Max Update 7-8-2012 - He is swallowing!

When I finally got to the hospital today the gang from the neurology dept had left for the day but the ER tech who came to greet me was excited and told me that when she flipped Max a few minutes before she started to see more of a spark in there. She took me back to see him and his eyes were open, he was blinking. His right pupil was responding to light, but the left one isn't yet.  He could move his legs a little, and was able to swallow which I thought was great!  If he can keep it up and keep improving HOPEFULLY we can avoid a feeding tube. 

I put my finger in his ear and he shook his head, however, when I tried to film it, it didn't work that way - he coughed instead.  Not sure he can see yet, but sometimes when I had my hand over his eye (not touching but a few inches away he'd close his eyes.  Still a reflex.. but a lot more than he was doing the day before.  Also when the tech went to inject his keppra into his leg catheter he kicked his leg.  Again, technically a reflex, but more than he was doing the day before and that was a reflex to something that was irritating him so he can feel it.

Please keep the good positive energy coming!  He's doing great!  The ER vet let me know that sometimes it can take 5-10 or more days to come out of a coma, we're on day 5... 

I wanted to post this video for anyone who is dealing with this sort of a thing... don't give up hope too quickly. It may look dire, but sometimes you just need time.

More Seizures

Today started as a better day for Max... but he ended up having 2 seizures one after the other... He tried to stand through both.  His right side was affected by both, more so the 2nd one... and his right front paw is now curling under when he tries to walk (...some of the time.  I did catch him walking across my office a little while ago when he was supposed to be sleeping!)

He only had two but I think this qualifies as a cluster seizure... both lasting about 45 seconds.. his tongue turned blue - the whole 9 yards...  but he knew what was going on and was trying to walk out of both seizures. He could breath through his nose.. his mouth foamed up and he was gasping for air when he started to recover.. He pooped during his 2nd seizure... He was afraid during the 2nd seizure - I could definitely see it in his eyes... his tongue actually turned bluish grey on that one. 

Unlike his previous seizures where he got up and started walking around like a crazy man for a few hours.. he actually lay down and took a nap (which is what my other dogs and cat did when they had seizures)

After his nap I managed to get him to take 1000mg of keppra and 10mg of prednisone with a little raw organic pumpkin.  (I was able to talk with Dr. Bush, our original veterinary neurologist from http://www.bvns.net who was able to tell me what do to.. ( always check with your vets before administering any drugs!)  It took him 10 seconds and he passed out after that... and he's been asleep mostly since then..

Keppra & Prednsone and 5...4...3...2...zzzzzzzzzz

His right front paw still curls under when he gets up and tries to walk, but hopefully it'll improve some by tomorrow so he can at least walk on his own.

I was away over the weekend and Max didn't get any keppra while I was gone... I'm hoping that is all that is going on.. but I suspect there's a little more to it..

Shortly before the seizures I was emailing with Dr. Joseph about his thoughts on a repeat cyber knife treatment.  For anyone thinking about doing it.. he said they wait at least 1 year after the first treatment to do any follow up treatments. He said the results are typically 1/2 of what they were the first go around.. so if it worked well for 12 months, a 2nd treatment will typically give you about another 6 good months.  He also mentioned that there is the possibility that there could be some kind of delayed damage from the radiation to blood vessels and his suggestion was to increase the prednisone to deal with either issue (tumor growth or blood vessel issues).  The only way to tell what's going on is an MRI.  Max is scheduled for one on June 5th.  Depending on how he's doing tomorrow though, we may run him up a little early.

On an emotional front... UGGGGHHHH... I really don't want to deal with this again!  It's been a rough year between Max's tumors, Tulsa and Buster's passing, and assorted other health issues..  but as much as I've been hoping I didn't need to face it.. it's right in my face right now and it's time to get to work on dealing with it... and seeing what we can do.. whether we go the hydroxyurea route, stay the course with just the prednisone, look at alternatives... who knows.. I suppose first we need to find out what's really going on... is it tumor growth or is it edema or blood vessel issues.. or is he just not responding to the medicine the right way... or was it just because he wasn't getting the right dose of the right thing?!

Heck (I said heck.. that's right!) each time he's had a seizure I had just finished dremmeling his nails... maybe the stress from that is what triggered it... although.. in this case.. after I finished dremmeling his nails I actually was picking a bugger out of his nose when he started to seize (not sneeze... seize)!  That old addage about not picking anyone else's nose rings true here.. apparently it could be dangerous! 

Post Seizure Update

Well... today is Thursday and Max had his 2nd seizure last Fri...(he has only had 2 seizures in 7+ months and both times he wasn't on anti-seizure meds. He did not have seizures before CK but we were told it could be a side effect)...  so we're 6 days out and no repeat seizure.  He has been on 500Mg of Keppra once a day and I've noticed over the last 3-4 days the twitching he had right before his seizure seems to be frequent after he takes the keppra, starting about 1 hour after.  It stops when he goes to sleep but when he wakes up and is awake, it will continue until  4-5 hours before he's due to take his next pill. At that point his groggyness has worn off and he's much more alert and the twitching has stopped.

After talking with his neurologist, we're going to split his dose in to 2 doses (250mg every 12 hours) vs. 1 dose and see how he does..  (Max is also on Chinese herbs, specifically ones that can carry stuff through the blood brain barrier so he is affected by medication differently than the average dog his size / weight who aren't on these prescription herbs)

Drunk Max

Drunk Max

Drunk Max

Drunk Max

Max on the move! I think this is what he sees...

If anyone else is dealing with similar stuff. Max has always been a pacer and has always needed to be in constant motion.  When he's "drunk" and groggy and on the keppra he walks a lot. He's trying to walk it off. This is pretty normal for him.  Sometimes he bangs into walls, but usually he just follows them. Not sure if this also has to do with his decreased vision in his right eye.   Max doesn't want to be a substance abuser!

Other than that, he's doing well, still foraging for food when he can and trying to sneak poop if he can get away with it... He's been attempting to play a little with the other dogs and their toys... but it doesn't last too long.  And he can still hear very well and follows commands.

Up until tonight we haven't gone for any walks, not because Max wouldn't go, but because it's horsefly season and they are out in force.  Even #2 refuses to go outside!!! I ran #2 yesterday and had no less than 20 horseflies on my back and no matter how fast I ran.. the were right there... #2 had plenty on him as well.. We have both decided to hide out until they disappear!

Tonight I took him out and he tried to run up the street, then down the street, then over to our neighbors house.. then he saw his cat and wanted to run at him! Once he saw who it was he stopped..  Right now he's doing his evening walk about the house.. (He's had 250mg tonight)

Max at about 4pm after his keppra dose has worn off from the night before

Below is Max about 1/2 hour after he took his 500mg of Keppra.. lots of walking..

That crazy Max!

Max has been doing really well the last week or so. I took him off his anti-seizure meds.. he hasn't had a seizure and is on a very low dose of 150mg 2x day.  First weaned him down to 1 at night time and then the last week off completely.   He's been sleeping a bit more, but when he's up he's more alert.  We've been going for longer walks, but I've notice his face is a little more sensitive - not sure if that's because of his eye injury from when I accidentally dropped him on his face in the gravel the night before we left for NY (I still feel really bad about that). His vision is still bad in that eye and if something sneaks up on him he flinches pretty quickly.  Even Buttercup walking up next to him suddenly caused him to flinch. But I kept seeing him do it every time the wind blew, unless he had bugs flying at him - which is a possibility the horse flies are REALLY bad right now.  He doesn't seem to do that at home in the house - just out on walks.   He's also been sleeping in weird positions and wedging himself in between dog beds.. or hanging off the back of dog beds.. he'll even get up to readjust to get exactly comfortable in between the dog beds... so he's doing this on purpose. Maybe the cooker floor under neath and using the bed as a pillow? I don't know but it's a new thing for him.   He seems comfortable. (He has had a slight limp on his right front shoulder.. so this could be due to an injury - or it could have caused him to be sore?  I don't know - maybe he needs a body pillow huh?!)

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He's been wanting to walk further on our walks.. he's slow at first but once he gets going he is faster than the other dogs (#2 has a hurt leg at the moment) but definitely seems to have more endurance them they do.  His eye drooping that I was seeing a few days this week seems to have gone away - it was in his eye he fell on so maybe it was just irritated. He was rubbing at it a lot.

Today a butterfly flew into his face and he actually tried to jump at it and catch it in his mouth!  Also when he was sniffing around at the field and realized he had fallen behind us, he turned around and ran to catch up with us. I haven't seen him do that in a while.   

To me, his face looks stronger, like it's filled out some.

I have been noticing some twitching though - aside from what could be bugs in his face - every so often it looks like he has a muscle spasm, so today I put him back on the 150mg of Keppra to see if that goes away..   It could be a muscle spasm from the increased exercise, but it could also be a focal seizure I suppose?  Better safe than sorry.  It's pretty funny though - he's been off the Keppra for just a short period of time and that 150mg is making him seem drunk and wobbly.  It reminded me of how it took a couple of weeks of playing around the with dose to get him to where he was where he could walk and wasn't sleeping all day and wasn't crashing into anyone (which he's doing).  I guess we need to get him used to it again.

Anyway - that's the latest on Max - we'll just keep him where he's been on the meds for the past few months - he's been doing very well and we want him to stay that way!

His face looks good!

His right eye has a little droop from earlier this week but it's gone now

Medication update

Just got a call from the neurologist's office and we're changing Max's dose of Keppra from 500mg 3x day down to 125mg 2x/day and seeing how that works...

Max's Neuro Check up and anti-Seizure meds

Last week Max went in for his neurology check up, the first since his Cyber Knife.  He's been doing well.  We talked about how his hearing seemed to disappear when we lowered his prednisone dose to 10mg every other day so we decided to keep him on 10mg every day for now.  We're also working on weaning him over to the natural hydrocortisone. We did another full week of 10mg of prednisone every day, then the following week 10mg or prednisone every other day and on the other days we did 20-30 mg of natural hydrocortisone (soy-based and less effects on the liver/kidneys).  Now we're up to 10mg of prednisone and 2 days of natural hydrocortisone, then 1 day of prednisone and 2 days of natural hydrocortisone.  I'm happy to say Max's hearing and vision are great and I don't see any issues this time!

Dr. Young checked Max's eye as well and said it looked like it was healing well.  He could see through the cloudy scar tissue in his eye. He's doing well with his eye drops and anti-biotic ointment. He goes back to the eye doctor for a re-check next week,

The other issue we talked about were Max's anti-seizure medications.  All of the neurologists who have taken care of Max have suggested he be on anti-seizure medication .. just in case.  Dr. Joseph said he has seen dogs who have never had seizures have really bad ones that seem to come out of nowhere, and it's better to be on a preventative.  My one concern is, Max is not doing very well with these anti-seizure meds. He's not himself, and they make him very drunk.  He was first prescribed zonisamide. Max weighs 48 lbs. He was prescribed 200mg 2x/day.  He was pretty much a mess on this. It does take a while for them to build up a tolerance to the medication, much like you build up a tolerance to drinking or any other drug. Max had a really rough time and didn't seem to be building up any tolerance.  He lost his appetite all together, would vomit and had really bad diarrhea, and was extremely wobbly, anxious and walked around like a drunk guy.  I seemed to be able to get him to be ok on 100mg 1 time a day - given at night.  Dr. Young wanted to try at least 100mg 2x/day, but it's hard for Max to function during the day and we felt like his quality of life just wasn't there. The hard part is- you want them to have a good quality of life.. We went through this to save him, not to have him live the rest of his life in a fog.  Max is the Alex P. Keaton of Dogs!  He's always had serious OCD... He likes everything in it's particular spot, can't stand it when a dog can't walk in a straight line and needs to go run over and smell something..

Dr. Young suggested switching Max over to Keppra. He was prescribed 500mg 3x day.  The problem with this dose was that we gave Max his dose at 6pm and he did not wake up until 3AM the next day. Not even for dinner, or breakfast or to go out!  I couldn't even get his 2nd and 3rd doses in.  The next day I tried 250mg at night and he went out again and woke up to eat breakfast and then went back to sleep and around 1pm got up - very groggy, went potty, ate something, took a short walk, then another 250mg and he was out again until the next morning..   At this time, I'm hoping that he builds up some sort of tolerance to Keppra.   The positives of the Keppra are that he is not nauseous, his poops are solid, he doesn't seem very agitated, especially if I can get him out for a good walk in the afternoon.  He will sleep through the night.

I don't like to be woken up by drunk dogs in the middle of the night!!!

We had one little instance last night though, he didn't get his walk and was getting his exercise by walking all around the house (which he's always done if he doesn't get to go for a walk - think of a dog who needs to go to the gym religiously every day.. that's always been Max - so this isn't too abnormal for him) Anyway - at midnight he was doing his laps, and was drunk from his medication and I suppose stumbled over the dog bed where our rottie mix was sleeping, and she's apparently had it with Drunk Max. She jumped up out of bed with her horrible growley voice and decided Max needed his nose pierced.. you know.. just in case he decided he needed to get a nose ring with all the drugs he's been taking.. then she figured she should also pierce his tongue while she was at it... just in case Max REALLY wanted to be a rebel.. (Again - this is the equivalent to Alex P. Keaton getting a tongue and nose ring..... Sober Max has severe OCD... Drunk Max.. not so much.)

So Ms. Buttercup spent the rest of the night locked in Tom's office. She has yet to apologize to Max.  Max seems to be fine today.  Normally Buttercup is a lovely girl... like the rest of us though, she doesn't like to be stepped on or have someone fall on her in the middle of the night while she's sleeping, regardless of whether they can see or hear and especially not if they are drunk!