Phoebe, The Baroness Von Peebleschnopps

Wednesday, February 8, 2012

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...

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