Saturday, July 26, 2014

Update: Immune mediated meningitis in my dog, Cisco

January 15, 2012

This is personal. On, we write in the third person and adopt a reporter’s attitude toward the subject. But this is about Cisco -- not my dog, but a dog I live with; and he is an irascible and idiosyncratic being who demands I drop into first person when telling his story.
Cisco is like a piece of balky software. He has “workarounds.” When I moved in and Cisco decided I did not need to be on his couch –and backed that up by breaking the bracelet on my wrist– it was up to me to become indispensable.
. I took over his feeding, so he would not “bite the hand who feeds him.”
Cisco comes by his personality naturally. He was adopted from what I believe is the best rescue in the country, “Paws Chicago.” They had an innovative storefront adoption center on a busy street – years before this was common – and one day a man walked in to drop off Cisco. The staff politely explained that this was not an intake center. “Then I will let him go outside.” He meant it and the staff relented. He said the dog had no name.
Cisco is a rat terrier, a Jack Russell mix perhaps, with beautiful markings. His age was estimated to be a year, but his back teeth showed an unusual pattern of severe wear. This wear was consistent with his having been kept in a crate full-time and spending his first year trying to chew his way out. That is a horrible fate for any dog, but particularly for a high energy breed like a “Jack.” He never kicked the chewing habit.
My housemate adopted him and adapted to him. She saw he would not stop chewing and it soothed him, so she made sure he always had something to chew. He guarded his chewies and at times seemed to enjoy the guarding as much as chewing. If I passed by his bed, he would raise his head and growl over whatever he was protecting. He put holes in socks, but he guarded shoes and a missing shoe would always be in his bed – usually undamaged, unlike the bed. Stuffed toys immediately came unstuffed when he took them from the other dogs, which he always did to ruin their fun; and toys had to be kept in a drawer and brought out for supervised playtime for those dogs who knew how to play with toys.
Cisco was one of those special dogs whose personality always makes him a presence. When my housemate’s husband developed Alzheimer’s; Cisco was the only one in their household who could respond to her. He helped her survive her husband’s decline and death.
Cisco enjoyed the usual good health of a small mixed breed dog, and he acted and looked younger than his thirteen years, with good weight and muscle tone and attitude to spare. We thought he had many good years to come.
How horrible then to discover recently that overnight something terrible had happened to Cisco. He was whimpering –something that was never in his vocabulary-- and his head was cocked to the right. He never stopped trembling. That morning, a Friday, Cisco went to the vet for X-rays and blood work. The vet did not know what to think. Cisco showed no elevated white count and only one slightly elevated liver enzyme (ALT). X-rays were negative.
Over the weekend his symptoms progressed. He was turning smaller circles, always to the right. This caused him to get stuck in corners and cry. The dog who bullied everyone and who would not let you touch his collar, now submitted to being picked up. The dog who ran out the back door barking aggressively multiple times a day had to be carried to a patch of grass where he circled and circled. I called the vet at home and arrangements were made to do an ultrasound on Monday to ensure the liver was OK, so Prednisone could be given. In the meantime Cisco was prescribed Valium.
Cisco’s appetite was good, but he had to be fed with a measuring cup, because he could only eat from the right side of the dish and not even from the bottom, but an inch up. In fact he seemed to perceive everything an inch above and to the right of its actual location. He seemed to be seeing out of the right side of each eye and only smelling from the right side of his nose. His left front leg was weak and his whole left side was . . . off in some way. No wonder he howled.
It looked like a stroke.
But my vet said that vets argue whether dogs get strokes. I had initially Googled the symptoms and was excited to find “idiopathic vestibular disorder” – an inner ear disorder which was treatable, but further reading revealed a symptom of rapid eye movement which Cisco did not have. We wanted something that could be fixed!
The ultrasound showed a good liver and no heart abnormalities. The vet suggested immune mediated meningitis or encephalitis as unlikely possibilities. The only certainty was Cisco had a problem with brain function. That could also be caused by a brain lesion or broken blood vessels in the brain. An MRI of the brain might confirm that diagnosis – but it was not a cure nor could it lead to any treatment, and it was expensive.
So Cisco came home with a “shotgun” approach of antibiotics and a steroid. My friend felt this was palliative for her, rather than for Cisco -- to buy her time to say good-bye, but with Cisco’s distress – she might not even have that. It is not right to keep a dog in pain, just to keep the dog.
Luckily the Valium was effective and he spent much of his time sleeping. His whimpering ceased unless he was stuck in a corner. His one unaffected sense was hearing. If he got stuck and cried out, we had only to call out "Cisco!" for him to orient and free himself. We checked on his whereabouts every few minutes when he was not sleeping and crated him if we left the house. But even though his suffering was minimized, Cisco still was not there. We would not keep the body alive if his spirit had fled. This just gave us a week to see if any of the meds worked.
We had blankets on the floor in the hope he would cease pacing and lie down. We turned circles with him trying to coax him to lie down. We had to ease him down and straighten his left front leg and hope he would stay put. He could not get into a dog bed and had trouble getting out. I stayed up each night until he collapsed in the crate and stopped crying. If he was left out, he would get stuck in a corner. He would fall off a couch or a bed if not held. If he was held, you could feel the faint vibration of a residual growl. Cisco would not turn touchy-feely at the end. This was no life.
I wanted back the not quite friendly dog who took everything out of purses left within his reach and who chewed his way through chew-proof dog beds and who, long past his prime, was still alpha to the pack. The younger dogs who should have taken charge years ago (and who have given up somewhat as Prince Charles has), did not know what to make of Cisco’s illness and paid him a wary deference. The entire household was on a death watch.
The Valium kept Cisco calm enough that we could go through the motions of seeing if the medicine worked. Every time he got his food, it was wet with someone’s tears. We had no hope.
Then came the miracle.
His circles got bigger and he started to unwind them. He would walk straight for a few feet before turning. At times his head was not cocked. He drank out of the water dish unassisted. He was getting better! He turned left!
It was and is unbelievable. He had a follow-up vet appointment that was fairly routine, rather than the final appointment we were dreading. The vet said Cisco has Immune Mediated Meningitis which is often caused by a vaccination. That was not the case with Cisco, but it is likely he had some sort of allergic reaction to something. Because this condition is often caused by a vaccination, he can never have another one. This makes boarding impossible except at the vet's. Cisco will be on a low maintenance dose of Prednisone forever.
Not ten days ago we were saying good-bye to a stranger – his personality gone overnight and a broken dog left in his place. Now Cisco walks straight with his head and tail up and he still doesn't like me much.
It is not a 100% recovery. There is a timidity or hesitation that was not there before – but you cannot argue Cisco is not himself again. Tonight, as I write this, he sleeps in his bed with a shoe which he warned me not to take. Enjoy, dear boy! You can have my sock too if you want it.
UPDATE: This story was written 18 months ago in January 2012. It is now July, 2013. Cisco is snoozing on a rug by the front door, but he put his head up just now hoping I had a treat. He walks haltingly much of the time due to a degenerative disc.
It is not treatable. He can never go under anesthesia due to his other condition. He is given Tramadol twice a day to manage the pain and we see his tale wagging, so know that he still finds quality in his life. He occasionally shows flashes of anger at other dogs in the household, but generally accepts he is no longer alpha.
Cisco receives the tiniest possible dose of Prednisone which manages brain swelling, or whatever caused the symptoms that made him walk in circles. This drug increases appetite. He gets a managed diet, but we err on the side of feeding too much. His time is limited and we do not want him to suffer from hunger. At the same time all he eats is low calorie as increased weight will be painful with his spine.
Cisco also started suffering from Sundowner's Syndrome in Dogs after his initial episode of circling. At night he would begin to cry and we could not seem to provide what he wanted. Outside? Water? Treat? Bed? Nothing satisfied him. I would say he was upset at some confusion in his mind. Selegeline has reduced this behavior to the point where if Cisco gets restless in the evening and whines a little, I can immediately offer choices and when I get it right, he trots off satisfied and stops crying. It is a miracle drug, but prohibitively expensive. Some creative Googling found a Canadian pharmacy that sends the drug directly from India at a price that allows Cisco to be on this expensive medication. There is no question that without one of these three drugs, Cisco would no longer be with us. When I see him rolling on his back, grinding down my Habiturf lawn, sun shining on his white haired tummy, I know I am watching a happy old dog.
Here's to you, Cisco! Long may your demons be vanquished by sunlight or a treat!