Really need help with a dog who suffered a stroke

[Jon]

Hello everyone. I'm new here.

I posted this in the Paralysis: Neurological and IVDD section but after looking through some of the topics here I thought my situation might qualify for this section. If not I can remove it:

I came across the site whilst searching for information to help my currently disabled pet. He's a 12 year old (almost 13 actually, only a few months shy of 13) mixed breed dog or mongrel. As best as I know he has German Shepard (on two sides), Rottweiler, Labrador Retriever and Dobermann Pinscher in him. He suffered a stroke about a week and a half ago and since then has been recovering. When he had the stroke he had all the symptoms: vomited, excessive drooling, couldn't stand, nystagmus (eye twitching), dazed look and head tilt. He's also anaemic but we've been giving him supplements for some time now. The visit to to the vet also found arthritis as we had started to suspect (for which he got medication) and signs that he may have tick fever (for which he got antibiotics). Over the initial few days after the stroke with some treatment the eye twitch stopped and he looked less and less dazed (looks almost entirely like his old self now). His head only tilts at times now but it has been a week and a half since he last walked. He can shuffle himself around at times in the bed/pen we've made for him and he can sit up (on his side, not on his haunches). He doesn't appear to have lost control since he can still wag his tail and if you rub his stomach or his back he will give the reflexive movement with his hind legs and within the past few days has been able to consciously stretch both his front legs and hind legs when stretching when he wakes up (we were told that was a good sign). One eye doesn't appear to close properly anymore though, but he still seems to sleep well. He hadn't defecated or urinated in about 2-3 days after the stroke but thereafter did both (again not standing) and has done so daily since. The vets had said that he could recover in 2 weeks to a month, but I'm growing concerned if he will ever be able to walk again.

Our family now has many concerns having looked up some information about pet urination and paralysed pets:

1. Do some dogs take more than 3 days or more than a week to regain the ability to stand after a stroke?

2. Could his anaemia have triggered his stroke?

3. We've recently learned that a pet needs to have their bladder expressed three times daily. We didn't know this before and for the past few days he had been peeing once a day which we now suspect is because his bladder just became full and then released. That's bad because it could cause the bladder to stretch and give him trouble to urinate if he recovers fully. I found that one should ask the vet about expressing the bladder and there was a website which showed techniques on how to do it, but in almost all cases it seemed to assume that the pet could still stand on it's own. Right now our dog can't stand but every day he seems to get a little stronger (unless that is just my hopes being projected onto what I observe) but how do we express the bladder for a 55 lb dog if he as of yet cannot stand up straight?

4. Is there any way to prevent the urine from catching the fur? We've been cleaning him every day but surely prevention is better than cure and if we could prevent the urine from coming in contact with his fur from the beginning it would be better. We've ordered doggie diapers but having never needed to buy them before I have no idea if they will actually catch the urine properly. Is there any way to cleanly collect the urine so it can be disposed of? Could it be collected in a bag or something?

5. How often a day do dogs need to defecate?

6. We've been giving him tender love and care (feeding, water, clean underpads, some gentle music in the day, massages and brushings) but is there anything else we can do? I've been told to use a towel under his belly (as a sling I presume) to help him walk, but having done something similar with our hands and thus far not getting anything positive (he moves his front legs and back legs when on the ground and tries to crawl but when we lift him he doesn't try as much...we suspect he might still be getting a bit dizzy)....we aren't quite sure what to do. Is there anything else we can do to help him start walking again?

7. I know we should get an MRI scan done to be sure of what caused the stroke (it isn't likely to be diabetes since he doesn't have that) but that may not be possible for us. What can we do? What should we do?



Any and all help will be greatly appreciated. Thank you.

[janew]

Hi Jon,
Did your vet consider 'vestibular syndrome' vs 'stroke' ??? They both present similar. Vestibular syndrome is also coined as 'old dog disease' it causes head tilt, nystagmas, nausea & makes them so 'dizzy' balance is not possible if it is severe onset / case. It is thought to be an inflammation of the inner ear nerves. As far as I can tell, no one knows the cause for sure. It has sudden onset & is frightening & often considered stroke or 'heart attack' & since it usually strikes older dogs sadly alot of folks figure that is the end of the line because the dog is old & just euthanise. It happened to my old dog, my vet prescribed amoxicillin (an antibiotic, incase the inner ear nerve inflammation was caused by an infection) & prednisolone (a steriod that reduces inflammation). It can take a month to resolve & sometimes (rarely) it does not. It sounds like your guy is recovering but has some other 'old dog' issues & maybe another tick borne issue. Was a test done that ID'ed 'tick fever' (I have never heard of it, I have heard of Lyme's, erlichlia, etc but not 'tick fever'). You can express him laying down or if have someone else available you can use that person use a strap or towel or 2 to stand him so you can express him...see the 'stickeys' on expressing & poop on demand. Also either under this subject or 'senior pets' (I think) look at Abbydog posts..very like your experience. It is worth the intensive 'nursing' care because there is a decent (good)shot of recovery.
Best wishes,
jane

[CarolC]

The part about the eye not closing...I think the vet has some drops or ointment you could use to keep his eye from being damaged by dryness.

If your dog has enough use of his front legs to keep himself from collapsing, you can express him standing by clamping his hips between your knees. I am not strong and have a back problem, but I could do that with my 60-lb dog. Your knees do the work, you aren't lifting once you've got him in position. (I learned that trick from Eros's mom.)

I agree with the idea of stimulating him to defecate, it is better than waiting for a surprise. There's a bit of the ick factor the first few times you do that with a large dog, but it's better than having him mess the bed. I swear by lunch bags and kleenex. Stimulate him to go, cover it with lots of kleenex, stuff it into a lunch bag, and carry it out to the trash....it's pretty painless that way. (Don't flush kleenex, I learned that the hard way. ) This article lists various methods people have used for this.

https://www.handicappedpets.com/mediawiki/?title=Bowel_management_in_incontinent_pets

Here is some information on male diapers (also called malewraps, belly bands) and u-bags (most people use the malewraps)



https://www.handicappedpets.com/mediawiki/index.php/Diapers_and_male_wraps

[Jon]

Hi Jon,
Did your vet consider 'vestibular syndrome' vs 'stroke' ??? They both present similar. Vestibular syndrome is also coined as 'old dog disease' it causes head tilt, nystagmas, nausea & makes them so 'dizzy' balance is not possible if it is severe onset / case. It is thought to be an inflammation of the inner ear nerves. As far as I can tell, no one knows the cause for sure. It has sudden onset & is frightening & often considered stroke or 'heart attack' & since it usually strikes older dogs sadly alot of folks figure that is the end of the line because the dog is old & just euthanise. It happened to my old dog, my vet prescribed amoxicillin (an antibiotic, incase the inner ear nerve inflammation was caused by an infection) & prednisolone (a steriod that reduces inflammation). It can take a month to resolve & sometimes (rarely) it does not. It sounds like your guy is recovering but has some other 'old dog' issues & maybe another tick borne issue. Was a test done that ID'ed 'tick fever' (I have never heard of it, I have heard of Lyme's, erlichlia, etc but not 'tick fever'). You can express him laying down or if have someone else available you can use that person use a strap or towel or 2 to stand him so you can express him...see the 'stickeys' on expressing & poop on demand. Also either under this subject or 'senior pets' (I think) look at Abbydog posts..very like your experience. It is worth the intensive 'nursing' care because there is a decent (good)shot of recovery.
Best wishes,
jane

Hi Jane.

Yes my vet did consider vestibular syndrome but the ears had no infection or inflammation so that would tend to rule it out.

Tick fever is another name for erhlichiosis apparently (which I'm guessing is what you call erlichlia). I live in the tropics, so that would probably be the more common local name.

Tried to express him laying down but it was practically impossible (in addition the fact that I didn't have a clue where to press).

Thanks for the links (the stickies and the posts for abbydog), I will definitely check them out.

[janew]

Hi Jon,
When my old dog had vestibular & most of the older dogs that presented with vestibular symptoms at vet clinics I have worked at over the years, had whisle clean ears & no outward signs of inflammation. The dog's ear canal has a bend unlike our's & the ear drum & middle ear are beyond that bend so it can not be viewed by just looking or looking down with an otiscope. So I am not understanding from your explaination how your vet ruled it out. And I would be very interested to know, I try to keep current on available techniques & equipment.
You are right, erlichia & erlichiosis are the same.
I think asking your vet about about adding prednisolone might be beneficial. The 'up' side to this steriod is that it is a great anti-inflamatory, if it is an 'idiopathic' (unknown cause)inflamation of the inner ear nerves it could ease it faster. Pred brings on appetite & helps with arthritis. At one of the vet clinics I have worked in it was referred to as 'make a dead horse walk & eat' drug. Down side is if used long term it can have bad side effects ( ie Cushing's, organ damage, etc) but short term is generally 'safe'. It makes dogs drink lots & therefore pee tons (not fun in your dog's current status), you taper of the intial dose when you 'wean' them of it. It also suppresses the immune system, so it lowers the body's ability to fight infection. Your dog is on antibiotics & as long as his antibiotic is the appriopriate one for what infection/s he has that should not be a problem.
When Abby dog's owner asked her vet in Canada about pred. they had a reason (she did not recall why) they did not want to use it with Abby. Last I heard Abby was doing great with just antibiotics.
Can your vet or one of his techs show you how to express him, lying down or Carol's technique of holding his rear up with your knees (if you have no help at home). Or did the stickies help you understand & master 'expressing'??
Hoping things are just getting better or this helps.
jane

[Jon]

The part about the eye not closing...I think the vet has some drops or ointment you could use to keep his eye from being damaged by dryness.

If your dog has enough use of his front legs to keep himself from collapsing, you can express him standing by clamping his hips between your knees. I am not strong and have a back problem, but I could do that with my 60-lb dog. Your knees do the work, you aren't lifting once you've got him in position. (I learned that trick from Eros's mom.)

I agree with the idea of stimulating him to defecate, it is better than waiting for a surprise. There's a bit of the ick factor the first few times you do that with a large dog, but it's better than having him mess the bed. I swear by lunch bags and kleenex. Stimulate him to go, cover it with lots of kleenex, stuff it into a lunch bag, and carry it out to the trash....it's pretty painless that way. (Don't flush kleenex, I learned that the hard way. ) This article lists various methods people have used for this.

https://www.handicappedpets.com/mediawiki/?title=Bowel_management_in_incontinent_pets

Here is some information on male diapers (also called malewraps, belly bands) and u-bags (most people use the malewraps)



https://www.handicappedpets.com/mediawiki/index.php/Diapers_and_male_wraps

Hi Carol and thank so much. I didn't have time to reply but I did read your message and I did ask the vet about eyedrops and she recommended some that would could buy in the pharmacy.

Thanks for the links as well. I haven't gotten to look through even all of the ones that were provided by Jane and Joanne. Feel so dejected now that I don't even know if I should....came back from the vet today and it's like one step forward and two steps backward. He is definitely recovering in terms of his head and forelimbs, but he still doesn't move his hind limbs all that much and when I try to help him walk his does move his hind limbs but unfortunately his hind toes remain curled which apparently is a bad sign since in indicates nerve problems/deficit in that area. It may or may not come back but apparently exercises should help. But just to top it all off it seems he has a bit of pneumonia/lung infection. I suspect I might be the cause of that since I've been trying to clean his urine off his coat but it is just so difficult to dry the hair. The scan of the lungs also revealed an enlarged heart and the ECG confirmed that he does have a heart conditions (AV Block 1) in which there is a delay between the two beats of the heart (systole and diastole). Currently he doesn't require medication for the heart but they want to give him another check up in a month or two (though I dunno if he will be The only silver lining in all of this seems to be that it might have been his heart condition which caused his stroke and not a brain tumour (the vet said if it was a brain tumour then he would probably have had more strokes) - if there had been any kind of blockage in the heart which found it's way to the brain then that might have caused the stroke. Back home now and I feel low since another family member has said he thinks we are being cruel to the animal in his current condition and that if doesn't show any improvement by the weekend then he thinks we should put the dog down. That certainly tore me a new one because I would never, ever, ever want to be cruel to my dog. Heck I called in sick today just to take care of him and take him to the vet because I was concerned about how he wheezed at times. He was born in my yard from two previous dogs I had (his father lived to be 14 but we had to put him down earlier this year because he had a tumour pressing on his spine which prevented him from walking and he was having...crystallization of the lungs? something like that...I was kind of too traumatized to remember it clearly but I remember that there was something to do with the lungs hardening and his breathing becoming difficult..I think it might have been lung cancer actually; his mum died much earlier at only 8 years old from what we now suspect was heart failure....it was so fast...one day she was fine and the next she cries out in distress, can't move, we take her to vet and then she just brings everything up and dies). I had been worried about tumours with him since his father had them but thankfully he doesn't seem to have it.

I still can't express him though. Even the vet tried and it wasn't happening. He's normally a very clean animal and I'm sure he had great discomfort with having to go where he was lying down the first few nights and even now. I've managed to express him twice but each time was by accident I'm sure. First time was on the grass where I suspect he wanted to go anyway and second time was in the evening when I managed to get him up and help him relieve himself. Irony of ironies though I was trying to feel his tummy when he lay back down because he was still complaining a bit when he just suddenly went...perhaps I expressed him a third time.

I just wish I could find something that would tell me how long it would take for him to recover. The vet said he may recover in 2 weeks to a month, stuff I read online seemed to indicate that he should be able to walk within 3 days of the stroke, a relative of mine who is vet overseas sounded surprised when more than 3 days later we said he still couldn't walk/stand up, asking online I got a response that for mixed breed dogs it might take "longer than 3 days" and might be a "few" weeks and here I've read it may take several weeks. But nowhere have I found anything to indicate the maximum time frame a dog has been known to take to recover from a stroke. Nothing like "this dog in Nepal or Timbuktu recovered the ability to walk 6 weeks after a stroke and that's the longest known recovery time" or something like that. I know it can take time, but how much time? It's rather difficult to take care of him at home since I'm practically the only fully able-bodied person (I'm not 90+ and I don't have a back problem like two others in the household). How will I know when his chance of recovery is less than 0.01% and I'm just prolonging suffering or when I should just wait 1-2 more weeks?


Thanks to all of those who have responded. It is much appreciated and I am anxious for any more advice from anyone.

[janew]

Jon,
Please, inquire if your vet would consider an addition of prednisolone with his antibiotic before you consider putting him to sleep, see my post above (that came out, it seems at the same time as your response to Carol's post). The addition of prednisolone & starting him supplements for his joints, hips & legs, ie glucosamine, MSM, fish oil, etc. & a non streroidal anti imflamatory once he off the prednisolone (like rimadyal, may be helpfull).
Hope it helps some,
jane

[Jon]

Jon,
Please, inquire if your vet would consider an addition of prednisolone with his antibiotic before you consider putting him to sleep, see my post above (that came out, it seems at the same time as your response to Carol's post). The addition of prednisolone & starting him supplements for his joints, hips & legs, ie glucosamine, MSM, fish oil, etc. & a non streroidal anti imflamatory once he off the prednisolone (like rimadyal, may be helpfull).
Hope it helps some,
jane

Thanks jane.

We started him on supplements (glucosamine) recently. We started with the tablets that had been left over after his father died.

He's actually doing a lot better since the weekend. He's now able to push himself up on his front legs and almost able to fully stand, but he still stumbles over. Holding his waist, I'm now able to help him walk (and at times he can go along fairly briskly), but he still leans to one side and at times when sniffing on the ground his head tilts. I suspect he's still feeling the effects of the stroke in favouring one side, but I hope that will disappear soon. His toes on his hind legs now flex properly when I help him walk instead of remaining curled and yesterday he tried to run (because he heard and probably smelled a person in the area that we all know he doesn't like). I don't think I need to express him anymore since he just complains in the morning when he wants us to take him outside for him to do it (both number 1 and number 2). I've tried it (and even my vet tried it), but his urethral sphincter must be made of steel because try as anyone might he doesn't seem to go unless he wants to go.

What is the prednisolone supposed to do?

[janew]

Hi Jon,
Prednisolone is a streriod, an anti-inflammatory, see my post above Carol's, I tried to explain it's 'ups' & 'downs' & why it might be worth asking your vet about.
I am relieved to hear he is doing better! I know it is hard trying to make the descion on whether to go on or not (& I am so glad you did), especially with how horrific & dramatic the onset is...it is hard to see how that time may resolve it. Alot of dogs are PTS because it so dramatic & they are generally older dogs...folks can not see them getting better or sadly, why spend the money on an old dog? I think he will continue to improve.
Best Wishes,
jane

[Jon]

Hi Jon,
Prednisolone is a streriod, an anti-inflammatory, see my post above Carol's, I tried to explain it's 'ups' & 'downs' & why it might be worth asking your vet about.
I am relieved to hear he is doing better! I know it is hard trying to make the descion on whether to go on or not (& I am so glad you did), especially with how horrific & dramatic the onset is...it is hard to see how that time may resolve it. Alot of dogs are PTS because it so dramatic & they are generally older dogs...folks can not see them getting better or sadly, why spend the money on an old dog? I think he will continue to improve.
Best Wishes,
jane

Okay, I see now. But the vet is pretty sure he didn't have vestibular syndrome so I don't think the steroid would be necessary to reduce any ear inflammation. Or were you referring to the steroid to help him with his arthritis? Up to this year I had his father on a steroid for his own arthritis but the name has slipped me at the moment (probably because I'm so tired). It worked wonders but he had to have it with large meals because otherwise it would be harsh on his stomach.

He's improved even more today and at times all I have to do is just hold my hand straight at his side to help steer him and he more or less walks by himself in short bursts. Gets pretty tired though and still has trouble getting up on his own, but he nearly got up on all fours today by himself. I think I'll wait til the weekend to see how he does and then maybe update the vet on his progress and see if she would recommend predni or any other steroids for his arthritis. I'm a bit wary of the organ damage side effect since he already has an enlarged heart with a heart condition.

[janew]

Jon,
I am thrilled he is improving!!! I hope his progress continues! My concern was your vet said 'there was no sign of an ear infection', I just wanted you to know with vestibular syndrome, it is not generally seen by looking down the ear canal.
jane

[Jon]

Jon,
I am thrilled he is improving!!! I hope his progress continues! My concern was your vet said 'there was no sign of an ear infection', I just wanted you to know with vestibular syndrome, it is not generally seen by looking down the ear canal.
jane

Thanks Jane.

Well from what I understand ear infections increase the chances of vestibular syndrome and my dog has never had one. His mum used to have ear trouble all the time (to the point of developing a haemotoma), but his ears have always been clean and he doesn't scratch them.

She didn't actually rule it out, but said given his history and after examining him she thinks it is more likely to be a stroke.

He actually walked by himself today for a few seconds. His hips were still low but he did it without assistance or without falling over.

and Happy Thanksgiving (if you are in the US).

[janew]

Happy Thanksgiving to you as well, yes I am in the US, Rhode Island...
I tried to explain, you do not need a history of ear infections or visible signs of an ear infection for it to be vestibular syndrome. In 30 years of vet teching & with my own dog almost always the dog has no previous history of ear troubles. As far as I can tell in researching & experience, it just happens usually to older dogs, it is thought be an inflammation of middle ear nerves, possibly from an infection or unknown reason (the middle & inner ear or not visible from regular vet inspection or looking in with the naked eye because the dog has a bend in the ear canal). The ears can be as clean & healthy looking as can be, it might still be vestibular syndrome. All the vets, I have worked with treated it with antibiotics & prednisolone. I have seen them adjust their choice of antibiotic if there is no improvement in 72 hours. It may resolve with no treatment in weeks to a few months but the dog feels too bad, in many cases, to eat or drink on their own with no treatment & may expire from dehydration. It has sudden dramatic onset in most cases & is many times thought of as a stroke. I am just glad your boy is getting better, whether it is a stroke or vestibular syndrome.
All the best,
jane

[Jon]

Update:

Well my puppy (yes I still think of him that way...kind of hard not to when you witness them mere moments after birth) is doing much, much better. He's now able to walk by himself and today was even able to shake himself without falling over (which happened before), though he still becomes unsteady if he does shake himself (for instance if he was rolling in the grass and wanted to shake the grass off or if got a bit wet and wanted to shake the water off). He has even been able to run a bit without falling down although if he over-exerts himself he will fall or slide. Sometimes has trouble holding himself up to poop but he can more or less do that on his own now (Thank God, because he complained greatly about not being able to do so). He hardly leans to one side anymore but at times whilst sniffing the ground his head still tilts a bit. For about a week and a half there wasn't much progress as he seemed to kind of plateau in terms of his recovery (could walk for a limited time, make an occasional run but would still lean to one side whilst walking and his head would still tilt at times) but since the start of this week he has made all those massive improvements. Even his eye is showing signs of improvement and seems to close better now (although that may be due to the drops I give him to protect the eye from drying out).

Once again thanks to you all for the support and advice.

[CarolC]