Saturday, October 02, 2010

Labour Day Weekend Day 4 - Neurology Consult

Mum took me to this place after my date with the 4 B's,

She said I was going to see the Stumbling Doctor about my stumbling, (mum: she meant a neurologist.)

I waited patiently in the hoooge waiting area,

When will it be my turn??

Then a nice lady came and took us to a room. She listened to my SuperHEART, and violated my MUSCLE BUTT..... (mum: she had her temperature taken)

The lady told us that the Stumbling Doctor was coming soon. See the drawing of the weird Dog X Snake creature behind me on the white board?

The Stumbling Doctor came in, his name was Dr. Sanders. He was very nice, and he thought I was very funny because I dragged mum's backpack down from the chair and started opening the zipper while he and mum were talking. (mum: there was a small bag of cheese and one boiled egg inside.)

Dr. Sanders and SVS came highly recommended to us. My friend Darwin saw Dr. Sanders when she had an owie back, and my other friend Sam had his owie back surgery at SVS.

Dr. Sanders flipped my toes, hit my knees with a hammer, and looked at my eyes with a bright light. (mum: reflex exam.) Mum had her laptop there to show Dr. Sanders videos of me stumbling. I just waited patiently for the boiled egg and cheese,

Dr. Sanders drew some funny picture on the white board. He said this is a doggie brain, and the purple ball is something bad in the brain. (mum: Pituitary Macroadenoma (type of brain tumor that causes Cushings).)

That's not my brain! I'm sure my SuperBRAIN is prettier than that.

Then he drew an X on the Dog X Snake creature. He said that's where he got an ouchie response from me, (mum: Dr. Sanders got a bit of a pain response from Sunshade at the thoracolumbar/lumbar junction (T13-L1) in the spine.)

I got bored from looking at the drawings and listening to them talk, so I thought I would show them how great my SuperBRAIN was working so they could stop saying how I might have something bad in my SuperBRAIN,

I scored an egg. See, brain working perfectly! (mum: That's Atypical Cushings acting, not normal Sunshade behaviour.....)

Mum and Dr. Sanders talked some more (while I finished the cheese chunks), and then we left the clinic.

(mum: While we were in Seattle, I took Sunshade to see a Neurologist about her stumbling.

Well, the result is inconclusive. Sunshade passed the neurological exam. Dr. Sanders said he couldn't pin point or localize anywhere that he could confidently say ok, this is what's making her stumble. Basically, Sunshade's history didn't really fit with his findings to come up with a firm hypothetical diagnose. He said he could make sense that her lower back pain (probably a chronically herniated disc or DDD) is causing her hind legs to stumble, but couldn't tie that to front end stumbling. At any point on the spine where an injury happens, you would expect functions below that injury point to be affected, not above. The "X" in the picture below is the spot where a pain response was perceived. If Sunshade had a chronically herniated disc in her neck, then the front + back end stumbling could then be explained. Sunshade's neck was fine upon palpation.

Dr. Sanders said he could make sense that a Pituitary Macroadenoma (tumor in the pituitary gland that also causes Atypical Cushings) is causing the front + back stumbling, but usually a dog develops severe neurological symptoms and is gone within a year's time untreated. That puts Sunshade at 4-6 months untreated if she does have a tumour.

The diagram on the bottom shows a normal brain with a normal Pituitary Gland (red arrow). The diagram on the top shows a Pituitary Macroadenoma (purple ball) that's putting pressure on the brain. The blue area is the part of the brain responsible for motor function. A macroadenoma can interfere with the motor function signals causing retardation in the motor function of the patient.

Sunshade was rated normal in the neuro exam performed. Her first stumble happened over 3 years ago, so that didn't really fit the Pituitary Macroadenoma profile - UNLESS the stumbles that happened 2-3 years ago were of a different origin (ie, ortho), then we could say it's of two unrelated sources causing the same symptom (stumbling). In that case, a Pituitary Macroadenoma might still stand. Another possibility is that its a separate brain tumour, unrelated to the Pituitary (Cushings), but that's stretching it a bit.

Dr. Sanders did mention the stumbling could very well be from the built up of the various orthopedic issues that Sunshade has had throughout her life, and at age 11, she's dealing with what naturally (for her) comes with that age. Front end stumbling could just be from an 11 year old with tired biceps muscles from years of over compensating due to the bad elbow. Hind end stumbling from the thoracolumbar/lumbar sacral region of the spine. He must have felt those were the more likely causes as he got his colleague, Dr. Kirkby, an orthopedic specialist to examine Sunshade as well. Dr. Kirkby had similar findings as Dr. Sanders. He also seemed to feel the front end stumbling was due to muscular weakness and aging.

I asked Dr. Sanders if there were tests I should do that would play a factor in Sunshade's longevity. He told me at this point, the only thing he would consider would be an MRI. The MRI would be able to tell us if a Pituitary Macroadenoma is present. If she does indeed have it, then we can do radiation therapy. The success rate for radiation on this type of tumour is apparently very high. The radiation therapy involves 18-25 rounds of radiation over a 3-4 week period. According to Dr. Sanders, dogs treated with radiation therapy are often older dogs, and they go on living anywhere between 2-5+ years of quality life without major neurological problems. Almost all of those dogs pass away from old age or other unrelated illnesses.

11 + 5 = 16 (years), not bad for an Airedale (not nearly enough for Sunshade...). MRI would also give us a better picture at what's going on in her lower back. Dr. Sanders mentioned back surgery could be considered if the pros out weigh the cons, and if I was willing to take the risk since back surgery could make a patient worse than before.

As far as I'm concerned, there will not be any back surgery for Sunshade, doesn't matter what the MRI say. So for me to do an MRI, it would solely be for the possible Pituitary Macroadenoma. But would I be willing to put her thorough 18-25 rounds of radiation therapy? I have no idea at this point.... SIGH..

Here is the full report for anyone that's interested, (click to enlarge)

One thing that had me quite excited from our consult was that, neither Dr. Sanders nor Dr. Kirkby got any pain response from Sunshade's bad right elbow. Some of you might recall, she had the stem-cell replacement procedure done on the bad elbow back in April of this year. Well, I'm so happy to report that the elbow that had been my main source of worry over the last 10 years is now clinically sound, even after days of being active!!! Dr. Sanders was genuinely surprised to find out about Sunshade's bad elbow and the subsequent stem-cell procedure. He said the elbow felt excellent and he was going to tell Dr. Kirkby that the dog he just examined (Sunshade) had a very successful Vet-Stem procedure. Apparently Dr. Kirkby had been wanting to take the Vet-Stem course.

For anyone with a dog/dogs with arthritis, or Elbow/Hip Dysplasia, or torn ACL (repaired or not), Vet-Stem is a great procedure to consider.)


George The Lad said...

Thumbs up to yea Sunshade, and well done for getting the egg out the bag, good trick that one lol!!
See Yea George xxx

Duke said...

We can't imagine you having anything bad in your brain, Sunshade! You are the smartest and most clever DaleGirlie that we know!
We are so happy to hear that your stem-cell procedure was a success!

Love ya lots
Maggie and Mitch

Nelly said...

Don't think there's anything wrong with your SUPERbrain Sunshade .... look at how you're extracting the noms from the rucksack!
Nelly x

Charlie said...

All in all, seems like pretty good news! Good for you for taking videos so they could see the problem almost first-hand. SVS sounds awesome.

The Thuglets said...

Sunshade you did really good at the consultation.

Welldone on the boiled eggie!

We know your mom will do everything in her power to resolve any problems you have.

Lots of airezen and pawsative thoughts & huggied to you both!

Big Nose POkes
The Thugletsx

NAK and The Residents of The Khottage Now With KhattleDog! said...

What a post -

So many khwestions with so many pawtential answers -

My head would be spinning as fast as my tail wags -

Khongrats on snagging the handbag treasures!

Paws khrossed fur all!


TwoSpecialWires said...

Sunshade. We've been waiting to read your consult feedback. You are one VeryLuckyGirl to have the family and doctors that you do. We know they will make the right decisions, because your best interests are in mind. In the meantime, keep doing what you are doing, healing joints and eating eggs and all. 'Cause it sounds like promising stuff to us.

Your smaller terrier pals in Colorado
Jake and Fergi

My Dog Sam - Ruptured Disk said...

Hi Sunshade, I think that you and I are "veterans" of SVS. I think that Dr. Sanders gave your mum a lot to think about. I'm not sure what your mum is going to do about this whole thing but first things first. She'll have to weight the risk of anaesthesia to do the MRI or not. If mum decides to do the MRI, it will answer the question of whether you have a pituitary macroadenoma or not. If you do, then mum will have another tough decision. But like I said, first things first. It's better to take this whole thing and break it up into little steps or else we risk getting too far ahead of ourselves and worrying about what might be as opposed to knowing what we're dealing with. Either way, I agree with mum, no back surgery for you. Way too many risks, especially if you end up worse off than before.

fromsophiesview said...

I'll be keeping my eye on you...hear...licks!!

Stanley said...


Stella and I were talking and we agree with Mitch & Maggie. There is NO WAY there is anything in your brain but SUPERDALE good stuff, and a little left over stinky attitude from your puppy days! We wish you long life and lots of play dates with admiring pupboys!

Goober love & smooches,

the many Bs said...

hi Sunshade, it sounds like your mum has a lot to think about now. those neurology docs really like to push that MRI. our human was extremely worried about Baxter having the MRI, but he did fine. But Baxter is only 6 years old. it's also very expensive, just for a diagnosis (which Baxter did not even get!). anyway, we're very happy to hear about your elbow and we will be interested to hear what your mum decides to do next. we will be thinking of you and we hope you will come visit us again, even though you don't like our stinky dog park.


Persephone and Buster said...

oh ms. sunshade... you definitely had an adventure.. all the way to washington.. i'm thinking that there isn't anything wrong with your aireeeedale brain.. your nose works well enough to find the egg and cheese! i, theBUSTER, understand the ways of the nose.. and sound like you are doing mahvelous!
ms. gracie and ms. blue and ms. persephone all send many slurps and buttbopps to you and hope they figure out the problem.. so you can come dancing..
we're thinking of you,
theBUSTER and the girs

NelsonandBoober said...

Sunshade we think (Booberdog and I and our mum)you are the smartest and of course the best looking Superdale out there so there can't be anything but good stuff in your brain. Your mum has a tough decision to make about a MRI for you or not. Whatever decision your mum makes you guys make sure you live life to the fullest everyday. Were thinking about you and sending you pawsitive thoughts. Super hugs to you :)
Nelson and Booberdog

Jemma Chihuahua said...

Sunshade, that is sure a lot to think about and we agree that the back surgery sounds risky. We know one thing for sure though - your brain is working just fine! Keep us updated on what your mom decides, ok?


Noah the Airedale said...

How could there be anything wrong with your brain Sunshade??? They do realise you're an airedale right?
Well done on the egg mate. You're a champion.

Oh and we're all fine. Been visiting the kennel for a few days but we hope to be back in action soon. We have been very slack lately.

Noah and the girls xxx
The girls say hi to Stinky

Jed and Abby in MerryLand said...

Dear Sunshade, you seem to us to be a super smart doggie of great accomplishments. We wish you the best and will look to hear good news on the medical front. We know your mom & dad will take the best possible care of you.

Paws crossed, Jed & Abby

ellen said...

I wouldn't have the surgery performed on one of my cats or dog pals, either.
I'm betting the stumbling is a cumulative result, as the vet said, of all the years of compensating for your other injuries.
MRI? Maybe, depending on the anesthesia, which always makes me nervous for older (sorry to say that Miss Sunshade, lovie) dogs.
If anyone can figure work the problem and figure out a solution, it's your (not) Evil Mum. She loves you like no other and takes care of you like no other. You're a lucky girl!

Princess Patches said...

Sunshade, we are totally thrilled that your elbow is doing so well! We know your mum will make the best possible decisions regarding your healthcare! After all, you ARE her baby!

Penny & Patches

DawgBlogger said...

So sorry about Sunshade's many trouble, I know how it feels, Jasmine is also a constant challenge!

I love that the elbow is doing so well after the stem cell treatment!

Jasmine also had stem cells injected in her knees and shoulders two years ago and the injected areas are doing great.

It is her left elbow now that is acting up and stem cells are being scheduled for that.

I would love if you'd share Sunshade's stem cell story on my blog, or any other part of the story you'd find relevant and helpful to my readers.


Scruffy, Lacie and Stanley's Place said...

Yeesch...that was a lot of stumbles from that doctor...and that drawing of that spinal cord...I swear it was really a rattle snakie...Stan got all scared and ran and hid...course he freaks out when he walks over a tree root...once he did that and freaked out so badly he fell down a hill and landed in a pond with a hooge splash, but I digress...

Honestly, Miss Sunshade...your ability to snatch that egg was superb...obviously your brain is super powered...

Why don't vets use oral thermometers I'm just sayin'....

Kisses dear ones...

Miss Lacie Cakes

Duke said...

We have an award for you and Stinky, Sunshade!
Check out our blog when you get a chance, okay.

Love ya lots,
Maggie and Mitch

Huskee and Hershey said...

ow can they rate you as 'normal' after the examinations?? You are not 'normal'.. normal is blah.. you, Miss Sunshade, is SUPER!!

Ok that drawing of the dog-snake is creepy.. certainly hope no such creature exists...

Hope everything goes well Sunshade..