Dawg Business: It's Your Dog's Health!: I've Never Seen That Before: Billy's Story (Part V)

Tuesday, September 6, 2011

I've Never Seen That Before: Billy's Story (Part V)

By Dr. Jonathan Mitelman and Barbara Kelly

Continued from part 4

Billy, a large, muscular dachshund, had shown idiosyncratic reactions to medications and peculiar behaviour not seen in the past. He was still suffering from constant itching.

Dr. Mitelman: Realizing that using steroids might be the only effective relief for Billy's constantly itchy skin, I suggested this to Barbara.

Puzzled about this, she joked about muscle and hair growth.

I explained that the steroids I would prescribe would be of the anti-inflammatory nature. She voiced her concern about the recent medication that knocked Billy out for a whole weekend.

Realizing we had few options we agreed to give the medication a try. Methylprednisolone, the steroid with the "fewest" side effects, was prescribed.

Billy was discharged with a handful of soothing shampoos, topical steroid creams and sprays plus the new medication to try. As in try and see what happens and how long Barbara and Billy will be up in the night.

A few days passed. Billy wasn't as itchy, but he did exhibit the anticipated increased thirst and urination.

Things were looking up. "We shouldn't see any more problems,” I said hopefully. Barbara, sounding somewhat relieved, agreed.

This temporary reprieve was the calm before the storm.

Barbara: Billy's behaviour had always been pretty straight forward. He was an easy to deal with type of dog. He loved to eat, he slept only at night but very soundly. He functioned well within the family's schedule. He was happy, full of energy and athletic.

The differences we saw as his day-to-day behavioural changed were noticeable and became alarming to us.

Dr. Mitelman: We didn't see fewer problems, but we saw different ones. Billy developed high frequency fine muscle tremors undulating like waves up and down his back. They were fasciculations (twitches) of the cutaneous trunci muscle (the thin muscle layer sandwiched between the skin and superficial fat layer along the back and the sides).

Imagine getting shivers running down your spine for prolonged lengths of time. In the middle of the night. Every night.

"Why is this happening"? Barbara asked, fear audible in her voice.

Little did I know my response of, "I have never seen that before" would figure so prominently in Billy's medical log.

Is it a pain response?

Billy had a previous bout of disc disease leading to hind-end paralysis two years prior. Was this a recurrence? But I couldn't elicit any back pain on palpation and the dog walked normally.

Barbara: The tremors kept us up at night. Billy came to me in search of comfort. I could feel the vibrations going from his body through mine. I timed them, counted the seconds in between. I sent Dr. Mitelman middle of the night emails from my Blackberry.

Once the tremors ended, Billy would fall into a very deep sleep. I would lay awake and listen to his breathing until I could do the same.

Dr. Mitelman: As the days passed, Barbara reported changes in Billy's behaviour and attitude. Agitation and pacing in the living room and hallway at night, lasting at times for hours.

And there was the unusually aggressive chewing and destruction of the "indestructible" chew toys.

"Could this be from the steroid"? asked Barbara.

"I have never seen that before", was my reply.

Another day, Billy stayed in one spot and barked at the radiator for close to an hour. Barbara captured it on video and showed it to me.

The now often repeated reply was given once again, "I have never seen that before".

Barbara: One day I came home to find Billy sound asleep in his crate.

He didn't come to greet me, tail wagging and excited as usual.

I called his name. He looked up at me blankly and stared. I called out to him over and over, there was no response. I went to him, touched him, spoke to him. Minutes passed and finally he looked at me, started to wag his tail and lick me.

I spoke with Dr. Mitelman later that day and described Billy's trance-like behaviour.

That was the first time the doctor used the word "seizure" in reference to Billy.

I was shocked.

Dr. Mitelman: When Barbara described the trance-like behaviour and later the snapping at the air, I realized I had seen this before. Billy may have had a seizure.

We needed to evaluate Billy more carefully. A full neurological examination revealed proprioceptive deficits or positioning weakness on his right fore and hind limbs.

And he was blind in his right eye. Though his pupils look the same, careful evaluation revealed his right eye responded weakly to bright light and did not respond to menacing motions.

"How long has he been blind," asked Barbara. “And how could we have missed this?"

Barbara: I could tell by Dr. Mitelman's demeanor that he was about to deliver some upsetting news. He cited the exaggerated itching, abnormal drug reactions, recent behaviour changes and blindness....

I cut him off, “A brain tumor?"

Dr. Mitelman nodded in affirmation.

"I have to know,” I said. "Who can see Billy as soon as possible?"

***

Dr. Jonathan Mitelman, DVM, graduated from the Ontario Veterinary College in 2002. After graduation he joined the staff at the Kingston Road Animal Hospital in Toronto, becoming a partner with clinic founder Dr. Morris Samson in 2005. Together they formed VETSToronto, the Emergency Service Trauma Network in 2009.

Dr Mitelman's interests are in orthopaedic and soft tissue surgery, ophthalmology, and cardiology. He is experienced with the endoscope/laparoscope, ultrasound, slit biomicroscope, and CO2 surgical laser. He is married and has a daughter, son, and three cats.

***

The Kingston Road Animal Hospital, and its founder Dr. Morris Samson, are celebrating the clinic's 25th anniversary this year. VETSToronto, the veterinary emergency trauma service, is housed in this location in the Beach area of Toronto.

The hospital is a full service emergency/after hours/critical care facility that provides around the clock care. There is a doctor on site 24/7/365. Owners Dr. Samson and Dr. Mitelman oversee all cases, providing continuity of care.

Referrals from other hospitals are examined, stabilized and treated, then returned to their regular clinic. Follow ups are done with both the referring veterinarians and the pet's owners.

As a full service hospital we have the following:

on site ultrasound
on site endoscopy
laser and orthopedic surgery
emergency/critical care specialists, internal medicine specialists, and surgeons on call

Tuesday, September 6, 2011

I've Never Seen That Before: Billy's Story (Part V)

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