Wednesday

I wish I had better news to report.  Max is still in a comma. He's no longer on Pheno and they reduced his keppra dose down to 250mg today. He's still on something to reduce the swelling in his brain. His blood pressure started to drop around lunch time today and his respiratory rate dropped and his temp dropped down to 98, but by the time we got to the hospital it had started to get better. His respiratory rate went back to relatively normal, and his body started to regulate his temperature again.  His blood pressure was still fluctuating when I left earlier this evening, but they're monitoring and adjusting his fluids accordingly.

When they get his BP back to normal he has normal reflex reactions in his eyes. At one point I did see his eyes and ear move on their own, but it was short lived. What we're hoping is that the drugs will get out of his system enough that he'll start to wake up. They're working on flushing him. 

So far his kidney and liver seem to be functioning well.

They realized that you can't give chinese herbs rectally because they are absorbed in the stomach through digestion, not the colon / rectum so unfortunately we can't give him the Stasis of the mansion of the mind.  Today we did give him the yunnan baiyao with the medicine that shrinks swelling in the brain. Hopefully that will help carry the Yunnan Baiyao to the brain and stop the bleeding, break up the clot and help reduce the pressure.  It's pretty much a wait and see kind of a thing right now.

Kind of a scary day.. I think he's still in there though. I sat and pet him for about 3 hours today.  Please keep my sweet little guy in your prayers and thoughts and send him some good energy! 

Visit with Max

Just got back from a visit to the hospital. Max is still unconscious - or at least looks that way - but sure looks comfy... His blood work is good, his vitals are good, he's still in a drug induced comma, but they've been lowering his meds a bit. He's been seizure free since actually midnight last night and that seizure at midnight was a tremmor with a little paddling.

He has Jennifer taking good care of him... He has had some eye movement under his lids and when you whistle or call him his ears move. They're still not sure if it's automatic or if he's processing but they seem to think he's actually reacting a little to it..

He aspirated a little during his seizure and has started to develop a pneumonia so he's on full spectrum antibiotics right now through IV... and seems to be making some baby steps forward. They're going to keep him at maintenance doses of everything over night and then work on lowering the meds again tomorrow to see how he does and if there are additional improvement signs..

I brought up more yunnan baiyao and he's taking the emergency pill, which hopefully will help. They are probably going to start his chinese herbs up again (stasis of the mansion of the mind, wei chi booster, and the anti-seizure one) but give them to him rectally, The herbs help flush edema, bloodo, and tumors out of the brain and cross the blood brain barrier. Max is super sensitive to the drugs so they herbs may throw him for more of a loop and make him more drunk.... but hopefully will help.. Dr. Young mentioned the absorption rate given rectally is something like 60% that of an oral dose, but since he's comatose they can't do the oral dose obviously..

His vitals are all normal, his blood work is all normal, his blood pressure is all normal.. he's doing great! We'll give it a few days to get him back down off the drugs and then see where we are. But it is good he's responding.

For his pneumonia they are coupaging him every few hours, and rotating him from side to side every few hours as well. Once he regains consciousness he'll be able to move more. He also is coughing bit it's probably a reflex...

Anyway - keep the good thoughts and prayers coming!

I got a great message from someone who's mom was one of the first Cyber knife patients and it's been 8 years and she's cancer free so lots of good stories coming to us from other cyber knifers!!! Thank you everyone!!!!

Max Update - BIG Seizure..

Max had a massive seizure yesterday... it wouldn't stop. I managed to get him to the local vet to get some injectible vallium and then got him up to the hospital an hour away to his neurologist.

They got him stabilized, and did an MRI and blood work..

Good news... is that the Cyber knife completely - I MEAN COMPLETELY!!!!!  got rid of the tumor on his brain stem!  How amazing is this!!!!!!!  His blood work was relatively good too.

The tumor on the left side of his brain was still there and may not be a meningioma since it didn't respond.  But it could be b/c it didn't increase in size... and may have just gone dormant... so from all of that.. all - things considered, he's doing great..

BUT then there's the long cluster seizure... The MRI also showed blood in Max's brain... He had a bleed- it's contained (vs all over his brain - which is a positive)... so we're trying to stop the bleed and then flush out the edema and the blood... They put him in a drug induced comma to stop the seizing.. and we started him on emergency yunnnan baiyao last night.. today they are going to work on slowly trying to wean him down from the drugs and bring him back to awareness if we can keep him from seizing...


The bleeding is what's causing the seizures.. Dr. Joseph mentioned he'd seen latent damage to blood vessels in some CK patients and that's what it looks like has happened with Max. We have him on Yunnan baiyao to try to stop bleeding, then try and figure out how to flush the swelling and blood out of the brain.. We also want to see if we can reduce the drugs he's on and make him more aware and if we can get him to come out of the comma and give him time to get back to normal... gonna be a slow process.. Going back up to the Hospital in a few with more emergency yunnan Baiyao...

One other good thing... during his seizures his color stayed pink so he was still getting oxygen to his brain which hopefully means no brain damage... time will tell but we definitely have some good things going on here... Just need to get rid of the edema and the blood.    Last I heard his last seizure was around 2AM.. it's just about 2pm...   so hopefully that's a good sign ... I'll find out more when I get up to the hospital

One other thing to note -  Max did not get his anti-seizure meds when both of his last seizures took place. 

Keep those prayers, white light, good energy, good vibes, and good thoughts, etc coming!!! .. He's a fighter!!!

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! 

Is it the Drugs?

Today Max had an acupuncture appointment.  We've had him on 10mg of prednisone 3x / week - essentially every other day, as well as his normal dose of Keppra (125mg 2x day). It's been a few weeks but Max is still seeming foggy when he's on those doses.  The plan is to keep him on the prednisone at the 3x / week for the next week (2 additional weeks total) to see how he does and then reduce him back down to a low dose..

On his prednisone days he gets his prednisone between 8-9am at breakfast... around 2pm he starts drinking water and then the water works start and we have a good solid 4 hours of peeing every 1/2 hour or so... sometimes in the house, sometimes out... the door is open... Not so pleased with the indoor peeing.   His regular vet has suggested dropping him down to 5mg of prednisone every other day - we don't know if that will work - but since he was on such a low dose before it may keep him from having the issues with additional thirst and peeing... worth a try - we'll know what to look for if it's too low a dose.

Kids... this is what happens when you pass out on drugs

And when you wake up you have a funny face!

We're going to start giving Keppra with meals to see if that slows down the absorption as well. He's been getting it with snacks but maybe not enough food in his belly.

He's still active and walking  - pacing when he's on the meds.. walking when he's not. He can hear, comes when he's called, he's started to chase #2 when he runs by, he'll also follow him. Today he jumped up with the other dogs and got into the morning scrum and thought about wrestling with them.. Then thought twice about it.. (smart boy - he's still a little weak and sensitive. He fell in a ditch and off his ramp when he was loopy on the meds and his shoulders are stuff and his back legs... ) 

He has not had any medication yet today - he'll have Keppra in a little bit, but at his vet appt this morning he chased a tennis ball and tried to catch it in the air and then walked around with it for a while.. which was a great sign!  He also jumped up when the rest of the dogs started barking at the FedEx truck and ran with them to see what was going on.  I am now realizing that his foggyness is most likely more drug related than anything else.. It's amazing to me that the same dose isn't working the same way it was before and he's more sensitive to it... but maybe you just have to monitor and adjust to the patient.  Body chemistry changes over time... I suppose another argument as to why all patients should be dealt with as individuals vs. all treated the same.. 

Max NOT on drugs at vet getting acupuncture and playing ball

Max and his ball

Difference A Day Makes

What a difference a day makes... I think.   Yesterday was Max's first day back on his regular dose of Keppra.  He was still a man in motion...  The below video is only 4 minutes.. but when Max starts moving.. he's moving CONSTANTLY for hours..  Last night he woke up at 1:45AM and didn't start to tire out until 4AM. I finally had to grab him and put him in bed.  As soon as he lay on his side and finally put his head down, he was out cold until 8:45AM... but while he's walking around the house he's waking EVERYONE up, including the other dogs who try and hide from him so they can get some sleep too!  (the video below is of Max yesterday)

Today I wanted to get him back on his old keppra schedule so I waited until late afternoon to give him his 125mg.  He was much more alert than I've seen him in a while. He had his last 125mg of Keppra at 11pm and around 11AM he started to chase #2 when he was playing with a squeeky football and he even tried to nip at him and herd him!  Rex was flinging stuffed animals by Max and Max went over and tried to join in for a minute.. Then Rex body slammed Max (He has a bad habit of body slamming everyone - he really does think he's the King of the world). This is the best part! Max was not going to have any of it and actually jumped Rex, growling and teeth out and nipped at him and told him to back off!  Max went for a ride in the car and did well. He was able to stop the constant movement and run into the kitchen when he heard someone in there so he could see if there was food to be had. He was sniffing things outside in the garden, coming when called, sitting when asked,  checking to see what everyone was doing and even came over for a few snuggles! - pretty normal.   The only thing he did that drove me nuts today was step in his water bowl and flip it 4 times (so far) today.   I have now moved it and hopefully he won't do it again in it's new place..   He's even been able to come in for a landing and lie down and just sit and watch things vs. pacing  and then passing out.

I did give him his keppra at 5:30.. and he fell asleep right before dinner!  Something I haven't seen in a LONG time!  He did wake up and got upset he had been forgotten - but did eat his dinner and then helped Rex finish off Buttercups dinner (which probably means we have another issue to deal with - she doesn't normally NOT eat)

Rex & Max eating Buttercups Dinner

So he's been moving constantly since he finished dinner (7:30 until now 9pm) and just lay down to zonk out.  I'm hoping he will get up, go potty, go to bed and then stay asleep without pacing for the rest of the night... It would be nice to be back to normal.  I'm beginning to believe that this has been tied more to the keppra than anything else. I was worried yesterday and this AM.   I'll still be watching carefully the next week or so, but hopefully we'll keep seeing improvement!  and Hopefully Buttercup is ok!

Keppra

Today we finally get to start to wean Max down to his regular dose of Keppra... Oh how I do not like Drunk dogs!!!  And I'm sure Max does not like being drunk...

Max posing by the door during a pace.

He had a mild seizure 2 fridays ago 4/27 after running around like a mad man.  We upped his Keppra dose from 125Mg 2x / day to 500 mg once a day and he was sleeping 17-18 hours of the day, which was fine.  He would pace around the house for about 1/2 hour -45 minutes after taking his dose until he passed out.  On Thursday of last week we split his dose down to 250mg 2x day to see if he'd be less loopy and less sleepy.  He only slept for about 6 hours at a time, and then paced around the house for a good 3 hours! and then was normal for 3 hours before his next dose... Then he'd start the pacing again until he passed out.  The 250mg doesn't make him as sleepy, but still kind of agitates him that he has a buzz so he just wants to walk it off.  Yesterday he started his pacing at 3:30pm and didn't stop until 9pm!  At 4AM, Buster #2 came into my bedroom to tell me that Max was up and pacing on the other side of the house and I needed to make him stop!!!    Easier said than done... He went out for a bit, came in, paced some more until I finally grabbed him and put him on his bed and made him lie down at 5am.

He woke up today around 8AM and was a little wobbly at first, got himself stuck behind the toilet in the bathroom for about 10 minutes before I found him... Reverse apparently wasn't working!  He had breakfast, and then went for a walk down to the end of the road (about 1/4 mile and back) and seems much more coherant now and CAN now go in reverse... but is still making his rounds. He's always been one of those dogs who doesn't sit still very well.. Out of 35 commands he knew when he first came to me, Stay was not one he every followed! Fortunately Lie Down is one he still remembers... but then he gets back up!

The other thing he started to do when we cut his dose down to 250mg 2x a day was go outside to pee and he's been pooping in the house - even though the door is open. He has always pooped while on the move. I've never been too sure what that was about. My only guess was his previous owners used to run with him and never let him stop to go potty, so he just learned to go on the move.   I don't know if this is a result of being buzzed or something else.. but we'll watch it.. He's done it 2 days in a row. Thankfully they are solid and easy to clean. When he was on the higher dose he slept all day so the first thing he wanted to do when he woke up was go out and he took care of his business all at once.. Maybe being buzzed is affecting it??? We shall see.  Today we start him back on his regular dose of Keppra 125mg 2x / day.

The twitching seems to have diminished quite a bit, ever so often I'm seeing some twitch - but maybe once a day vs. frequently so that's good.  He can hear when you call him and will turn around, but he seems a little foggy still so I'm guessing that's from being drugged up still. When he is asleep he's not waking up when the other dogs are barking unless they are standing right over him.. but again - probably because he's drugged up.

I'll report back after we see how he does with the regular dose.. but all in all - so far so good. No more seizures, he can still turn right and left, still can see and hear.  I think he's just drugged and foggy.