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Lymphoma, spondylosis and now vestibular


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HI All,

 

I've been a lapsed member for years now but thoroughly enjoyed participating when Skye was younger. She is now 13 1/3 and besides being an almost 5 year lymphoma survivor, is also struggling with spondylosis.

 

She had her first episode of what we quickly realized was vestibular disease on Wednesday evening (the 25th Nov). She has been on daily cerenia (a 4-day course) to prevent nausea, has been drinking well, eating moderately well, but her soft poops that we have been struggling with before this episode have now turned into full-blown diarrhea. For the last four nights we have been up almost every few hours or this last night, pretty well all night, encouraging her along. She had two episodes of diarrhea but each was preceded by at least an hour of hysterics because she could not go outdoors and she was pretty freaked out by this. She has a help-me-up harness and we are using this to manipulate her (she is now moving from her bed in the living room, with our assistance, to the kitchen) but the whole issue of eliminating is causing her great distress (as it is us as well!) Just emailed our mobile vet and asked for Flagyl, since I think this is required at this point.

 

She is on 800 mgs Gabapentin three times daily for her spondylosis, as well as 100 mgs Amantadine once daily, and Metacam. I have been giving her 75 mgs of Tramadol for the last several nights to help her along as well.

 

I guess I'm just looking for encouragement and support at this point. She is our hero as she will be celebrating five years in remission from lymphoma in late February. I hate to see her struggle with one more thing that affects her mobility as it is already pretty challenged with the spondylosis.

 

Thanks!

 

Ailsa, with Skye-dog

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A five year lymphoma survivor - that's pretty special :)

 

Sorry to hear about her current issues. I hate to mention the idea of lymphoma again but acute, fast onset diarrhea was the first symptom my dog had with GI lymphoma. It might be worth speaking to your vet about just to rule it out.

 

Of course it very possibly could just be stress related and in that case something like flagyl. Some canned pumpkin may help today while you're waiting for meds.

 

Hope you can find a solution to get her feeling better quickly. The old ones sure are special :)

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My first reaction is YIKEs that is alot of pain meds. I would sure want to go over everything she is getting during the day with the vet. In a quick internet search Amantadine can cause dizziness, agitation, diarrhea and Metacam can cause ataxia, trembling, diarrhea.

 

I have no doubt she may be more comfortable with some pain management but those meds are terribly hard on liver and kidney. I would go so far as speak with a vet at an emergency center today and make sure you are able to give those all together, then I would be inclined to check her blood work and go from there.

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Thank you Maralynn. Yes, she is a miracle girl and very, very special. Yeah, I feared that her multicentric lymphoma had either slid sideways or at some point metastisized but x-rays, ultrasounds, etc. sees no cancer. But of course i live in fear.

And yes, pumpkin has been part of her daily diet, as diarrhea is one of those things that any lymphoma/chemo survivor knows lots about. She is very sensitive and I know that this whole thing has made her acutely upset; not least of which because she can't yet manage going outdoors to toilet :(

 

Denice, yes, that's what I thought too but she is under the care of a vet who specializes in pain management and rehab, and he deals with a lot of geriatric dogs. She hasn't shown any signs of gi upset with just the gabapentin and amantadine, but the Metacam obviously had added more to the pot....and I'm not entirely sure that this isn't the culprit, althought I'm hoping not as it has been helping her mobility. Yes, she takes Denamarin for her liver and gets regular blood tests to look at her values. It is a balancing act right now.

 

To be honest, the tramadol I gave is probably expired so I'm not sure it's had any effect. I have a message in to my mobile vet to see if I can nix it and maybe just give gravol instead to help her settle at night. My instinct tells me that once the diarrhea is resolved, her nights will improve.

 

gcv-border, thank you. Yes, we have travelled many roads in terms of ensuring her quality of life is not compromised so that is my priority. Some say vestibular is even harder to navigate through than chemo, and I can actually agree with that as it is testing us in a way we haven't been before....I wish the same -- that senior dogs didn't have to fight any of these battles.

 

thanks all for your input. It's very much appreciated and I'm hoping that the Flagyl (which I drove for an hour to pick up on a Sunday!) does the trick and she starts to feel better tomorrow.

 

Ailsa, with Skye

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I have learned that after 20 years being a vet tech not all vets are as good as I would like them to be or as good as they think they are. A second opinion is never a bad thing.

 

I personally do not like Metacam. I think there are other options that are better with few problems.

 

Some vets go with drugs - often choose one over the other because a kick back program if they feel everything else is equal - Some dogs do better with one over the other. While other support a mix of drugs and nutritional additives. Fish oil is anti inflammatory. Things like Platinum Performance CJ can help with mobility in some cases.

 

Lots of options to sort though and you just have to go with your instincts and do what you think best.

I wish you both the best. It is tough seeing them struggle - been there

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afrancis- I am so sorry for Skye's current troubles!

 

Just want to say I've never heard of a 5-yr lymphoma remission. That's incredible!

 

I wish I had something helpful to offer. I can only sympathize. I had older dogs with both of those issues. I understand how hard it is, and heartbreaking too.

 

My Rio had lymphoma, diagnosed early. He got a good quality year post-diagnosis with treatment. About 6 mo.s after Rio died, his litter mate Wryly had a vestibular episode with ataxia. Unable to eat by himself stand/walk/potty etc. I used a sling to help him stand and walk outside and hand-fed, and tried (dramamine? I think) The acute phase resolved after about a week, but we never got a clear diagnosis as to the cause. He went on for several more months before dying in my arms. I kept thinking he was recovering, then not, then yes, then no... The only option I had was to do invasive and expensive stuff like CT or MRI just to get more info... but that would not have led to any real treatment.

 

So sorry! You are very devoted, and it sounds like you're doing all you can to address any pain etc.

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Denice,

 

Thanks for your reply and concern.

 

Yes, our vet for the last almost five years has been primarily holistic and did not favour using pharmaceuticals at all. For Skye's immune support during chemo we added high omega-3 fish oil, l-glutamine, probiotics -- I also home-cooked with all human grade ingredients, adding a high quality vitamin and mineral supplement. We also did customized homeopathic protocols, added other supplements like Flexadin (glucosamine etc.), Wobenzyme, several other joint supplements and something for her 'soft' heart. He upped the ante to include laser therapy and neural therapy, and then we added acupuncture. Honestly, we've been down the benign road already and then tread very carefully by adding gabapentin at low doses.

 

But none of this was actually continuing to help her spondylosis/lumbar sacral disease. So we sought out physio (swimming) and then when I was concerned about it causing her to have a heart attack and there was no one trained to react if she did, we switched to this other vet who, as I said, specializes in pain management. We first just upped the gabapentin, added the amantadine and did physio, including underwater treadmill and proprioception exercises. Then this summer we moved to include Metacam as she needed more relief. Believe me, I don't like it either but it was going to be a carefully watched trial. There was some gi crisis, so we left it and moved to Onsior (used just for cats in the US, I believe), ok'ed for dogs in Canada. This seemed to up her liver values, so off we came, rested and now we're trying Metacam again, as we believe the gi upset actually had more to do with a rich meal than the med. As of today, we've added Duralactin and turmeric to her repertoire.

 

I do feel as though we are feeling our way as my first dog left at around 10 after having IMHA as a response to a mass in her chest. I've never had a real "old" dog before and my god, it is challenging.

 

Alfreda, thank you for your kind words. Yes, five years is a miracle although I am on a group with other dogs who have lived longer than that, either on their first remission or successive ones. Since I lost my first dog one month after diagnosis of IMHA, all I asked for was more than a month with Skye. We've been very blessed.

 

Your experience with first Rio and then Wryly (my first dog was Riley, I guess I'm more of a traditionalist ;) ) is just heart-breaking. Yes, most lymphoma diagnoses end up with 12-18 mos of remission or life, but it is never enough. Some dogs with lymphoma never see a few weeks, it all depends on the variety, stage or type (I am now the expert on canine lymphoma that I didn't want to be)...

 

In terms of the vestibular, I've been told you turn a corner at around 4 days, where we are now, and then it largely resolves in two weeks. It IS hard being patient. I've also heard that its largely idiopathic (someone joked that means either the pathologist is an idiot, or there is no known cause). That is supposed to be the vestibular you want them to get, rather than the one that is caused by a brain tumour or stroke.

 

Thanks very much for your good wishes all. We all appreciate it tremendously.

 

Ailsa, with Skye

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Ailsa,

Don't be surprised if the vestibular thing takes longer than four days. My old girl took longer than that, probably closer to 10 days. Even my vet was talking things I didn't want to hear because her improvement was so slow (she also had mobility issue resulting from a spinal embolism a few years earlier). The combination of a very weak hind leg and the vestibular made the going tough at times, but she did pull through with only a residual head tilt.

 

Also, I would look at the pain meds. At one point I tried gabapentin for Kat, and it cost nearly immediate diarrhea. My other old girl was able to take it without problems. I know she was on gabapentin before the diarrhea without issues, but it's possible one of the newer meds you added was just the proverbial final straw....

 

J.

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My heart goes out to you and I'm sorry I really don't have much to add to what others have already said expect to offer my sympathy and support. I'd never had a really old dog until Tilly (14 1/2 was the oldest prior to Tilly, but other than some dementia he was pretty healthy) who was a couple months shy of 18 when she died last summer. The final couple years were challenging, yet I wouldn't have traded them for anything.

 

Friends' JRT had vestibular disease that reoccurred a couple times and never did completely resolve. She listed and wobbled with a fair amount of falling down and a distinct head tilt for the last several months of her life.

 

Skye's very lucky to have you. Best wishes for both of you as you cherish this time with her, difficult as it may be.

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Hi Julie,

Thank you for your thoughts. Yes, the four days is just the amount of time to see some significant improvements (which to me means no more wonky eye movements, less head tilt and nausea). In terms of serious improvement (i.e. walking without support and not falling over while doing so) is definitely more than that. She walked tonight around the ground floor for the first time, with me holding her back end, so we all cheered! I'm hoping she will walk again without support and some sense of balance for Christmas -- that would be my best present.

 

And in terms of meds causing diarrhea and gi upset, yes, most definitely. She's been on gabapentin and amantadine for many months now and her poop has been fine until recently, so I'm sure it's the Metacam that is causing the off-balance. It's all about trade-offs about now I guess. But I have always felt that the poop is the window to the overall health so I am not willing to continue with it and will nix the Metacam if we need to. Diarrhea is not fun.

 

Gentlelake, thank you so much for your kind sympathy and support. She is my beloved girl, the funniest most lovely and biddable border collie (everyone says that right? lol) who just wants to be in my company -- what more could you ask for? I just want the best for her. Geez, 14 1/2 *is* quite old to me lol! and almost 18 is virtually ancient! You're doing something really right for your beasties. Yes, the old years are priceless, heart-breaking, challenging and bittersweet all rolled into one. I read about people who dump their old dogs at the pound when they start failing and I just can't for the life of me comprehend it.

 

Thank you again,

 

Ailsa, with Skye-dog

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Hi Ailsa,

I should have been more clear. Kat's appetite was not back after four days. And she was still pretty immobile. I'm sure the bad back leg just exacerbated the mobility issues. But the nausea and hand feeding (only way I could get her to eat anything) went on for much longer than four days. At her recheck by the vet a week after the initial episode, the vet was talking about euthanasia because she was still in such poor shape. I ended up going with a very expensive anti-nausea med that is used for chemotherapy patients and it helped marginally. For Kat, who was about to turn 14 at the time, giving her more time is what ultimately allowed her to turn the corner. I was living in a 23 foot camper at the time, with 7 dogs, I think, so managing her was a tricky thing. But she did go on to live a good 18 months beyond that. I lost her this past summer to something completely unrelated.

 

As for the gabapentin, it really seemed to help with her discomfort, but the diarrhea that occurred within an hour of giving the meds made me choose to quit giving it, which was a shame, because it did seem to provide better pain control than all the other meds I was using. Anyway, that was my way of saying that if you added the metacam and the diarrhea started then I think you're right to take her back off the metacam.

 

I did use turmeric and cinnamon on the advice of my holistic vet at the time for another oldster I had with severe spondylosis. I don't know that it helped a great deal, but it certainly didn't hurt and I didn't have to worry about drug interactions by adding yet another med.

 

Right now I have a 14 year old who also has arthritis problems and possibly spinal stenosis caused by spondylosis spurs that the vet thinks may be pressing on her spinal nerves inside the vertebral column. I am trying to keep her comfortable without a ton of meds, so she's mostly on tramadol and some nutraceuticals, but I add in metacam (you can get a generic 100 mL bottle that does offer some cost savings) if she's had a particularly active day and I know she will be more painful that night. I just bought some turmeric to start adding to her food.

 

I hope Skye can get past the vestibular episode quickly. You might want to consider some sort of mobility harness to help her walk. I have used the Ruffwear webmaster for several of my oldsters (one who was dysplastic and so had problems in later life when she was no longer well muscled from working), including Kat. I found that with Kat, I could help her get up with the handle on the back and then I could thread a leash through that handle to provide extra support to her when walking without actually having to stoop over. I gave away the medium harness that Jill wore up till her death, but I still have Kat's small harness (in the last year of their lives both she and Jill--and Willow in her turn--wore the harnesses pretty much 24/7 unless I took them off to dry after being soaked in the rain) and I'd be happy to send it to you if you want such a harness and a small would fit her (their website has measuring instructions). I got the harness for Jill on the advice of my rehab vet. Ruffwear actually makes harness that provide even more rearend support, but my rehab vet though the webmaster was sufficient. They aren't cheap, but they have been lifesavers for me when dealing with mobility issues in my oldsters and I've certainly gotten good use out of them!

 

Kat did have one or two additional vestibular episodes, but they were not nearly as bad as the first one.

 

J.

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Hi Julie,

You're awesome. Thank you so much for your thoughtful comment and very kind offer of Kat, Jill and Willow's harness. I'm really touched.

 

It's hard to say all that is the case when you're operating on little sleep, lol, but here's trying.

 

Yes, I think the medication you're talking about is Cerenia for nausea, and Skye did get a 4-day course of that beginning the day after, so it's finished now. But she is on Flagyl (metronidazole) for her diarrhea, and I'm giving small meals to help bring her gi system back under control. I'm hesitating stopping the Metacam right away as it has helped with her mobility so much up until this episode (and we have been diarrhea-free) and now I feel it is the thing that will help her over this hump. But, I am putting a call in to our vet tonight/tomorrow to talk about it. So many things to consider.

 

I also should have said that yes, we purchased a help-me-up harness for her several months ago and it has also been a life-saver for us. At times, she wears it a lot although I must admit not 24/7 since this episode as she has been spending most of her time lying down and I want to give her a break from being confined in that way. It is incredibly helpful -- as are the accessories I also purchased (supplemental leashes to help steady them or put over your own shoulder to help carry a portion of their weight.) So your offer isn't needed but still greatly appreciated.

 

I can't imagine how you coped in your trailer, getting in and out, and manoevering all the dogs around Kat, and then moving beyond the suggestion to euthanize. I actually had a similar experience with our long-time holistic vet, who before Skye's vestibular episode, saw her and when he heard some heart arrythmia and seemed to have trouble feeling a strong pulse, said she was ready to check out. That took me completely by surprise and I immediately went to our other vet, did diagnostics and discovered her heart was fine after all. She's not checking out yet!

 

Your 14 year olds (Twist?) situation sounds similar to my Skye and her back and back leg troubles. What are the nutraceuticals you use Julie? I hope she's doing well with your plan. BTW, I also give Skye something called Duralactin, whether it is helpful or not is unknown. But I do know that when the rehab/physio tech came the other day and did some needle-free acupuncture on her, she was blissed out.

 

Thanks again for all your kindness,

Ailsa, with Skye-dog

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Ailsa

 

Justa suggestion for the diarrhea you might try Biosponge from Platinum Performance. It will not conflict with that you are u

sing and goes well with probiotic. Basically helps eliminate the toxins produced in the gut. Good luck

 

C Crocker,

Thanks a bunch for this suggestion. We're nearing the end of our Flagyl course (and Skye's diarrhea seems to be resolved, but it is good to have this in case it rears its ugly head again) so I have just ordered some of this product - looks like it has some great testimonials! Thanks again! Much appreciated.

Ailsa, with Skye-dog

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I did use turmeric and cinnamon on the advice of my holistic vet at the time for another oldster I had with severe spondylosis. I don't know that it helped a great deal, but it certainly didn't hurt and I didn't have to worry about drug interactions by adding yet another med.

 

I surely don't mean to pick on anyone in particular here, but do want to mention that many "herbal" remedies are indeed medicines (and even some foods) and can have interactions with pharmaceutical meds, so anyone considering adding herbal medicines please be sure to check with your vet to be sure there won't be any unanticipated reactions.

 

Just as an example, St. Johns Wort can interact with some meds. Grapefruit can also. These are just a couple off the top of my head, but there are definitely others. Sometimes it's not necessarily an adverse reaction, but if the herbal med. has similar action as the pharmaceutical it can cause over medication.

 

Again, not referring to this specific example, just a general caution. It's why doctors and pharmacists ask people to report all supplements people take as well as their medications.

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