Phoebe, The Baroness Von Peebleschnopps

Sunday, February 12, 2012

SUNDAY UPDATE: Again, Miss Phoebe Gets Well

I knew I named this blog properly! If there's one thing our Miss Phoebe does consistently throughout her life, it's survive, get well and thrive. It's been a busy 4 days but I wanted to update everyone who reads the blog.

That's a photo of Phoebe, begging for more food, just an hour ago. Clearly, feeling herself, again!

Phoebe came home last Wednesday night and she was super unstable. Essentially, dogs with Idiopathic Vestibular Disease (IVD) have to completely re-learn their senses of balance and proprioception without the use of their inner ear. This takes quite a bit of time. Dr. Mlekoday told us to expect this to really show improvement in 72 hours with a more complete resolution over the next 2 to 3 weeks, and that's exactly what's happening.

As I said, on the night we brought Phoebe home (the night this happened) she was very unstable. Sitting propped up on her front two legs was really challenging for her. If she ever tried to shake or twist herself to scratch or lick herself, over she would fall. But the next morning, her balance had already really improved. Michael stayed home with her that day and he even noted by midday how much better she was doing. By the time I came home from work, she was walking around and appeared to be much more steady. However, that evening (day 2) she became very tired and as she tired, her balance gave way to more falling. She was still having crazy nystagmus.

But with day 3 and 4, she tired less and less and her nystagmus calmed down. Her appetite has been very strong throughout this whole episode. Last night she actually tried to chase Charlie around the living room and this morning, she jumped up onto the couch! Getting down is still pretty dangerous for her, so we're helping her with stairs and up/down jumping. Still, knowing her, she'll be back to normal jumps/landings and stairs in the next week. She's just amazing.

I'm posting a link to a short video in 3 parts: Phoebe's Recovery from IVD The first part is her the night she came home from the hospital. She had just finished eating her dinner and was trying to shake and lick herself. In the middle part of the video, you can see her on day 2; the nystagmus was still very active. But the last part, on day 4, was taken today, just a few hours ago. She can pee and poop without assistance for balance. She can run around the yard and do what she wants. It's been a hard 4 1/2 days for her-- for us all-- but she's surviving and getting better each minute.

Again, to everyone who has asked after her, emailed, called, text-messaged, it's been an amazing display of support and we appreciate each and every one of you!


Wednesday, February 8, 2012

Mid-day Update

Phoebe seems to be stable, according to Dr. M.

She had some breakfast, but needed help eating. She's still super wobbly, but she's not panting anymore and she' not trying to stand up. Her labs were 100% normal. So was her X-ray.

It's too soon to tell but, for now, Dr. M is leaning towards believing that this is Idiopathic Vestibular Disease, and NOT a brain tumor or a stroke. This is the best news we could have hoped for!

Phoebe is being monitored constantly and they're checking for signs of deterioration because, usually with a tumor or a cerebrovascular incident (like a stroke) we see pretty rapid changes in the vitals and lab values. So far, none of that is present.

They're going to monitor her for the next few hours and, as of now, the plan is for us to take her home and confine her to a small space where she can be contained and safe from hurting herself. It's going to take some serious nursing to get her back on her feet, walking and such, but Dr. M thinks that a few days at home should be enough.

If we notice that she's not improving or if we feel that she's getting worse, then we'll bring her back into the city to see a Neurologist who can do an MRI.

But for now, this is the best news we could have ever hoped for.

Thank you ALL for your messages, texts, emails, comments on Facebook-- knowing that we have such a great support network rooting for us and for Phoebe makes all of the difference.

Phoebe is not well

When I went into the dog's bedroom this morning, I found Charlie up and pacing around. I thought it was simply that he had to pee really badly. I went to pick up Phoebe out of her bed as I always do (because she can't go down the stairs, so we carry her). As soon as I lifted her up, she lost her balance and wobbled over onto her left side. She couldn't straighten her head out. At first, as I was carrying her down the stairs, I thought that this was a vaso-vagal response; Like what happens to us older folks when we suddenly stand up, the blood pressure to our heads doesn't keep up and we get light-headed. I thought, "I moved too fast for her" but she'd normalize in a few seconds. But as we came downstairs and I put her on the floor in the kitchen she couldn't stand up. Try as I might to help her right herself, she kept falling over. Finally, beginning to panic (because this is looking like a stroke) Michael said, "take her off the slippery wooden floor and bring her outside." So we ran out the back door, put her on the grass, and while she peed, she could barely keep from falling over. Michael had to hold her up.

I was completely freaked out. This is neurologic.

We rushed the boys into the house, grabbed our packed bags and jumped into the car. We took the drive to Manhattan to her internist, Dr. Mlekoday, who manages her Cushing's Disease and 45 minutes later, we were in the office. They rushed her back, took her vitals and did a physical exam.

Dr. Mlekoday came in to talk to us. Here is the differential diagnosis as of 8:45 AM:

This might be Idiopathic Vestibular Disease; a fairly common condition in older dogs wherein, suddenly and for no apparent reason, they have an inner-ear phenomenon that causes them to suddenly loose balance, have nystagmus (eyes rocking left to right) and tracking of the head and neck to one side. Essentially, the world is spinning for them and they can't keep balance. If this is the case, they will monitor her today, give her fluids, keep checking her heart rate, pulse ox, and respiratory rate to see if there's a change. Ultimately, she should start to be able to stand, then eventually to walk (against a wall for support) and lastly, after a number of days the head-tilting will resolve and this whole episode will be a thing of the past which, interestingly, never seems to repeat itself.

However, given her advanced Cushing's disease, her history of inexplicable weight loss over the past year (and even more this morning) it's not looking good. Phoebe has had every test and we cannot figure out why she's losing weight. The fact that her Nystagmus is NOT left-to-right, but wobbly in a figure of eight pattern, points to something more severe. It could be infectious, though her blood tests have been normal. It could be the pituitary tumor (the Adenoma in her brain which causes the Cushing's) having grown to a size where it's now pushing on stuff, causing these symtoms. It also could a stroke.

I asked about doing an MRI. Right now, given her severe neurologic presentation, they think it's very dangerous to sedate her (which needs to be done for an MRI) and, frankly, we won't gain much information that would affect treatment from an MRI. I asked Dr. Mlekoday what she would do. She asked me, "Would you consider doing brain surgery on her?" I said I would not. She's too old, she's been through too much and that would be a cruel thing to put her through at the end of her life. She thought that was the medically sound and compassionate choice.

So, for now, we wait. They're doing X-rays, labs and physicals every 2 hrs, and watching her constantly.

More updates to follow...