Friday, April 3, 2009
Our Lambie's case history to date
Simba’s case history (15y/o male, neutered, Lab/Shep/Collie? Mix)
Prior med history: ear canal surgery around 1998 due to chronic yeast ear infections.
5/07 arrived in NJ cross-country drive from CA, rough on Simba, jumping in and out of the car for 3-4 days and fell into pool at a hotel
7/07 noticed signs of right foot dragging, kicking foot out behind him like muscle spasms, loss of coordination, sensitive shoulders. Corporate housing in hotel had much higher bed than in CA and he jumped up and down from it
8/29/07 Red Bank to evaluate Simba’s clumsy walking and foot dragging, seen by resident,. Wanted to do lyme test:negative. Saw nothing wrong, sent home w/Rimadyl. We did not administer Rimadyl after researching side effects
9/07 first episode : became clingy, then started looking up and 3rd eye lid covered both eyes, seemed not to hear me, collapsed in my lap. Lasted for about 1.5 minutes. Was tired after about 5 minutes seemed back to normal after
10/07 drove back to AZ/CA, also got vaccinations in CA since they were due. (I now wish I had not)
11/07 drove back to NJ
7/08 Evaluated by Delucia. Elevated liver enzymes, stated not issue at this age
[Alkaline Phosphatase: 220, ALT(SGPT) :315, AST(SGOT):55, CHOLESTEROL: 269, GGTP: 11, pH:7]
7/30/08 MRI done per Dr. Delucia at Valley Rehab. Report give br Dr. Goggin. (see attached report) Based on diagnosis, we accepted DM as cause and prepared for it
It seems radiographs were also done by Delucia around this time and left lung is mentioned. (see attached report) Nothing further mentioned on left lung
8/19/08 second episode:similar to 1st, recovery is 3-4 min. Made urgent appt w/Dr Staubach, local general vet. Suspected petit mal seizure. Suggested seeing an Oradell neuro doc. Prescribed metacam for pain and lameness. We did not give metacam after researching due elevated enzymes 1 year prior
9/08 began weekly and biweekly hydrotherapy and stability ball sessions at Vet at Barn, improvement in stiffness
12/08 Simba now showed signs of incontinence. Nighttime wetting, sometimes could not make it outside to empty bowels.
1/09 Simba licking his penis and seemed to be uncomfortable, we took him to local vet who gave novasan and antibiotics. Used only novasan and it seemed to help
2/09 Started D-mannose supplement and encouraging more frequent urination. This helped much, but still has dribbles now and then and irritation, but much less
2/09 noticing Simba does seem to be in pain in back and neck and shoulders
2/14/09 started hydrotherapy at Aquapets w/Cindy Fabernash and d/c’d w/Vet at Barn
2/20/09 Saw Dr. Bliesath after much coaxing by our hydro therapist. Suspected enlarged bladder, decreased heart size, fuzzy liver in x-rays. Prescribed tramadol for pain.
Blood work also done: showed higher liver enzymes than prior report in 7/08. Suggested neurologist or U of P to get to bottom of everything. Felt DM was not cause of his lameness. Also suggested abdominal ultrasound and possibly bile acid test
Blood levels worse than prior year:[UREA NITROGEN:32, Alkaline phosphatase:320, ALT:409, AST:77, CHOLESTEROL:365, BUN/CREAT RATIO:29, GGTIP:15, pH:7.5
2/24 3rd episode: eyes open, looking up and twitching rapidly w/a worried look, did not collapse. 1:49pm for 1.5 min. recovered after 2-4 min. slept much after
2/25 saw Dr. Rick Joseph Neuro guy at ASC per Dr. Bliesath’s recommendation. He felt it is DM. and felt I didn’t observe episodes astutely enough to give him enough info to assess properly.
2/27 I called Simba’s vet in CA Dr. Grant. Suspected possible chalangiohepatitis. Prescribed amox. Advised against another MRI or surgery, too traumatic. Started amox.
3/9 saw Dr Strauss Internal Med vet @ Animal Referral & Specialty in Fairfield. Observes major muscle loss. Took Simba back to get yet another neuro doc to assess, though we stated we already had a neuro consult w/Joseph. Strauss said their neuro feels there is a lot of pain in the lower back and something other than DM going on. I mentioned vestibular or head trauma but Strauss ruled out. Abdominal US also done. Nothing significant, but liver looked a little fuzzy.Bile test recommended. We asked what is causing the rapid muscle wasting, replied, hoping liver tells us that. Have not done bile acid test yet.
3/10 Called Dr. Jean Dodd in CA. to ask about ordering urine bile acide test from her. After hearing Simba’s blood test levels re: liver, bilirubin & GGTP didn’t agree that liver was issue and bile test not warranted. Based on what I told her from Goggin’s report, believes has spinal issues, very painful, tramadol 3x day and DLPA, milk thistle & SamE . Advises against disc surgery as can later contract and cause fibrosis.
3/12 Simba finished his amox course today. Giving him many supplements and (also tramadol 3x day beginning 3/10). We don’t feel DM is primary cause of Simba’s digression. We now feel Simba most likely damaged his spine during the course of the move to NJ and stay at hotel with high bed. We believe disc bulging is worse than before, causing his worsening neurological defecits and pain. We want to do what is best for Simba without causing him anymore pain and discomfort or unnecessary tests/procedures. Very rapid digression in the last month and obvious signs of pain in back, shoulders and front paws. Muscles spasms in hind legs more frequent.
3/18 Saw Ortho surgeon Dr. Arnold Lesser. At first said DM, then after closer examination found several areas of pain along neck and back. Simba yelped when Dr. tried to turn his head to left. Dr. felt DM was not the cause of Simba’s condition due to level of pain and fact that weakness has been mostly limited to right hind leg and progression over 1.5 years not same rate as usually seen in DM. Neuro doc there felt lots of pain in neck and said lymphoma or brain tumor shouldn’t be ruled out.
3/26 I would like to stress that Simba is worse at night. He whines and paces. Also, he is always acting like he is starving to death and esp at night keeps on wanting to eat, yet his weight has not increased. He shakes his head even while lying down, like a dog does usually if he’s wet and standing. He shakes his head each time he stand s up. Sometimes he hurts himself if he does it too close to the ground or near an object. He presses his head on the right side a lot and always falls hard with a loud thud when trying to lie down on the right side. He seems more disoriented.
Also would like to mention eye discharge, usually worse in left eye. Greyish mucous that accumulates. I mentioned to other vets and didn’t get much feedback. The Internal Med vet said it’s because he’s lost so much muscle in his face that the sockets are causing the discharge. I have convinced my husband that we should see an opthamologist and I’ve made an appt for this coming Monday w/Dr. Brown in Little Falls. I don’t know if this is the best way to use our resources, esp if the eye is due to something more systemic, however, I am worried about his eye becoming damaged if neglected.
We have stopped the hydrotherapy because if Simba is seriously ill, we don’t even know if that is safe anymore. We are also finding that it has been harder to afford w/the increased vet visits.
We need help in diagnosis so we can at least provide relief if not a cure. His swaying and coordination and pain seem to be much worse day by day. Simba is not in any condition to take long drives but we were considering going to U of P, but then after all the vets we’ve already seen, we wonder if it would be money & time well-spent.
Since Feb, he has not had another seizure like episode.
4/2 Saw another vet. US done on liver, adrenals, kidney, heart. US showed nothing significant. Thinks pains & muscle wasting and spasms should be managed. Prescribed diazepam, amantadine, winstrol, neurantin & gave vetalog injection
4/3 I Did research on vetalog and have concerns. Ideally , if Simba’s blood work comes back okay, we are considering another MRI that includes the t12 region AND the neck and brain, if possible. However, we don’t have the money to do anymore diagnostic tests. Also, we don’t know if it is fair to our baby to be putting him through so much. However, we know this condition has stolen his dignity and ability to perform normal functions independently. He is very proud and he still loves life and begs to go out for walks, loves food as always (I pushed for an ACTH test to rule out Cushings as he loves it so much) and loves us to death . Hope someone can help. Our current vet whom we like, is trying his best, but we are just concerned w/the vetalog and other drugs combined. I know quality of life vs quantity should matter, but I keep thinking his disc is worse and something in his neck/brain is causing the seizure like episodes.