Tuesday, September 6, 2011
I've Never Seen That Before: Billy's Story (Part V)
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.
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.
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?"
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)