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Anida 01-19-2017 12:58 PM

Second Opinion ?
 
Hey,

This isn't for our V, but our beagle, Willard. He's 8 and has been having some issues since October. I got home from work in October and went to feed him and he wouldn't come to me, was shaking, his eyes were looking back and forth and he wouldn't eat. He was super wobbly too. He felt kind of warm so I took his temperature and he had a fever. After about 30 minutes, he finally ate and he started drinking. We got him into the vet the next morning and he was doing a lot better. The vet determined he probably just had an episode of Canine Vestibular Disease since he also had balance issues during the episode and still wasn't very steady on his feet. He seemed to mostly recover after about a week of being on antibiotics. Now he still has a permanent head tilt but he pretty much lays around all day on his dog bed and only moves to go out and relieve himself.

We've done blood work, a cytology on an enlarged lymph node. We've tried 2 separate rounds of antibiotics, steroids, and now pain medication but nothing has changed with all of this. (Blood work and the cytology also were not helpful as far as identifying any issues).

At this point my vet is leaning towards he has some autoimmune condition. (He's also lost pretty much all of his facial muscles). The problem with autoimmune, is that he has already been on steroids and that is the treatment option and he didn't have any reaction to them better or worse.

He also hardly eats now. Kibble, wet food etc. he isn't interested. We were desperate last night and my hubby cooked him some chicken and he did eat that.

Any ideas or vet recommendations in the Salt Lake, UT area?

I have another appointment scheduled for a different vet on Monday and am picking up his records from our normal vet today.

Sorry for the paragraphs, we just want our guy to feel better. He wasn't ever extremely active but he was always happy to see us. Now we hardly get a tail thump when we come home :(


texasred 01-19-2017 03:33 PM

Re: Second Opinion ?
 
Hoping you can find some answers for Willard.
The only thing that comes to mind is a stroke, or possibly some sort of nerve damage.

hecallsmebama 01-19-2017 05:34 PM

Re: Second Opinion ?
 
If it does turn out to be neurological or autoimmune, look into a drug called Low Dose Naltroxene (aka LDN). I just googled and it looks like there are vets who will prescribe it for cats and dogs for this reason, but it appears there is a longer history of them prescribing it for behavior issues???

Anyway, my husband has had success in managing his nerve/autoimmune issues with it. It's kind of an off-label use, but it's only side effect is strange dreams (could be different for animals). It's FDA approved at 50 times the strength for helping opioid addicts....hence the "low dose" designation. That's people not pets, of course. Many MS patients use it. It's just not FDA approved because there is not enough money to be made off running the tests. So no drug company will invest in getting it approved at such a low dose. The upside to that is it is very affordable. We buy it out of pocket.

If you feel confident about a second opinion that points to autoimmune or neurological issues, I would ask my vet about it and if he/she is not comfortable prescribing, ask if they know any vets who do prescribe it.

Here is a blog post by a pharmacist that I found about it's use for pets:
http://thecompounder.com/2016/03/07/ldn-for-pets/

Here is the info on the drug from the pharmacy where we order ours:
http://www.skipspharmacy.com/wplog/s...se-naltrexone/

These are just from a quick search. I'm sure there is more/better info out there on the topic of LDN for pets. Good luck and keep us posted.


einspänner 01-19-2017 06:25 PM

Re: Second Opinion ?
 
It may be worth seeking out a holistic or integrative vet. When conventional modalities reach their limits it can be helpful to approach the problem from a new perspective. That said, both my best and worst vet experiences were with holistic vets. I prefer ones that give me more of a country vet vibe, competent and practical, but not too new agey.

I did a search of the Salt Lake area and came across this practice in Park City http://www.animalhealthvips.com/home/. This is who I'd try if I were in the area.

There's also this practice which offers some holistic rehabilitation services like acupuncture and laser therapy. The West Bountiful location is what came up on the AHVMA website, but they also have a SLC location. http://www.utahanimalcarecenter.com/

I hope you can figure out what's going on with him. It's just worse not knowing. :(
And maybe try some scrambled eggs. They're pretty easy to digest.

1stVizsla 01-19-2017 08:24 PM

Re: Second Opinion ?
 
Having a family member with Superior Canal Diheisence syndrome (SCDS, a cause of vestibular disequilibrium in humans) I can tell you that an excellent diagnostic tool for sources of inner ear/vestibular structural causes (skull fracture, fluid/infection in inner ear) is CT.

The fact that your dog improved w/antibiotic makes me think it may have been infection. There may be residual fluid/inflammation in one ear (vestibular problems only require one affected ear and SCDS in humans typically presents unilaterally) that explains the tilt of head. It doesn't explain the facial paralysis, although neck muscle problems/stiffness are fairly common in humans dealing with the Diheisence/tinnitus which btw is depressing for humans and likely never studied in dogs but may be overwhelming. It certainly seems there are similarities to his symptoms.
If you wanted to spend $$ a head CT might provide an answer, however, SCDS in humans (with accompanying balance, tinnitus problems) is almost untreatable. I'm not sure what I'd do if it were my dog. Maybe a university affiliated vet clinic opinion if he was truly suffering and unable to enjoy life. :(

Anida 01-20-2017 12:07 PM

Re: Second Opinion ?
 
Thank you for all your input. I really do appreciate it. I'll be calling those vets today and seeing if I can get him in and maybe a different approach will be able to shed more light on what is really going on.


Anida 01-20-2017 12:34 PM

Re: Second Opinion ?
 
Quote:

Originally Posted by TexasRed
Hoping you can find some answers for Willard.
The only thing that comes to mind is a stroke, or possibly some sort of nerve damage.

We at first thought he had a stroke with the first episode but the vet was pretty sure it was vestibular disease. Now I'm not so sure any more :(

Quote:

Originally Posted by 1stVizsla
Having a family member with Superior Canal Diheisence syndrome (SCDS, a cause of vestibular disequilibrium in humans) I can tell you that an excellent diagnostic tool for sources of inner ear/vestibular structural causes (skull fracture, fluid/infection in inner ear) is CT.

The fact that your dog improved w/antibiotic makes me think it may have been infection. There may be residual fluid/inflammation in one ear (vestibular problems only require one affected ear and SCDS in humans typically presents unilaterally) that explains the tilt of head. It doesn't explain the facial paralysis, although neck muscle problems/stiffness are fairly common in humans dealing with the Diheisence/tinnitus which btw is depressing for humans and likely never studied in dogs but may be overwhelming. It certainly seems there are similarities to his symptoms.
If you wanted to spend $$ a head CT might provide an answer, however, SCDS in humans (with accompanying balance, tinnitus problems) is almost untreatable. I'm not sure what I'd do if it were my dog. Maybe a university affiliated vet clinic opinion if he was truly suffering and unable to enjoy life. :(

If it is an infection I'm leaning towards viral or fungal at this point. He doesn't seem to have a viral infection (no more fever or anything) and he's been on 2 separate rounds (different types) or antibiotics with no long term changes at least. Our vet mentioned an MRI but said they are around $1500 and it probably would just tell us if there was some sort of neurological issue or a tumor but there really wouldn't be much they could do at that point to help him.

Quote:

Originally Posted by HeCallsMeBama
If it does turn out to be neurological or autoimmune, look into a drug called Low Dose Naltroxene (aka LDN). I just googled and it looks like there are vets who will prescribe it for cats and dogs for this reason, but it appears there is a longer history of them prescribing it for behavior issues???

Anyway, my husband has had success in managing his nerve/autoimmune issues with it. It's kind of an off-label use, but it's only side effect is strange dreams (could be different for animals). It's FDA approved at 50 times the strength for helping opioid addicts....hence the "low dose" designation. That's people not pets, of course. Many MS patients use it. It's just not FDA approved because there is not enough money to be made off running the tests. So no drug company will invest in getting it approved at such a low dose. The upside to that is it is very affordable. We buy it out of pocket.

If you feel confident about a second opinion that points to autoimmune or neurological issues, I would ask my vet about it and if he/she is not comfortable prescribing, ask if they know any vets who do prescribe it.

Here is a blog post by a pharmacist that I found about it's use for pets:
http://thecompounder.com/2016/03/07/ldn-for-pets/

Here is the info on the drug from the pharmacy where we order ours:
http://www.skipspharmacy.com/wplog/s...se-naltrexone/

These are just from a quick search. I'm sure there is more/better info out there on the topic of LDN for pets. Good luck and keep us posted.


I will look into this in case it is a route we need to go.

Again, thanks for all the advice. You all are great and invaluable resources. Willard is my hubby and I's first dog together so this is all new territory for us.

texasred 01-20-2017 05:11 PM

Re: Second Opinion ?
 
Our vet mentioned an MRI but said they are around $1500 and it probably would just tell us if there was some sort of neurological issue or a tumor but there really wouldn't be much they could do at that point to help

I think it would depend on the findings, as to if he could be helped. It's so tough trying to make the right decisions for them. Not wanting to put them through any more tests than is necessary, and not giving up to soon. My heart goes out to you, and I hope you find the answers.

Anida 01-24-2017 12:45 PM

Re: Second Opinion ?
 
4 Attachment(s)
Kind of a quick update. I should be able to add more later today after the vet calls me.

We took Willard to a second vet and I'm really happy we did. This vet seems to care more and spent over an hour with me and Willard looking at him and discussing. (We will see if that changes at all in the future or if it was just a good show since he knew I was coming for a second opinion).

He's pretty sure Willard has Masticatory Muscle Myositis which is an autoimmune condition that all the facial muscles have deteriorated. It can also make it difficult to open their mouths and painful to as well since the muscle eventually gets replaced with scar tissue. I told our other vet that Willard eats really gingerly when he does actually eat but she didn't seem considered. This vet completely checked out his jaw and got him to wimper and cry :( so yeah, his jaw hurts. Willard also refused to let his mouth be opened -- again he's probably uncomfortable. It also explains why he won't eat his kibble. He'll eat chicken or eggs but that's pretty much it (i.e. something so tempting the pain is worth it).

Pictures are attached. First is from the beginning of June 2016. The second is within the last month. Huge difference.

Really his only complaint about our previous vet was that the dose of steroids she put him on wasn't high enough for his weight. So we are going to start him on a higher dose and taper down from that. Hopefully we see some improvement there.

The next issue is that he has other symptoms that cannot be explained by the autoimmune issue. He also has foxtails in both ears. Which I'm extremely angry about because he has been to our original vet multiple times in the last few months and prior to that last January and no mention of them even though she has looked in his ears. She's always said his ears look good, nothing to really be concerned about :( I'm really upset about this because we moved in May 2015 and no longer have a fenced yard. Any extended period of time spent outside has been either on our deck (no plants) or in a dog run on a patio again no plants. We also don't have any long grass at our new home where we did previously. The stupid things have probably been in his ears for a long time. Since October he hasn't even been outside other than to use the bathroom. >:(

Hopefully the steroids start working this week because we need to sedate him next week and get his ears cleaned out. The vet will also be taking xrays of his skull to see if he has an inner ear infection which would explain the enlarged lymph node and the balance issues. He also could just have an enlarged lymphnode if he an infected tooth so when he is sedated he wants to get a better look at his teeth too since Willard wouldn't cooperate, which I don't blame him.

He also has protein in his bloodwork that is low. I can't remember what it is called but it's the kind that your liver makes. So he either isn't making it or is having an absorption issue. We also did a urine sample yesterday too so I should get that back today and know more about that.

Sorry for the not so short update haha.

texasred 01-24-2017 02:22 PM

Re: Second Opinion ?
 
I'm so happy you might be getting some answers to help him. Fox tails alone can travel once they have penetrated a dogs system. And can be hard for vets to find at that point.
You can look up Nocardia in birddogs. But this is when the grass awns travel to the lungs.

MMM is known in vizslas, and there have been some studies. Some are listed on the forum, but a high possibility you may find others searching Google.
I know Willard is a beagle, but some of the same things the vet is considering affect vizslas.
Thank you for the update, and you'll be in my thoughts.

Edited: due to darn phone thinking it knows the words I want to type.


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