22nd October 2012, 12:18 AM
New symptoms - are they related to SM, liver, IBD or another issue?
Hi everyone, it has been a crazy couple of weeks and was hoping to get some insights on if any of my SM girl's new symptoms are new SM signs or something else. Please excuse the length of this message as a lot has happened recently and I didn't want to leave anything out in case it was important.
My nine year old Cavalier, Sadie, was first diagnosed with SM and hydrocephalus when she was five years old after having an MRI, and was classified as severe but with mild symptoms. She has been on 100mg Gabapentin 3x/day along with Omeprazole and Furosemide, with occasional increases in the Gabapentin during flareups such as when we are traveling with altitude changes. She has been stable for several years and she seemed happy. She would dance and jump and spin in the air and give happy barks while I was preparing her dinner or when she knew she was going for a ride in the car. She loved her food and lived for figuring out ways to get treats, both at home and at the vet. She has had no loss of motor skills. Her symptoms when she would have them would be some air scratching and some yelping. Once she had fast breathing and screaming when it is real bad (only had one episode of that so far thank goodness).
Now fast forward to two weeks ago. Sadie is now nine years old. I noticed her belly was quite round. She wasn't fat, I could feel her ribs, but she was quite round underneath. I was familiar with bloat from my cocker spaniel that had it a few times years ago and this didn't seem quite like it. Sadie still acted normal, eating, drinking, peeing, pooing normally, seemed her happy self with no loss of motor skills. I got her in to see our regular vet immediately just to be sure. Nope, not bloat. But she was retaining water in her belly. They drained a small amount of it for a sample, did a blood test where they found her albumin and protein to be quite low and said she needed to be seen by her internist for an ultrasound. We got her in to see her internist by going through the ER in her hospital in the city 1.5 hrs away the next morning at 7am since we didn't have an appointment. Btw, Sadie's neuro is also located in this same hospital. By this time, her stools were soft and getting less shape to them. ER got her vitals and had her set up by 8am for when the internist arrived. The ultrasound was done at noon. Nothing conclusive and she recommended doing a biopsy thru endoscopy to rule out or confirm her suspicions. This wouldn't be done until the following afternoon so we left her there overnight and waited to hear from them the next day. At 2pm the following day they called to say that the biopsy was done and she would be released in a couple hours and we could talk to the internist at that time. So we made our way back to the hospital. We were told it was confirmed that she has Inflammatory Bowel Disease (IBD) as primary with Lymphangectasia as secondary. We met with the internist who explained what was going on and where we go from here. Her absorption of fat is impaired and causes further problems when fat is in in her diet, so Sadie has to be on an ultra low fat diet such as Royal Canin Low Fat prescription food or a home cooked diet referred to as a "white diet". Her stools are now quite bad diarrhea. She also has some medications she needs to be on to reduce the fluid buildup in her abdomen, and to help with the inflammatory response. She is on Prednisone, Metronidazole, and Cyclosporine. She was taken off of her furosemide and Omeprazole because they said the other drugs would do the same thing. I questioned it and asked that they inform her neuro (in the same hospital) about the changes. Sadie was only allowed this food and anything with no fat in it such as vegetables like carrots. She has been eating the Royal Canin food, enthusiastically at first.
After being on the diet and medications for one week, her stool has improved to very soft but formed light colored stool, and we brought her in for a blood test. The test showed an improvement in the albumin and protein, although still not where they should be, but now her liver values were quite high and not in the normal range. Was told to start reducing the prednisone and continue everything else for another week and then do another blood test. Did the blood test last Tuesday, finally getting someone to give me the results on Thursday. The albumin and protein continue to improve. Liver values were much much higher!!! Very disappointing. She had an appointment for Saturday morning to be seen by her regular vet again (she hadn't seen her since we started with the internist) but by Friday morning Sadie didn't seem as eager to eat, only licked at her food but ate more when I put it on my fingers or had the competition of Joey standing there waiting to eat it if she didn't. But still she didn't eat half of it. I kept an eye on her the rest of the day. I noticed things like tripping over the lip of the dog door or a small hesitation before climbing the two steps up to the sofa. She slept and laid around a lot but that really isn't unusual for her as she has always been a couch potato. That night she again only half ate her dinner and not that enthusiastically. She was a bit more enthused about the carrots and dry version of the food that I offered her. She also didn't have that sparkle in her eye. She would stand there and just look around with no emotion. Obviously she wasn't feeling well and I wondered if she was in pain. At about 8pm I walked into the room and looked over at her on the sofa and thought she looked strange. She was laying flat on her side, eyes wide open and not blinking or moving. I talked to her, touched her face, blew in her face, no reaction. She was breathing but fast & shallow. She finally came around, gave a big sigh, sat up and fell back down. She tried to get back up and walk and her legs kept going out from under her, either buckling or sliding on the sofa. She was also panting with her tongue hanging out. My husband came running when I called to him and he stayed with her while I got on the phone and tried to get in touch with the internist. Luckily she was still there in the hospital! She got on the phone and I described what was happening. She said it sounded like a focal seizure. Sadie has never ever had a seizure of any kind in her life. After a few minutes Sadie was better, she seemed stronger and able to walk on her own without falling down. She did some pacing at first and later went outside and went potty. A little wobbly but not bad. I sometimes see a slight head tremor but wasn't sure if it was due to weakness. I brought her in to see the regular vet early Saturday morning. She was pleased to see that the water fluid was gone and her abdomen was back to normal, and was of course very concerned about what had happened. She also saw a dog who lost her sparkle, very lethargic and weak. One who didn't care that there were treats in the jar up on the counter or that she was going in the back room to see her favorite techs. She was not alert at all. They ran a bile acids test ordered by the internist and that should be back Monday or Tuesday.
Today (Sunday) Sadie is still off her food, I can barely get her medicine in her (I hide it in her canned food like little meatballs). She is very very weak, can't/won't climb any steps (although goes down the steps fine at times), and we are now carrying her outside to potty, bringing her the water dish filled to the brim so she doesn't have to bend over to drink it, and carrying her up to the sofa and watching her so she doesn't fall off or slip between the cushions since she doesn't have the strength to pull herself out. When she is laying down I sometimes see the C in her spine. She has no yelping or whining. Sometimes her foot folds forward at the ankle and she doesn't correct it. She is very restless at night, does not want to sleep in her crate (has a thick pillow type pad in it, maybe she needs a pad that is firmer?), and so she is now sleeping on our bed between us so we can keep an eye on her all night and so she doesn't fall off. She could very well be still experiencing more seizures too as they are hard to notice, especially when she is sleeping or resting so maybe that is why sometimes she seems worse than other times throughout the day.
Okay, so here is my question (finally!). Could the focal seizures be a symptom of worsening SM? Can seizures be part of SM? How much of the symptoms we're seeing is a sign of pain or related to SM versus due to liver disease, IBD, not eating, or something else? Is it common for SM patients to get liver disease? Because she was acting fine before we started on the new medicine and made the changes to her SM meds, I am thinking the changes in meds for her IBD have made her SM worse and that is what we're seeing. Especially with being off of her Furosemide and Omeprazole. I am just sick thinking that this one change could have started this horrible downhill motion. I plan to call her neuro first thing on Monday morning but am wondering whether I should be increasing her Gabapentin in the meantime if she is indeed in pain. I am hoping the neuro will talk to the internist and get Sadie back on her Furosemide and/or Omeprazole now that her abdomen is back to normal and remove the other drugs. My neuro has said that I can increase her Gabapentin as needed.
It is killing me to see her like this. She was a happy sweet silly girly girl who lived for food, treats, playing outside on the grass, and car rides, and now she has lost her light and happiness. Any information, insight opinions or support would be most appreciated!!! Thank you so much!
Mom to Sadie (11 yr old Blenheim)
and Joey (at the Bridge)