Thursday, September 29, 2011

Dog Development

This is another awesome iconographic that is brought to you by pet365. This one will help you understand dog development stages.

All dogs pass through various stages as they grow and develop. 

Psychologists use the term critical period to describe a specific time in a dog's life when certain experiences have a lasting effect on their psychological development.

Understanding these critical periods and dog's stages of development will better help you understand your dog's behavior and how to handle him during these special times.

Dog Development

Dog Development graphic created by Matt Beswick for Pet365 - a UK stockist of Dublin Dog collars and brands like Hamish McBeth. Click here to view the full post.

Wednesday, September 28, 2011

Dog Cartoon Of The Week: Damn Webcam!


***

Dog Cartoon of the Week is brought to you by Andertoons. Check out the website for more great cartoons.


Cartoonist Mark Anderson lives in the Chicago area with his wife, their children, two cats, a dog and several dust bunnies. You might have seen his cartoons in a number of publications including Reader's Digest, The Wall Street Journal, Good Housekeeping, Forbes, Barrons, Woman's World, Harvard Business Review, Saturday Evening Post, American Legion Magazine, Funny Times.

Tuesday, September 27, 2011

Time To Make A New Plan: Billy's Story (Part VIII)

By Dr. Jonathan Mitelman and Barbara Kelly

Continued from part 7

When we last left Billy, he had seen the second neurologist and everyone was waiting for the results of the MRI to come back.

Barbara: I remember the MRI so clearly. It was the Saturday before Mother's Day and we had to drive about 45 minutes in a nasty rain storm to get to the diagnostic clinic.


Billy had to be fasted as he would have anesthesia for the procedure so we timed everything so we could put him right in the car. He wanted his breakfast and he let us know about it.  All the way there.

I was anxious for the results and to be honest fearing the worst but Dr. Mitelman did his best to keep me focused on the positives. 

Remember that quirky sense of humor we share? It comes in handy at times like this.

The MRI went well and Billy recovered from the anesthesia quickly. The staff were compassionate and supportive and I was told we could have the results by the following Tuesday.

Dr. Mitelman:
Trepidation fought with anticipation and curiosity for the emotional spotlight the morning of Billy's MRI. Would a physical anomaly in his brain or spinal cord finally provide answers, relief and lay to rest months of anxiety and unpredictability?

But, what would be worse? 

Would it be the brain tumor that could threaten Billy's future or the clean scan that would mean devising a new game plan?


It made me re-examine myself, my peers, and my clients.

Where are we going with this and what are we going to do when we get there?

A few days later the neurologist called to confirm no anomalies were found on the brain and spinal cord scan. What a relief! No grounds for back pain and no anomalies within Billy's head.

Time to make a new plan.

Barbara: When the neurologist called to report the MRI results I actually cried with relief. She gave me some options to discuss with Dr. Mitelman.

She suggested we consider doing the brain biopsy to provide us with a more conclusive diagnosis and that we needed to pursue the cause of his skin and possible pain issues.

Back to see Dr. Mitelman. We had more conversations about this than I can count.

So many questions, so few answers. Process of elimination is frustrating.

All I knew was Billy's peculiar behaviors were increasing: pacing, agitation, restlessness. And the now-daily tremors were growing in frequency and intensity. At times, he was licking and chewing any body part he could reach.

Dr. Mitelman: If there wasn't a tumor, could that mean there was an inflammatory problem hiding? Some bad wiring?

The neurologist suggested the next stage was getting cerebrospinal fluid and brain biopsy samples. Barbara's response was a definite “no”, as she felt the risks were too great. Though it sounded outlandish, there was some logic to performing the biopsies. However, I had to concede to Barbara's firm decision.

So, if there was pain, where could it be? His skin? Would any other organ system care to step forward and speak up?

Our goal became to seek some immediate relief. An e-collar worked just about as well as handcuffs. Though he couldn't manage to lick and chew his target feet, he managed to disrupt himself and his family through loud nocturnal activity.

We used gabapentin to mitigate pain signal transmission at the level of the spinal cord, and tramadol, an opiate, to dull pain sensation and awareness to some degree.

For anti-inflammatory relief, I prescribed methylprednisolone, a cousin to the steroids used and previously discarded. Steroids are the mainstay in relief of pruritus, and this one has fewer side effects than some others.

And it worked. For a short while. 

Soon the side effects of the steroids including increased water consumption and urination began to overtake the benefits.

So the licking and chewing resumed. Then bouts of aggression were added to the nightly pacing.


A consulting pharmacologist suggested this could be 'steroid mania', a condition I had only heard of but hadn't witnessed. I didn't have, nor did my peers have, any other cases to compare to or contrast with.

Barbara: This was such a physically and emotionally exhausting time for us. We still had some avenues to explore but the mounting costs were having a bigger impact on the family.

I had many questions but I never 'questioned' Dr. Mitelman's judgment or treatment plans. I was always a part of the decision making process, and we were certainly on a challenging journey together. Put simply, I trust Dr. Mitelman.

It was suggested to me on several occasions, by those around me, that I should ignore Billy. Put him somewhere safe at night and just go to sleep. Let him pace, have tremors, cry out. 

I could not ignore him then, nor can I now.

My commitment to Billy means taking care of him, including times when he isn't well or has discomfort. This is not open for discussion.

***

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

A full listing of diagnostics and additional services is available on our website, www.vetstoronto.com



www.vetstoronto.com
www.vetstoronto.com/blog
www.facebook.com/vetstoronto
Twitter. @vetstoronto & @iambillysmom
Ask Dr. Mitelman vetsdrjm@gmail.com


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)

Monday, September 26, 2011

Adoption Monday: Rocket, Greyhound, Middleburgh, NY

On Saturday Jasmine went to see her chiropractor. In the reception she met a male Greyhound who is getting physical therapy as part of his knee surgery post-op.

He was a racing dog who was tossed after he busted both of his cruciate ligaments. Yes, that's how they get treated.

Jasmine gets along with all dogs, but she fell in love with this guy. They were both quite taken by each other. It was love at first sight. His new forever parent had a hard time convincing him that it was time to go.

His sad story has a happy ending, he found a good home where he is treated like a member of the family and not like an expendable commodity.

Thousands of Greyhounds are not as lucky and are destroyed each year!

Meet Rocket, 4 years old, beautiful light brindle Greyhound.

He is neutered, had his teeth cleaned and is current on his shots. Heartworm negative.

Rocket will make an excellent family companion and will work well in an apartment or condo type dwelling.

Rocket was tested feline tolerant and is proving himself to be a very sweet boy with a nice mellow disposition.

Find Rocket's profile on Petfinder or visit Forever Home Greyhound Adoption's website.

***

Forever Home Greyhound Adoptions is a 501 C3 Not For Profit Organization dedicated solely to sheltering Greyhounds in need until a warm loving and responsible home can be found for them. They are especially interested in the plight of the Florida Greyhounds and have dedicated themselves to helping as many of them as possible to reach the safe haven of a loving and supportive family in the Capital District and beyond .


Forever Home Greyhound Adoptions aims to change the world for as many Greyhounds as possible.

Saturday, September 24, 2011

Kidney Disease – Say What?

by Jennifer Coates, DVM

When I was writing my book the Dictionary of Veterinary Terms, Vet-Speak Deciphered for the Non-Veterinarian, the kidneys (not my kidneys thankfully, but kidneys in general) caused me no end of grief.  Not only are the kidneys themselves complicated, but so is the terminology associated with the diseases that affect them.

So here’s a primer on canine kidneys and all the associated verbiage. 

Kidneys: Where are They and What Do They Do?

The kidneys are two separate but essentially identical organs that are located between the abdominal space and the lower back.  Technically, they do not reside in the abdomen but within the retroperitoneal space (i.e., the space behind the peritoneum or lining of the abdomen).  The left kidney is usually a little farther back than the right.

Each kidney is made up of hundreds of thousands of nephrons, the functional unit of the kidney.  

Think of a nephron as basically being a microscopic filter attached to a long tube.

Image: Encyclopedia Britanica
The blood that enters the kidney progresses through progressively smaller vessels until it meets a single nephron.  There, “bad stuff” (e.g., toxins that are produced by the body’s metabolism) is filtered out and turned into urine, while “good stuff” (e.g., red blood cells and water) is either not filtered out in the first place or is reabsorbed before urine production is complete. 


Normal kidneys have many more nephrons than are needed on a day to day basis.  

Why is this important?  Because we can’t replace a nephron once it is no longer functional, and LOTS of things damage nephrons (more on this later).

But the kidneys do more than just filter out “bad stuff,” they also secrete a hormone that stimulates red blood cell production, play a role in regulating blood pressure, conserve water, help balance electrolyte levels, and more.

What is Kidney Disease/Failure/Insufficiency

A disease can be defined as anything that adversely affects the functioning of the body.  Therefore, kidney disease is anything that adversely affects kidney function… this could be infection, an immune disorder, degenerative disease, neoplasia (cancer), trauma, etc.

Saying that a dog has kidney disease is basically the same as saying that it has sick kidneys. 

What many people mean when they say “kidney disease” is kidney failure.  

Failure can be defined as a loss in the ability to perform normal functions to the point where the body experiences a significant adverse effect.  Some veterinarians don’t like the term “failure” (it sounds so untreatable) so they use “insufficiency” instead. 

A diagnosis of kidney failure usually means that laboratory values associated with kidney function (blood urea nitrogen (BUN), creatinine, urine specific gravity (USG), etc.) are found to be abnormal.

Another word that can apply to this situation is “azotemia.”  An azotemic dog has higher than normal levels of BUN and creatinine in its blood.

Uremia” basically describes the same scenario but also implies that the patient feels poorly because of its azotemia. 

What all this means is that most of the kidneys’ nephrons are no longer functioning. 

In fact, the earliest sign of kidney failure seen in typical lab work is a low urine specific gravity, and this doesn’t occur until about two-thirds of the nephrons have been lost.  Azotemia doesn’t occur until at least three-quarters of the nephrons are gone. 

Acute or Chronic?

Kidney failure can be either acute (describing something that just happened) or chronic (describing something that developed over weeks, months, or even longer). 

Acute kidney failure is caused by things like infections, toxins such as antifreeze or grapes/raisins, and episodes of low blood pressure, but in some cases an underlying cause can’t be identified.  

If the incident kills off enough nephrons, the patient will die without a kidney transplant.  On the other hand, if the patient can be supported through the crisis, nephrons that essentially went “offline” but weren’t fatally damaged may recover allowing the body to return to a satisfactory level of functioning.

Chronic kidney failure comes on slowly and is a progressive disease. 

As I mentioned before, LOTS of things can damage nephrons.  Acute episodes may knock out a bunch all at one time, but the wear and tear of daily life also takes a toll and gradually reduces the kidneys’ reserve supply of nephrons.  Over time, the kidneys may reach the point where only one-third to one-quarter of nephrons are left, and the symptoms and laboratory evidence of kidney failure develop.

The International Renal Interest Society (IRIS) has come up with a staging system that lets veterinarians communicate how severe a dog or cat’s chronic kidney disease is.  IRIS uses the term “disease” because they include animals that are not currently in kidney failure but are at high risk for it in the future.

But this also begs the question, what’s up with the “R” in the “IRIS?” 

Here’s one more term for you.  “Renal” is the adjective form of “kidney.”  I guess “kidneyal” was just too much of a mouthful.

***

Jennifer Coates, DVM graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999.  In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado.  She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-speak Deciphered for the Non-veterinarian

Jennifer also writes short stories that focus on the strength and importance of the human-animal bond and freelance articles relating to a variety of animal care and veterinary topics.  Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and pets.

Related Articles
Whats In The Urine? (Part I: What You Can Notice On Your Own)
What's In The Urine? (Part II: Urinalysis)

Further Reading:
Recognizing the Signs of Kidney Failure in Dogs
Early Diagnosis of Kidney Disease in Dogs
Acute Kidney Failure in Dogs
Diagnosing Chronic Renal Disease and Kidney Failure in Dogs
Kidney and Urinary Disease in Dogs
Kidney Failure in Dogs

Articles by Dr. Coates:
The Perplexities of Pancreatitis
The Other Side Of The Coin: The Cost Of Defensive Medicine
To Neuter Or Not To Neuter… That Is The Question
Don’t Forget the Physical Therapy
Common Misdiagnoses (Part 1)
Common Misdiagnoses (Part 2)
Picking the Right Dog to Breed
When Is It An Emergency?
Dog Allergies: Common, Commonly Misdiagnosed, or Both?

Thursday, September 22, 2011

What Do Those Nutrients Do? Calcium

nutrient n. a substance required in the diet to maintain normal body function
Source: Dictionary of Veterinary Terms: Vet-speak Deciphered for the Non-veterinarian

The importance of calcium

We all know that calcium is an important component of bones and teeth. What you might not know is that calcium does much more than that!

IMG_4290
Calcium is not only found in bones, but it is also circulating in the blood.

The blood calcium is essential for a number of important functions, such as blood clotting, hormonal secretion, nerve conduction and muscle contraction (don't forget, the heart is a muscle too!).


Because of its importance, your dog's body has a control mechanism to keep blood calcium at proper  levels. When blood calcium levels drop, calcium is withdrawn from the bones to correct the deficit. If your dog doesn't get enough calcium in his diet, or cannot absorb it properly, it will result in loss of bone density.

There can be quite a substantial bone density loss before calcium deficiency might show up on blood work or present with other symptoms!

Because of her long unaddressed undiagnosed metabolic and digestive issues, when Jasmine was undergoing her first ACL surgery, her vet had to use a chuck and pin to drill through her tibial crest; he noted that he's never felt a softer tibia!

Other nutrients (such as vitamin D) and hormones (parathyroid hormone and calcitonin, a hormone secreted by special cells of the thyroid gland) play a regulatory role in calcium absorption, function and metabolism.

Kidneys are also involved in regulating calcium to phosphorus levels.

The dog's body takes the importance of proper calcium levels seriously.

With the bones serving as a repository, this system is to ensure that there is always the right amount of calcium in the bloodstream.

Image source: Visible Body
What happens when the fail-safe system fails?

Calcium deficient diet, or poor calcium absorption will foremostly reflect in the bones. Hypocalcemia, low levels of calcium in the blood, is typically caused by regulatory problems.

Hypocalcemia

Severe hypocalcemia can be life-threatening! Symptoms can range from muscle twitching or weakness to convulsions. Because the heart is a muscle also, hypocalcemia can lead to heartbeat abnormalities and even cardiac arrest.

Hypocalcemia is most commonly caused by disfunction of the parathyroid gland (often immune-mediated) but it can also be brought on by kidney disease, pancreatitis and other conditions.

The other side of the coin are calcium levels that are higher than normal, hypercalcemia.

Hypercalcemia

Hypercalcemia can be caused by a number of factors, such as cancer, Addison's disease or kidney failure. Overactive parathyroid gland or vitamin D toxicity are less common causes of hypercalcemia in dogs.

Hypercalcemia can lead to damage of any tissues but will most commonly affect the kidneys, nervous system and cardiovascular system.

Some of the symptoms of hypercalcemia include increased thirst and urination, lack of appetite and other difestive problems, lethargy, confusion and depression. In severe cases hypercalcemia can result in heart arrhythmia, seizures and even coma and death.

Got more respect for calcium yet?

The dog's body goes to great lenghts to keep the vital blood calcium at the right levels. It is not likely than poor nutrition would lead to hypocalcemia. Vitamin D toxicity can, however, cause dangerous and potentially fatal hypercalcemia.

What imballanced, calcium deficient diet will do, though, is have a damaging impact on your dog's bones and teeth. Calcium deficiency can be one of contributing factor in development of arthritis.

Disturbances in blood calcium levels require serious attention, diagnostics and treatment.

It's your dog's health,
Jana

Related articles:
Minerals in Dog Nutrition

Further reading:
Calcium-regulating Hormones
Kidney involvement in calcium phosphorus balance
Hypocalcemia in Dogs
Hypocalcemia: Low Blood Calcium
Calcium and Phosphorus Requirements for Dogs
Hypocalcemia: Low Blood Calcium
Hyperparathyroidism in Dogs
Hypercalcemia in Dogs

Tuesday, September 20, 2011

Neuronal Ceroid Lipofuscinosis (NCL)? Billy's Story (Part VII)

By Dr. Jonathan Mitelman and Barbara Kelly

Continued from part 6

When we last left Billy he had responded to the medication for possible seizure activity quite well for two weeks. Then the symptoms, including unusual behaviour, returned.


Dr. Mitelman: The reports of a calmer, happier Billy were welcomed by all. Barbara was talking about how the playful puppy-like behaviour that had all but vanished had returned and was now once again part of Billy's day. And with it came more restful sleep, for everyone.

We all breathed a sigh of relief. Again.

But, about two weeks later, in typical "Billy" fashion, everything changed. Barbara called to say they had a sleepless night, full of tremors and pacing. Finally the agitated dog gave way to sleep around 5 a.m.

Perhaps this was just an isolated incident? Wrong.

Add to that the loud whining and crying. Tremors became more frequent and much stronger. Billy's agitation was growing. And after each episode came a collapse into deep sleep for a number of hours.

I consulted with the neurologist. What were we missing? Had something new come to the surface?

What else was coming out of the woodwork?

We adjusted the dose of Levetiracetam, each time with temporary relief though only for a few days.

And then Barbara called to report the symptoms had returned.

Barbara:  We were exhausted. And I was always waiting for that "next episode" that would give us the clues we needed.

Despite Billy's obvious discomfort and lack of sleep, he was always a wonderful dog. In his calm moments he loved to snuggle, was loyal and affectionate. Tail wagging. And very dedicated to me.

But his agitation was increasing, and I felt we needed to explore other options.
I asked Dr. Mitelman to seek out specialists to help.

And I wanted to have a second neurologist look at Billy.

Dr. Mitelman:
I consulted with neurologist Dr. Linda Shell. She too agreed the signs were very vague, but perhaps Billy was on the cusp of something developing. She led us in a different direction.

Perhaps Billy had a degenerative disease, slowly causing deterioration in his brain, called "Neuronal Ceroid Lipofuscinosis (NCL)". 

I forwarded the article to Barbara.

The clinical signs are reduction in vision, tremors, ataxia (lack of muscle co-ordination), hypermetria (involuntary movements), behavioral abnormalities like aggression and hyper sensitivity and, ultimately, seizures and death.

That was certainly not news that was easy to deliver. 

Although visibly upset, Barbara agreed to think about testing for this condition, but she wanted to have Billy assessed by another neurologist first.

Barbara: The thought that Billy might have this life-threatening condition made me feel sick. But I knew we must try to find some answers and give my poor dog some relief. And I knew Dr. Mitelman was committed to Billy and supportive of my family.


The meeting with the second neurologist went well. I took my best friend with me to help gather the information and make decisions. Billy was given a thorough examination, though the doctor did not do anything unusual and confirmed that he had no notable deficits from his prior disk injury.

The doctor viewed the videos we took and reviewed the journal I had been keeping. I felt we had more to offer by way of clues this time.

Although Billy had some behaviors associated with focal seizures, she wasn't convinced that was what we were dealing with.

This neurologist was the first person to say that she was inclined to believe that Billy's tremors might be associated with a pain response.

I had nothing to offer, I couldn't see any obvious signs of pain. 

She requested we do an MRI and recommended we add another medication. She prescribed Gabapentin, a drug used to manage both seizures and pain.

At this point, I must add the mounting costs of Billy's veterinary expenses were beginning to impact our family. The MRI would need to be delayed by a couple of weeks so we could work the cost into our budget.

Dr. Mitelman: When Barbara brought Billy back for follow up she seemed relieved to have a plan in place. Keep in mind we were still dealing with Billy's itchy skin and constant cleaning regime.

We monitored the use of the two medications and anxiously waited for the results of the MRI.

***

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

A full listing of diagnostics and additional services is available on our website, www.vetstoronto.com



www.vetstoronto.com
www.vetstoronto.com/blog
www.facebook.com/vetstoronto
Twitter. @vetstoronto & @iambillysmom
Ask Dr. Mitelman vetsdrjm@gmail.com


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)

Monday, September 19, 2011

Adoption Monday: Adopt-A-Less_Adoptable-Pet Week

Big black dogs. FIV+ cats. Senior pets. Special-needs animals. Many factors can make a pet seem "less adoptable." To promote these unusual (or, in some cases, too common) animals, Petfinder has designated Sept. 17-25, 2011, as "Adopt-A-Less-Adoptable-Pet Week."


Deep down we all want the perfect dog. But what does that really mean?

The perfect dog for you might be just among those nobody seems to want.

He might be a bit older. He might not see, hear or walk so well. He might not be all that good looking. But he might have a big heart and he might change your life in a way you never thought possible.

Shiloh is one of those dogs. A dog with a great disposition and no luck finding a home.

Breed: Hovawart Mix
Female
Date of birth: approx. Feb 2008
Location: Charlotte, NC

Frankly, I can't believe she is still hasn't found one. She is such a sweet and loving girl.

She suffered from severe hip dysplasia but had FHO surgery done on both hips and recovered well. Long term prognosis after successful FHO surgery is excellent. She might not be as mobile as other dogs but the source of pain and arthritis is no longer a concern.

All she needs now is a loving home and little bit of attention to her weight and exercise regime.

She's been waiting so long, she truly deserves to finally have a loving family of her own.

If you have any questions about Shiloh or the Hovawart breed, talk to my dear friend @Kenzo_HW or read related articles on his blog Kenzo the Hovawart.

Ready to adopt Shiloh?

Please visit  www.projecthalo.net to fill out an application or contact Rhonda at projhalo@bellsouth.net for more information. PetFinder link http://www.petfinder.com/petdetail/15567762.

Related articles:
Shiloh Is Headed For A Second Hip Surgery And Hopes To Find A Forever Home
Shiloh Is Still Looking For A Forever Home

Saturday, September 17, 2011

Dawg Business: My 7 Links

Many thanks to Kenzo the Hovawart for passing “my 7 links” to Dawg Business. And sorry it took me a while to get around to this!

While the links below are my picks, I would also love to hear which post would you pick for each of the categories.

1. Most Beautiful Post
Wow, well, beauty in any form isn't really the mission of this blog but I'd have to pick The Many Reasons Why I Love Our Dogs: Loyalty. Loyalty is probably the most valued character trait in dogs and our guys can measure up to any of the heart-warming stories out there.


2. Most Popular Post
Officially and objectively Dawg Business' most popular post is Speaking For Spot: The Single Most Important Dog Book You Will Ever Read. Which makes me very glad because it IS a post recommending the single most important dog book you will ever read.

Seriously. Go, get it. Or as Dino would say, “Buy it, borrow it, steal it … do whatever you gotta do to read it.”


3. Most Controversial Post
My most controversial posts are still in working, I'm being very thoughtful about it because they will be controversial. Having to pick from those already posted, I'd have to go with Brad Pitt Doesn't Believe in Germs. Could he be right? This post is meant to challenge you to question things.

Just because everybody accepts something as a truth it doesn't make it so. What is black today may well be white tomorrow. Keep that in mind. Value expert opinion but remember it is always just that—an opinion. When it comes to your dog's health, I believe that any solution you reach for has to feel right to you also. If it doesn't, look for a different one. There are always other opinions and other solutions out there. (Hm, I wonder whether this post is making it's way to the most controversial one right here)


4. Most Helpful Post
Being helpful is the purpose of this blog. I'm hoping that all my posts are helpful to somebody. I am particularly grateful to all of you who shared your dogs' stories. I believe that real-life stories are most helpful.

If I had to choose one of my posts that I think is the most helpful, I guess I'd pick Talk To Me About ACL Injuries.


5. Post Whose Success Surprised me
Hey, that doesn't sound like very good English! A post, response to which truly surprised and touched me, was my cry out for help in Please Help Jasmine. I was really overwhelmed by all the help, friendship and kind response I received. I'd like to take this opportunity to thank you all again, you are truly wonderful.

Jasmine is doing great and it's in large part thanks to you!


6. Post That Didn’t Get the Attention it Deserved
Well, I tend to think that if a post didn't get much attention, it probably didn't deserve it. I wouldn't even blame the topic but rather the way I addressed it. With that said, I'd have to second Kenzo's dismay at Shiloh still not having a forever home. Shiloh Is Still Looking For A Forever Home. Come on, folks, let's find her one!


7. Post I'm Most Proud Of
There are a few posts I'm quite proud of but if I had to pick one I'd have to go with What's In The Urine? (Part I: What You Can Notice On Your Own). When I was researching for the post I couldn't find any comprehensive resource on the subject. With kind help of Dr. Lorie Huston I think we put together one of a kind article on the subject.

Cliche

I am also quite proud of The Cancer Antidote that Lies Within: You Will Never Look At Fat The Same Way Again. There, I did it, I put two links instead of one. Do with me what you may. I've put a lot of work into that article, trying to give you one heck of a good reason to keep your dogs thin.

***

I am passing the “my 7 links” to the following bloggers, looking forward to their picks:

Fearful Dogs Blog
Intellidogs
Dog Lover's Digest
Pet Huligans
That Mutt

Thursday, September 15, 2011

Dog Allergies Basics

by Ciara Black

While in humans allergies most commonly manifest with respiratory symptoms, dogs with allergies are most likely to suffer with skin issues.

Sierra scratches her ears

If your dog is itching and scratching, an allergy is one of the prime suspects.

It is important to properly diagnose and treat your dogʼs allergy, as he cannot do it himself. 

Be sure to monitor your dogʼs change in behavior or any symptoms of a possible allergy.

The most common types of allergies in dogs are
  • Flea allergies
  • Atopy (sometimes called inhalant allergy)
  • Food allergies

About 40% of dogs suffer from allergies everyday. 

It could be a change in your dogʼs environment, a new type of dog food or something a little more difficult to determine.

Most allergies are very minor, however, you should always take your dog to the
veterinarian for proper diagnosis and treatment.

Not sure what to look for when it comes to allergies? 

Without a doubt, the most common symptom of an allergy is excessive itching and biting of the fur.

However, there are other things to keep an eye out for. Other symptoms may include:
  • Bumps or sores on the skin; also known as “hot spots”. A hot spot is a localized area of skin inflammation and infection. These can be caused by excessive biting, licking or scratching of the skin. Common areas for hot spots are on the paws or right above the tail.
  • Ear infections. These are very common in food allergies. 90% of ear infections occur on the outer ear of your dog. Some signs of an ear infection are itching, a yellow to brown coloured discharge or head shaking.
  • Irritated, red rashes under the fur. If your dog is itching in one area in particular, check that area for a rash. The area is usually flakey, red and slightly swollen. Often times a rash can pop up within the first few hours in contact with the allergen.
  • Watery eyes and nose. Your dogʼs nose and eyes are naturally moist and may water for no reason. It is important to note if your dog has excessive eye discharge or mucous along with any other allergy symptoms to determine whether or not it is an allergy.

You can learn more about dog allergies, their symptoms and a list of treatments at
www.dogallergiesresource.com

Related articles:
Why Is My Dog So Itchy? Top 5 Causes Of Itching In Dogs
Dog Allergies: Common, Commonly Misdiagnosed, or Both?
Food Allergies in Dogs

Tuesday, September 13, 2011

Billy's Diagnosis Still Unknown: Billy's Story (Part VI)

By Dr. Jonathan Mitelman and Barbara Kelly

Continued from part 5
When we last checked in with Billy he was showing signs of possible seizure activity and blindness in his right eye.

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.

*** 

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

A full listing of diagnostics and additional services is available on our website, www.vetstoronto.com



www.vetstoronto.com
www.vetstoronto.com/blog
www.facebook.com/vetstoronto
Twitter. @vetstoronto & @iambillysmom
Ask Dr. Mitelman vetsdrjm@gmail.com


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)

Monday, September 12, 2011

Adoption Monday: Mocha, Rottweiler, Monticello, NY

Meet Mocha, 2 years old house trained Rottweiler female.

Mountain Rottie Rescue found Mocha in an urban kill shelter.

Her owner was arrested and there was nobody to care for her or her mate.

If loosing her home and finding herself at an overcrowded kill shelter was not hard enough, Mocha was also very much pregnant.

The male she came in with was pulled by another rescue.

On July 5th , Mocha gave birth to beautiful Rottweiler puppies. 

Mocha was an fantastic mom. She nursed them so tenderly and her mothering skills were amazing. She probably had a litter before this one as mothering just came so naturally to her.

All of Mocha's babies grew to be healthy (thanks to Mocha!). They have all found homes and will be leaving in early September.

Mocha still needs to find a forever home. 

Mocha is 2 years old, healthy and weighs over 100 lbs. She has beautiful markings and is docked.

Mocha is housebroken and loves to play!! 

She loves attention and just wants to be with you, she has a great personality and will make a wonderful addition to a family. She is social with male dogs. It is not clear how she is with adult female dogs but with an easy going female she would probably be ok.

Mocha might not be idea for a home with a cat, as she gets excited when the cats runs.

For everything this amazing girl has been through, she deserves to find a wonderful family to love her. 

Mocha will make an exceptional, loving and loyal family member! Won't you find it in your hearts to give this terrific momma a life of happiness, a life she most certainly deserves!

Check out Mocha's Petfinder listing or email Mountain Rottie Rescue

***

Mountain Rottie Rescue  of NY is located in the Catskill Mountains & The Capitol District of New York area.. MRR is dedicated to re-homing homeless Rottweilers.


Some of their dogs are owner surrenders , but most come from kill shelters in The New York State area. They also pull dogs from out of State Shelters, such as Virginia , Arkansas, Alabama and Georgia -Where the Gas Box is still used to euthanize dogs .


Some pulled dogs are cruelty cases & come from abusive pasts - MRR offers rehabilitation & training to these dogs. Most of their cruelty cases were rehabilitated and placed into loving homes.


All dogs are temperament tested before acceptance into the program. MRR members consist of Certified Dog Trainers, experienced animal handlers & experienced Rottweiler owners. Any dog adopted from Mountain Rottie Rescue of New York has been fostered in a home prior to adoption. All  dogs are up to date on vaccines, Heart-worm tested, on prevention, spayed /neutered, micro-chipped & activated .


Mountain Rottie Rescue adopts out to the following locations: NY,NJ,VT,CT, parts of PA & Western Mass. They also adopt out to other neighboring states based on volunteer availability, please contact them to see if they cover your area!!

Saturday, September 10, 2011

Have You Encountered This? Bernese Mountain Dog Prostate Issues

A friend asked me to turn to you, my readers and friends, for insights on an issue he has with his dog.

Do you have experience the following problem? Can you offer any insights?

His 7 year old Bernese Mountain Dog gets Benign Prostatic Hyperplasic ( BPH) flare ups a few times a year. During these flare ups he drips blood from his enlarged prostate.

Bernese Mountain Dog

This only happens when he gets near a female dog in heat on her smell.

These flare ups could be kept under control with Previcox to reduce the inflammation but my friend would prefer a solution that does not involve drugs.

They tried Saw Palmetto but that doesn't seem to help.

Has any of you have good experience with Proscar or Ovuban for treatment of this condition? 

Apparently there have been people using either of these to shrink the prostate with no reported negative side effects. Please share whether you have positive or negative experience.

My friend's last two males suffered from the same condition but died within 12 months from being neutered; he'd like to avoid that this time around.

Any experiences and ideas are welcome.

Thursday, September 8, 2011

Spoil Your Dog Like There Is No Tomorrow

Spoil your dog like there is no tomorrow. Because you never know when there won't be one.

Let your dog sniff that fire hydrant. Let him do all the doggy things he wants to do. Let him get dirty. Give him the piece of steak he craves.

Spoil your dog like there is no tomorrow.

Because you never know when there won't be one.

There won't be a tomorrow for Rufus, our neighbor's dog.

Rufus was 2 years old Bull Mastiff. He was one of the nicest, happiest dogs I've met. Always excited, always ready to play, always polite.

Last Saturday I was busy in the kitchen. When I was done I went for a smoke to find Rufus laying on the front lawn, being hosed down. He wasn't moving, other than spasm-like movements which might have been breathing or not. He was irresponsive to what was going on around him.

What happened?

The neighbors figured he got a heat stroke; thus the hosing down. Could have been, as it was a hot and humid day. They were out on a walk when he suddenly collapsed.

One thing I knew was, that regardless of the cause, just hosing him down was not going to save him.

If it was a heat stroke, he looked quite far gone.

"Listen, you need to take him to the emergency vet," I said.

"If he is to stand a chance, he needs to see a vet now. You need to take him now, trust me on that."

I gave them a card with the emergency vet's address and number. Rufus got loaded in the car, covered with wet towels and off they went.

They were gone for quite a while, so I started getting hopeful. 

It's taking a long time, which to me meant they were doing something, which meant he had a chance.

One look at their faces when they returned told me that Rufus did not make it.

The emergency vet declared that it was not a heat stroke after all, but his heart. The heartbeat was very irregular and then he stopped breathing. And that was that.

He was two years old!

With no known history of heart disease.

Spoil your dog like there is no tomorrow. Because you never know when there won't be one.

Jasmine is the most spoiled dog on the planet. We almost lost her twice. But she pushed through each time. She is eight years old now and living it up.

We are thankful for every day she has.

As she was getting older I used to worry about how long we might still have her in our lives. But now I look at it differently. She is eight years old.

That is eight years she has had that nobody is going to take away from her!

Every spot she wants to sniff, she gets to sniff. Every bit of attention she desires, she gets. Every piece of steak I can give her, I give her.

Spoil your dog like there is no tomorrow. Because you never know when there won't be one. RIP Rufus.

Jana

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

A full listing of diagnostics and additional services is available on our website, www.vetstoronto.com



www.vetstoronto.com
www.vetstoronto.com/blog
www.facebook.com/vetstoronto
Twitter. @vetstoronto & @iambillysmom
Ask Dr. Mitelman vetsdrjm@gmail.com


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)