Worried and Scared: A Maisy Update

In the last week or two, I've noticed that Maisy seems... off. She's just slightly stiff. She needs to take a break halfway up the stairs. She's reluctant to jump in the car, and she's slow and sad-looking on walks. Things that would be easily attributable to aging- Maisy is seven, after all- but these are some of the same things I saw emerge over the summer. You know, before her immune-mediated crash? The one that almost killed her?

I called Maisy's neurologist, who told me to increase Maisy's prednisone from 5mg every other day to 5mg every day for 7 to 10 days. Then, we have three options: do 2.5mg daily, 7.5mg every other day, or add in cyclosporine (which tends to be quite expensive). He recommended option one, so that's what we'll do.

But then he added that it is not unusual for dogs to have a recurrence of immune-mediated inflammation after one or two months of reducing the dose. Which we did for Maisy about six weeks ago. He also added that dogs who recur at this point tend to have "less longevity" than dogs who successfully transition to no steroids at all.

It's one thing to suspect that your dog likely won't live as long, but it's quite another to be told so point-blank. I may have cried at work. I'm trying to be positive, though. Not only is Maisy very sensitive to my moods, but being sad and scared and worried won't help me enjoy whatever time I have left with Maisy.

Which I hope is a very long time.

Hindsight

I’m amazed at how well Maisy is doing… and feeling bad because it’s (now) obvious that Maisy was not feeling well for quite awhile. Over the summer she became hesitant to jump in the car. Since she didn’t seem to have trouble getting on the furniture or the bed, I thought maybe she was getting carsick. Nope. She’s now bouncing into the car, even running to it hopefully at other times. Well okay then!
 
I’d also forgotten how much ENERGY this dog has. She’s been a nutcase (in a good way): having evening zoomies again, playing with the cat, even playing with obnoxious adolescent chi-mixes. Although she had never stopped playing ball, she’s redoubled (retripled? requadrupled?) her ball-bringing efforts. It’s getting a bit obnoxious, honestly.
 
Not that I’m complaining! I’m so thrilled to see her feeling so well! She clearly feels better than before she got sick. Yay steroids! I’m so relieved she hasn’t had any negative behavioral side effects with them.
 
Bladder-health-wise, Maisy had a urinalysis on Saturday. I had at done at 3 weeks, which was a bit early (she needs them every 4 to 6 weeks for awhile), but counting is hard. Or something. I’m not sure how I did that.
 
At any rate, it makes the results THAT MUCH MORE exciting as they came back pretty good. Ideally, she should have a urine pH of less than 6.5 and a specific gravity (USG) of less than 1.020. Maisy’s pH was 6.5 on the dot and she had NO crystals! Yay! Her USG was high: 1.050, which means that her urine was more concentrated than we want. We did do the test first thing in the morning, so it had probably been 10-12 hours since she had peed last, but either way, I need to encourage fluid intake. Which is so hard with this dog.
 
We will continue to check her urine every 4 to 6 weeks for six months (when she is due for an ultrasound to confirm there are no stones). The vet- our regular practice vet, not from the hospital- and I discussed other preventative things we could do; she agreed that while effective, the prescription diet is nasty, so in a few months I’ll be consulting with a nutritionist to get a raw/home cooked diet formulated for her. The vet also recommended probiotics and a cranberry supplement (which I already started Maisy on).
 
Any suggestions for increasing fluid intake? I’ve tried broths (usually but not always successful) and adding water to her kibble (I don’t like doing that because I prefer to put her kibble in food toys, but I guess maybe I need to). I want to try drink mixes or even just sugar added to the water. Girlfriend has a sweet tooth like woah. What am I missing? I'd love to hear some other ideas!

A Week of Good News!

Both Maisy and I received great news this week! (Finally. Last month was hard.)

Maisy's Health

Maisy on her 7th birthday earlier this month.

Maisy had a follow-up appointment with the neurologist at the U of MN on Monday. He saw her during her first hospitalization for immune-mediated inflammatory disease of the spinal cord. Although Maisy really, really, really did not want to enter the vet clinic at the U (and really, who can blame her?), she was a good dog for her exam. Perhaps a bit more drama-queen-y than usual, but she didn't try to bite anyone, so I'm calling it a success.

The neurologist was pleased with her quick recovery and said that I could treat her the way I normally do- no activity restrictions! She does tire a bit easier now, but that's largely because she isn't in the same condition as she was before all this. She will continue on daily steroids (down from twice a day) for three weeks, and then will take 5mg of prednisone every other day for 4-5 months.

Maisy has had no appreciable side effects from the steroids. Some dogs get thirstier (and thus need to pee more); this hasn't happened with Maisy. Some dogs will have behavioral effects (heck, I get incredibly grumpy when I'm on high doses of steroids), but Maisy hasn't. If anything, she's friendlier. About the only thing I've noticed is that she wants to lick my face more than usual. I have no idea if that's related or not, and while it's annoying, it's also manageable. The only side effect that might yet show up is muscle wasting. I hope we don't get that!

Of course, Maisy had two issues last month, the other being her bladder stones. She is still on her very restricted diet, and she will need regular UAs and other monitoring. However, this is a highly manageable condition, if expensive. I now have three jobs. It sucks, but what can I do?

Crystal Thompson, CPDT-KA
 That's right! I got my exam results back this week (hey, I took the professional dog training exam the first day Maisy was sick, remember?), and I passed. I am now officially a CPDT-KA. I am thrilled to report that I got a 97% on it! Yay me!

Wait. I missed one on learning theory?

All in all, it's been a great week. Hopefully things continue going this well!

Hopeful for a Full Recovery

Cross your fingers, knock on some wood, put a rabbit foot on your key chain… anything to prevent me from jinxing things here, because I think Maisy might have a full recovery.

As you know, September was a hard month for us. First she landed in the ICU for what turned out to be immune-mediated inflammation of the spinal cord. Then, just as she was starting to recover, she ended up back in the ICU with some pretty bad bladder stones (and a very uncomfortable procedure to remove them). It’s been almost two weeks, though, and over the weekend Maisy started showing signs of being herself again.

She has more energy and stamina again. She’s enjoying her (short, for potty breaks only) walks again instead of plodding behind me like we’re on a death march. She’s even asking for longer walks. Her coordination seems to have returned as well. She’s not tripping over her own feet when going up the stairs anymore.

Her enthusiastic naughtiness is back, too. She’s bringing me tennis balls whenever I’m… well, awake, really! Last night she shoved open the bathroom door and insisted on sitting on my lap while I was in there. She’s joyfully nipping at my heels and running circles around me in the morning.

And, instead of sleeping in the other room or at the far side of the bed, she’s back to sleeping pressed up to me, and last night she slept in my arms for at least half an hour. Oh, I missed that! Perhaps of everything, I missed that the most.

I’m optimistic that she will have a full recovery. Visions of hiking trips and dog shows have returned, and I’ve begun making plans again.

Of course, that isn’t assured. Last night we did the first reduction in her steroid dose. She had been on 7.5mg twice a day, and now it will be 5mg twice a day for a week or so. We’ll see how (if) that changes things. She sees the neurologist next week, and I assume that we’ll discuss steroid use then. Worst case scenario (I think/hope!) is that she’ll be on them for the rest of her life. Since they don’t seem to be affecting her behaviorally, that’s just fine. After all, I take steroids twice a day, too.

The bladder stones actually seem to be the bigger issue at this point. She’s on a prescription diet that I hate, but that I also have confidence in. I’ve had a hard time not giving her little extras; she’s not supposed to have any treats at all. I have always shared everything I eat with her. I wasn’t able to do it cold turkey, but I’ve really cut back, and each day it’s a bit easier. I still plan to consult with a nutritionist at some point.

She will also need pretty regular monitoring, at least for a while. The U of MN Urolith Center actually has a lot of good info on it, with recommendations on how often to test and what parameters to look for. She will need a follow up urinalysis every 4-6 weeks until the specific gravity is less than 1.020, the pH is 6.5 or ungder, and there are no crystals. After that, follow up UAs should happen every 3-9 months. They also recommend either x-rays or ultrasounds every 6-9 months to evaluate for stones. Since none of the billion x-rays Maisy had last month showed any stones, I’ve decided to do ultrasounds.

For now, though, I’m just going to enjoy having my dog back. 

Spinal Tap Results

The results of Maisy's spinal tap came back today and... I don't know. It's not bad news, really, but it's not exactly good news, either.

Here's the deal: They tested the cerebral spinal fluid for tick borne diseases and ran a full infectious disease panel (that included things like fungal infections or protozoa). These were negative, meaning that we don't definitively know what caused the inflammation of the spinal cord.

But we do have a guess based on her current condition. Overall, Maisy is doing well. She's bright, perky, eating well, and wants to play. She's been friendly and outgoing with people, though a little reserved around other dogs. I think this is related to low-grade pain that she continues to have- or at least, that I think she has. She moves stiffly and sometimes just looks like she hurts. She has very little stamina; if we go more than four or five blocks, I have to carry her home from our walks. And if she does get this tired, her back end becomes weak and/or uncoordinated. She's tripping a lot more, especially when going up steps.

So, when we look at this picture, the vet believes that Maisy's illness is probably immune mediated. I only kind of understand what this means. I started to google it, but the wiki article talked about increased morbidity and mortality, so I backed the hell out of that window. I do know that the vet said arthritis can be an example of an immune mediated disease. It also means that Maisy's illness is likely going to be a long-term, chronic problem. I spoke with a friend of mine that's a vet, and she said that typically immune mediated diseases can go into remission, but aren't usually cured.

Tonight Maisy will start an increased dose of steroids, roughly tripled what she was on before. We will see how this goes over the next week and then will reassess the treatment plan. The goal is to taper off the drugs, but she may need to be on some dose of steroids for the rest of her life. The good news is that a little known (to me, anyway) side-effect of steroids is that it can actually improve behavior, and so far, Maisy seems to be one of these dogs. (Seriously, I had to drag her away from toddlers the other day.) Of course, they can also cause recurrent UTIs, an issue Maisy already struggles with.

I'm trying not to freak out about the future implications, like whether or not she'll be my hiking buddy again. For the most part, our day-to-day lives should be relatively unchanged (though perhaps with fewer, shorter walks), and I am grateful for that. Right now, I'm trying very hard to just take things one day at a time, and enjoy the present moment with her as much as possible. Since I tend to be a worrier, this is pretty difficult for me, but it's also probably very good for me.

I'll keep you all updated on how Maisy is doing on the steroids...

Looking Back

A lot of this has been shared on Facebook already, but I need to write about it some more because that's how I deal with stressful stuff. Plus, I wanted to include some of the non-medical happenings and share some pictures.

One week ago yesterday, everything in my world was normal. It was a lazy Sunday spent half-heartedly studying for the CPDT exam when I would have rather been reading a novel, so when my friend Elizabeth invited me over for supper, I gladly accepted. I took Maisy with me even though Eliz has an 18 month old, figuring that Maisy could hang out in a crate if it got too stressful.

It really wasn't. Maisy and Baby O got along wonderfully. In fact, Baby O was more interesting in giving Maisy treats than anything else. Feeding Maisy became a reward for everything else- eating supper, taking a bath, putting on a diaper. First do this, then you can feed Maisy.

We came home, went to bed. Maisy did need to go out in the middle of the night, but considering the sheer amount of junk Baby O had fed Maisy, I wasn't surprised. I did note that she looked a little stiff when we went up the stairs to our apartment, and made a mental note to email her chiropractor to schedule a visit.

Maisy was not in bed with me when I woke up, which is weird. I came out into the living room to find her sitting hunched over, glassy-eyed and panting. She took her medicine, but refused to eat breakfast. I called the vet.

From here, you know the story. In the span of 24 hours, she went from happily playing with a toddler to being admitted to the ICU. That first night, even with IV pain medication, she would cry out in pain every time she was touched. She had a high fever and we didn't know why. Nothing significant came up on spinal or thoracic x-rays, blood work, a urinalysis, or from a neuro consult. She had a spinal tap done, and we finally learned that she has an inflammatory disease of the spinal cord, although we won't know what caused it until the result come back sometime this week.

Those days are a blur in my mind. Visiting hours are pretty limited, but thankfully I have a flexible job and an understanding boss. I saw Maisy twice a day, with regular phone updates in between. The morning after being admitted, she looked better, but just barely. She couldn't settle down until I physically held her in my lap, but it wasn't long until she got up and asked to go back to the ICU. Heart breaking.

That evening, once again I came and brought her to the visiting area. She was restless but also reactive, barking at every noise and movement outside the closed door. I felt awful for her; being sick is bad enough, why did her anxiety have to rear up again? Still, with a lot of coaxing (read: cookies), she was able to lie down with me for a bit. She was even offering me her paw in exchange for food.

On her last day in ICU, I went to visit before she had the spinal tap. Because it was done under general anesthesia, she couldn't have treats. Still, she seemed more settled and curled up with me on the floor. The tech told me that she'd been a bit of an attention-seeker overnight; if the staff were on the other side of the room, she was quiet, but if they were working with an animal in the cages near hers, she'd begin howling. As soon as they came to check on her, she seemed to brighten up and quit vocalizing.

Still, it was clear that it was mom that she wanted. When the vet came in, asking to take her back for a quick test, Maisy refused to leave my side and they had to tug a bit on her leash. When Margaret (Maisy's former vet behaviorist, who works in the same building) came to visit us a bit later, Maisy got up and hid behind me... even though she knows and likes Margaret in other contexts. And when I finally gave her back to the ICU staff, Maisy would not go with them. I had to turn and walk away before she would, and I think that was the hardest thing I've done in awhile.

Maisy was glad to come home. With the antibiotics and steroids, she is making progress each day. I'm actually pretty surprised at how quick her recovery has been. Today- one week from when all this started- she tried to initiate play with a dog friend, has been bringing me her ball, and is just generally acting like herself. She doesn't have her normal stamina and endurance yet, and I expect I'll need to keep her quiet for awhile, but I think she's out of the woods.

Now that I think she's going to have a full (or incredibly close to it) recovery, I'm finally feeling the full impacts of the week's events. I'm finally acknowledging how scared I was. I'm finally feeling the physical effects of so much emotional stress. It was a weekend full of naps and massages and hot baths. And spending time with my dog. I want nothing more that to be with her just one more day; thankfully, it looks like my wish will come true.

I will end today's post in gratitude: I am grateful that Maisy is home and improving. I am grateful that she is acting mostly like herself. I am grateful to the staff at the U who took such good care of my baby dog. I am grateful to all my readers and friends and their friends who made it possible for me to get Maisy the care she needed without having the stress of money over my head. I would have made it work, but I don't know how. It probably would have involved a lot of Ramen and skipped meals. So thank you all for your support and love. I have so much to be grateful for. 

She's Coming Home!

Maisy had a spinal tap this afternoon. The procedure itself went very well (she had a slightly low BP during anesthesia, but meds took care of that). They analyzed the cerebral spinal fluid and found a lot of white blood cells, which is abnormal. There was no obvious bacteria, although the final report from pathology is pending.

This means that Maisy has an inflamed spinal cord/nervous system. We still don’t know why. A full tick panel is being sent out, and they will also look for an immune mediated disease. These results will take about a week to come back, so at this point we’re going to treat with 3-4 weeks of doxy (the antibiotic of choice for tick stuff) and a smallish dose of steroids (to treat the inflammation). She should feel better in 24-48 hours, although she may still have a fever during this time. As long as it doesn’t go over 103.5, I don’t need to worry. 

Oh, and she gets to go home tonight.

I did ask if they thought it would be better for her to be monitored and have the benefit of IV fluids, meds, etc., but they said that she’s so stressed in hospital that they think she’ll recover better at home. This is very true: when I visited her yesterday, she was pretty reactive to noises outside our visiting room. She was back to Old Maisy, Pre-Medication Maisy.

I did have to laugh when the tech this morning told me that she had been a bit attention-seeking overnight. Apparently when they were on the other side of the room, she was quiet in her kennel, but if they were in her area but with another dog, she would howl. As soon as they checked on her, she was fine. Rotten, rotten dog (said with a huge smile and all the love possible).

During this morning’s visit, the doctor had to come in to borrow Maisy for a quick test. Maisy would not get up and leave my side. When I went to leave, again, she would not go with the tech into the ICU area. In both cases they had to… I want to say drag her back, but that sounds much rougher than what happened. She just needed a lot of encouragement to go with them.

Anyway, depending on the results of the pending labs (tick panel, checking for fungi or bacteria in the CSF, her urine culture), we may change the meds/doses a bit, but overall, I am incredibly relieved to have a treatment plan. Maisy isn’t out of the woods entirely, but things are looking much, much better.

Finally, I wanted to thank each and every one of you for your emotional and financial support. I am deeply grateful (and a bit overwhelmed) by your response. I so truly appreciate everyone’s kind words, positive energy, prayers, and hard-earned money. I will post a photo of the final bill later today or tomorrow over on the facebook page (and sometime after that over here, just not sure when) so as to be fully transparent and accountable to everyone.

Thank you so much. Thank you for being part of our lives, and for helping me care for Maisy. I love her with all my heart, and I’m just grateful that I will have another day with her.

Speaking of which… I’m gonna go get my dog. Love you all!

She was fine. And then she wasn't.

We had a completely normal weekend. I taught on Saturday, and then hung out with Maisy while I did some last-minute studying for my CPDT exam (which was yesterday, I think it went okay). Sunday we went to my friend Elizabeth’s house, where Maisy followed her toddler around the house. (Apparently pushing treats on a dog is genetic, as we had to reward things like eating and taking a bath with the opportunity to give Maisy a treat. So. Cute.) We came home, ate supper, went to bed.

I woke up alone. This is unusual, but not unprecedented. I figured that she was a little stressed from All The Good on Sunday, what with not biting a kid and all. But when I got up, she just didn’t look right. She was stiff and panting and then she refused breakfast. She never refuses food. Never.

I called our vet. An hour later, we were in their office. Maisy sat hunched over with a miserable expression on her face. She had a slight fever of 102.9 (normal is 101-102.5), but nothing noteworthy. She yelped when the doctor touched her neck. We agreed to do some blood work and x-rays. Neither showed us much of anything, although she did have a faint positive for anaplasmosis, a tick-borne disease. But since the blood work didn’t support that, we figured it was just that she had been exposed to it before- completely plausible here in Minnesota.

She came home with antibiotics, a pain med, and instructions to monitor her temperature. When we left the vet clinic it was 103.3. An hour later it was 104; I called the vet back and they gave me some directions on how to cool her down. Despite this- cool washcloths in armpits and on paw pads, misting her with water, putting her in front of a fan, and having her eat a popsicle (she refused)- her fever actually went up, so I took her to the closest 24 hour clinic, which happens to be the U of MN. She was having a lot of pain in her neck and hips and her fever was 104.5, and we didn’t know why.

They admitted her to ICU, put her on IV fluids, started IV pain meds (fentanyl), and did a CBC and chem panel. Those results were inconclusive, but her fever did go down to 102.6. Spinal x-rays showed mild narrowing of the discs in her mid-back, but we don’t think that’s causing the current issues. A neuro consult ruled out disc herniation. The vet suggested discharging to home and either doing a wait-and-see or further diagnostics tomorrow. I said I needed a few minutes to think about it and then called a friend who is a vet. She told me what questions to ask so I’d know how to go forward.

When I called back, her fever was back at 104.4, despite the IV fluids, so going home was no longer an option. A urinalysis this afternoon showed some bacteria and white blood cells; a urine culture has been ordered. Surgery consulted and agreed that there is no joint swelling.  Tomorrow they will do a spinal tap and a joint tap. Those tests will tell us if she has a bacterial infection of the spinal cord, meningitis, a tick-borne disease, and/or some kind of immune mediated disease like arthritis. 

Her fever is down again this evening at 102.9. Still not normal, but much better. Still- we have no idea what is wrong, and I am so worried.

I also am quickly running out of money. Before I got divorced, I was solidly upper-middle class, and vet bills like this wouldn’t be a problem. But now, single and a social worker, it is. I spent just over $500 at my regular vet yesterday, and the current estimate for hospitalization and diagnostics at the U is around $2700. Plus cost of treatment. And it will obviously be more if she needs to stay another night. I’ve used up my emergency savings on this (and my cat’s ER visit last week), and am getting close to my credit card max.

I need help. I feel really weird doing this, but can you help us? I’ve set up a YouCaring site (the new ChipIn) here. I posted this link on our facebook page earlier, and I am so grateful to everyone who has donated already. And a little overwhelmed; we've gone from "how am I going to afford this?" to "well, I can still pay my rent." Thank you.

If you can’t spare a few dollars, that's fine. Your prayers, good vibes, positive thoughts, and white light (and whatever else you might do) means a lot to me.

Finally, I wanted to address a very common question: we do not think she has that deadly virus that started in Ohio. Her symptoms really don't match up (those dogs have had vomiting and diarrhea- Maisy doesn't.)

Regular and frequent updates are available over on our facebook page.