Kari - any news on Penny? Has the hospital called?

[Barb]

All - Penny is back in the hospital with a lot of pain from last night.  Kari's post is under Health.

[Kari]

All - Penny is back in the hospital with a lot of pain from last night.  Kari's post is under Health.

Hi Barb - I just talked with them and Drew and I are going to meet with the Doctor at 3 pm PST today. It looks like Penny has other issues going on - one of them being Focal Inflammation on her spinal cord. Apparently this is extremely uncommon as usually the inflammation is spread over more than one area. The inflammation is created by her immune system. This has become more apparent since we reduced her Prednisone and the pain is back. Treatment is long term anti-inflammatories and the prognosis is unknown. Some dogs fully recover and some never do. That is all I know at this point - we will get a lot more information when we meet with her at 3 pm. I am not doing well so send us some rays. I am barely holding it together.

[TerriL]

Please know that you and Drew and Penny are all in my prayers. 

[Jeri]

Rays coming from Kevin, Skeeter, Boone and me.        

[Mike]

Rays coming Clifford (the survivor!!   ) and me.

[Jenny G]

Lots of rays coming your way! 

[Barb]

Kari and Drew - multi rays and prayers on the way.   Penny will be ok, she has to be.  Be strong.  Hugs to you both -

[Leslie]

huh, weird.  Hang in there, kid.

[Kelly]

 
  Rays are coming to you Penny from Kelly,and firkids Blusky&Manny in Illinois!

[Valerie]

OMG! How horrible for her to be back in the hospital.  Cookie and I are sending all of our good thoughts to you!
You must be there right now… gosh I can only imagine how upset and nerve wracked you must be!

~~~~~~~~~~good vibes for Penny~~~~~~~~~~

[MimisMomma]

Kari and Drew, may all of our rays be with you and help you during this time. I know that this will make you stronger for Penny. She is such a sweet girl. My two furkids, Tuttle and Mimi watcher her Saturday night and they just loved her. Even speaking to the computer when she moved. She will be fine. She will pull through this and be back to normal in no time.

God Bless, we are all with you during this time.

Mel, Mimi and Tuttle

[cheryl186]

Kari, this is terrible.  I am so sorry to hear that Penny is back in the hospital.....Healing Rays and Hugs and Kisses to you, your family and Penny from Cheryl, Zoe, Winston and Sheba.   

We will be on pins and needles awaiting your update!!!!

[Dee Dee and Hallie]

Kari I was so shocked to read this. I was sure Penny was on a straight road to recovery! Hate to hear she took a detour. I can imagine how you guys are feeling now, my heart sunk to read your post too, I have never heard of this inflammatory thing? We're on pins and needles here too, please let us know the minute you hear anything. Many prayers coming for all three of you, poor baby girl Penny just breaks your heart. But at LEAST they do know what the problem is, that has to help them treat it as quickly and efficiently as they can.

Hugs to the 3 of you.  Just hang in there.

[David C.]

Sending loads of mega-rays Penny's way.   Dachsies are stubborn for a reason, and it's times like these when it's a good thing.  I'm sure Penny will be fine.

[Kari]

Hi All - Here is the update on Penny. She is home with us very drugged up at the moment. Here are the Owner Instructions/Summary from our discharge paperwork. They will explain it better than I can. We are hanging in there...we really just don't want her to be in pain.

Penny was evaluated by the Neurology service for recurring back pain. Penny previously had back surgery for an abnormal area shown on the myelogram at T13-L1. Unfortunately no disc material was found and the spinal fluid did show some inflammation and contamination. Swelling of the spinal cord on myelogram with no disc material found at surgery and recurring pain with tapering of the prednione support focal inflammation (inflammatory  focal myelitis) and not a concussive disc. We suspect Penny has inflammation of her spinal cord that is most likely immune mediated as she is not better after the prednisone taper. It is not very common to have a focal inflammattry swelling as we usually see multiple areas of inflammation.

We are prescribing prednisone, cytarabine and azathioprine for immune suppression. The azathioprine is being compounded at a special pharmacy for an appropriate dose for Penny. Cytarabine and azathioprine are chemotherapy drugs that suppress inflammation, but can affect the bone marrow. Penny will need to have a blood test, a CBC, performed 1 week after the cycle of cytarabine is completed. At this time, Penny's prognosis is good, though it will depend on her response to therapy. We will need to contine to treat her and follow her as she is tapered off the medications.

Medication:

Prednisone - 1/2 tablet twice daily for 2 weeks. Then give 1/2 tablet once daily for 3 weeks. Check with Dr. Levitski about further tapering.

Cytarabine injection - give.7m mL under the skin every 12 hours for 2 days, a total of 4 doses. This cycle can be repeated in 3 weeks pending Penny's condition

Imuran - This medication is being compounded at a pharmacy. Penny should receive 10 mg orally once daily for 10 days, then 10 mg every other day indefinitely.

Tramadal - 1/2 tablets orally twice daily for pain. You can decrease to 1/4 tablet orally twice daily when she becomes more comfortable.

[Kari]

She is up on the Penny Cam if you want to take a peak at her sleeping 

[Valerie]

Wow, what a lot to digest!  You all must just feel so emotionally drained after going through this.
I loved reading that the prognosis is good!

[Valerie]

Just checked the webcam- she looks so precious so sound asleep.

[Teresa]

I'm was relieved to read about the good prognosis! I thought my heart stopped for a moment when I read your earlier post when I got home from work! Watching Penny all weekend has gotten me quite attached! I'm going to peek in on her in just a minute before heading to bed. I hope you and Drew can get some much needed rest. She may have a rough couple of weeks, but hopefully will be feeling much better after that.

[Barb]

Kari - you and Drew must be exhausted.  At least you now have a plan and can go forward.  There are a lot of us praying and sending rays for our Penny - she will get better - she just has to.  She looks so sweet sleeping in her bed - at least medicated, she will rest and we all pray the swelling will go down.  When you get some rest, put the information on Dodger List - you may get feedback on others who have experienced what Penny is going through.

We are here for you - smoochies to Penny......

[Dee Dee and Hallie]

My gosh what a terrifying time for you guys. But it sounds very promising!! So does this mean she did not have a disc problem at all? Or does it just mean that she had a herniating disc that did not rupture and that is what sparked her immune system to cause the odd focal inflammation? Does it mean her immune system is off somehow that this happened or can it be reversed and a "lightning strikes twice" type of scenario?

Ignore me if too many questions...that is what I do at times like this ask a million questions my coping mechanism I guess. I just like to understand everything so I can get my mind around what is going on. it sounds like your neurologist is awesome, and very on the ball! I am so glad, that has to help put your mind at ease a little bit, not having to worry if they are doing the right thing.

Makes me smile to know she is home, I'll bet she is going to sleep like a baby for a while! You guys will all get through this, hold on to your sanity just a little longer!

[Kari]

My gosh what a terrifying time for you guys. But it sounds very promising!! So does this mean she did not have a disc problem at all? Or does it just mean that she had a herniating disc that did not rupture and that is what sparked her immune system to cause the odd focal inflammation? Does it mean her immune system is off somehow that this happened or can it be reversed and a "lightning strikes twice" type of scenario?

Not a problem at all Dee Dee - I am the same way. So, in the end no...she did not have a disc problem (which is the good news). We wouldn't have done anything different at this point. We looked at the symptoms (pain and problems with walking) and the myelogram which clearly showed a problem  and the breed and moved forward. When they got in there and there was no disc material the believed it to be a concussive disc. But when she didn't respond to that and the prednisone we had to re-evaluate. I believe in my heart that we have made the right choices and it has brought us to the true problem. We don't know what is causing her immune system to create this inflammation - which is frustrating. At this point we are going start this treatment and as we go along taper certain meds we will see how she responds. She may have to be on certain medications long term but that is too be determined. I'm not sure if it goes away if it can come back. Hopefully that answers some of your questions. Your questions are good and triggers me to want to ask the dr other questions I might have forgotten to ask in the madness.

[Dee Dee and Hallie]

Thank you Kari! What exactly is a concussive disc? I have been through this too, and have studied up on it obsessively over the years but you have brought up two terms I am not familiar with (the focal inflammation and the concussive disc). I understand herniated and rupture but not concussive?

This makes me think of my friends young golden over a year ago, who had horrible back pain and they did tons of tests, I can't recall all that they did now but it was an immune thing I believe...they also didn't know if it would come back, it hasn't yet! He's been the picture of health. I hope Penny will follow a similar path. It is GREAT news that it wasn't actually her disc...it almost always is when a doxie has back pain. A lot of times people think it's just a pinched nerve or pulled muscle in their back, or even constipation, but with a doxie you can almost bet it's a disc issue, so for Penny to have dodged that bullet anyway is nothing short of amazing.

Would she have needed the surgery had they known it was focal inflammation? (did the surgery help relieve the swelling going on in there?) Sounds like you may never get the answer to why her immune system is working like this...but once she is 100% again (and she WILL be) it probably won't seem important!

I totally agree, I am sure you have made all the right choices for her and moving so fast on it all is going to make a big difference. Hopefully she won't need the meds long term but thank goodness they do have the meds if it turns out she does.

Not the fun part of being a doxie owner! But this too shall pass and you'll have your happy healthy Penny back, and every moment with her will be even that more precious.

[Sandishooligans]

Kari, I'm so sad to read this backslide with Penny.  Mark, the grrrrls (even Dolly with her tender tummy) and I are sending MEGA rays to Penny and prayers to you and Drew.  Please!  Please!  Get better, Penny, darlin'.

[Kari]

Thank you Kari! What exactly is a concussive disc? I have been through this too, and have studied up on it obsessively over the years but you have brought up two terms I am not familiar with (the focal inflammation and the concussive disc). I understand herniated and rupture but not concussive?

Would she have needed the surgery had they known it was focal inflammation? (did the surgery help relieve the swelling going on in there?) Sounds like you may never get the answer to why her immune system is working like this...but once she is 100% again (and she WILL be) it probably won't seem important!

Here is her original discharge summary from when she had the surgery which explains concussive:

Penny was evaluated by the Neurology service for back pain and weakness in the left rear leg. A myelogram, or dye study, of the spinal cord was performed and showed an abnormal area in the spinal cord at T13-L1 over the disc space. A small amount of spinal fluid was collected for analysis and was consistent with blood contamination. Marked inflammation was not found. Penny did have surgery to decompress her spinal cord and remove any piece of disc material. No free fragments of disc material were found. This means that Penny may have had a concussive type disc problem where the liquidy disc material hit the spinal cord and then dissipated. She does have a focal area of spinal cord swelling a T13-L1. If it was a concussive type disc problem then she should continue to improve over the next 2 to 6 weeks. At this time we cannot determine if Penny's spinal cord swelling is due to a concussive, liquid disc or due to a primary focal inflammatory myelitis as we were unable to document disc material.

When they performed the surgery they did alleviate the pressure on the spinal cord, but since the concussive disc wasn't the problem now it is back. In the end the surgery didn't help her, but it did point us in the right direction. If we didn't know that it wasn't a disc problem we would still be treating it as if we thought it was a disc and not a immune problem. On the positive side the did fenestrate while they were in there so if she were to have disc problems in the future that should help.

Thanks for the support - let me know if you have any other questions! I'm glad to hear that your friends dog is doing well - that is my hope for Penny!

[papbouv]

Very sorry to hear of Penny's back slide hope now they know what the problem is the new medications will work and she will be doing better in no time.Know you are wore out with worry but if some one on the forum has time can they explain Fenestrate tried to look it up but did not have much luck understanding what they said.Will be thinking of you all sending rays from Gizmo,Patches & Buddy too.
Papbouv

[Kari]

Very sorry to hear of Penny's back slide hope now they know what the problem is the new medications will work and she will be doing better in no time.Know you are wore out with worry but if some one on the forum has time can they explain Fenestrate tried to look it up but did not have much luck understanding what they said.Will be thinking of you all sending rays from Gizmo,Patches & Buddy too.
Papbouv

The way that they explained it to us in regular terms was that they create (cut) windows in vertebrae so that when/if the disc were to swell it would do so sideways instead of up into the spinal column.

Hope that helps!

Kari

[Teresa]

I know it is very very early PST, but I hope everyone in Penny's household is able to have a restful day. Hopefully this post will find Penny resting and feeling much better! I'll check in on her when I get off this evening.

[Jen]

Kari,

I am so sorry to hear Penny has had a detour in her recovery :(

Poor girl - I will talk to Maryanne later today and see if she knows any other dachshunds who have had this problem. Did you join dodgerslist?

Lots of prayers coming your way! 

Jen

[TerriL]

Mega Rays coming from all of us in Clearwater.  I can't begin to imagine how difficult this must be for you.  Thank you so much Kari for sharing all of this information with us.... not to mention the web-cam.  I think all of us who have spent any time at this board learn to love and appreciate all of the furkids that we come to know.  Helping each other through these horrible problems that our babies are prone to is really what we are all about.  Please know that we are here for you.  Your doing and have been doing what it takes to get Penny healthy.  God Bless you for that.  I shared with DeeDee (when Hallie had her back problem) some words that Roberta gave to me when my Toby was so sick.  Baby steps are all that is required.  Hang in there. 

[Barb]

Very well said Terri - baby steps - we all need to remember that.........  Sending Tuesday rays to our Penny !

[Jeri]

I had never heard of this condition, but I do know that Dachsies are precious and delicate things.  We are sending rays and prayers that this is only a brief setback and that penny will soon recover.

[PattyInAK]

Oh geez!!!  Kari, please keep us posted.  Hang in there, and all that.  I do know how upsetting it is when our dogs are at the vet, staying overnight and we're hanging in limbo wondering what's going on.  We're all here to support you, and its okay to cry and pour your heart out here.   

[Kari]

Good Tuesday Morning to Everyone! Penny is up on her webcam :) We had a rough start to the night. Penny had been sleeping soundly when we got her up to potty and move her crate upstairs with us. When we put her back to bed she just whimpered and cried. Drew pet her head, then held her to comfort her. Finally after about an hour  she settled down.

It was hard on Drew giving her injection. It was about 75 units of the drug. I held her still and he gave it - he was shaking like a leaf (which isn't normal for him considering he is a diabetic and gives injections to himself all the time). Just afraid to hurt her since she has been through enough. But we all got through it. My mom is coming to pick me up at 9:45 and we are going to take her to our regular vet that is 10 minutes away for them to give her the third injection - I'm a baby and can't do it. Then tonight Drew will give her the fourth one.

I did join Dodger's List but haven't had a chance to post this update on there yet. Hopefully today. My work is being super nice considering I have already taken a lot of time off the last 2 1/2 weeks to be with her. They gave me a laptop so I can process our companies payroll from home. So I can stay home today and tomorrow and maybe Thur but I have a ton to get done! Drew will be home Friday and next Monday.

She seems more alert this morning probably since the pain shot she got right before we picked her up yesterday has worn off. You can tell she is still uncomfortable when you pick her up she grunts - at least it isn't the yelp she was doing.

Thanks again for all the support...yes...I have to remember baby steps.

[hildiesmom]

Hi Kari,

I don't post here often, but have "been there done that" with a couple of my dogs and back surgery, so my friend Jen asked me to come over here and take a look at what you are going through... it certainly isn't a "normal" case, is it. First of all, sending many hugs to you guys...I know what it feels like, especially when you are dealing with something the docs can't quite put their finger on. In my mind, you have done everything right so far, given what you are going through, but there are just some things that are questions in my mind.

So, here goes...

Focal myelitis is a very vague diagnosis...basically it says there is a "spot" on the spinal cord that is inflamed, and causing this "over reaction" of the immune system--including, possibly, the original swelling or as a reaction to the surgery. The biggest question here, as I'm sure you and your vets are debating, is what really caused this in the first place? Since there was clearly some inflammation on the original mylogram, but it hasn't clearly been identified as IVDD (in spite of the surgery), what the heck is it?? They call it "focal myelitis", but that's really the "result" or the "symptoms" and not the "what is it". I hope that makes sense. So, my next question is, what have the vets done to try to answer that question? Have they done bloodwork? Other types of diagnosis--including analyzing the spinal fluid? You said they didn't see disk material--but did they take a good look at everything under a microscope? The reason I'm asking is that there are many, many things that could have caused this... none of them very good, unfortunately, but if they are properly diagnosed, a more effective treatment might be achieved.

Some of the things that immediately spring to mind, when I'm thinking about these "mystery" back problems, are things like tick diseases (which OFTEN mimic back problems; I do wonder if some sort of antibiotics would also be indicated, in addition to the other drugs they have prescribed..might want to ask your vet), some sorts of meningitis (which can be caused by viruses), and possibly GME (granulomatous meningoencephalitis). That last one I bring up because it seems to be more and more common nowadays...seems to be more common in dachshunds, and is very difficult to treat...but if you know what's actually going *on*, then you can target the treatment more effectively. I suspect that your vets feel it is one of these things--given the drugs that they have prescribed...the imuran and chemo drugs that they are using are not ordinary.

I know you've been referred to Dodgerslist--and I know there are some folks over there who will suggest these things to you as well...but I'd also like to refer you to my friend Karen Henry, who formed the Abledogs list, and who went through something similar to this with one of her dogs. KLHenry@ix.netcom.com Tell her I sent you, and tell her your story...or direct her to this board and your posts... I bet she'll have some suggestions too, since she is now more the 'expert' on GME than I am. I'm not saying I'm sure this is what's happening here, but in my gut, I think it's worth asking about...that's why I'm mentioning it. I am not a vet, by the way, but have been looking closely at dachsie back problems for nearly 20 years now...so I guess that I have more experience than lots of folks with asking these questions...

I am so, so sorry this is happening to you and Penny... I remember how scary it was when I went through it with my first Dachs, Hildie...and it was equally scary with one of my other dogs... it is never, ever easy. But, rest assured, there are lots of folks out there pulling for you guys...and lots of folks who can help you over the rough parts... If there's anything I can do, please don't hesitate to email me, I will try to remember to check the Board over the next few days (but I'm in the middle of a move, so haven't been sitting at the computer much, so email is best if you need a quicker answer), and I'm sure Jen will keep me posted on what's going on with you guys.

{{{h}}}

MaryAnne Teal
a.k.a. Hildiesmom
http://www.tealdachs.com

[Kari]

Thanks for the information Mary Anne. The why is still the question - the have done blood work as well as a work up on her spinal fluid in which both of them indicated nothing. I'll check out the other information that you gave - I really appreciate your input.