Mystery paralysis

[CarolC]

Hoping all goes well and you get more answers this time.

[LisainCAN]

My thoughts are with you. Please keep us updated.

[clonmel08]

We're here now and I'm afraid I'm being pushy. But we need to be clear going forward.

[CarolC]

You're advocating for your dog.

[clonmel08]

Our newish neurologist at OVC was very informative and thorough. He understands where we are and how we want to move forward with some kind of treatment. He did an assessment to compare to the intitial one. Unfortunately Robin has deteriorated in that he is losing nerve function to his voice/bark and face. New xrays did NOT show Megaesophage(loss of nerve to esophagus) as he thought. Or a thymus tumor or pneumonia from aspiration of wzter or food. In fact it was perfect. They gave Rob fluids as he does not want to swallow water.
Dr Leonardi suggests
1. M gravis. This was suggested at the very beginning. I dismissed it because I thought the disease was caused by the fall. On the way home after we left Robin, Nancy and I talked about all of the "strange" unexplained weakness and other possible symptoms we put down to old age.
Dr Leonardi doesnt seem to invested in this diagnosis but it is the rasiest thing to try. We began meds for MGravis right away, I can only pray that is what it is. Turn around should be immediate though he may need to be on meds for 6-8 months.
2. If there is no response to the MG drugs then Ro in will go on Prednisone. Im not sure what disease this is for ? I missed that part of the discussion I think.
Rob is going back tomorrow to see if he is responding to the meds. I pray we see some improvement.
I'll let you know.

[clonmel08]

Myasthenia Gravis in Dogs and Cats


https://veterinarypartner.vin.com/defau ... id=4951980

[CarolC]

Ohmygoodness. I'm going to be reading a lot about that tonight but it would be great if that was it. A neck problem would not lead to facial paralysis so I guess that is ruled out now. The article says if the initial medication does not work, they try steroids (like prednisone). Ohmygosh I hope this works.

Immune-Suppression

Corticosteroids, such as prednisone and similar drugs, can suppress the production of the antibodies that are destroying the neuromuscular junctions. In general these medications are avoided unless the anticholinesterase therapy does not yield acceptable results.

Even if the doctor is not invested in it, I am glad he is trying something! Good for him!

[CarolC]

On the way home after we left Robin, Nancy and I talked about all of the "strange" unexplained weakness and other possible symptoms we put down to old age.

It would be great to know what symptoms you noticed, as it may help someone else someday...

P.S. Did you read the information in the article about side effects of medication? Not sure which med he is taking but here is what the (2003) article calls the typical one:

Pyridostigmine (Mestinon®) is the typical medication used to prolong the action of acetylcholine. By inactivating acetylcholinesterase, the receptors that have not been destroyed by the immune system can bind acetylcholine longer. It is typically given orally two to three times daily and is associated with some nausea, cramping, and possibly diarrhea. This can be dealt with by diluting the medication or by giving medication on a full stomach. Other side effects can be excess tearing of the eyes, and drooling.

Hopefully you have a stock of potty pads, paper towels, disposable gloves, and laundry detergent, or can get them before the stores close.

Maybe he hasn't developed mega-E because he has only shown involvement in the throat this week? It was just yesterday 11/25 you mentioned he lost his voice.

[clonmel08]

Thanks for responding. Some of the weaknesses we put down to age, or perhaps, missing his " brother" my dog, who passed away in July 19.
1. He couldn't jump up onto chairs or bed in the last year or so. We put it down to eye sight? He would rock back and forth facing the chair but couldn't get up.
2. After Pip died July 2019
Robin stopped coming out to the barn for chores.
3. He stopped going for walks in the fall. He might go around the house or garden but not around the field. We thought it was strange but just old age?
4. He couldn't get up the cellar stairs at all. Not even one step. I put it down to arthritis but still thought he should be able to climb stairs. This is the late summer/ fall 2019.
5. Stayed in bed later in the morning, even if we got up. Again, just old age? But at 11?
Yes we are aware of the side effects. Hope there aren't any. Praying this works but prednisone as a back up anyway. The drug that was suggested 5 weeks ago. Strange journey.

[CarolC]

Thank you so much for posting that information. I could easily see chalking things up to age, hips, knees, arthritis, vision (indeed) and the like.

It makes you wonder why now. That is something I will be looking for. But probably the sadness of losing his brother didn't help his immune system these past several months.

I've found 3 videos that seem good. Two are of fox terriers. They are in a foreign language but you get the gist and the pictures are wonderful. The third video is a discussion by a board certified neurologist and also seems helpful.

I totally agree, how much distress might have been avoided for all of you if this had been tried 5 weeks ago when they mentioned the possibility of MG, or if prednisone had been tried because they didn't have any better ideas. But when I saw the first video (below) of the dog completely down, yet he walked again, I'm hoping for the best.

Is his rehab evaluation in 2 days?

[clonmel08]

Well, Nan and I haven't seen any change or improvement. The Dr suggested that we might if it were MG. I'm headed back to OVC at noon for the Dr to re-ealuate. Perhaps there would be an improvement that we can't see yet? Nan and I have nearly given up. Robin has lost the brightness in his eyes and he cries anytime we are not holding him. The Dr said steroids next but then that would be the last option. I'll let you know. Nan is crying because all we can find on the web is success stories. Every dog seems to get better. Anyway I know there are so many that don't. We postponed our rehab appt till the prednisone. If it doesn't help the dx is probably a tumor. We haven't found any metastatic but then we selected not to do the ultrasound of his abdomen. If its cancer we' ll know as nothing we do will help. Nancy will not put him through cancer treatment.
Let's hope for some positive news today.

[CarolC]

OK...well, I read they start the dog on a low dose to minimize side effects, so I assume he has only had maybe three doses and they were low. I hope the vet does find some subtle improvement.

There is a test called the Tensilon test, did you see that? It was in a video in the link you gave, and there are several other videos showing it on youtube. It is an injection of short-acting medication, and a minute or two after the injection you see the dog responding to it and walking well (then it wears off and the effect wears off). When they respond, it tells the clinicians the dog will respond to medication. I wonder if they have that available at OVC. I do not actually know how long it would take for the oral form of medication to begin to work. I have a veterinary drugs manual and would love to look it up, but I am not certain which medication he is on, Mestinon?

EDIT TO ADD: If it is Mestinon, my reference only says "the onset of action after oral dosing is generally within one hour". (Plumb's 4th ed)

SECOND EDIT: I wonder if he is looking less bright because the medication is making him feel a little off. The manual says "Start at low end of dose and increase as necessary to avoid a cholinergic crisis." To me (not being a vet) that sounds like it's something the body adjusts to. I know there are human medications where you feel crummy for a week or whatever until you get used to the new med.

[LisainCAN]

The part about him crying when not being held broke my heart. He loves and trusts you with all his whole being. He knows you are doing everything you can for him. Please do not feel like you have failed. Sometimes, it is beyond our control, and no matter how much money we have, or how many treatments we try, we simply have to give in to nature. I would have given anything for my Corso to survive and there was literally nothing in the world that we could do but let her go. In the end, that is hardest and most important part of loving a dog: deciding when to stop and being there when it does.

[clonmel08]

So there was no response to the MG drug. Dr wants us to give another two doses just to be sure. If nothing seen by tomorrow he sent us home with prednisone. He said we wouldn't see improvement right away, perhaps by friday or even next week. He didn't sound hopeful. He says we're out of options now. Robin just ate a big plate of beefstew( made for him, no salt) The prednisone will reduce his immune response that is destroying his nerve endings. If thats what the problem is. We have to monitor his breathing. If he begins to really struggle, well Nan and I agree that will be the end. I cant thank you enough for being so supportive. Ill continue to keep you imformed. You never know what might happen next.

[LisainCAN]

Exactly. You never know. Here's hoping pred will do the trick