Taking A Break From Orthopedic Issues To Deal With Inappetence, Diarrhea And Listlessness That Come And Go

"Sometimes a change is as good as a holiday," they say. Well, that depends on the kind of change, doesn't it?

It all started last Monday.

We took Jasmine to the horse farm, which made her very happy. The whole day went well and safely enough, everything was good. Later that evening Jasmine threw up and looked a bit under the weather. Mostly bile, with couple bits of undigested jerky. That was not all that strange or alarming; it happens sometimes but not often enough to truly worry about it.

After that she didn't want her dinner, which wasn't unusual either.

Jasmine would say it was unfair to have an upset belly without even getting a chance to munch on any horse poop that day. You know, like getting a hangover without the party that is supposed to come before that. Not that horse poop munching is typically behind her occasional belly upsets.

She didn't want to eat until Tuesday afternoon; still not alarming.

Then her appetite came back but the stool wasn't all that great. We figured whatever upset her stomach was making its way out. Again, nothing that hasn't happened before. Since the appetite has returned, we thought things were going to sort themselves out.

Instead, the stool got worse and then on Wednesday evening she refused food again. On top of that, this time she actually LOOKED ill.

Normally, when she gets her typical belly upsets, she still acts and looks her usual happy self.

By next day she looked better again but I called her vet anyway, because this was not following the normal pattern. We discussed it in detail and he felt that it's probably from the prednisone, and since she's being weaned off it, the symptoms should resolve along the way.

She looked OK the rest of Thursday and the stools have improved somewhat. Friday her appetite and disposition seemed normal. We were hopeful that things were sorting themselves out. We went for a walk, the stool looked quite good.

On the ride home, though, my heart jumped into my throat.

Suddenly she looked very wrong. For a moment I thought we had another relapse with the neck. She laid there, her head lowered by held couple inches from the floor, ears straight back. Something was not right at all! When we got home, she literally crashed on her bed and looked completely listless. Again, she refused food and later that night the diarrhea returned once again.

First thing in the morning on Saturday I was calling the vet to bring her in.

She still didn't want to eat but otherwise looked a bit better but was running a low fever as well. Didn't want her breakfast but accepted couple treats.

Wouldn't you know it, the vet was out some place for continuing education and wasn't coming in at all that day. I've put up the latest updates to his online messaging system, hoping he might check it through the day.

Meanwhile, we had to make some decisions.

We have a standing prescription for Metronidazole, in case her IBD flares up; though I always consult with him before starting it. This time we had to decided whether to start her on it or not ourselves.

It's always helped in the past, but these recent events were nothing like what Jasmine's had before. I was worried about the up and down pattern and particularly about the crashes. Starting the meds might interfere with diagnostics later.

We could, of course, take Jasmine to the emergency, but, while ready to do so if we had to, we would rather avoid it. Last time we took here there we spent $700 on a total misdiagnosis and recommendation to euthanize. Needles to say, we weren't eager to repeat THAT experience.

We did start her on the Metronidazole.

I spent the rest of the morning watching her like a hawk and monitoring her temperature. By noon she seemed to have bounced back (again) and started looking for her lunch. That was a good sign which would normally make me feel relieved. This time, though, twice she bounced back and twice crashed again. So her feeling better didn't mean as much as it usually would.

Holding my breath I was waiting to see what happens Sunday afternoon, which, following the pattern would mean another crash.

Thankfully, this time it didn't happen.

I was quite sure this was not her typical flare-up and we were looking at something else.

Too many things didn't fit the pattern. But what WERE we looking at? That was the question.

There are some scary conditions that come with wax and wane symptoms like this. My biggest concern was Jasmine's spleen. A splenic tumor, even if benign, could still be deadly if it ruptured. Some of the symptoms did not exactly fit in with that but some of them did. Brother in law just lost his dog to hemangiosarcoma early this year.

The other nasty thing that has symptoms that come and go is Addison's disease. The big pretender, the early symptoms can be just about anything, can even mimic neck and joint issues. It has been on the table before, but was ruled out. Did we add on the fire with the prednisone treatment?

Even though Jasmine still looked good on Monday, we went to see the vet anyway.

I didn't want to take any chances; there were things about this that really worried me.

Jasmine's vet checked her out and he's quite confident it is neither splenic tumor or Addison's, though we'll test resting cortisol once she's off the prednisone for a while. We'll run a full blood panel then too. Right now, having been on the prednisone, the blood levels wouldn't be diagnostically very useful.

He is still convinced that what's been happening IS from the prednisone treatment.

Either result of the treatment alone, or in combination with a normal flare-up. I can live with that and hope he's right. Since Jasmine had her last quarter prednisone today, I'm hoping she remains feeling well. Fingers crossed.

A change is as good as a holiday? I think not.

xxx

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A Time Bomb Ought To Go Off At Some Point, I Guess: Jasmine's Neck 
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Positive Update, Though Little Clarity

Jasmine continues to do well. I always knock on the wood when I say that, but since the last neck event she seems to have recovered and, while I'm writing this, we had no mishaps or setbacks of any kind. We are VERY thankful.

Of course, I am still very paranoid, as if Jasmine was made of crystal.

This has been particularly difficult, because with the recent weather, the conditions outside are far from ideal. First we got a huge snow dump. That was fine, all I had to do was to shovel some trails for her to get out and about safely while still in recovery.

By the time should would have been allowed to start getting out again, we had a thaw. As a result, the paths and sidewalks became covered with ice, while the areas under a good snow cover developed a hard crust on top. Neither of these things are any good when you're trying to ease your dog safely back into some walks and exercise.

We have started the intensive laser therapy for Jasmine, but even with that we had to cancel one of the appointments due to weather conditions.

There was just no way would could have made it to the hospital with a hundred percent guarantee of safety.

The upside is, that this new facility also has an underwater treadmill, so we added that to her laser sessions, because Jasmine does need to regain her strength and, frankly, was going stir-crazy. Even though that is far from a fun activity, it is beneficial to the body and does help draining some of the energy.

The first appointment for the laser therapy included an initial evaluation.

I was very impressed with how thorough that was. The vet was bending and stretching Jasmine like a rag doll. He got her neck moving to places I didn't realize it could go. Needless to say, I was on pins and needles, but nothing got broken in the process.

The advantage of going through this was having a fresh set of eyes evaluating things.

 

Unbiased by Jasmine's history, the vet was assessing what he was seeing in front of him.

The good news was, that he didn't really see anything wrong. He thought Jasmine was doing exceptionally well for her age and breed. I liked hearing that very much.

Except, that does not explain any of the things that have happened starting last December.

At the time of the exam, a week after Jasmine's last neck event, the vet didn't find anything wrong with the neck, and he didn't find any neurological deficits, including the hind left which previously tested with decreased responsiveness. He even used the little rubber hammer thingy.

Should we believe those findings just because we liked the sound of all that?

While that on its own, liking what he said, is obviously not a good enough reason, his evaluation WAS extremely thorough.

The only things he discovered was a little smaller muscle mass on her left legs, both front and hind, and minor crepitus in her elbows.

The difference in circumference does mean something but it is not clear what exactly. Some crepitus in the elbows is not a surprise, we know the elbows are not completely happy.

The vet was quite impressed by Jasmine's range of motion.

Here are the findings as per his report:

Musculoskeletal exam findings:

• Jasmine was found to be in good muscle condition however there was a slight variation in thigh and gastrocnemius circumferences with her right thigh being 2 cm larger than the left one and her right gastrocnemius being 3 cm larger than the left one.
• The right triceps was also found to be 1 cm bigger than the left.
• At the time of examination there was no pain on palpation or manipulation of the neck. The only area that seemed to give mild consistent discomfort was on stretching of the left for leg into shoulder extension.
• Range of motion was measured using goniometry and found to be normal on all 4 limbs.

Neurological Assessment:

• Neurological examination revealed normal stretch reflexes, no proprioceptive deficits (owner reported that there had been a slightly delayed response on the left hind in the past).

Goals:

• As it is difficult to pinpoint exactly where Jasmine’s problems are arising from, at this time we will attempt to get her to be less painful or have less painful episodes

Rehabilitation Plan:

• We did Jasmine’s first laser session today with laser treatments over her lateral and dorsal cervical area, both elbows, both stifles and the left supraspinatus, infraspinatus and latissimus dorsi muscles.

***

It is a fact that Jasmine is not showing any problems we can see either. 

She even got to go the the farm over the weekend, even though with me shadowing her everywhere as her own personal ball and chain.

The conditions were even worse there, as they had more of the thaw. Lots of areas were completely under ice. So I was running around sanding what I could, and then breaking trails for her through the crusted snow. Then making sure she actually used those trails, as she had other plans.

In spite of all my efforts the terrain was quite hard to walk on.

However, Jasmine did well and did not come home either sore or limping! So that was a very good news.

I'd still very much like to get to the bottom of things, as well, as figure out—and correct—the reason behind the muscle mass differences. And I would really like her last neck event being the LAST.

We will continue with the laser treatments, acupuncture, and some time soon we should take her to her chiropractor again too.

For now, she's looking good and had enjoyed her weekend safely, so I'll take that.

Related articles:
A Time Bomb Ought To Go Off At Some Point, I Guess: Jasmine's Neck 
Jasmine's Disc Injury(?) Day Two 
Jasmine's Disc Injury(?) Day Three 
Jasmine's Disc Injury: Mom, Why Can't I Go For A Walk?
Jasmine's Disc Injury: The Parole Hearing  
Jasmine's Disc Injury: Spanking New Ramp 
Back To Where We Were Last May?
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Jasmine's Neck Setback Update  

Jasmine's Neck Setback Update

I am glad to say that Jasmine seems to be improving quickly.

The setback happened on Thursday.

It was around noon. Everything looked OK in the morning. Jasmine went for her morning patrol, enjoyed her breakfast, everything looked just fine. She spent the morning resting, waiting for her afternoon walk. Around noon, she jumped up from her sleep, as she often does.

(I'm not saying that the "jump" was what did it. It's the only thing that would make sense to us, though. But, apparently, for something like this to happen it doesn't not need much at all.)

Then she laid back down but as I looked at her, a red flag popped up in my head.

It seemed she was laying there just as usually but she kept shifting her front right leg. That looked way too familiar, thinking back to the neck incident back in December. I was trying to convince myself that it didn't mean anything, but deep down I knew, it did.

Surely enough, Jasmine got up and it was like a heartbreaking replay of the December situation. 

She was walking with her rear end really stiff, thumping hard at the floor. She had her head turned to the left and kept holding it at that position. Please, God, no, may it's not THAT again! But it was clear that it was.

Immediately, I was on the phone with her vet, reporting breathlessly, that we have a repeat of the neck problem.

We still had a couple of the Tramadol left, he said give them both to her. But that was all we had. Hubby was at work and the roads were a mess, and closed due to accidents. How were we going to get the pain meds Jasmine needed?

He suggested we could give her Tylenol instead, but I really didn't feel comfortable with that.

But we needed SOMETHING! Then I recalled, that some time back, when her neck was a suspect behind her episodes, he gave us a prescription for some heavy-duty pain killers to a local pharmacy. We never used them, they expired and we got rid of them. But maybe we could get those this time, instead of the unattainable Tramadol and instead of the Tylenol.

That's what we agreed on and he faxed a prescription for Codeine to our pharmacy.

Next thing to figure out was, whether or not we needed to start her on the Prednisone again. I was really hoping to keep her off it at least long enough to be able to go through with the IV stem cell treatment.

The vet said, that as long as it looked like we can manage with pain control only, we could try without the Prednisone. If there was any foot dragging, or other warning signs, than we'd need to start her on it. At the time of the conversation, what I was seeing COULD have been caused by pain only.

We did have an emergency bottle of Prednisone, so we could start any time we felt we had to.

Unfortunately, as the time progressed, just like last time, things kept looking worse.

Jasmine had a really hard time with the rear end, and the front right got thrown into the mix again also. What really scared me was, that she was hardly bearing any weight on her hind left, and when she was standing the rear left foot remained "folded", meaning the toes were together instead of spread out on the floor as in an normal stance.

Not as in knuckling; imagine trying to hold liquid in your hand--that kind of thing.

Could it have been simply because she was not putting weight on that leg? Or was it neurological?

The vet had gone home for the day and it became our call. Hubby did come home by then, and we both agreed that we didn't like the look of that.

We decided not to take any chances and start the Prednisone after all.

Whether it was because I was able to start the pain meds so soon, or because this time there wasn't the additional trauma of a long trip to the vet and back, or because the neck wasn't in as bad of a shape as last time, Jasmine was able to rest for most part.

In December, she just stood there, unable to lay down comfortably. She would cry every time she tried. This time, thankfully, while in pain and obviously miserable, at least she was able to lay down and sleep for a good deal of the time.

When she did get up, though, she had a really hard time.

So yet again, we all slept in the kitchen with her. Well, they slept, I just laid there, watching her and worrying.

By the next morning, though, Friday, she had improved quite a bit.

Her rear end was still stiff but nowhere as bad, her feet all looked fairly solid on the ground and she seemed to have been in much less discomfort.

In the afternoon, she walked almost normally, and was already full of beans and wanting to go for her walk.

She has little understanding for the fact that just because she FEELS well enough, it doesn't mean she IS well enough. One of the side effects of the pain meds is supposed to be sedation. Really? The one time we would actually WANT a side effect, it was not meant to happen.

By Saturday, Jasmine looked quite good. So we are so thankful for that.

A bunch of questions remains

• is this going to keep happening now?
• is there nothing we can do to prevent it?
• was the severe front left leg lameness couple weeks ago part of this equation or an elbow issue?
• was the stiff rear end last weekend a sign of things to come, or simply sore muscles or joints from the rear end bearing more weight than it liked?
• and where do we go from here?

I was able to find a hospital in town (Jasmine's old hospital, as it turns out) that now has a fully equipped rehab center and laser treatments.

Jasmine's vet sent referral forms and we can start with intensive laser therapy there, as soon as it looks that Jasmine is ready for the trips.

We're hoping that intensive laser treatments might help turn things around.

We will keep up the acupuncture and everything else we've been doing. If we get so lucky to have Jasmine off the Prednisone for 45 days, we will try the IV stem cells. That's not going to happen any time soon, because right now we're back to the original protocol we did back in December.

I wish we can get Jasmine's body working for her yet again, so she can get back to the life she loves.

She is NOT happy being under house arrest AGAIN. But she seems to be feeling and looking good, so that's something.

I pray we can get things turned around for her and have not a repeat of this ever again.

To make things more interesting, because they always need to be more interesting, Jasmine got one of her episodes today again too.

She is on high dose Prednisone!

That seems to finally conclusively rule out allergies as the cause behind those episodes. Jasmine's vet said that even quarter Prednisone, the dose she was on the last time she had an episode before this one, should have been enough to prevent allergies from causing such trouble. Well, she's not on a whole one!

No, I am not really glad for that.

Because that might mean that the episodes might have been neck-related the entire time (ever since she was about two years old!). But the truth is, that we never felt it could have been allergies. I just was not adding up with what we were seeing.

Could it be something else all together? Everything else seems fine. We discussed potential hormone issues, but the vet said that after all this time those would have to have shown up some place (bloodwork, liver and other organ function ...) Which makes sense to me.

But it makes sense to deal with problems in order of severity.

If we can get the neck back to the shape it was at before last December, than we can worry about other stuff.

Related articles:
A Time Bomb Ought To Go Off At Some Point, I Guess: Jasmine's Neck 
Jasmine's Disc Injury(?) Day Two 
Jasmine's Disc Injury(?) Day Three 
Jasmine's Disc Injury: Mom, Why Can't I Go For A Walk?
Jasmine's Disc Injury: The Parole Hearing  
Jasmine's Disc Injury: Spanking New Ramp 
Back To Where We Were Last May?
Elbow Problem Or Root Signature? 

Jasmine's Neck Setback

Just very briefly today, Jasmine's neck is in trouble again. It looks about the same as it did back in December. And again, no good idea how it happened. She was fine in the morning. Did nothing during the day other than hanging around. And around noon we're back in the ditch.

I think it must be the way she throws her self up sometimes when getting up from sleep.

There is nothing else we could think of. So we're back on the prednisone; so much for the stem cell treatment, which cannot be effectively done unless a dog is at least 45 days off steroids. Looking into setting up some intensive laser treatments, provided she's in good enough shape for getting there and back.

More detailed update later.

xxx

Related articles:
A Time Bomb Ought To Go Off At Some Point, I Guess: Jasmine's Neck 
Jasmine's Disc Injury(?) Day Two 
Jasmine's Disc Injury(?) Day Three 
Jasmine's Disc Injury: Mom, Why Can't I Go For A Walk?
Jasmine's Disc Injury: The Parole Hearing  
Jasmine's Disc Injury: Spanking New Ramp 
Back To Where We Were Last May?
Elbow Problem Or Root Signature?