MAGGIE: the dog who changed my life

MAGGIE: the dog who changed my life
Click photo to visit dawnkairns.com

Sunday, July 5, 2009

Advocate for Your Pet: Misdiagnosis Happens! Part 2

On June 19, 2009 I posted an experience my husband and I had with our rescued black lab, Maddie, being misdiagnosed with masticular myositis last fall. I promised I would share with you a second serious misdiagnosis that occurred in December, 2009 while we were in Texas with Maddie and Cinnamon, our cat.

I share these examples of misdiagnosis to encourage you to trust your intuition with your pets as no one know your animals like you do. Many of us have wonderful veterinarians that we trust and know want the best for our pets. But our animals can't talk, so a veterinarian's job of diagnosing our precious pets can be more difficult than a doctor diagnosing a human illness. As a mother with her child, our intuition often gives us valuable information regarding our pets if we pay attention. Please bring it to the table when you take your pets to their vets when intuition speaks loudly to you.

It was a warm, humid day on South Padre Island – in the 70’s. Maddie had developed a bit of a limp from running and playing ball on the sand as she chased it into the ocean, so Tom, my husband, was playing with her in the grass outside the condo we were renting to give her even ground to run on. He played with her for about 15 minutes. As they walked down the walkway toward our condo, Maddie’s hind legs gave way, frightening Tom tremendously. He walked in visibly shaken, and told me what had happened, but I could see for myself. As we spoke, Maddie was clearly weak and uncoordinated in her walk, and again her back legs swayed towards the ground. She was panting heavily. We immediately rushed her to the vet on the other side of the bridge in Port Isabel. When the veterinarian walked into the room, I immediately had that intuitive feeling I now recognize—I wanted to see someone else. But there were only 2 vets in the clinic, and the other one was busy seeing her clients. We were not close to a larger town, so this was our choice.

We described the period of exercise that led up to Maddie’s symptoms, explaining that she had never exhibited symptoms remotely similar. We informed the vet of her recent limp, but explained she had developed a similar limp after playing in the sand last year, also. Other than a hesitancy jumping up into our truck, which we thought had been due to tired muscles from her incessant desire to run and play, we had no other symptoms to share.

The veterinarian examined her along her spine and felt Maddie moved away from his touch when he examined her cervical spine. I can’t say I saw that. He said he wanted to take some X-rays of her spine and needed to sedate her to do so. We needed to leave her there for a couple of hours. I felt reluctant about having Maddie sedated, but wanted to rule out a herniated disc. I knew the X-rays wouldn’t be definitive, but might show a narrowing disc space. The clinic didn’t have access to an MRI scanner, so we had to begin somewhere. By this time Maddie’s panting had eased and she was walking fine, with no apparent weakness. Little did I know the vet was searching for a much more serious condition.

Upon our return, a vet technician escorted us into a room to wait for the doctor to come speak with us. I sensed his seriousness & my gut tightened. When the vet walked in and placed the X-rays up for us to see, he pointed to an area of Maddie’s cervical vertebrae that appeared to exhibit a subluxation to him. He believed Maddie had Wobbler’s Syndrome, or Cervical Spondylopathy. When I asked him to explain what that was, Tom and I both nearly buckled at his next statement.

“It’s a compression of the spinal cord from malformed vertebrae. It’s just a matter of time before she becomes paralyzed,” he related with regret. He went on to explain how his nieces’ dog had just been diagnosed with this.

The Great Dane is the principal breed affected with Canine Wobbler's Syndrome or Cervical Spondylopathy, I later learned from Bruce R. Wittels, D.V.M. at http://www.chetbacon.com/wobblers.htm. "It consists of uncoordination or lameness caused by pressure on the spinal cord as it travels through the neck (at any age for any reason) ... Many dogs will object to neck manipulation and may even collapse when the movement is forced.

The pressure of the spinal cord is due to improper formation of the anatomical parts surrounding the spinal cord during growth. The pressure can be due to one or a combination of the following:

1. weak ligaments

2.hyperplasia of the yellow ligaments - normally these are thin loose elastic sheets located between the arches of adjacent vertebrae.

3. malformation of the vertebrae


“How do you know she doesn’t just have a subluxed vertebrae like we get as humans, where we need a chiropractic adjustment?” I inquired.

The vet never really answered that question. “I can’t be 100% sure this is what she has until she has dye injected with films taken. But I’m pretty sure Wobbler’s Syndrome is what she has.

The treatment for Maddie was high doses of Prednisone and having her be a couch potato, totally inactive. I asked what other anti-inflammatory agent we could give her. She had not been off Prednisone very long since her misdiagnosis of masticular myositis. I insisted I wanted to try something other than steroids. The vet strongly advised against a milder anti-inflammatory, but went along with me, so he prescribed Deramaxx.

We left devastated. How could my high-energy, athletic, joyful girl become paralyzed? This couldn’t be! I called our vet in Boulder and he asked us to have the digital X-rays sent to him. He gave me the name of a neurologist in Denver and I called and made an appointment. We planned on leaving South Padre Island for home the next day, weeks earlier than planned. Then a voice inside said, “Wait a minute. Vets have been wrong before. Consider how you felt about him when he walked into the room, and his interaction with Maddie. Look at Maddie, she seems fine! I remembered how Tom wanted to turn the air conditioning on in the car on the way to the vet to cool her off. Could Maddie have overheated? I knew humans could become weak when dehydrated. I began looking up the symptoms of canine heat exhaustion/dehydration, and there it was.

HEAT EXHAUSTION SYMPTOMS:
(from Heat Related Illnesses Website)

Heat Exhaustion occurs with exercise, particularly on hot, humid days. The symptoms are similar to those of heat stroke, but may not be associated with an elevation in body temperature, as is the case with heat stroke.

HEAT EXHAUSTION SYMPTOMS INCLUDE (but are not limited to):

Heavy panting ... gasping for air, dog begins to weave when s/he walks, muscle weakness, dog lies down or collapses and cannot get up ... collapse or fainting, mentally dazed, vomiting, muscle cramps (seizure-like tremors), abnormally rapid heartbeat and rapid breathing ...

In addition to the above, heat stroke symptoms may also include (but are not limited to): Incoordination - stumbling and/or trouble standing or walking, listlessness or weakness, seizures, unconsciousness, weakness and muscle tremors, difficulty standing or walking, diarrhea.

Animals showing these signs need immediate medical treatment, so take the dog to a veterinarian or animal emergency room as soon as possible. This is an EMERGENCY! Even at the earliest stage of heat stroke, you may be fighting for your dog's life. If not treated immediately, these symptoms can be followed in minutes by collapse, seizures, coma, and death.

WHAT TO DO:
This is a life threatening situation and needs immediate veterinarian attention. There are a few things you can do if your vet has to call you back or on the way to the veterinarian's office or emergency room:
1) Immediately move the dog to a cooler area. Place the dog in a shady area or put a large umbrella over him/her.
2) Offer the pup small amounts of water (too much water may cause the dog to vomit and add to your pet’s dehydration).
3) If the dog will not drink of his/her own accord, then wipe the mouth area with a clean, wet cloth.
4) Sponge down the whole body, including tummy and groin area with COOL, not cold water.
5) If you do not have an electric fan, improvise one with a towel or something that will cause a draft around the wet dog; however, do not do anything that might panic him/her unnecessarily. Fanning the dog will help to cool him/her through the process of evaporation. If the dog has collapsed, continue with the above steps until professional help arrives. Be prepared to carry out cardiopulmonary resuscitation (CPR) should it become necessary. The dog needs electrolyte replacement and oral replacement is not sufficient. The electrolytes need to be replaced through intravenous (IV) administration.

The Bottom Line?

I knew in my gut after reading about canine heat exhaustion, and watching Maddie become more and more herself over the next several hours, that we were dealing with heat exhaustion, not cervical spondylopathy. With the later, she should have gotten progressively worse. My veterinarian at home was a great help, too. "We can't hang our hats on that diagnosis," he said after viewing Maddie's X-rays. But he cautioned us to keep her quiet until we knew for sure, preferably by seeing a veterinary neurologist. But I did know. Over the next several days we slowly increased her exercise. Maddie was fine. Thank heavens! To this day she is the graceful athlete she has been for the past 4 years! All's well that ends well! Once again, as Maggie taught me and I share in MAGGIE: the dog who changed my life, trust your intuition when it comes to your pets! And know the difference between their heat tolerance in dry vs. humid conditions, as we so humbly learned.

Posted By:

Dawn Kairns
Author of MAGGIE: the dog who changed my life
www.dawnkairns.com
www.maggiethedogwhochangedmylife.blogspot.com
www.twitter.com/themaggiebook

4 comments :

shmabadab said...

My husband and I are undergoing a similar situation with our dog Mulligan. I found your blog and was wondering if you might be able to give us some advice. Two weeks after adopting her from the shelter, she started acting very lethargic and her hips seemed to be giving her problems. Our vet performed a series of tests and after we spent almost $1000 in procedures he diagnosed her with leptospirosis. One thing that always bothered me with the diagnosis is that she had a combo booster just days before her sickness occurred. The combo booster included a leptospirosis vaccination. The doctor now wants to perform a follow up lepto vaccination. After doing extensive research, I am almost positive that she had an adverse reaction to the first vaccination, which makes me wary of giving her the second. Because she has been tagged with this illness, kennels, groomers and obedience trainers will have nothing to do with her until she is cleared of the sickness. Do you have any suggestions for us?

Dawn Kairns, Author of MAGGIE: the dog who changed my life said...

I am so very sorry for what you and your husband are going through with your dog, Mulligan, and how much money you've had to spend on a dog you just adopted. First, you have to know I am not a vet and not really in a position to advise you medically. My understanding, though, is that leptospirosis can become life-threatening so if you are not trusting or feeling good with the vet you are with, I'd get a second opinion without delay. Did a blood test come back positive for leptospirosis? Is that how he diagnosed Mulligan? I sure understand your concern about a vaccine reaction and I always think it's important to trust and bring your intuition to the table with your pets. According to the information below that I copied from

(http://www.marvistavet.com/html/canineleptospirosis.html),

treatment is with a penicillin type drug, not another lepto vaccine. I'm not sure what else was in the combo vaccine that your vet wants to repeat, but if it's crucial to receive the 2nd shot to confer immunity, say to parvo or distemper, you can ask for the vaccine to be give as a single vaccine without the leptospirosis component. Interesting that the information below states that testing is difficult to interpret if a lepto vaccine was recently given. It also calls for a second titer to confirm diagnosis:

"TESTING

Blood testing to detect antibodies against Leptospira interrogans (“microscopic agglutination testing”) can be performed. While a value of 1:800 or higher is supportive of a positive diagnosis, confirmation is not made until a second antibody level (called a titer) is run between 2 & 4 weeks and shows a four fold increase. Vaccination may interfere with testing since obviously the entire point of vaccination is to generate antibodies. If the dog has been vaccinated in the last 3 months, testing will be difficult to interpret; however, a single titer of 1:800 or higher against a serovar for which there is no vaccine is considered a positive result. The PCR test, which amplifies small amounts of DNA, would be an excellent test if vaccination has been recent but PCR testing is not available in most reference laboratories."

I sure hope this helps you.

shmabadab said...

Thank you so much for your thoughts and advice! We have an appointment with another vet in a week. Regarding the testing and diagnosis, I'll definitely bring to his attention that she was diagnosed with the disease within a week of receiving the lepto combo vaccination. I dont think the PCR test was done on the blood culture, but I'm not positive. The website you found was so helpful. Thank you again for your help!

Dawn Kairns, Author of MAGGIE: the dog who changed my life said...

You're very welcome. Best of luck with Mulligan ...