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Potassium Bromide and Hind Leg Weakness

Marina AdoptionThe bond with a true dog is as lasting as the ties of this earth will ever be.
Konrad Lorenz

Life with our fur-kids is a constant learning experience. The picture on the left is Marina’s adoption photo. It’s hard to believe she’s been with us for over eleven years.  She was a feral dog – most likely abandoned by her owner, and thankfully saved by San Diego Pet Rescue.

She was a handful, not fully house-broken but as smart as as they come, and very food-motivated which made working with her  much easier. She is now a sweet girl, still with a bit of a wild streak I hope she never loses.

A month ago, I thought our journey together might be nearing the end and it was brutally painful. Over the period of a few weeks, her arthritis seemed to be getting worse and worse. It was harder for her to lay down and she stopped jumping on her favorite sofa.  When we took her on short walks, she had a hard time controlling her hind legs.  It had happened once before, but not nearly as severe. Her hind legs seemed to be getting weaker by the day.  I made an appointment for her with Dr. Peter Slusser, the miracle worker that saved Petey from IMHA and gave us several more years with him.

At the time of our appointment, Marina was taking 1 Yunnan Baiyao capsule twice daily to control a tumor, 25 mg Tramadol twice a day for her arthritis pain, 125 mg of Zonisimide twice per day to control idiopathic epilepsy, and 2.5 ML (500MG/ML) of Potassium Bromide once per day that was added approximately five years ago when the Zonisimide alone stopped controlling her seizures. She has been seizure-free for at least three years.

Background information:

I did a lot of research prior to our appointment. I learned that many herding breeds have a gene mutation known as the multidrug resistance gene, also called MDR1. In short, the mutation allows certain drugs to build up in the brain. Side effects can be as mild as tremors and severe as death.  As soon as I read about the mutation, several things came to mind. Marina’s seizures first started years ago when her flea medication was changed. She became lethargic, and I switched to another type suggested by one of her vets. She still had a reaction to that one – lethargy, loss of appetite, and vomiting. Our vet even called the manufacturer to see if there were any other known or reported side effects – nothing.  Both of the flea medications contained Ivermectin – one of the drugs that can build up to toxic levels in dogs with the MDR1 gene. The side effects are ataxia (muscle weakness), seizures, and even death.

The Solution:

During our visit, Dr. Slusser ordered CBC and Potassium labs. He let me know that Potassium Bromide can build up in the system to the point that it causes hind-end weakness. I also mentioned that she was a rescue and she was listed as a mixed breed of Cattle Dog, and possibly Australian Shepherd.  I let him know that I didn’t know about the MDR1 gene until recently, and was wondering if that might have been the cause of her seizures to begin with – they seemed to start and stop with the use of flea medication.  I started to taper her from the Potassium Bromide after that visit. There was a significant difference within a matter of a few days. Within a week, she was jumping up on the sofa, and is now back to jumping on “her” sofa, and running home from the park. As I told Dr. Slusser, when I took her in, I felt as though she had aged years in a month – and now that she was off the Potassium Bromide, it was as if she was five years younger.

There is always the chance that her seizures may return, but for now, we’re keeping her off the Potassium Bromide. I’m happy to say that she’s doing beautifully and we couldn’t be happier or more grateful. Once again, Our Miracle Worker came through.

Goodnight Sweet Petey

We Love you Petey

We Love you Petey

I think dogs are the most amazing creatures; they give unconditional love. For me they are the role model for being alive. ~Gilda Radner

It is with great sadness that I let you know of the passing of our dear, sweet Petey. Many of you started following this blog because of his battle with IMHA, and it’s similarities to Evan’s.

It was not IMHA that took him, rather his tired body, and our desire to always return his unconditional love .  For this reason, we made the most painful, yet responsible decision when it became clear that his qualty of life would no longer be what he deserved to have.  Because we loved him, we did not want to subject him to a life of pain from advanced osteoarthritis and a now fragile and unforgiving body.  We are heartbroken over the loss, but better for having had his love in our lives.

We cannot thank Dr. Peter Slusser and the amazing team at VCA Animal Group for their outstanding care. It is because of their care and compassion that Petey pulled through his bout with IMHA. I give them my highest reommendation, and my utmost respect. If you know me, you know that is not something I give easily. Thank you Dr. Christine Wilson for referring us to Dr. Slusser.

Our entire family would also like to thank Dr. Kristi Freeman, who, through her kindness, compassion, and dedication to animal companions, allowed Petey’s final moments to be filled with love and peace.  Without a doubt, Petey’s second chance at life would not have been possible without Forte Animal Rescue and it’s volunteers Raquel Magro and Diane, who quietly work behind the scenes to create forever homes. It’s because of them, that the unwanted, forgotten and abused come into the lives of those lucky enough to be chosen to be their forever caretakers.

Following is an excerpt of my letter thanking Marie Atake, founder of Forte and volunteers Raquel and Diane for all they do. They are my heroes and I am eternally grateful to them for introducing me to Petey and allowing us the honor of caring for him for the last eight years. We love you Petey, we will miss you, and you will forever live in our hearts. Goodnight my dear “Sweety Petey.”

Email Excerpt:

Thank you for sending Petey your thoughts and prayers today. During a most difficult time, Dr. Kristi Freeman helped us give Petey the best farewell he could have possibly had. She is the kindest, gentlest person you could imagine and Petey took to her immediately, she even won Marina over and she is much tougher to win over.

Since we were at home, Petey was very comfortable and had all of us around him. He was given a deep sedative/anesthetic and you could tell when he became pain-free, there was such a sense of peace. He was awake with us long enough to experience the relief of pain and know without a doubt that he was very loved. That love is the last thing that he was aware of. When he was in the deepest sleep, Dr. Freeman gave him the second injection and he was very peacefully released from his tired body. All I sensed, in every moment, was peace. It was the best one could hope for at such a difficult time, and the best send-off our dear friend could have had.

His ashes will be back to us in a week or so, his love will never leave us. After some time at home today, we went to the ocean, it’s the place where Eddie and I both feel the most connected to the universe. As we were walking towards the sand, the very first thing we encountered was someone walking a big pointy-eared dog and the second thing we encountered was a man walking a dog who could have been Petey’s twin, big ears and all. It made my heart feel good to see him running. Maybe it’s just to make myself feel better, but I liked to see it as a sign that our Petey boy was free and happy again. They were the only dogs we saw our entire time there.

And so it goes, our hearts break, but they are a little bigger for having had such a wonderful companion in our lives. Thank you both for all you do and thank you for giving us the opportunity to have Petey and his unconditional love in our lives.

Canine Vestibular Syndrome

Happy New Year! We wish you and your current or future rescues a fantastic 2012!

Last month Petey gave us a bit of a scare. As I was walking through our front door, our eldest son let me know that “Petey was walking funny.” Now, this was a bit of a concern because Petey has a permanent limp, partly from his osteo-arthritis and partly from a bone infection quite a while back. I wasn’t sure what “walking funny” meant given his normal limp.

When I made it all the way through the door, Petey came to greet me as he always does when I come home. My son wasn’t kidding when he said he was “walking funny.” The best way I can describe it is that he was high-stepping with every step, his head was tilted to one side and he seemed to want to tip over. It was as though he didn’t have any sense of balance or perception of where the floor was. So many things ran through my head – did he have a stroke? Did he lose partial eye sight? Did he have an ear infection or something worse? I examined him and he was able to follow my finger so it seemed as though his eyesight was ok. His limbs all seemed to move normally so it didn’t appear to be a stroke.

Being a researcher, I went to my laptop and started the search. There were several posts from people that had a dog with similar symptoms.  After reading through several responses from vets, I started to feel a little better. The diagnosis of “canine vestibular syndrome”, “vestibular disease” and “old dog vestibular syndrome” seemed to come up time and time again. Our vets office had already closed for the evening and based on what I was seeing and reading, I opted to wait until the office opened. With Petey’s very long history, I felt more comfortable waiting for Dr. Slusser.

I called the office in the morning and described his symptoms – the initial thought was – canine vestibular syndrome! He was due for his annual check-up later in the month, so we decided to move it up a and check him out all at once.

I was able to make an appointment for later that week and by the time I took Petey in, he was almost back to “normal”.  I found out that in some dogs, the symptoms are so bad that they can’t even walk, they literally “roll over” to move.  The good thing about canine vestibular syndrome is that it typically resolves itself in approximately two weeks, and once they’ve had it, it usually doesn’t come back. In some cases, the head tilt can remain but it doesn’t seem to bother them.  If the symptoms are severe, your dog may not have an appetite – imagine being sea-sick and trying to eat. If this is the case, anti-nausea medication can be prescribed.  Hopefully your faithful companion won’t encounter this syndrome, it is difficult to watch. If the symptoms ever appear, please contact your vet for a full exam and proper diagnosis.

And now for the happy ending to the story – All of Petey’s labs came back as “normal”. No sign of his immune mediated hemolytic anemia, and his thyroid (T-4) levels are normal as well!

 

Immune Mediated Hemolytic Anemia ongoing care

Petey on the mend

The last post left off at a critical point in our journey. Petey’s prognosis was not looking good, and we could only hope that the new combination of medications would help turn things around. 

Our follow-up appointment was on October 6th, and Petey’s numbers remained fairly stable. He developed a rash on his hind end which ended up being a reaction to the Metronidazole. We switched to 150 mg of clindamycin, two tablets – twice daily. We were able to decrease the prednisolone to 20mg every other day. We scheduled a two-week recheck.

Progress

October 20, 2009 was the first happy (ok ecstatic) day since Petey’s initial diagnosis. One of the Techs who was now like family, raced out to show me the lab results. I couldn’t believe what I was seeing. Everything fell into or very near the middle column which was “normal”!!!! His red blood count was still a tiny bit low, and the RDW which measures the variation of red blood cell sizes, was still on the high side. This however, was the best CBC result since August. I think even our vet was a bit surprised at how resilient our Petey had proven to be. It was so good to receive positive news.

We were able to stop the clindamycin, Lasix, and prilosec, and scheduled a re-check for one month.

The eighteen months or so since that time have been a series of baby steps moving in the right direction. After a small setback due to a staph infection, Petey is down to two medications. Imuran every other day, and Soloxine .5 mg daily.  The Soloxine was prescribed earlier this year when his lab work showed that his T4 levels were almost non-existent, and he was diagnosed with hypothyroidism. He will be on those two medications for life.

We are eternally grateful for the amazing care from Dr. Slusser and his staff. They are the reason Petey is still here to share his success story. If you are in San Diego and ever need an internal medicine vet, he is the absolute best!

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Immune Mediated Hemolytic Anemia Complications

Petey Shaved for Ultrasound

Petey’s treatment for Immune Mediated Hemolytic Anemia  (IMHA) would prove to be a complex one. His follow-up was scheduled for August 31. Thankfully, things at that point did not get worse, his medication was unchanged, and his drains were scheduled for removal on September 4th.

After the removal of his drains, we continued to monitor his progress and scheduled a follow-up appointment for September 14th.  In the days prior to the follow-up he seemed a bit lethargic, and his appetite dwindled. We discussed this at the recheck, and as normal, a CBC (complete blood count) was performed. The news we received was not positive. His hematocrit was 21, down from 31 the week prior. He was given another ultrasound to rule out or confirm any other complications.  A blood clot in the vein to his spleen was discovered. The only way to remove the clot for certain would be surgery and we were all in agreement (including his vet) that it would not be a good option as he would likely not survive the surgery.

Our only other option was to give Petey daily heparin (anticoagulant) injections. At this point we needed a miracle. I tried to prepare for the worst, and contacted Forte Animal Rescue to give them the sad news. They are an amazing Rescue Group, and like anyone familiar with Petey’s story, huge supporters. I wasn’t prepared for the news and my heart sank, but I wasn’t ready to give up hope. When I left the office with Petey, our new regimen was:

Baytril (antibacterial) 136mg tablet once per day, Metronidazole (antibiotic) 500 mg (1/2 tab twice per day). Imuran (immunosuppressant) 50mg 1 tablet every other day. Prednisolone (corticosteroid) 20mg, two tablets every other day, Lasix (diuertic) 50mg ½ tablet daily, Baby Aspirin ¼ tablet daily, Heparin (anticoagulant) injection .4ml every twelve hours, subcutaneously. Prilosec (acid reducer) tablet, 1 per day.

I created a daily chart and used two pill organizers to keep his medications straight. Getting him to take that many pills was a challenge that involved pill pockets, peanut butter, deli meat and an occasional piece of cheese. The next week would be the telling week, and as grim as it was, I still had to hope for the best.  To be continued….

Evan’s Syndrome Symptoms

By 2009, our rescue Petey, had been part of our family for nearly four years. He settled in nicely, was healthy, eating well and a pretty happy go lucky dog in general.

Every August, we have a summer party with friends and family and Petey and Marina are regulars.   At the party that year Petey seemed a little mellower than usual, to the point that more than one person commented that he seemed to be laying low.  We kept an eye on him and the next morning, he continued to be a bit lethargic and didn’t have his usual appetite. At one point we thought that maybe he had eaten something at the party that didn’t agree with him. Later that evening, he was getting more and more lethargic and we knew we had to get him in to the vet. We weren’t able to get him in to our regular vet and felt that his symptoms warranted a trip to a nearby animal hospital.

The hospital conducted an initial exam, CBC, Chem Panel, Urinalysis and a brief abdominal ultrasound. Per the hospital, Petey’s blood-work, while not 100% conclusive suggested that he had Evan’s Syndrome, a disease where the immune system begins to destroy it’s own red blood cells and platelets. It was also suspected that he had a biliary obstruction and moderate to severe osteoarthritis (we knew about the osteoarthritis).

Since the results were inconclusive, the hospital’s recommendation was to leave him overnight for further testing which was estimated at over $2,000. We opted for a second opinion, which marked the beginning of a very long journey.  To be continued..