Spike's Upcoming MRI and Spinal Tap

[Catalyzt]

We've basically decided to move forward with this, but I'm very interested in any experience anyone has with these procedures or circumstances, and still open to any input.  I do hate the idea of putting him through all this (and the cost, of course, though that's secondary) but I think the circumstances justify the extra testing.

Here's how we see it: If there was just one symptom that suggested a neurological problem-- say, just the fly snapping, or just a single seizure-- we'd probably be okay with just going straight to a trial of medication to see how he does.  But what we have is one incident of extreme, out-of-character aggressive behavior, a single seizure that was pretty intense, and he's still snapping at flies that do not exist, which strongly suggests a neurological problem.

The fact that there are three different symptoms that seem to be neurological is suspicious, and warrants further follow-up.  If we're looking at some kind of encephalitis, the treatment plan moves one way, if it's more like an idiopathic or epileptic issues, we take a different fork in the road.

There are some times in the evening when it seems like he gets agitated for reasons I can't identify-- he may be hearing or seeing something that I don't because my senses are less acute, or he could be hallucinating.  Sometimes, Bartleby barks at these invisible events as well, but sometimes not, which could just mean that he's an older, more experienced dog who's learned not to freak out at certain sounds.  Sometimes Spike will seek me out at these times, looking nervous, and need to be calmed down... he's probably just a little edgy, but he could also be having some frightening hallucination.  (He does always calm down when I sit with him and cuddle him and tell him everything is all right.)

He seems fine in all other respects, still playful and happy, full of fun and mischief.  Wants to turn around sooner on the night walk but not on the day walk-- could well be because of mountain lions and coyotes, they've been very active here lately, so I follow his lead.

Do you folks feel I'm formulating the problem correctly, and/or have any experience with either of these procedures? 

I just HATE the idea of the spinal tap.  I know it's probably irrational.  I feel the same way about some procedures I've had to have myself!

 

 

[Sam I Am]

I know from previous posts here, from their dogs being agitated for no known reason due to  our lack of hearing or smell which we humans can’t detect but they do.

Suggestions of mice, squirrels close by or in the walls or attic, to alarms and electrical activities that we are unaware of  and given your comments about mountain lions and coyotes in the area (they both hunt at night) I think a lot of dogs would be very apprehensive and act accordingly.

 I think and this is just my personal thoughts, and is not meant to sway you one way or the other, I would go for the MRI as it can certainly detect tumours etc.

 Our previous Cairn Jock had seriously high liver enzymes detected through a routine blood work up prior to a dental procedure. The clinic that we went to at the time wanted to do a liver biopsy to rule out cancer. We went ahead with it and it turned out to not be cancer but if it had been There was nothing we could do anyway. I would never do that again. Jock went on to live another 6.5 years and did develop cancer but not in the liver. We controlled his high liver enzymes with meds and he lived  till he was 13 yrs old .

 Has Spike been on seizure meds and if so did it help?

In the end you have to have faith in your clinic and feel ok with how far you want to take this.

Edited March 9, 2021 by Sam I Am

[pkcrossley]

Quote

 

I would guess that the agitation in the evening is the usual rise of cortisol and increased cranial pressure. It can have many causes. Some dogs are medicated to allow them make it through the night, since the cortisol drops in the morning. 

I had a dog go through all these diagnosiics. They are not particularly stressful for the dog, since he is fully anesthetised for the MRI and I presume they would do the spinal tap at the same time (if not, why not??). He will just be happy to come out of it and go home.

Diagnoses coming out if it are usually pretty definitive, more so than any other diagnostic technique. In my view, good information is worth almost anything you have to pay for it. Pretty clealry Spike is showing neurological symptoms, but that can be anything --organic, metabolic (llke a severe vitamin deficiency), developmental, infectious. Whatever comes out of it does not weigh so heavily on the mind as doubt, in my experience.

Good luck to Spike and you for the procedure. He will come out of it fine and be happy to go home, have a nice meal, and a good rest. Then you will inow what the next step is. 

[Hillscreek]

I have no experience with any of my own dogs of any symptoms like Spike has. I do think you are right to................as I write this I see pk has just posted. I was going to say some thing similar. Personally speaking I would go ahead with the tests. As pk says you will get information. Spike will be ok with the tests. Then you can go ahead and think what's best to do next for him. If you don't do them you may always wonder whether you should have done them. 

You can be sure we will all wish you both the best.

Whatever you decide let us know how things go. All the information we can get from each other's different experiences helps all our cairns stay well. 

[Catalyzt]

Thanks so much, guys. 

-- Sam, liver problems can actually cause some of the issues Spike has experienced, but we've had a full liver workup done already-- including the test where they test before and after eating, so that's ruled out.  I agree, if it was some other situation where there's nothing that can be done even if you have the diagnosis, I wouldn't do it.  But many neuro symptoms are very treatable, and others are not.   An added benefit is that knowing is better than not knowing even if the diagnosis is terminal-- but that, by itself, might not justify the test.  If it's an encephalitis, we're looking at steroids short term and more diagnoses.  If it's more like epilepsy, we're looking at anti-convulsants. 

--PK, great point about doubt.  When a dog is ill or passes away, the self-torment begins, no matter what you did, but it's shorter if you covered all the bases.  We gave Zippy subcutaneous fluids-- God, please, let me never have to stick a needle in my own dog again-- cooked all his meals for six months, and vet bills ran north of five figures.  I also could probably have lost my license for the way I was driving when I took him to the vet, I thought he was dead when I raced in with him in his arms.  (And I found out what the MX5 is really capable of, which is quite shocking.  I've never been so grateful to have a fast car.)  But he lived 11 months after that, and had great quality of life except for a few weeks here and there.  Still, I was convinced there was something else I could have done... but only briefly.

--Hills, thanks for the encouragement, and yes, I will absolutely post back with updates.  Everyone's positive energy is really helpful, and I'm very grateful.

[Sam I Am]

C you are an amazing, caring pet parent. Spike is a very lucky dog. I wish you and Spike all the best for a speedy diagnosis ...upwards and onwards.

[Kathryn]

No advice to add here -- just want to say that all fingers and paws are crossed in this household hoping for good results for Spike. 

[Catalyzt]

Quick Update:  Patient is home and resting!  Still waiting for the final CFS tap results, but first glance under the microscope, nothing abnormal, MRI = nothing abnormal.  He's tired and alternately clingy and pissed, but no significant mental status changes other than lethargy.

His attitude alternates between clingy-- "I love you so much, I just want to cuddle" -- and kind of pissed "Why the hell did you do all that?!" though he's not growling or anything, it's just the way he looks at me.  The shaved patch on his head is disturbing, it makes him look like he just got a lobotomy.  (Any Ramones fans out there?!)

PK, I mentioned the cortisol issue to the neurologist, and there was a pause on the other end of the line, and she said, "No, I don't remember that specifically, but now that you mention it, elevated cortisol at night would make sense."  Nice call, maybe that's part of the diagnostic picture.

We'll know more after the final CFS results are in tomorrow.   Just glad there are no tumors or alien embryos in his head and he got through the procedure with no side effects!

[Hillscreek]

 good news 

[pkcrossley]

cortisol increases cranial pressure (as a few other things, including fever). 

i like the "nothing abnormal" theme. let's hope they stick to that. i can say from my perspective, if that is the outcome, that is priceless.

 

 

[Catalyzt]

Yow, decisions, decisions.

Neurologist wants us to choose a seizure medication, choices were Potassium Bromide, Phenobarbital, Keppera and Zonisamide.

We kind of narrowed it down to Phenobarbital or Zonisamide, and were keeping Potassium Bromide on the secondary list due to toxicity and Keppera due to dosing concerns, has to be 3x per day, and you have to be pretty accurate with it.  The XR version seems like too high a dose for such a small dog, though few side effects have been reported when it was tried at high doses.

So we will choose a medication, but I'm not sure we should start it yet.  Now that it's been a week since Spike's MRI, the fly-snapping has decreased on its own-- he'll do it a few times during psychotherapy sessions with my clients, but they don't seems to mind, and he's only a 'working dog' in the loosest possible sense of the word!  The fly snapping did increase a lot immediately after the MRI, spinal tap, and anesthesia, glad that it's back to baseline or below!

The thing is, he's only had one seizure, we've had the one extremely violent incident that came out of nowhere which hasn't repeated, and the fly snapping.  So we have two questions:

1) Should we wait a while before starting meds?

Pro: The drugs are toxic, he's only had one real seizure, and conventional anticonvulsants only work about 30% of the time for fly snapping, and fly snapping doesn't really cause him distress, we might not even be able to tell if they're working, and if tolerance builds up, we're better off waiting with drugs until or if he really needs them-- when we see increasing severity or frequency.  Also, Cairns do have weird developmental issues, and maybe if we wait it out, the overactive neurological whatever will settle down.  (I feel like I see that with my human teenage and young adult clients with TBI.)

2) Which drug do we choose?

Phenobarbital is tried and true, but requires more monitoring than Zonisamide.  I still haven't done a deep dive on the research yet.

I know no one can offer medical advice, and I'm not asking for any, just if anyone has any relevant experience with either of these questions.

Thanks again, as always, for your insight and assistance!

 

[Sam I Am]

I probably would ask for a second opinion.And me being me would consult a veterinary practice that practices integrated veterinary medicine. 

[pkcrossley]

i. have no experience wtih those meds, probably best to canvass specialists. if i'm understanding, they found no organic cause for his seizures? did that suggest that is could developmental --something that will diminish or disappear as he matures?  or acute --perhaps a single episode prompted by some kind of irritant or stressor? i'm guess that they don't take these seriously if they are suggesting medicating him instead of watching for subsequent episodes?

 

[Hillscreek]

If there's "nothing abnormal" think I might question vet further as to why they think he should start on meds now rather than wait and see how things go. I think I would want to wait and see if he has another seizure before starting meds. 

 

 

 

[Catalyzt]

Quick follow up: No repeat of aggression, no more seizures.

I thought about what PK and Hills said, and this was echoed by the rescue we got him from: They said they would not start meds with only a single seizure.

It really helped to know what I learned here: That cairns can go through some pretty wild developmental phases and mature late.

We selected phenobarbital because I think we know more about it; I generally trust older meds more, and the online chatter about Zonisamide wasn't all that encouraging.  Pheonbarbital also worked well for our other small dogs who had seizures, BUT...

We will not be starting it yet, just keeping a week's supply on hand in case we need it-- e.g., if he has more seizures within a six month period, or a really bad one, etc.  Thanks again for all your help!

[pkcrossley]

i think it sounds wise. you're ready if there is reason to believe he needs the meds, otherwise you are acting precipitously. i can see that some vets may want to try to prevent seizures, but with such a tiny history it seems hard to know exactly what you are trying to prevent. the causes and curouses of seizures are so complex and variable. good luck, sounds like you have a handle on this. 

[Catalyzt]

Hi, folks!   Just a quick update here, but the headline is that Spike is doing really well!  There are still some transient neuro issues, and we've developed some outside-the-box ways of dealing with them.  We have not started any medication, and I don't think we need to.

Spike does still snap at imaginary flies (and real ones, though less often!)   Sometimes, the snapping seems to get a bit intense, and sometimes he'll snap close to a finger or hand-- though still a good 35-45 degrees and ten to 12 inches away.  He's not responding to the finger or the hand, he's seeing flies that are not there, or some other internal event, and I think there's very little risk of a bite.  Sometimes when we are napping, he will wake up to snap at the air.

Our technique for managing this called the "No Flies" (R) technique.  Basically, whenever we see a snap, we say gently, in a medium-high pitched voice, and with a reassuring tone,"No flies," or "No flies, pal" and follow up with a reassuring pat.

I swear, he looks at us sometimes like, "Really?  I was so sure I saw a fly."

At which point I will say, "No flies, everything's okay!" or something demented like that.  It sometimes takes three, four, or five tries, but this does actually bring the episodes to an end sooner! 

There has been no biting.  The worst that happened so far is when I was dozing on the couch with him-- never with him near my head, usually he's down by my hip cuddled up with me, sometimes with his muzzle on my leg or stomach-- I woke up from a nightmare flailing around, and accidentally whacked him.  He leaped to his feet and snarled, but didn't snap.  I apologized and he settled right down.  Another time, I sat down next to my wife on the floor and put my head on her shoulder, and he charged at me, barking angrily-- but then skidded to a stop, looked at us curiously for a moment, and came up to be cuddled by us both.   These incidents happen  when he's waking up, and I think he has trouble with reality testing for a few seconds.

He's a very loving dog, and we are so glad to have him!  I'm glad we had so much good advice here, and from our neurologist.

I still haven't shaved my mustache to see if I have a scar yet!

[bradl]

Appreciate the update and hearing that things are manageable.  Forewarned is forearmed and it sounds like you have created a sensible and loving environment to enjoy each others' company. So glad you and Spike have found a path forward.

[Sam I Am]

Jock our past Cairn did some fly snapping as a youngster however it never amounted to anything. Also if you woke him up suddenly or touched him he would leap up and snarl also, then realizing it was us , settled right down.  I think a lot of Cairns have this reaction..ready to take on the world attitude.

Sounds like Spike is doing ok under your great care and understanding.!

Edited June 30, 2021 by Sam I Am

[Hillscreek]

Good to hear things going along the right way for Spike. He is fortunate to have found a patient caring family.

[Catalyzt]

On 6/30/2021 at 3:27 PM, Sam I Am said:

Jock our past Cairn did some fly snapping as a youngster however it never amounted to anything. Also if you woke him up suddenly or touched him he would leap up and snarl also, then realizing it was us , settled right down.  I think a lot of Cairns have this reaction..ready to take on the world attitude.

Sounds like Spike is doing ok under your great care and understanding.!

That is really helpful to know!  The episodes that worry me are when he gets very worked up about it... last night I was trying to put him and Bartleby to bed despite the neighbor's very loud music, so I cranked up a nature sounds app, and he got really agitated, and was leaping a bit when he snapped.

I finally figured out the sounds that bugged him were the birds and crickets chirping, and when I pulled those out of the mix, he settled right down and responded to my petting him and telling him there were no flies, he fell asleep lying on my arm.  I dozed with him for a half hour, and then slowly eased my arm out from under him... a few little sleepy puppy grunts... and then he went back to sleep.

A few nights ago, he started trembling before the evening walk-- mostly his rear legs-- and I was sure he as going to have a seizure.  I just told him we didn't have to go right way, and pet him gently until it stopped, and we went and had a fine walk without any incident.  Sometimes I think he's growing out of these odd neuro micro episodes, sometimes I think they're getting worse... and sometimes, I see real, tiny flies buzzing around, and I wonder if I'm imagining the whole thing.  (The neurologist sure didn't think so based on the video.)

This has been such a hard year, and he's been such a comfort to us.  Thursday, I was tired and wanted to sleep after work, but I went into the yard and played ball with him-- just 15 minutes or so.  (His fetching was very erratic, so we practiced "catch," which he's really good at.)

An hour or two later, I found him on the couch in the office waiting for me, looking at me like, "That was the most fun I've ever had, you are the best Dad in the world."  Whenever I do something extra for him, whether it's a treat, a game, or whatever, he always makes a point of doing something extra for me-- usually an extra session of cuddling.

[pkcrossley]

it really does sound like this could be something developmental --lessening or going away as he ages. it is very interesting that you seem to be able to head off some episodes by calming him. all dogs are susceptible to neuro issues, but i do kind of think cairns are one of those breeds more susceptible. they were bred to have hair-trigger fight reflexes, and it is something you often see when they are startled, angered or frightened. they can calm down quickly, but it takes them a moment to get ahold of themselves. in the little moment between being triggered and finding some self control, i don't consider them responsible for their actions. they were bred to respond like that or, basically, die. those reflexes might have some associated echoes in more mild neurological issues of Spike's sort. you are doing brilliantly. it is so gratifying to read of a dog being treated with such intelligence and compassion. 

[sanford]

On 7/2/2021 at 8:06 PM, Catalyzt said:

A few nights ago, he started trembling before the evening walk-- mostly his rear legs-- and I was sure he was going to have a seizure.  

Several years ago, Ruffy developed increasing episodes of trembling. Unlike Spike, it was his entire body, not just rear legs. I worried that he might be in pain and reported this to 2 different vets over a period of time, but neither one had much to offer and couldn't determine if the cause could have been pain or environmental. Then one prescribed Trazodone which I think might be an anti-anxiety med. Within a few weeks, the trembling stopped and did not return. 

I can't know if this was due to the Trazodone, or if the trembling stopped spontaneously... I'm just glad that it did, so I offer this anecdote in case it would apply to Spike. Good luck!

 

[Catalyzt]

3 hours ago, pkcrossley said:

it really does sound like this could be something developmental --lessening or going away as he ages. it is very interesting that you seem to be able to head off some episodes by calming him. all dogs are susceptible to neuro issues, but i do kind of think cairns are one of those breeds more susceptible. they were bred to have hair-trigger fight reflexes, and it is something you often see when they are startled, angered or frightened. they can calm down quickly, but it takes them a moment to get ahold of themselves. in the little moment between being triggered and finding some self control, i don't consider them responsible for their actions. they were bred to respond like that or, basically, die. those reflexes might have some associated echoes in more mild neurological issues of Spike's sort. you are doing brilliantly. it is so gratifying to read of a dog being treated with such intelligence and compassion. 

Yes, PK-- these are my thoughts exactly, after reading so much about the breed here.  Never would have tried to manage the symptoms this way if I hadn't learned so much on Cairn Talk!  And Spike is a Cairn X -- who knows what other nervous, fight-or-die instincts are buried elsewhere in his lineage?

I've run anger management groups, and I understand this concept-- interrupt the episode, that's the first priority, then engage the prefrontal cortex-- but this is such a dramatic, in-vivo example of it!

I hope you are right about him growing out of it.  We won't know for a year or two.  He just has these little phases when he is more at risk.  Usually he responds immediately to "no flies" and petting, there are just occasional episodes every six weeks or so when he needs more encouragement.
 

2 hours ago, sanford said:

Then one prescribed Trazodone which I think might be an anti-anxiety med. Within a few weeks, the trembling stopped and did not return. 

I can't know if this was due to the Trazodone, or if the trembling stopped spontaneously... I'm just glad that it did, so I offer this anecdote in case it would apply to Spike. Good luck!

 

Trazodone is an odd drug, and for humans, it has a weird classification: It is considered a painkiller with some, but very vague, euphoric effects-- potentially drug of abuse, but rarely.  Sometimes in people I think it has been combined with opiates to avoid high doses of opiates and tolerance, but the problem is that in that situation, oddly, it lowers the threshold for seizures slightly, so it's an unusual option that's rarely used.

I've used it with our Bichons after severe dental work or surgery, and it just makes them a little sleepy, and even that was subtle.  Did you guys continue the Trazodone, or were you able to withdraw it after a while?  At any rate, none of my dogs ever had a problem with it.

[sanford]

2 hours ago, Catalyzt said:

 Did you guys continue the Trazodone, or were you able to withdraw it after a while? 

We continued with Trazodone for a good number of months until the end when Ruffy’s heart condition caught up with him a few weeks ago.

Edited July 5, 2021 by sanford