maintenance over-emoters with foul hygiene and questionable dietary habits.

Laddie, as he soon became, turned out to be the easiest dog a person could own. He was perfectly housebroken, came when called, and was completely nonchalant with dogs of all sizes and temperaments. He didn’t chew up much besides a shoe or two, didn’t dig in the yard, and was, frankly, hilarious. I watched more than once as he cannily tricked other, much larger dogs out of their choicest bones, and then ran away hell for leather, stubby legs pumping, pink ears flapping, the spoils of his escapades gripped tightly in his pointy little teeth. We took him to the dog park, the bookstore, the beach, outdoor cafés, and on a road trip to Nova Scotia. He slept on our bed, right up at the top near our heads, between us. He didn’t even shed. He was a perfect companion.

God, how I fell in love with Laddie.

Laddie loves the snow!

Laddie loves the snow!

Then one day maybe eight or so years later, we woke up to find a turd on the pillow. He had trouble getting up on the big, high bed himself, but he’d never had trouble getting down. He had until then spent every night of his life with us happily snoring in the middle of the king-size bed and had never had even the minorest of accidents. But, hey, if you’ll pardon the obvious pun, shit happens, and we didn’t think much of it. Until it happened again. He was none too happy when he had to start sleeping on the floor.

Another day, we noticed he was having trouble getting up the stairs. His nails had always grown, as my mom would say, higgledy-piggledy, shooting off in strange directions, brittle of texture and prone to breaking, and he did suffer from the traditional Westie dry skin at times, but he’d otherwise been perfectly healthy.

Our vet told us that he had some sort of spinal problem, some numbness or other and that, eventually, he would no longer be able to pee, become toxic, and die. We got a new vet.

My Laddie

My Laddie

It was another year or so before he started peeing inside. I didn’t make the connection until I took him to the new, kinder, more empathetic vet, who told me that he wasn’t peeing exactly; rather, the dreaded time had come. He could no longer use the muscle we all use to expel urine. His bladder was full to bursting, stretched beyond its normal size, and urine was leaking out because it had nowhere to go.

I stood in that office and sobbed as the kindly Dr. Dave offered one weird ray of hope. I could catheterize him, he said, but I’d have to do it every day. I couldn’t even imagine such a thing was possible, and I left in tears with Laddie by my side, completely at a loss as to what to do. I had to make a decision, though, and fast. The good doc had drained his bladder, but he’d need it done again in a day.

By this time, Laddie’s mobility was compromised significantly, but he was still the plucky Westie he’d always been. He would still barrel out into the backyard at the first sign of a squirrel, although now his back legs sometimes failed to share his enthusiasm and gave out on him halfway to the fence. The daily walks he once pestered us for unmercifully were no longer a possibility, but he gave them up with much greater grace than he’d shown when we kicked him out of bed. He was still my Laddie, and I couldn’t imagine not having him around.

I wasn’t even at the car before I turned around and went back into the clinic.

“Okay,” I said to Dr. Dave, wiping my streaming eyes on one sleeve and hitching a breath. “You may as well show me how.”

So he put Laddie on his exam table and showed me how to unsheathe the little guy’s penis and insert a long, slender catheter as far as it would go. “You can’t screw it up,” he said, but I had my doubts. Every time—every single time—anyone has ever said to me, “You can’t miss it,” I’ve missed it. But okay, I’d try. Dr. Dave had sealed my resolve with a few simple words: “There’s no medical reason to put him down.”

Laddie and me at Algonquin Park

Laddie and me at Algonquin Park

So that was it—he was still the same Laddie, I was still responsible for his quality of life, and there was no medical reason to put him down. The decision was made.

I took Laddie home. The first few days, it was a two-person job, but we managed. We even managed the odd time when poor Laddie would poop while we were at it, much to our disgust and his embarrassment.

It wasn’t long before I discovered that it’s actually an easy one-person job once you get the hang of it. Left hand for unsheathing, right hand for insertion, a few pulls on the plunger of a syringe that I then empty into the second sink. Then I rinse Laddie’s feet, hoist him onto a towel on the floor, coil up the catheter, and turn my disposable rubber gloves inside out, and then chuck it all in the garbage. Then I pour bleach down the sink, and get out the Mr. Clean. I scrub the sink with that, and then spray Lysol everywhere, and then I give Laddie his treat. Every day, sometimes twice. It’s a delicate balance between making sure he’s never uncomfortably full of pee and trying to keep from introducing infection. We’ve had our fair share of those, but he still responds well to antibiotics, and they clear up quickly. For the most part, the whole process hasn’t seemed to bother him much. When “our time” approaches, he comes over to me and turns around, offering me his back to be picked up and hoisted into the sink.

The catheters plus the tube of topical anesthetic/lube cost me about $130 a month. His occasional antibiotic prescriptions and accompanying vet visits cost anywhere from $75 to $200, maybe every four to six months. That’s in addition to the usual heartworm meds and shots. My “free” dog is no longer cheap. Dr. Dave says I could send him for an MRI that would cost more than $5,000, but he doesn’t think it would bring us a solution, and he’s doubtful it would even bring a diagnosis. I haven’t done it, and I don’t plan to. Sometimes things just are what they are.

“Am I cruel to keep doing this?” I asked Dr. Dave at one appointment.

“It’s only cruel not to,” he said.

Laddie’s not in pain; of that I am certain. He’s still a great friend. He still wants treats, still chases squirrels, and is still the smartest dog I’ve ever met. We just do what we gotta do.

I can think of far worse ways for my days to end.

A Near-Bloat Experience

We were lucky. Yes, it was the long weekend. Yes, it was late at night. Yes, it cost an arm and a leg because we had to go to the emergency clinic on a Saturday at 10 p.m. But we were lucky.

Dusty showing off his normally trim belly.

Dusty showing off his normally trim belly.

Dusty had none of the typical symptoms of bloat, other than extreme thirst and a distended belly. He was resting peacefully (no pacing or arched back), and I had been watching him carefully for hours. At 7:30 p.m., about a half hour after he ate dinner, I noticed the distended belly. Remembering one of the many things I had learned at my pet first aid course, I gave Dusty half a Gas-X tablet. I debated going to the clinic. He showed no evidence of discomfort, but I know the twisting can happen fast. Once I heard and smelled the Gas-X working, though, I thought, We’re in the clear. The air was coming out of him. (Boy, was it ever!)

However, at 10 p.m., when his belly was still really distended—seemingly more so than it had been—I woke Dusty from his sleep and took him to the emergency clinic. Since I was home alone this long weekend, it meant leaving Cora and Hogan alone for God knew how many hours (it’s never a short visit). I had been hoping to avoid it, but better safe than sorry.

Dusty with his bloated belly waiting for the vet.

Dusty with his bloated belly waiting for the vet.

I believe this was Dusty’s fourth visit to the emergency clinic in the two and a half years we’ve had him. He should get a frequent visitor discount by now. His digestive system has caused so many problems, and this one was just the latest and potentially the most serious. However, you’d never know by Dusty’s behaviour that anything was wrong. At the clinic, he wanted to say hello to all the other dogs and all the people, and he wagged his tail (his whole body, truth be told) nonstop. He put several smiles on several sad, concerned faces, and I think he believes that’s his purpose.

It didn’t take long for Dusty to be called in to see the vet tech. Vets take bloat symptoms seriously. The vet tech examined Dusty and noted that his abdomen palpation was abnormal and his heart rate was slightly elevated, possibly due to pain but also potentially a result of his excitement since he so enjoyed meeting another new person. We had to wait a while to see the vet, which suggested to me little cause for concern on the part of the vet tech, setting my mind somewhat at ease. Dusty lay down on the floor and slept, still burping and farting up a storm, while we waited. Once we saw the vet, she recommended X-rays to ensure his stomach wasn’t flipped. The X-rays showed an excess of stuff in his belly—food, water, and air pockets—but, fortunately, no signs of twisting. The vet recommended inducing vomiting to get it all out of him. I consented.

Dusty's innards--the black parts in the abdomen and stomach area are air pockets. The rest is a whole lot of food and water.

Dusty’s innards–the black parts in the abdomen and stomach area are air pockets. The rest is a whole lot of food and water.

It turns out there were about three to four cups of food in Dusty! He gets just over a full cup a day (at two feedings), so the quantity of water he drank must have increased that food volume exponentially! Once it was out of him, we were able to go home and have a mostly restful night (with one bout of diarrhea). Phew! Crisis averted.

Going forward, my dogs won’t have access to the water bowl at meal times. I’ll wait half an hour to an hour after feeding them to return the bowl to the floor. I think it was the water that caused Dusty’s issues (none of the other causes fit the situation). Let’s hope that our first bloat scare was our final one!

Dealing with Dusty’s Allergies

In January we started giving Dusty allergy shots in the hopes of an itch-free summer. Unfortunately, after months of ramping up the dosage, we had to stop the shots for a month and slow down the ramping-up process when his allergic reactions went berserk in the spring. He got back on course well over June and July, but August has been terribly itchy for him again.

IMG_0380

Benadryl worked for a while (one a day at first, then two), but then it stopped working, so we introduced Benadryl spray again (and a T-shirt so he couldn’t lick the spray). When he was still scratching seemingly incessantly through the night, we switched to Chlortripolon—4 mg twice a day at first, and then 8 mg twice a day. Three days later, no improvement. Now we’ve resorted again to Vanectyl-P, the steroid/antihistamine mix we were hoping to avoid.

However, we do hope Dusty’s time on this drug will be limited to only a month. His reactions this August haven’t been nearly as bad as last year’s reactions. And by September 21, he will be on the full dose of his allergy shots. Let’s hope next summer is itch free!