Monday, March 24, 2014

"A list of all good things"

So before Bella blew up a disc in her neck, we were chatting happily about the behavioral path we've been on with her since just after Christmas. I told you about how she had flipped out on me just before Christmas and our conversation with Dr. Dodman and his staff and what treatment option we chose to pursue with his team. Tonight, I'll finally get around to telling you how it's been going.

When we last spoke, Jan and I had chosen to add Gabapentin - a neurogenic pain medication with anti-convulsant properties - to Bella's treatment regime.

As a recap, Bella's still on Soloxine (for sub-clinical hypothyroidism) as well as Fluoxetine (anti-anxiety) but we've taken her off the Clonidine (our original wonder drug) and switched it for the Gabapentin. She still gets a tiny bit of Clonidine for especially noisy situations like snow-blowers, thunderstorms and snow falling from rooftops.

So how has it been going? Well, here's a list of things Jan and I have said to each other about Bella over the last couple of months:
  • "She slept through New Years' Eve fireworks without so much as a blink."
  • "She closes her eyes when I pet her."
  • "She actually fell asleep when I was petting her!"
  • "Wait, did she just come in to bed without the usual histrionics?"
  • "She comes and gets in her own bed as soon as the lights are out."
  • "She sniffed a fly! Come here, watch!"
  • "She slept right through me stepping over her in the closet."
  • "She slept through the morning squirrel crossing!"
Also of note:
  • Her ears are up and happy.
  • Her face is softer and eyes more relaxed.
  • And she requests petting sessions.
I still don't really know what's going on: has she been suffering from nerve-pain and twitchy-tingling for oh these many years and has finally found relief? (I have reason to believe she has...) Or is she really experiencing a seizure-like episode? I'll go deeper into what we believe is going on in our next chapter.

Whatever it is, we'll figure it out. Because, if you haven't guessed already, we're in this for the long haul. Whatever it takes, whatever she needs. Bella is ours and we are her forever family.

We see the neurologist again on Thursday and hope to be making some decisions at that time about her neck problems. Thank you for all the kind words and helpful suggestions on how to entertain her in the meantime. We will keep you posted.

Sunday, March 23, 2014

Black & White Sunday: Open to suggestions

So Bella is more than a little bored being on 'crate' rest for her second week. We've pulled out all the stops: stuffed Kongs, Nina Ottoson puzzles, photo sessions, even toenail trimming practice for treats but she's still bored.

How do you entertain your dogs when they're on crate rest? Got any ideas we haven't tried? Let us know in the comments.

Bella, and her exasperated mom, thank you.

Monday, March 17, 2014

This was supposed to be a list of all good things...

I know everyone is waiting to hear how well Bella is doing on her new protocol and believe me, I do have that list formulating. But if you've dropped by our Facebook page recently, you'll know we hit another bump in our road to Bella's happy and carefree life.

Last Tuesday night Bella hurt herself again. We don't know if she awakened an old injury or created a new one but she had an unexpected visit to Tufts Emergency Hospital on Wednesday and is in strict rest and recovery mode at this time. It appears to be a ruptured disc in her neck and we're not sure if it's a new, unrelated injury or a degenerative disease related to her previous lameness.

Needless to say we're all a bit subdued here at Casa de Bella and in a bit of a wait and see mood.

Bella has been a very good and tolerant patient through all of it. They even wrote that she was "a good girl for her exams today and wonderful to work with" in her release notes from the hospital.

In the meantime, she's getting lots of pampering and allowing lots of snuggles. And until next time, we leave you with a glimpse into a recent snugglefest.

In case you think I live in fear of my dog...

I don't.

Or she a life in fear of me.
She doesn't.

As always, thanks for following our crazy dog. We'll be back next week to tell you all how great she's doing.

Wednesday, March 12, 2014

Wordless Wednesday 127 - I'm gonna get you!

Bella has a monkey er, cow? on her back and she's determined to shake it off. Mid-play with the crazy dog.

Monday, March 10, 2014

Little dog, Big problems

"She's a very sweet dog - when she's not biting us."

And so began our most recent conversation with Dr. Dodman and his staff. I'm sure they think Jan and I are absolutely batty.

As with any appointment with Dr. D and his staff, we completed our multi-paged pre-consultation paperwork, and the meeting always begins with a review of it: What brings us there today? What was the original diagnosis? What steps were recommended and how have closely have those steps been followed? Have there been any changes in the household? Any physical changes to the dog? Any new injuries or illnesses?

One of the things I noticed when completing the paperwork was that we had gone off-course with Bella's low-protein diet. With so many cooks in our dog's healthcare kitchen, it is easy to lose track of who said what and when and how and why we should be treating her.

In this case, even Dr. Dodman's staff was surprised to discover that, while Hill's Prescription Diet w/d was a low protein option at 19.2%, the r/d version prescribed for her to help settle her colitis, at 34.6%, was not.

So it was noted that in late July we had switched Bella to a high protein diet and by September, she had bitten Jan again.

Note to self: You alone are responsible for knowing what Bella is eating and managing her protein intake regardless of who is advising you at any given time.
Action item #1: Switch her back to a low protein diet. Add fiber via pumpkin or Metamucil to achieve the higher fiber content which was the aim of the prescription dog food.
I hear  you talking about my food. 
Next up was the discussion of what happened between me and Bella in December. I covered this last week so won't go into again here but it was acknowledged that, while I missed her signals, Bella still shouldn't fly off the handle over such trivial offenses.

We talked about her shoulder pain and stomach upset and how that can wear on one's nerves over time. If Metacam is making her sick, there are other medications we could try to help ease the pain while not upsetting her stomach.
Treatment option #1: Consider a different pain reliever. If Metacam upsets her stomach, find another and get her off this never-ending roller-coaster of ick.
We then went on to talk about the possibility that Bella is suffering from PTSD (post-traumatic stress disorder) which could stem from her less-than-positive puppyhood on the streets of Puerto Rico or, rather surprisingly, could be associated with when I broke my arm and Bella was left alone for several hours afterwards.
Action item #2: Increase Bella's Fluoxetine dosage. We had never been successful in getting Bella up to the recommended dose of "Prozac" which Dr. Dodman prescribes specifically for aggression issues but is also used routinely to treat PTSD. He recommended now that she has been on it for a while, she may take to an increased dose better than she did when we tried previously.
The conversation moved on to how Bella responds during these incidents which is to say, she doesn't. I mentioned in our intake sheet that Bella seems to "disappear" during these episodes and it takes some effort and an external force to stop her. We also noted that these bouts go on more than just a couple of seconds lasting upwards of 15 or 20 seconds.

Dr. Dodman noted that this particular behavior was not common in 'ordinary' cases of owner-directed aggression and could in fact, indicate partial complex frontal lobe seizures. Huh. I did not see that coming.
Treatment option #2: Consider the anti-convulsant medication Zonisamide. While some of the symptoms Bella is displaying seem indicative of behavioral seizures, not everything aligns perfectly. Adding an anti-convulsant medication could help but it could be months before we'd really know whether or not that was the right diagnosis.
Finally, almost as an aside, I mentioned Bella's quirky little episodes of apparent reaction to unknown pain that I've been telling everyone who will listen about for as long as I can remember. I was taken aback when Dr. Dodman, instead of trivializing my concerns, actually took note and questioned me further about this.

What everyone else had dismissed as "probably" just static electricity, Dr. D took seriously. And on top of that, he gave us suggestions about why it could be involved in Bella's outbursts and what we could do to possibly treat it. He thought it could be nerve pain.
Treatment option #3: Consider adding Gabapentin (Neurontin) to Bella's current medication regimen. Gabapentin has both pain-relieving and anti-convulsant properties. This could potentially help manage both the shoulder pain as well as the possibility of partial seizures with a very notable side benefit being that it would also address any neurogenic pain she has that we have yet to identify.
PTSD, you say?
I can't imagine why.
To summarize, we were left with a number of possible diagnoses:
  1. Post-traumatic stress disorder which could be separate from or associated with
  2. Frontal lobe, complex partial seizures, and/or
  3. Un-diagnosed nerve damage/trauma.
After much discussion, we went home with a prescription of Gabapentin.

The choice was obvious: Gabapentin is often used in combination with NSAIDs like the Meloxicam we had Bella on to boost their efficacy. Add in the neurogenic and anti-convulsant properties combined in one medication as well as minimal side effects and we could possibly treat all of Bella's issues whether conclusively diagnosed or not.

That "not conclusively diagnosed" still gives me pause. If Bella has un-diagnosed nerve damage, shouldn't we be looking into what that is and possible options to fix it? Could we be masking something that should be cause for concern? And what about seizures? If she's having them, should we be trying to discover the root cause and address that?

We've opted to take one step at a time.

We have made the recommended changes and we're monitoring our girl's progress. I keep a daily journal of what Bella eats, what meds she takes, how she feels and behaves. From there we can track trends and gain insight into what is really going on inside that little body (and really big brain) of hers.

Next week we'll talk about how it's been going.

Wednesday, March 5, 2014

Wordless Wednesday 126 - Ever wonder...

if your dog thinks you're a little dim sometimes?

I don't have to wonder.

Monday, March 3, 2014

How to Make a Bad Situation Worse in One Staggeringly Stupid Step

So, you want to know what happened when Bella attacked me, do you? I could sum it up in very few words: Leslie is an idiot.

But I suspect you'd like to know a little more about the details than that. After all, 'Leslie is an idiot' will hardly come as a revelation.

Let's start with some background:

Bella had been off the painkiller she takes for her shoulder inflammation for several days. We had been taking her off the medicine when she showed signs of gastric distress from it - balancing her achy shoulder with her upset tummy. At the time of the incident, she had been off the painkiller but not yet showing any signs of benefit to her tummy. So basically, she was feeling pretty flipping crappy.

A week before Christmas and all through the house...

The Friday before Christmas, I had gotten home from work late due to 'issues' and, while I thought my stress levels were pretty much under control, it's entirely possible Bella thought otherwise. Jan said she had been a little snarky with him earlier in the day and when I tried to take some photos with her, I noted she didn't seem especially cooperative this night. I gave up, poured a glass (or two...) of wine and went downstairs to watch some TV with Jan.

I don't remember what we were watching but it was something with bangs and booms and Bella was not impressed. I noticed she seemed to be a little 'off', maybe in need of some kindness and even thought she might be looking for comfort.

She was sitting in front of Jan willing him to share his popcorn. I got down on the floor next to her and reached my arm around her as I have done a thousand times before. I must/may have startled her or leaned a little more than usual because all of sudden she turned, snarling and snapping at me. She muzzle-punched my chin and snapped at my left hand (the one wrapped around her).

I actually told Jan to 'stay out of it' thinking that she would let up in a moment and, given their previous encounters, I thought his interference could possibly make it worse. Well, I didn't need Jan's involvement to make that happen - I made it worse all by myself. As I was trying to stand up and get Bella to calm down, I used my right hand to grab her collar.

And we'll just chalk that up to one big, huge, colossal, gigantically stupid mistake.

Had I not grabbed her collar, the situation would probably have left me with a bruise on my chin, some scratches on my arms and a relatively minor bite on my left hand. Instead, Bella turned and latched onto my right arm with no intention of letting go. Damn it.

Seeing this, Jan ignored my warning to stay away and grabbed Bella's collar from behind at which point she let go of me and I immediately walked away. I headed upstairs to the bathroom knowing there was clean up to be done.

And yes, I also walked away because she frightened me. I didn't want to her to bite me again. My right arm was smarting. Not to mention dripping sticky red stuff.

Upstairs, I took off my over shirt and began to assess and clean the wounds. Jan came up and we locked Bella out of the bathroom while he finished cleaning me up. I am a horrible patient and make an even worse nurse as the sight of blood makes me queasy. As a result, I kept getting light-headed and Jan had to change the dressings for the first few days.

I'm not bad, I'm just photographed that way.  ;)

Anyway, as usually happens when Bella has one of these episodes, she was immediately contrite. It's almost as if she doesn't even understand what just happened. And in this case, I noticed her apparent confusion for several days afterwards. As I mentioned previously, we avoided each other for a few days. Jan has always been so quick to forgive - almost immediately willing to reassure her that he is not in fact the big scary monster she sometimes envisions.

But Bella's not afraid of me. We all know that so I was confused. If she's not afraid of me, then just what the hell happened?

Over the next few days we thought about it and talked about it. We acknowledged the last two 'attacks' had been decidedly worse than the ones that originally sent us to seek professional assistance from Dr. Dodman. In these attacks it was like Bella wasn't even there any more.

When these attacks happened, Bella was solely focused on the 'threat' in front of her. Jan cannot get through to her when she is going at him and I couldn't reach her when she was going at me. However, as soon as Jan grabbed hold of her collar, Bella let go of me and ceased her attack. The same was true when she attacked Jan in September and I stepped in between them to break it up.

That's an important piece of information to remember - it will come into play later on in our story.

I've been bitten by dogs a few times in my life. I'm not proud of that fact and I don't present it as a badge of honor so much an acknowledgement that things happen. Dogs mostly do their best to communicate with us but sometimes we miss the signals they're sending. Or sometimes we get complacent and forget that they are entitled to their own moods and issues.

Preoccupied with my own concerns, I made the mistake of ignoring my instincts that told me she was "off" that night. I went on to make an even bigger mistake by grabbing her collar. The lesson I learned is to remember that even dogs have their own rich inner life to which we are not always privy. And we need to be ever mindful that mounting pressures can push any dog over their limits, never mind the crazy ones.

We're all back to good: Bella giving me snuggles and kisses, me trying to remember to give her the space she wants and needs. Bella's never been shy about asking for comfort. Next time I won't try to second guess her. I'll wait to let her tell me what she wants.

Next week I'll cover our meeting with Dr. Dodman and fill you in on our conversation and his advice. Thanks for hanging in there with us and our crazy dog. She really is worth the effort.