Unusual collapsing: vet still pushing Myasthenia gravis idea

Started by Deeinnz, November 17, 2014, 03:49:24 AM

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Amshura

Hullo Dee yes I did  experience very much what you have had with BOSSDIN,NORMALITY followed by "freak" episodes of staggering gait, syncope, panting, distress etc ,...this was in my FIRST dog diagnosed who was only 6 years old.
This was always  our problem, I got to the stage when I felt my vet  was NOT believing me.
My dog totally lacked energy ,yet by the time we would have a vet seeing him, he appeared so normal. I started keeping a diary to record EVERYTHING & this proved very helpful to the specialist vets at the AHT here in UK when he was finally referred there.

James, who I lost in August, was different ,possibly because being older less energetic so conserved his energy levels, only when the blood sugar dropped dramatically did I notice something wrong, he would twitch his head a lot, the expression on the face tells you that they are about to go "off course"
The younger dog had gone through a variety of cardiac  investigations all proving   negative. Of course I could be wise in hindsight, I was so fortunate  because after  what amounted to weeks  of frustration, FREDDIE suddenly had a gran mal fit episode & the vet I spoke  with  diagnosed my dog by what I was telling her, on the phone..
I am not saying Bosein has an insulinoma but   the signs are highly suspect & this should ,most definitely be  considered. You need a blood sample  when he is actually  going through a "seizure"...even then you might only get a low sugar reading.

You really need a vet who  has seen the condition I feel, or a specialist who is prepared to LISTEN to what YOU are telling them of your dogs symptoms.
unfortunately I do not do FACE BOOK.
I wrote a long article about FREDDIE & INSULINOMA on  our  AFGHAN HOUND HEALTH PAGES on  the AFFI LOVERS forum, you can access it via the web page. Might be of help to you.
Take Care.
SYLVIA


Amshura

just thought Dee, you mentioned HONEY helps him, this is exactly what we did  with JAMES but the quick fix, that helped shorten his episodes Before we commenced treatment was ICE CREAM, (just like suggested to the epileptic dogs on GUARDIAN ANGELS site) also  I started feeding   3 or 4 x daily as opposed to a single meal or breakfast & dinner, this at the least keeps the levels  in a certain degree of balance.
SYLVIA

Deeinnz

Oh my goodness Sylvia.......

Thank you for sharing your information. It's 7am here in NZ, I'm just having my first morning coffee and am taking deep breaths, trying to keep myself calm.

I have been writing a detailed diary and sending it to my vets (two who regularly see Boss) for the last few months. On 25 July Bossdin had a terrible collapse, witnessed by two of my doggie girlfriends. From that event, because he picked up when Wilma gave him some food I went home and researched hypoglycemia. It fitted. I started feeding him 3 meals a day on 26 July. I waited about 5 days before telling my vet of the remarkable change in him. Vet agreed it sounded like Insulinoma and that's why we did the insulin/glucose blood test and ultrasound.

Because they were clear I'd discounted that. Now clearly because of your experiences I need to reconsider this.... but...... doing anything vet like with Bossdin is incredibly difficult. Early on the vet asked me if I thought it would be possible for them to take blood while he was in a collapsed state. I doubt it!!! Depending on how severe the episode is, sometimes he gets very distressed and mouths me, two times, before the event happened he got so agitated and demanded to be 'free' ( I was holding him so he couldn't run) I was worried he might actually bite me so had to let him go. This was clearly because of 'it'. He would never in a million years intentionally bite.

I will have to ask about another insulin/glucose test. As mentioned previously, we have to sedate Bossdin to do that. I'm not aware of any specialists vet centres anywhere remotely near to me. My vets have been corresponding with a specialist at Massey University Vet School (not possible for me to go there, it's in the 'other island' of NZ) though. The specialist up there has viewed one of my videos ( not sure which one) and suggested the heart monitor.

I have changed the food I'm feeding him and now he's getting lots more protein and complex carbs. I cook up chicken, no bones of course, potatoes and vegetables and he has that for his evening meal. Maybe I should give him that for his breakfast meal as well. He gets kibble or dog biscuits at lunch time. We always go out at about 2pm for his 'walk'. I had read about icecream but I can't carry that around with me on the golf course.... or wouldn't it matter if it was totally melted? Is icecream better than honey?

I will go now and find your articles on Freddie and insulinoma. Thank You !

Dee  :)

PS, just read your stories and on one page you say  "The signs/symptoms tend to be vague initially but  they become more severe and frequent as time progresses."

Yes, unfortunately this is the case with Bossdin. I restrict him severely in his exercise and we may go 8-13 days without any episodes. Because there have been no episodes I gradually let him do more of the things he loves (play golf with his golfing buddies) and then eventually we come unstuck again and have a period of bad episodes happening far more often.  If it is insulinoma, surgery is not an option for Bossdin.... the staying in hospital would be far too traumatic for him. Oh Dear!   :'(
Dee and Bossdin (SLO, DLE, Pemphigus, BCC)
New Zealand

Deeinnz

I have managed to get the video of him having a bad collapse inside my house onto a cloud service. I have no idea why you can't automatically preview it, but you can download it (50MB) to your computer to view it. For anyone who wants to view it here is the link:

https://app.box.com/s/isebiroka4nujgm9b0gb

Thanks.

Dee
Dee and Bossdin (SLO, DLE, Pemphigus, BCC)
New Zealand

Deeinnz

This is another video (38MB) that shows him starting to do the 'heaving thing'.. you have to look closely at 54 seconds and at 1 min 40sec. You also see him become totally 'altered' for a brief moment... he starts nodding his head. That is not normal. I sent that to my vet and she said nothing!

https://app.box.com/s/lye1arl3j0zqdsbz5pth

Dee
Dee and Bossdin (SLO, DLE, Pemphigus, BCC)
New Zealand

Jo CIMDA


Hi Dee

I have had a look at both videos and I wonder if the reason for  Bossdin's episodes are due to  cerebellar disease. This can be genetic or acquired.  Genetic CD usually shows in young dogs.  Just another on the list of differentials!

Have a look at this link:

https://www.inkling.com/read/fossum-small-animal-surgery-4th/chapter-38/attitudeposture

and

http://www.youtube.com/watch?v=QdPWlZhDgZ8

Jo

Catherine

I have looked at both the video clips. It is very difficult to comment fairly with only a small amount of information. I know what it is like to have a dog who has seizures (fits). I am not sure what advice you have been given about what to do when he is having one of his episodes. I know what it is like to panic and think your dog is going to die but I read up about seizures and tried to be prepared as much as possible for when they happened. I then tried to keep calm and keep the dog calm, just gently stroking her. I also used cold items on her (pack of frozen peas say,) which seemed to help. I realize you were taking the video in these clips and you may have had different advice in that you have to try and keep him alert, but if not, then it may help for you to try and keep calmer and let him lay there (if he will!)

I hope you will not take that the wrong way, I know how difficult it is to have people telling you to keep calm when you are so worried, but if you can, it really does help.

Now to the head nodding episodes and eyes flicking. I had an old dog who would start the head nodding. it was a bit different from the video clip but to all intents very similar. She might be sitting or walking and when these episodes occurred she stood still as though she could not move. They only lasted a few minutes if that and she was fine afterwards.

So, have you had Bossdin's thyroid tested? I really feel you need to rule out thyroid problems if you have not already done so. The other thing is - have you had his liver checked, a blood test to check the enzymes etc.? I only say this because my dog had liver problems. I can not say that the head nodding etc. episodes were linked to the liver problems but I thought I had better mention it.

Deeinnz

Hi Catherine,

Thanks for watching them and your comments, which are totally valid. I know I panicked totally in those videos because I knew I had to try to film the event, and found it all very overwhelming. I am a lot calmer when it happens outside because I'm so used to it now. The reason I speak so loudly is because the first few times it happened I really thought he had 'fainted' or was somehow 'drifting off' (if that makes sense) and I was saying 'stay with me, stay with me' to keep him conscious. And when he goes like that I've just kept doing it.  When it happens next I will en devour to let him lie down (normally I hold him up) and will be a lot quieter and calmer to see if that helps any.

Re the thyroid test, I've asked about that twice and vet, while not ignoring me, has tried to steer me in other directions because of all the things that can effect the result (and knowing I don't have endless $ to spend so have to spend them wisely).

After I had the abdominal ultrasound done and the insulin test came back inconclusive my other vet (the more senior and more qualified and owner of the clinic) sent me this:

2.    "   Liver dysfunction. More difficult to test in Bossdin as it involves taking a blood sample before food, then feeding and taking another sample 2 hours after eating.

3.       Insulinoma which is not yet giving us clear information on the fasting blood test. I think a 6 week interval since the last test and then repeating the blood glucose and insulin test together would help sort this out.

"So we need to think about the practicalities of doing these tests with Bossdin."

And therein lies the problem, actually trying to do the tests on Bossdin. But I will discuss these issues again with him. I feel now due to Sylvia's experiences I have to have another glucose/insulin test done.

I will put some other videos up of him having more 'normal' collapses, god what a thing to say.... more normal collapses.... where he isn't altered mentally.

Jo,

Thanks for that info, I had a look and watched a few videos on line but don't really think it fits as there doesn't seem to be anything about the dog having an altered mental state with that condition ?  The head nodding like that has only happened very infrequently. The eyes blinking generally happens if he has a really bad collapse.

Thank you both for looking and commenting I appreciate it.

Dee
Dee and Bossdin (SLO, DLE, Pemphigus, BCC)
New Zealand

Deeinnz

More Videos

This one shows Bossdin running on the golf course later in the afternoon of 2 Nov after he had that awful collapse in my house in the morning.  I took 3 separate videos of him showing how fine and happy looking he was. I only let him run one circle at a time and then force him to rest (but he doesn't want to rest).

https://app.box.com/s/zif4qjv89qssuxdyfvme

This one shows a more 'normal' collapse. There is no sound. This happened after he had intensely played golf for about 10 minutes, then had rested for about 5-10minutes. He was excited going down the path to meet the golfers as he knows what they are about to do.... Tee off, his most favourite thing. As soon as the video stopped he was perfectly fine again and did watch the golfers Tee off and he was fine.

https://app.box.com/s/ztv4ejo7ye8nkta37p6e

This one shows him collapsing after about 10 mins of playing golf with a nice guy who was hitting the ball just a tiny way so Bossdin could find it. Bossdin was on the long lead doing this cos I was aware it could cause him to collapse and needed to get it on video for Michelle (one of my vets). The crazy thing is sometimes he can 'play golf' for 1- 1/2 hours no problems at all and other times, all it takes is 10 minutes and he will collapse. I'm not letting him play golf at all now, he can only watch from a safe distance.

https://app.box.com/s/aff4jbkp9q2d6rlia4fu

From these two last ones, which are mild, I can understand why Michelle (vet) was pushing the MG idea, but it doesn't explain the changes in his mental state, or the blinking and heaving etc. And doesn't explain how he can still run flat out sometimes perfectly fine.

Again thanks all for watching, all comments are welcome.

Dee

Dee and Bossdin (SLO, DLE, Pemphigus, BCC)
New Zealand

Catherine

What sort of things was your vet referring to when he said they could affect the thyroid result?

Have you had a biochemistry blood panel done on Bossdin recently? Or is it difficult to get Bossdin to have his blood taken? Along with the thyroid test it could rule out some things or throw up some answers. Things like the cholesterol, ALKP, ALT, GGT with regard to the liver as well as the Glucose you mention.

Deeinnz

Quote from: Catherine on November 23, 2014, 08:34:18 PM
What sort of things was your vet referring to when he said they could affect the thyroid result?

Have you had a biochemistry blood panel done on Bossdin recently? Or is it difficult to get Bossdin to have his blood taken? Along with the thyroid test it could rule out some things or throw up some answers. Things like the cholesterol, ALKP, ALT, GGT with regard to the liver as well as the Glucose you mention.

Hi Catherine, I can't remember now re the thyroid test but something about their general health. I've done two other post on here in the Endocrine diseases (hypothyroidism, Addison's) thread that explain more of Bossdin's symptoms and his blood results.  Yes it is incredibly difficult to get a blood sample, we have to sedate him and even then he can still get very worked up... and him getting worked up can affect the results my vet said. Hence I will only do a test if there is a really, really good reason cos the stress on Bossdin (and me) is enormous.

Dee and Bossdin (SLO, DLE, Pemphigus, BCC)
New Zealand

Amshura

Dee I have looked at your videos & the last 2 of Boss on the golf course and his   stumbling gait, falling over are typical to what I had   with JAMES & experienced similar episodes when I had him out walking on a lead, this is exactly how his episodes started, falling to one side, losing his balance... these were initially intermittent ...he would return to the house& seem quite normal! I think your vet is right in suggesting another insulin/glucose ratio blood testing, James   condition did not show up  until the 3rd testing  by then  the   episodes were increasing in frequency &   his co-ordination was far worse during these attacks, losing his legs completely, unable to get up etc. Of course other neurological conditions could show similar ...BUT... the fact that he is so well in between raises the stakes for me in ruling out   the insulinoma diagnosis.
Will mail you privately later.
SYLVIA

Catherine

I can sympathize with you and some of the blood test results can be affected by him getting stressed at the time but with regard to the thyroid test if you have the full panel (Free T4 etc.) as well as the T4 then that should be better. Can you not get the vet/nurse to come to your home to take blood from Bossdin when he is calmer...or on the golf course? :)

I noticed with his previous results that his HCT and Platelets were on the slightly lower side......

Still with the thyroid, Acquired MG has been associated with Hypothyroidism.

Is Bossdin still having Carprieve?

Your head must be full to bursting with all these things to consider. I hope you get some answers soon.

Deeinnz

Catherine I mentioned that to both my vets about going to the golf course and they didn't respond so I took that to mean a NO.

Bossdin would not be any better at my home anyway. He always goes nuts when someone new arrives and it would take ages before he calmed down enough to be able to draw blood from him.

Boss isn't on Carprieve, I have that for emergency SLO problems and if he ever goes lame. He sometimes limps a bit now and again, but he has very tender/sensitive feet, and he has arthritis. He is on a very good green shell mussel pill for his arthritis.

You said : "I noticed with his previous results that his HCT and Platelets were on the slightly lower side......" what does that indicate? Thyroid problems ??

I will wait a day or so to see if my vet emails me back re my request for an eco-cardiogram. Then I will ring up and make an appointment to have another insulin/glucose test done. This alone will be another $220 odd but seems, unfortunately to me the most likely cause.... given feeding him honey can stop the collapse so quickly.

The full thyroid panel costs $400 + I was told when I asked about it.

Dee
Dee and Bossdin (SLO, DLE, Pemphigus, BCC)
New Zealand

Jo CIMDA

Quote from: Deeinnz on November 23, 2014, 10:28:57 PM

The full thyroid panel costs $400 + I was told when I asked about it.

Dee

That sounds a lot of money Dee.  You only need TT4, FT4 and TSH to get a good picture of the thyroid.  I would use the money on the insulin/glucose ratio test first.

Jo