Tuesday, August 30, 2011
The Plot Thickens: Billy's Story (Part IV)
Continued from Part 3
Where we left off: An inter-digital cyst had been found on Billy the large dachshund’s left front paw, adding to the problem of the badly infected right front paw. Out of nowhere came an unexpected bad response to medication.
The plot thickens …
After having a peculiar response to the combination steroid/antihistamine, Billy was left at the hospital for further assessment.
Dr. Mitelman: The pharmaceutical company was kind enough to authorize a thorough diagnostic work up including blood and urine tests, blood pressure, radiographs and ultrasound.
I'd hoped the tests would shed some light on Billy's unusual and prolonged reaction to the medication.
liver enzyme called alkaline phosphatase (ALP), derived from the bile ducts within the liver.
We could not ascribe any significance to it.
Notwithstanding that, the idiosyncratic reaction to the medication itself did not make sense. Sedative effects for over two days?
Perhaps Billy's liver couldn't metabolize or eliminate the drug properly?
Maybe the selective barrier surrounding the brain (the blood-brain-barrier) wasn't selective enough. This reaction was definitely a first for us.
Barbara: I was actually finding it hard to believe that my dog had a reaction that NO ONE had seen or heard of.
So I started doing my own research.
Dr. Mitelman: Billy's leg licking, chewing and irritated armpits from presumably itchy skin was unrelenting. He was up in the wee hours of the morning, scratching, whining, catching his leg in his e collar while attempting to chew it.
Nothing the sleepless family tried offered any relief to him (or them).
We discussed our options. Barbara was reluctant to have Billy take steroids, a concern left over from side effects experienced by her first dachshund, Auggie. So we decided to try an over-the-counter antihistimine.
Barbara: Yes, and then we tried the antihistamine. I was comfortable with this as my husband and son took it to treat their allergic reactions to stings/insect bites. I actually had some at home.
I hoped this would give Billy some much need relief that night.
Dr. Mitelman: The veterinary drug book indicated this drug would be safe, particularly at the low dose prescribed. I haven't had or heard of any complications with it before, when given to dogs half Billy's weight, at this same dose.
Wrong again. Several hours after the always trusting Billy accepted his medication, he changed. Dr. Jekyll and Mr. Hyde. He became delirious. Confused, wide eyed and agitated. Pacing in the house, back and forth.
Perhaps he indicated the urgency to urinate. As Barbara opened the door, out he darted, almost falling off the porch. Unresponsive to her calls, he darted into the street, confused. And then he froze. Barbara, visibly shaken, scooped him up and carried him back home.
Barbara: Billy's reaction to the antihistamine was frightening. Never again.
The only way to keep him safe that night was to crate him. He eventually stopped whining and thrashing about. By morning, eight hours later, he finally slept.
Dr. Mitelman: Pharmacologists were consulted again. An explanation called "hyperexcitation", at paradoxically low doses of the antihistamine, was offered.
This was a hard pill to swallow. The previous combination drug knocked him out, the current one over stimulated him. Where is this all coming from?
James Herriot, meet Sherlock Holmes.
Barbara: So we went on a search for possible sources bringing on Billy's unrelenting itching. What could he be reacting to? Dr. Mitelman and I started to dissect every aspect of our family's life. Shampoos, deodorants, cleaning products, dust mites. Our family life became an open book.
Somewhere in here we changed Billy's food to a kangaroo and oat formulation, used for sensitive skin issues. Billy loved it. But I was told it could take months to see the desired results. If it helped at all.
Late night emails, back and forth with ideas.
Dr. Mitelman, Billy and I really didn't need to sleep, did we?
Dr. Mitelman: In addition to the stresses revolving around Billy's physical and mental state, Barbara had her hands full with those of her own.
Her aging mother, in the advanced stages of dementia, required intensive care, beyond what the nursing home had to offer. A certain end was coming and Barbara was faced with challenging decisions. The stress and responsibilities placed on Barbara were immense. You could see it in her eyes and hear it in her voice.
Fortunately, she was surrounded by caring people and her strong will and determination helped her forge on.
Barbara: Dr. Mitelman, Jonathan, was an amazing support during my mother's difficult last months. I will always remember this and be grateful.
Billy could not be left alone so Dr. Mitelman arranged for me to leave him at the hospital any time of the day or night.
Billy continued to show us more and more peculiar behaviors. We knew we had to continue our search for some answers.
Dr. Mitelman: Little astonishment to our readers, more surprises lay ahead.
When A Small Sore Turns Into A Catastrophe: Billy's Story (Part I)
Life-threatening Infection Resolves; All Is Good? Billy's Story (Part II)
What Is Going On With Billy's Skin? Billy's Story (Part III)
The Plot Thickens: Billy's Story (Part IV)
I've Never Seen That Before: Billy's Story (Part V)
Billy's Diagnosis Still Unknown: Billy's Story (Part VI)
Neuronal Ceroid Lipofuscinosis (NCL)? Billy's Story (Part VII)
Time To Make A New Plan: Billy's Story (Part VIII)
Atopic Dermatitis? Billy's Story (Part IX)
It Is Not Neuronal Ceroid Lipofuscinosis But What Is It Then? Billy's Story (Part X)
My Dog Has A Gut Of Steel, Doesn't He? Billy's Story (Part XI)
Feeling As Though Running Out Of Options: Billy's Story (Part XII)
Fighting Fire With Fire Backfires: Billy's Story (Part XIII)
A Second Endoscopy: Billy's Story (Part (XIV)
Staying The Course: Billy's Story (Part XV)
Fewer And Fewer Solutions Left: Billy's Story (Part XVI)