Continued from part 5
Dr. Mitelman: The situation was certainly offering us some challenges and it was time to consider exploring our options.
Billy was not able to get comfortable.
And neither was Barbara. We were now thinking that Billy's behaviour was beyond the tangible allergic skin or the previous back pain problems.
Would it make sense that his agitation, muscle trembling, unusual aggressive chewing behaviours and his right eye blindness were a sign of something wrong in his head?
A tumor? Something degenerative?
Perhaps a sudden change in his brain was the catalyst to the licking that pushed the ball into motion back in August. He was normal before this.
We needed a neurologist to do a complete assessment of Billy.
Barbara: This situation was certainly going in some unexpected directions. How did we go from a small skin lesion to a near-fatal paw infection to skin allergies to suspected seizure behaviour? I was understandably confused and concerned.
My first reaction to taking Billy to see a specialist was concern that Dr. Mitelman would feel I didn't trust him. But it was actually Dr. Mitelman himself that made me realize that another opinion would help guide him with regards to Billy's treatment plan.
At the same time, my mother had passed away and I was left to deal with this loss and the settling of the estate. Dr. Mitelman continued to be a huge support, making sure Billy was well cared for while I took care of my family's needs.
Dr. Mitelman: The next couple of weeks were rough. The initial neurologist's appointment was delayed when Barbara's mother passed away. But the possibility that something serious might come from the upcoming neurologist's appointment weighed on us. And Billy's unsettled behaviour continued.
The neurologist's examination actually brought us a couple of surprises.
The on-site ophthalmologist inspected Billy's right eye blindness and declared it to be Optic Nerve Aplasia. This is an inherited trait and congenital. Billy had been blind in his right eye from birth.
The neurologist could not find any identifiable anomalies from her examination.
And Billy did not appear to have any noticeable deficits from his previous back problem.
So now what? Could this be middle age-onset epilepsy? Focal seizures? Not enough to spiral him paddling into unconsciousness, but enough to unsettle him and induce odd behaviors?
Working on this hypothesis Billy was prescribed a seizure control medication called levetiracetam. Thankfully this did not cause any surprise side effects.
Barbara accepted this protocol, but with trepidation.
No one likes to live with unknowns. Billy's diagnosis was still unknown.
Barbara: Hearing that Billy was blind in his right eye from birth was quite a surprise. But as he had only seen the world from one side, he had learned to compensate.
The idea of focal seizures was a little unnerving. We were given "emergency" seizure interventions and instructions should this condition escalate. And I was not accustomed to giving Billy medications without a defined diagnosis, which is the way I viewed the levetiracetam.
The neurologist explained that if we were to do an MRI we could have a clearer picture of Billy's brain, and possibly a diagnosis. There was also a test called cerebrospinal fluid tap which would investigate the fluid encasing Billy's brain for any clues. This was an invasive procedure with inherent risks.
At this point I declined both. I needed some time to discuss the options with my family and Dr. Mitelman.
Our plan became to monitor Billy and I was asked to keep a daily journal of his behaviors. Perhaps this would offer us more clues.
Dr. Mitelman: With the levetiracetam on board we noticed Billy's demeanor and sleep patterns improve. Gone was the muscle trembling, staring, pacing and frantic chewing. The Billy of Olde was back.
But in two weeks, Billy's trembling returned.
Related articles:
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)
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