This is an account of Plato's illness (canine epilepsy) and recovery. We are posting it because it may be useful to others with dogs in similar circumstances.
Perhaps a little background on Plato is in order. Plato is a black Labrador Retriever, born September 7, 1989 at the kennels of Sharay Labradors on Whidbey Island, Washington. He's not that big for a lab and weighed about 75 pounds most of his life. He was neutered at an appropriate age. Plato is a well-behaved dog who did very well at obedience training, although he can be aggressive to other dogs. He had a few misadventures as a puppy, including eating his leash one time. It had to be surgically removed. He had some fairly serious allergies and skin problems, but we got these under control with the help of Dr. Alan Mundell at Animal Dermatology in Seattle (Ballard). Plato was on antibiotics for a long time (Oxycillin and later Baytril) because he kept getting yeast infections on his skin whenever we stopped using them. He also takes Soloxine for his thyroid.
In recent years, he's had trouble walking. His rear legs drooped. Of course, we thought of hip dysplasia right away. We consulted a veterinary surgeon, Dr. Mark Engen of Puget Sound Animal Hospital in Kirkland, who did X-rays and found that he does not have hip dysplasia. He thought Plato might have degenerative myelopathy, but additional tests seemed to show he didn't. He suggested an MRI of his spine.
A local clinic for humans in Totem Lake does animal MRIs after hours. It's very interesting - you have to wait until all the human patients have left and then bring him in after hours. People getting an MRI don't want to think a dog was just in there. Dr. Charles Root of Redmond did the MRI and interpreted them for us. They showed some compression (not severe) and we felt that this might be the source of his problem. His regular vet, Dr. Craig Ritchie at Companion Animal Hospital in Overlake, put him on Rimadyl for some months. That helped, but then he got worse and we put him on steroids (dexamethasone). This allowed him to keep walking, but he walked less and less.
We took him to him to some alternative and holistic practitioners. Dr. Larry Siegler of Animal Healing Center in Redmond gave him various supplements (glucosamine, MSM, vitamins, Chinese herbal oil) and acupuncture. Dr. Michael Salewski of Pilchuck Veterinary Hospital in Snohomish gave him chiropractic adjustments. He walked a little straighter for a few days after this. We took him to Cindy Horsfall at La Paw Spa for warm water exercise, thinking that would be easier for him than walking. Plato loves to swim and he loves Cindy, too, but his swimming got weaker. Nothing helped much. He had a couple of accidents with his bowel and bladder, which surprised us, as he had always been a well house-trained dog. He was getting weaker and weaker. The muscles in his rear legs had become atrophied and started looking like the legs of a holocaust victim.
Around 11 o'clock on a Friday night (both a Friday the 13th and Good Friday), we were watching TV and Plato was lying in his usual spot by the door. Suddenly we heard thumping noises and ran over to Plato to find him overcome by a grand mal seizure! All of his muscles were spasming, his face was in a terrible grimace, and he had lost control of his bowel and bladder. This went on for almost a minute, though it seemed like an eternity to us, and then he went into a quieter but still strange state. We was moving his legs like he was swimming, his eyes were open but blank, and he didn't respond to us.
We called the After Hours Animal Clinic at Aerowood Animal Hospital in Eastgate, Bellevue. The vet there suggested that we keep him close and monitor him. If he had another seizure, we needed to make sure that nothing was in his way to hurt himself. She said it was hard to say what caused the seizure, because it could be caused by any one of a number of things. It could be as simple as a one-time isolated incident to as bad as meningitis or a brain tumor. After about an hour, Plato settled down and went to sleep. Shelly slept downstairs with him. Unfortunately, he had three more seizures that night.
In the morning (the 14th), we brought him to Dr. Ritchie at Companion Animal Hospital, who admitted Plato for tests and observation. He had a blood test, a urine test and a liver bile test. Dr. Ritchie phoned us and told us that he had a high fever and that he had two more seizures that day. They gave him Valium, which we've learned is used to stop seizures.
We picked him up at closing time on Saturday and took him to Animal Emergency Services in Kirkland for the night, because Companion Animal does not keep a vet on duty at night. They monitored him, gave him fluids and tried to keep his fever down. We got a call from them after midnight. He had had more seizures there, was very weak and running a high fever (105 - 106 degrees). They didn't think he would live through the night. We asked if we could come to say goodbye and they said yes, so we drove over to Kirkland at one in the morning. He really looked terrible, lying on his side, eyes not tracking, wheezing weakly. His mouth was moving like he was trying to eat. He even tried to nibble on our fingers. It was very sad. We said our goodbyes.
But come the morning (Easter, April 15th), Plato was still alive, despite having another seizure. We went over to Kirkland and brought him back to Companion Animal. We talked to the technician later that morning, and she said that Plato was more perky for part of the morning (sitting up, reacting to her, his fever had gone down, etc), but that by the time we called, he was out of it again. Some of his blood work came back from the lab and showed that his liver was not functioning well. This is a typical side effect of steroid use, but would not explain seizures. The vet on duty said that Dr. Ritchie would probably want to do a liver biopsy next, but that they would continue to monitor him and nothing more could be done on Easter Sunday. Later he had yet another seizure. We couldn't visit him there because of the holiday overload of animals.
We brought him back to Kirkland that night and were able to visit with him later in the evening. He seemed much better than the previous night. He knew it was us. We could tell by his eyes that he was listening to us. But he tired quickly. We were probably there for 15 minutes or so, and by the time we left, he was pretty out of it. He still had a fever. He'd had two seizures but they were short (long seizures are not good). They took good care of him. He had ice packs around him and a fan to try to bring the temperature down. Plato would like that under normal circumstances (he always gravitates to the coldest spots). They had him on an antibiotic mixture and fluids. They monitored his heart and kept his bedding clean. They tried putting a catheter in him, but he ended up peeing around it. His last seizure was at 3:50 in the morning.
We took him back to Dr. Ritchie the next day (Monday the 16th). Plato had an ultra sound and a something that was "just short of a biopsy" (because he'd have to be put on anesthesia for a biopsy, and they didn't want to do that). With these tests, they ruled out a lot of bad things like a liver tumor and cancer. His liver, kidneys, stomach, heart and lungs all looked okay. No signs of cancer. Still no diagnosis, but the list of possible things got smaller. One of the things that Dr. Ritchie thought it might be is Cushing's Disease. This is a disease of the pituitary or adrenal glands. It causes premature ageing, lethargy and general weakness. It is treatable. It's hard to test for Cushing's, however, because Plato's liver has been affected by taking steroids. There were some possibilities that would not be treatable, like a stroke. Dr. Ritchie did not think it was a stroke, because Plato wasn't twitching, his eyes were tracking normally, and one side of his body wasn't weaker than the other. Still, a stroke couldn't be ruled out entirely. Plato's fever was down and he didn't have a seizure all day. Dr. Ritchie scheduled a specialist to come in the next day.
We again took him to Kirkland Monday night. At this point, we had to carry Plato into the vet on a stretcher. They take good care of him there and give us a written report when we picked him up the morning. They even wiped his feet with alcohol to help cool him down. We got reports that Plato was eating eagerly, ravenously, energetically, "like a pig," with gusto, etc. This sounds like the Plato we know.
We brought him back to Companion Animal in the morning (Tuesday the 17th). He looked much better in his expression and his eyes. He hadn't had a seizure since early Monday morning (this was a huge relief to us). His temperature, while higher than the previous day, was still low. The technician said that normal for a dog is between about 100 degrees and 102.5. Plato was 101 at times yesterday, but was 102.9 this morning, still much better than the weekend. He had a total of about a dozen seizures from Friday to Monday. They call this a cluster. They are not feeding Plato in case he needs a liver biopsy. This makes us sad, because he loves eating so much. The specialist arrived and examined Plato.
Dr. Ritchie, Plato's regular vet (who was also conferring with Dr. Mary Sprague, who works with Dr. Ritchie and is Plato's other regular vet) decided not to do the test for Cushing's Disease. It evidently had something to do with the amount of steroids his body produces and the fact that he was on steroids ("even though it's not a high amount") would interfere with the test results. Rather than "running around chasing zebras," Dr. Ritchie decided to wait until Dr. Wilson, the internist specialist saw Plato. That happened late in the afternoon, and they all decided that the next step should be an MRI to check for brain turmors. Dr. Wilson did not feel like the elevated numbers connected with Plato's liver were anything at all high enough to be causing seizures. The temperatures could be explained by the brain being off. If there is a tumor, there is a brain surgeon specialist in Seattle. If there is one and it's too close to things, there is an experimental radiation program at Pullman (vet school), and he thinks that Plato would qualify. Plato sat up with urging for about 30 seconds, but then slinked down again. Richard and I want to try to encourage him to stand (we think that, while he might not be able to stand, he might also just be in a "needs encouragement" mode).
Again we took Plato to the overnight vet Tuesday evening. They monitor Plato, clean his bedding when he needs that, feed him (he's eating good) and turn him every two hours. We go over there to see if we can make him stand. We put his dish of food a few feet in front of him. He staggers to his feet, walks over and starts eating. He gets about half way though and falls back down. This is the last time he will stand on his own for a long time.
The next morning (Wednesday the 18th), we had a long conference with Dr. Ritchie. Plato looked pretty sorry: unable to stand, tongue hanging out, depressed, eyes glazed. He doesn't want to put Plato on anti-seizure medication because it often happens that a dog has one cluster of seizures and never has them again. Dr. Ritchie told us there are three types of epilepsy (seizures): primary, secondary and idiopathic. Primary, or inherited epilepsy, always comes on at a younger age and so can be eliminated as a possibility. Secondary epilepsy is due to a specific cause, like poisoning, liver failure or an infection such as encephalitis. Idiopathic means essentially "of unknown cause." His best guess for what was ailing Plato was that he had secondary epilepsy due to a brain tumor. He suggested that we get another MRI, this time of Plato's head. The MRI service that we had used earlier was not available immediately due to a staffing problem. The other nearest ones for animals were in Portland, OR or Pullman, WA at Washington State University.
Of course, we were wondering whether it made sense to carry on, or should he be put down to end his suffering. Since we still did not have a diagnosis, it was possible that he had something curable, so we decided to continue treatment.
All in all, Plato wasn't getting any better and we were running out of options. With Dr. Ritchie's advice, we decided to take Plato to Pullman to the Washington State University Veterinary Teaching Hospital, where the best possible care would be available. Pullman is a five hour drive away. We rushed home to pack. We had a piano technician tuning our piano, so we quickly paid him and told him to lock the door when he was done (I wonder what he thought?) and rushed off with Plato in the back of Shelly's little van.
Plato was so weak that he could not even lift his head to drink water. We had to hold his head up so he could drink. It's a long drive to Pullman and half of it is on secondary roads. We had Plato lying on a kind of urine pad that the vet gave us. It worked pretty well. We got to Pullman in the late afternoon and they admitted Plato right away. The way it works at WSU is that there is a "clinician" (a senior faculty member) on duty, other vets and technicians, and a number of student vets. The clinician on duty when we got there was Dr. Michael Moore. This worked out well because he knows Dr. Ritchie and his specialty is neurology. While very weak, Plato seemed to have stopped having seizures. His wheezing was pronounced. An MRI CT scan and many other tests were scheduled for the morning and he was put in the intensive care unit.
We checked into the Holiday Inn Express, a nice place that allows dogs in certain rooms and gives a discount for those people who are there for the Veterinary Hospital. They have a business center with a computer hooked to the Internet, which you can use for free, so we were able to keep everyone updated on Plato's condition by email. We visited Plato that night; they were very nice about allowing visitors even after hours.
Plato had his brain MRI Thursday morning (the 19th). We met that afternoon with Dr. Moore and Plato's student vet, Jason Strope. (Plato got a whole student vet to himself, which was good because he needed a lot of care.) The MRI did not show a brain tumor; his brain was "unremarkable." The spinal tap did not show encephalitis. An X-ray they did at the same time showed mega esophagus, meaning that his esophagus was all opened up and not closed as is normal. He also had a bit of pneumonia, probably caused by aspirating food up from his esophagus into his lungs. They took Plato off all his old meds. They put Plato on an intravenous drip to give him fluids and antibiotics. They were not feeding him. He was lying in a kennel in the ICU looking weak and confused.
On Friday (the 20th), because of the whole mega esophagus / aspiration / pneumonia scenario, Plato had a feeding tube installed (so food can be directly "installed" into his stomach and greatly lesson the likelihood of aspiration). Putting the tube in meant surgery. And this also meant another round of anesthesia. We saw him in the evening, still recovering from surgery and from the anesthesia. He was very weak. It's always discouraging seeing him in that state, but everything evidently went fine. While Plato was under anesthesia, they took a liver biopsy. They looked around inside with some sort of endoscope (some kind of little camera down his throat). And they cleaned out what they could of the junk that was sitting in his esophagus because, although he's eaten since this all started, the mega esophagus means that he can't really push the food down, so much or all of it can sit there or get thrown up. They also did (another?) liver ultrasound, but perhaps this wasn't when he was under anesthesia. Plato's blood tests showed his albumin levels were up significantly. This information led to them doing a urine test. They found lots of protein, loss of protein through his urine. So they took another urine sample and ran a second kind of urine test that looks more closely (or differently) at this loss of protein in the urine.
Meanwhile at WSU it was "Mom's Weekend." This is the weekend that all the mothers come up and see their students. Our hotel was booked and we had to leave - it books up a year in advance for these weekends. We drove forty miles to a hotel in Lewiston. We got lost on the way because we had directions like "turn left at Burger King and then turn right at Pizza Hut" and we turned at the wrong ones! Even this hotel was pretty booked and we had to stay in a fancy suite with a Jacuzzi. Well that part was fun. The next day we drove back to Pullman and were able to book the "Canoe Room" at the Hawthorn Inn. This was another fancy room with a bed made up to look like canoe, with paddles and all. There was a waterfall over the bathtub. After one night at the Hawthorn, we returned to the Holiday Inn. Our favorite things about Mom's Weekend was that the local sex shoppe had a "Mother and Daughter Sale."
On Saturday (the 21st), we met with Plato's vets and visited with Plato. It was "open house" day at the veterinary hospital and there were many visitors and a buffet. Plato was more with it than he'd been in days. We visited for at least an hour, longer than we had for days, because he hadn't stayed "with it" for that long before. He was lying on his side when we first started visiting. His heavy gurgled breathing (from the pneumonia) really scared us. We moved him so he was in the sphinx position, and his breathing improved. At one point, we all moved from the examination room (where we were visiting) to what they call an interview room (because they needed the exam room and because the interview room was more comfy), and, on our way there, we saw a baby/toddler in a stroller. Plato is always been very interested in children (the smaller the better). He lifted his head up and forward to sniff and looked really bright-- really his self as far as saying hi to a kid goes... encouraging. Once we moved to the interview room, we could hear and smell party noises (people and food). Plato became agitated (kind of frantic), like he wanted to get off the gurney-- We think he really-really wanted to investigate that food (he hasn't eaten in probably 5 days). So we went back into ICU. We left him there where he was going to be hooked back up to his fluids, get some water and meds through his (brand new) feeding tube and let him rest.
The biggest risk with his mega esophagus is aspiration (food and/or phlegm going down the wrong tube and getting into the lungs). And the biggest risk of aspiration is pneumonia. Pneumonia can be fatal. This is why Dr. Moore is "discouraged" about Plato now having pneumonia. We're scared and worried.
Earlier in the day, they did what they call a "tensilon test" to test for Myasthenia Gravis. This is an auto immune disease that attacks the nerves (the head tells a body part to move, but really doesn't have control over that body part because the chemical communicating "move" is being blocked). With this tensilon test, it is usually quite clear-- a dog that is as weak as Plato will literally get up and dance. Plato did get up, but still didn't use his back legs. Since Plato has this disk disease on top of whatever else, he might not have been able to stand (or dance), so they are going to send off a blood sample to the one lab in San Diego that tests for Myasthenia Gravis. It will take at least a week to get back this result.
One of the next tests they did Friday had them feeling that Myasthenia Gravis was less likely, but we're still sent the blood off to be tested for that just in case. This other test was an EMG test. That tests for electrical activity in the muscle and (insert complicated explanation here including words like velocity and speed). From this test, they ascertained that Plato definitely has what's called poly neuropathy (Latin for "many bad nerves"). He explained that poly neuropathy is a symptom, not a disease, but we had not determined the cause. His epilepsy appeared more and more to be the idiopathic kind. They like to joke around there that idiopathic means "we're idiots." Plato continued to run a fever. Jason worked hard to keep him cool, putting cool cloths on him at night, and running a fan. Plato was very weak, and without his steroids was no longer able to walk. His "mentation" (mental state) was depressed; he hardly seemed to recognize us.
On Sunday (the 22nd), he started getting fed through his tube. They (usually Jason) used a huge syringe, filled it up with food and shot it through the tube. Afterwards, they put water in the syringe and shot that through the tube (to clean out the tube). We were amazed at how okay Plato was with this. We thought the smell of the food would drive him mad, but he was his calm self. Jason thought that Plato probably liked it, because he felt better afterwards. His pneumonia was about the same.
On Monday (the 23rd), Plato's liver biopsy came back - normal. We were still waiting on the tensilon test. They were also considering Cushing's disease and Addison's disease, and were worried about the albumen levels of his kidneys. His pneumonia was slowly getting better; he was coughing up green mucus, a sign of it breaking up. The pneumonia sounded tons better, just a little snorkly (you had to put your ear next to his face to hear it instead of the loud hard-to-breathing sounds he was making earlier). He continued to get antibiotics to treat the pneumonia. At this point, he had "eaten" several meals through his feeding tube. He got about the equivalent of a cat food can worth of food 4 times a day, and it's a fairly rich food made especially for sick dogs and cats (so it's more nourishing than that amount of regular food). We're sure his finally having gotten some food played a big part in his feeling better. He hadn't eaten in 5 days, and who knows how much longer he's had that mega esophagus before that, a problem that would prevent food from getting where it's supposed to.
We settled into a kind of routine, visiting Plato several times a day and seeing what we could of Pullman and Moscow, Idaho (eight miles away). We liked Swilly's Restaurant the best of those we ate at. We had coffee at the Daily Grind, and found to our amazement that a singer/songwriter we know from the Grateful Bread in Seattle was scheduled to play there. Wes Weddell was touring the state, like Woody Guthrie, and writing songs about the people of Washington. His concert was very well attended; it turns out he grew up in Pullman but is now a student at the UW in Seattle.
Monday was also shift change day at the hospital. Plato got a new student vet, Holly O'Brien. She took over all of Jason's responsibilities.
On Tuesday (the 24th), we got the liver biopsy back. Good news, no cancer. In fact, there isn't anything super serious wrong with his liver, just what they call Hydropic Hepatopathy that is consistent with steroid use (Plato's been on steriods for about 6 months for his back problem). We kid with each other about how for such a sick dog, Plato's pretty healthy. So, we still don't know what the poor boy has, but he's looking better. It seems like they are out of obvious tests to do for his symptoms. It could be something that will get better with time. He certainly looks much better than when we brought him in, when he couldn't even lift his head up, but they don't know. The plan is to continue giving him supportive care for now and wait and see.
They did another chest X-ray to check out how the pneumonia is coming along and it looks much better. We visited him three times. It was a gorgeous day so, for two visits, we had him outside on the grass. He seemed to especially like that in the afternoon. We found a shady spot for that visit and were out there for at least a half hour (there was no shade this morning). He raised his head often, sniffed and whiffed the air, looked up at things that might have been interesting (a person going by, a dog going by). He still doesn't seem overly thrilled to see us, but that isn't out of the ordinary (especially since we are no longer giving him treats or any kind of food or scrap or leftover or bite or lick or taste or anything). He likes riding around on the gurney, though.
Our plan was to come home the next day (Wednesday) and leave Plato there. They'd continue the supportive care thing and call us daily. Here is a summary of what we had had learned at this point in time.
According to Holly's phone call, Plato is pretty much the same Thursday (the 26th) as he was the day before. We thought he was much better on Sunday than he'd been since we started on this bad ride. He was more subdued on Monday (evidently he had a bit of a fever). Then better on Tuesday and Wednesday (perhaps sort of the same as on Sunday).
So what does "better" look like? Lying sternal (sphinx-like) instead of on his side (although he needs help getting him up in that position). Brighter eyes, and even raising his head up to look around, especially when there is something interesting going on (like a person or a dog walking by). Holly said she took him out again for a half hour. He seemed to enjoy this. But it's sometimes hard to tell with Plato. He doesn't always acknowledge our presense, which isn't necessarily abnormal (especially since we are not giving him food or getting him out of jail). Holly said they also got him walking with his front legs today using some kind of sling.
Holly calls again on Friday (the 27th). They don't know why his legs aren't working right. They disconnected the catheter right about the time we left. They are giving him all his fluids and his meds (including antibiotics) through his feeding tube.
We head off for Pullman again on Monday.
We arrived about 5pm and went directly to visit Plato. Holly was just finishing a session of physical therapy with Plato. She wheeled him on a cart thing out to the waiting room to visit with us. He looked tired (from his physical therapy), but alert. He raised his head and looked around every time the door opened or a dog went by.
Plato still had the aspiration pneumonia. Holly said the pneumonia sounds lots better when she listens through the stethoscope. His fever is still spiking throughout the day. It went up to 104 after we left this afternoon. Holly wrapped him in a cool, wet towel, and he slept until we visited him again around 10pm. He wasn't too interested in visiting.
Holly has started making him walk in a sling. She rigged this up from some contraption that they had in a back room, plus several straps. Plato seems up for this, but he's weak and only semi-alert. His front legs make steps, but his back legs just dangle. Holly crouches behind him and makes his back legs work with her hands, and in this way he slowly moves around a bit. She showed Shelly how to do this also. It was a nice day and we all enjoyed doing this outside in front of the hospital. Holly is pretty enterprising and has ideas for Plato. She feels that he mostly needs physical therapy, hence the sling thing.
On Tuesday morning (May 1st), we helped take Plato out for his physical therapy. He was suspended in a sling on a wheeled thing that reminds Shelly of a short garment rack. He was able to use his front legs but his back legs just hung there useless - very sad. The right rear leg moved a little once in awhile but not much. He certainly enjoyed going around and being out of doors.
In the afternoon we pulled Plato around on a little bed on wheels thing. He now enjoys riding around (of course he can't jump off). We spent over two hours with him and he was lively and interested in all passersby. He's in good spirits. But nothing moves in the back half of him - he can no longer wag his tail. He started to look hungry so we sent him back for his dinner (through a tube). It turned out he was an hour late for dinner.
On Tuesday evening, we talked with his new vet, Dr. Rodney Bagley, who is a neuro-surgeon. Dr. Bagley would like to do another MRI, this time on his middle spine and all the way back - the only part of him that hasn't been fully scanned. He is convinced that it's not just poly neuropathy alone because his front works fine and his back doesn't - with poly neuropathy his problems would be all over. He thinks there may be a tumor or disk problem that we haven't seen yet. The result of his myasthenia gravis test was negative.
On Wednesday (the 2nd), we talk again with Plato's vets. We decide not to do another MRI right away. It's risky with his pneumonia to put him under, and he seems to be getting better anyway. We decide to come home again, and leave him in Holly's care. We get back to Issaquah late Wednesday.
On Friday (the 4th), according to Holly, Plato wasn't doing well. He did not look up when she came in the ICU in the morning, he was not looking bright, he was basically "blah." He had a temperature. He hadn't spiked a temperature in five days, but Holly noticed that he seems to spike a temperature whenever there's a major-crisis-commotion in ICU (like there evidently was last night with a Great Dane). He had more blood tests and they were okay, or okay enough. She decided to take him out for physical therapy and see how he did, see if that helped his frame-of-mind. She said that when she took him to the waiting room, he seemed to perk up and look around. She thinks he was looking around for us-- how sad. She said that the physical therapy brought him out of his blah's, that his temperature went down after that. She thinks that maybe he's depressed. We talked and decided that maybe it was time for him to come home, that he'd probably do better out of the ICU. She said that he's in no shape for surgery (because of the pneumonia), so, even if they did find something on the MRI, they wouldn't be doing surgery right away anyway. So we decided to postpone the MRI.
On Saturday (the 5th), Richard drove by himself out to Pullman to pick up Plato, and then back home again with Plato on Sunday. Shelly's Mom was in town for a visit, so Shelly stayed home to be with her.
The cost of this long hospital stay was surprisingly reasonable. One day in intensive care is only $28. There were many extras, of course, such as the MRI, the lab tests and surgery, but the total wasn't even a tenth of what human medicine would have cost.
Holly sent Richard and Plato off with a box of those big syringes and a brief lesson in how to use them. When we got home, Plato's big bandage (surrounding where the tube went into his stomach) was soaked in urine and falling off. We changed it as best we could (we didn't have the right bandages and tape) and then tried to feed him. Wouldn't you know it, the tube was blocked! We called WSU and managed to get a technician on the line (it was a Sunday), who suggested that we fill the tube with cola and wait an hour. This we did and sure enough it cleared the tube. It works like Drano, apparently. We were able to feed him through the tube OK. He was getting used to this.
We really were unprepared to deal with Plato in this state. Every time he urinated, he made a big mess and soaked his bandage with urine, so it had to be changed. His skin (a lot of it shaved from all his procedures) developed diaper rash. Every couple of hours he needs to be turned over onto his other side. With the help and advice of Dr. Ritchie and our friend Cindy at La Paw Spa, we finally figured out how to deal with the situation. I'll spare you the day-by-day descriptions and just tell you what we eventually figured out:
We wanted to continue the physical therapy that Holly had started, so we looked into getting him a set of wheels. We settled on the product from Doggon' Wheels because they have a version with four wheels. Plato's front feet were still pretty weak and we didn't trust them to hold up. The "quad chair" works putting "saddles" under his front legs and rear legs, and then hanging him from the chair with straps and snaps. You can adjust how much help he gets by how long you set the straps. It all worked fine, and we were able to take him for walks. If his rear legs got too tired and started to knuckle under, we could put them up in the "stirrups" and let him continue using just the front.
Most of the the time we have to pull Plato along, but sometimes when he is feeling strong he can push it himself. His steering is bad, and he doesn't seem aware of where the wheels are, so he tends to get stuck. One of the fun things about walking him in his cart, is the cars that screech to a stop when they see him. They want to know what that contraption is and what happened to Plato. So he became something of a neighborhood celebrity. There are a lot of dog lovers around. Even our neighbors cat, who usually hides from Plato, shot out and sniffed him all around in his new rig.
We see Dr. Ritchie and go over his meds. At this point he is on:
Just when things were going so well, Plato had a setback - more seizures. He had a total of 11 seizures over a period of a day and a half, the last one being in the afternoon of Wednesday (June 6th). We started him on the anti-seizure drug phenobarbital after about the 4th seizure. I've learned that it takes a few days for the prescription of phenobarbital that Plato is on to reach what they call a "drug maintenance level," so that is likely why it took longer for the seizures to completely stop. (Phenobarbital is a generic drug and it's incredibly cheap; I get a kick out of picking up a bottle of pills at the pharmacy and have them ring up a big $4 - at first I thought it was a mistake.)
Plato's seizures are still a mystery (and probably will remain so). Dr. Ritchie says that he imagines that they are another symptom of the overall nerve problem that Plato seems to have. Mentally, Plato is back with us. He's aware of stuff around him and alert, but he's sedate. The vet encouraged us to get Plato up and into his cart. Plato was like a wet noodle, like we were starting over again. Seizures are exhausting, and phenobarbital acts like a sedative at first. The vet said that things should level off in maybe 10 days to two weeks.
While Plato was at the vet's, a funny thing happened. Plato was lying on a rug on the floor, pretty much out of it. Another dog, a spaniel named Kudo, that they were treating walked over and laid down on top of Plato while their backs were turned. Dr. Ritchie took this photo of them. Apparently Plato just gave a little look, and settled back down. The two of them are very cute sleeping in a pile.
As some of you probably know, phenobarbital is the first drug of choice in controlling canine seizures. We read that it controls seizures (stops or reduces them) in something like 75% of the cases. Although it was a similar series of seizures that started this whole ride some seven weeks ago, we didn't put him on the phenobarbital until this time. We understand that it's common for people (and dogs) to have one seizure or one "cluster" of seizures and then to never have one again. So, since phenobarbital is such a serious drug (addictive barbituate), they often don't prescribe it right away. Plus Plato had all those other related health problems cropping up during and right after the first cluster of seizures, that we/they were concentrating on those. They will test his blood later for drug concentration and work from there (the first dosage amount is figured almost arbitrarily).
Report on June 19th: Plato is doing great! He hasn't seized for nearly two weeks. He seems much less restless and wobbly, so we think he's feeling much less stoned on the phenobarbital. Thanks to the help of his little cart, he's getting stronger (walking longer and doing more of the work himself). But the best news... A couple days ago, we started feeding him orally. He still has that Mega Esophagus, so eating orally is tricky. It doesn't hurt him or anything, but there's the danger of aspirating. Aspirating leads to aspiration pneumonia. This is exactly what happened to him earlier on in this saga, and he was one sick (elderly) puppy. Anyway, we are being careful to get him in an inclined position before we feed him, and then he has to stay in that awkward position for ten minutes after eating. It seems to be working well-- he hasn't vomited, or even as much as coughed. We imagine, when we put him in his new eating position, that Plato is wondering to himself, "what in the heck are they doing to me now?" But he's going along for the ride with his usual equanimity and enjoying his food, as those of you who know him, WITH MUCH GUSTO! He's not only perked up for meals, but he's perkier in-between meals now too.
So we're in a transition period between feeding Plato through his tube exclusively and feeding Plato all his food orally in just three meals a day. Over a period of maybe two weeks we are increasing the amount of food he gets orally at each feeding, and we're decreasing the frequency in which he gets these meals. If things keeping going so well, we should be able to pull that feeding tube in a couple weeks. Yippee!!! For Plato, that burst of excitement will probably be about being able to swim again. For us, it's probably more about giving our getting-ranker-by-the-day boy a proper bath. And not worrying about infection. Or whether the tube will hold up. Or who-knows-what-else could go wrong with a tube hanging out of his stomach.
In the middle of this transition period, we went to Chicago for Richard's Mom's birthday. We found a local veterinary hospital that is staffed 24-hours a day, Alpine Animal Hospital in Issaquah. While Plato isn't "sick," because he needs so much attention, he was in the hospital part of their facility there. Plato stayed there three days and it all went well. The folks at Alpine enjoyed taking him around the parking lot in his cart.
Plato finally has his feeding tube removed. It was a simple procedure and everything went well. Eating his food via mouth did wonders for his spirits. He had one staple where the feeding tube was, and that comes out after 10 days. He has stronger and more perky days than others, but he's generally improving in both those areas as time goes on. The improvement isn't as big as it was as he was getting over pneumonia (because he's already doing pretty good), but there's still improvement over time. He seems back to where he was before that last slew of seizures.
By trial and error, we worked out a routine for Plato's care. We do this routine three times a day, one for each of Plato's meals. First we give him some meds in water that's been tainted with food (otherwise he's not interested in drinking). We put him in an inclined position to eat and drink, because it's important to let gravity help food and liquid go down in animals who have mega-esophagus (otherwise the food might come back up and go down the wrong tube, and he could get aspiration pneumonia again). Plato's meds include Soloxin for his thyroid (he's been getting this for several years), Phenobarbital for seizure control, and metaclopramide to help his food go and stay down. He needs this last medicine a half hour before he eats, and so he gets this before each of three meals (the other meds are only given twice a day).
We let Plato hang in this inclined position for a bit of time, and then we take him on a walk in his cart. Lately, he's been able to make his cart go by himself (as long as we are not going uphill or he doesn't get it stuck in a rut or fence or something).
When we get back, it's about time for his meal. Again, we put him in an inclined position to eat, and we leave him in this position for at least 10 minutes after he eats. We mix his canned food with water (so it will more easily slide down that faulty esophagus of his), and we add a bit of glucosomine to it for good measure (an over-the-counter supplement that is supposed to be good for inflammation and joints and stuff). Besides this 3-times-a-day routine, there's taking him outside if it's nice, there's cleaning his bed (because he can't walk by himself, he's forced to be incontinent), there's flipping him if he's been lying on one side too long... and we try to not get so burdened with all this that we don't stop and pet and talk to him a bit during the day.
We got the bright idea to hire someone to come in and do Plato's routine. Shelly was walking him and two gals came over to fuss over him and talk. It turned out they are on summer break from college, and would love a job caring for Plato! Their names are LeAnn and Jeannie, and they go to college in Southern California. After a couple of lessons, they get the hang of the job and are doing about half of his meals. This is great - we can finally go off for awhile and know that Plato will be taken care of.
Shelly talks to another gal while walking Plato, Rachel, who's a senior in high school. She also learns the job quickly and we now have all of Plato's weekly meals covered. These last few months have been quite an ordeal and it's great to take it easy for awhile. All of Plato's girls, as we call them, do a great job and Plato enjoys being fussed over.
With his tube out, Plato can go swimming again at La Paw Spa. He has to be carried into the pool, but once in he can swim pretty well. He's not as strong a swimmer as he once was, but he's confident in the water and the excercise does him good. He seems quite happy to be back splashing around.
Since Plato was over his pneumonia and had his tube out, we decided to bring him back to WSU for that third MRI that Dr. Bagley wanted.
We met with Brian, and Dr. Sanders. Brian is Plato's student vet this time around. Dr. Sanders is one of the three head vets, the one who is "in clinic" this week. We met the other two last trip, but hadn't worked with Dr. Sanders before. Plato had an MRI on July 23rd for the rest of his back (from his neck down-- the middle area that hadn't been done before, and the lower back that had been done in Seattle but not as extensively as they like to do it here in Pullman).
Brian and another vet, Dr. Laura (a resident?), told us that the MRI didn't show anything that shouts out that it is causing Plato's problems. There is compression, but nothing "remarkable" (there's that word again!). They also re-did the test that originally told us that Plato has Poly neuropathy. This time that came back normal. Turns out that once the muscles have atrophied a lot, someone with this "Poly-neuropathy" could then test out "normal," and that's what Dr. Sanders thinks happened. In other words, he thinks that most of Plato's problems are still about this Poly-neuropathy, and not a bum back. They are also worried about his thyroid, Cushing's Disease and Addison's Disease, again.
They did see some small amounts of disk compression, but they don't think that is causing Plato problems. So no back surgery.
They tested for this again, but it came back negative. Evidently, when muscles atrophy a lot in a dog (person too?) with poly-neuropathy, the test can then come back negative event though there IS poly-neuropathy. This is what they think is going on. They said the only way to know for sure would be a nerve and muscle biopsy. We said no to that (it would require surgery, and it didn't seem like the information would do us much good).
They checked the phenobarb levels, and they are good. Dr. Sanders did say that phenobarb also affects the liver, but he said that Potassium Bromide doesn't, so he thought that we might want to think about switching meds. He thought that since Plato did well with steroids as far as walking is concerned, that maybe this would allow us to put him on some milder steroids (like a small dose of Prednisone).
First Dr. Laura explained to me why we would want to tend to this (how it's something that progresses). Then we got the blood tests back, and it was back to normal. Now that I better understand why that number from the Spring would be a concern, I am all the more happy about it now being normal. They now figure that the pneumonia/fever was affecting the kidney at the time.
I guess these are high and they explained why it would be beneficial (or at least not hurt) to add a small dose of aspirin to Plato's daily drug regimen.
We returned home again. Plato's thyroid panel comes back a few days later and showed that he does not have Cushing's or Addison's.
The rest of August was uneventful. Plato slowly got stronger again. LeAnn and Jeannie had to go back to college. Shelly did some research and found another woman, not a student, who would come out and "process" Plato during the weekday mornings and lunches when Rachel was in school. Her name is Tracy Schroeder and she has a company called Canine Club. Tracy is terrific and gets Plato walking further and further. It turns out she was a personal trainer in a former career phase - just the ticket!
We went to one meeting of Seattle Special-Needs Pets. We met some other owners in similar situations. It was good to trade tips and stories.
We went downstairs one morning and Plato was not in his bed! We found him by the foot of the stairs up to the bedroom. We were puzzled by this - did he crawl over there? We put him back in his bed, and he got up and started walking around! We were all completely thunderstruck by this! He had not walked for five months.
Tracy came over to give him his morning walk and was astounded to see him walking on his own. She went ahead and put a leash on him and took him for a walk. He went a couple of blocks, to the amazement of all. But when she came back, Plato refused to eat his food. For such a food nut as Plato, this is very worrying, so we called the vet right away.
Dr. Ritchie did a blood test and found that Plato had elevated white blood cell count, a sign of an infection. We got him on antibiotics for this. Back home, he was walking everywhere. He even tried to go up the stairs and tried to go out the doggie door. The doorbell rang and he got up to wag at the guy soliciting, who didn't think it was anything remarkable. He walked across the street and got petted by our neighbor. But he refused to eat all day. We forced some water down him, but he threw it up later. Rachel arrived to do his evening meal (which he didn't eat), and took him for a walk, and of course she too was totally astounded at his walking.
The next day, he started eating again. He was still getting up and walking around, but less than the previous day. The day after that, he kept walking, but had to be helped to his feet. We had his blood tested again a week later, and he was back to normal.
And that's pretty much how it stands. He goes on walks three times a day (one for each meal), but he rarely gets up by himself. It just takes a little boost to get him to his feet and then he walks fine. He has walked as far as one mile at a go. When he sees another dog, he'll break into a little trot or prance. It's great to see him looking so well. His rear leg muscles have gotten bigger and look almost normal. His mood is good and he's attentive and more affectionate than he used to be. We still hitch him up to the cart to feed him in an inclined position.
We have the feeling that arthritis is his main problem now. After consulting with Dr. Ritchie, we now have him on aspirin (half a regular strength aspirin, twice a day). We may go back to Rymadil, which is a derivative of aspirin, or another non-steroidal anti-inflammatory drug. We won't go back to steroids, as it's possible that they were the cause of all his problems (we still don't really know).
We know he won't live forever, but Plato has pretty much recovered, as of this writing (late November 2001). In some respects he's better than before the seizures, and in some respects worse. He enjoys his weekly swims and in fact is swimming more than he ever did before. We're glad to have him back. Many thanks to all his caregivers for all that they've done for him.
--Richard and Shelly Gillmann
Written November 2001
Plato passed away April 8, 2002. He will be missed.
-Richard Gillmann, February 2007
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