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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 13096
Experience:  University of California at Davis graduate veterinarian with 42 years of experience
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Hi ~ My dog had what we assume was a vestibular attack over

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Hi ~ My dog had what we assume was a vestibular attack over 4 weeks ago. He is a 13 year old Shar-pei with recurrent ear infections. Infections are being managed better than ever over the past 6-9 months. I had definitely seen some improvement after the vestibular, although he still has a severe head tilt and his ataxia, while still disturbing to watch for some, had greatly improved from when this all began. He is on Prednisone, Cephalexin, Soloxine for thyroid and Gabapentin for back pain, etc. I noticed right after the Gabapentin was started in June, he had his vestibular episode. Any correlation between the 2 as far as you know? He's never had a problem with seizures or anything before. My vet had me take him off the Gabapentin the other day and yesterday, right before my eyes, he was standing one minute and fell over on his side the next and was shaking a bit, looking completely helpless. My husband stayed with him while I ran to try to call the vet. It terrified me, needless to say - as he has never fallen over like this since it all started. What amazed me was that within a minute after this happening, he was up and walking towards me again - but now his ataxia has once again become worse, although he still is up & around frequently. It's like we're back to square one in this regard & its very frustrating. Nystagmus disappeared completely a couple weeks ago & appetite has been fine the whole time. He vomited twice during the onset of the vestibular back in June & that is all. When he's lying down, he's still very alert and always wags when I walk by or cuddle with him. Last vet appt. a week or so ago, I was told the ear drum in the right ear could not be located and the vet assumes it has ruptured. Just at a loss as to what I should do at this point -I simply can't give up on him.. I understand the head tilt can remain in some dogs and can live with that, but the episode yesterday (was it a seizure!?) and now the worsening of the ataxia really has me down. I can't help but think there's still an inner/middle ear problem that is not responding to the (750 mg of) Cephalexin (but we've tried a few other antibiotics within the last month or so w/out much luck) and of course I'm not accepting the worse case scenario, a brain tumor. Short of a $2K MRI that I simply cannot afford, any advice as to where we should go from here? Thanks so much! Lisa
Submitted: 3 years ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 3 years ago.
Aloha! You're speaking to Dr. Michael Salkin
Hi Lisa - I understand your concern with his chronic ear issues. I see no need for an MRI after reviewing your very thorough history. It would be foolish to assume that there is anything more than a persistent inflammation of his middle and inner ear(s), most likely due to chronic infection. In fact, current studies have demonstrated that it's more likely than not that a dog with his history had (at least) middle ear involvement long before his vestibular episodes. Antibiotic therapy must be continued for many months in these patients, and based upon culture and sensitivity testing. Unfortunately, even after identifying the culprit and using the appropriate antibiotic for an extended period of time we still may find that we haven't been able to reach the blood levels of the antibiotic necessary in the middle ear to be effective. In these cases we've resorted to total ear ablations - we literally remove the external and middle ear, thereby surgically removing the infection. Unfortunately, I can't imagine a surgeon contemplating surgery on a patient who is as "vestibular" as your pet. His quality of life would be dreadful post-operatively. I believe you're left with the treatment as you've outlined for me (unless a current culture and sensitivity hasn't been done). I've not heard of gabapentin causing seizures (unless it is abruptly withdrawn - weaning off the drug is appropriate) , nor do I feel that your dog suffered one - an acute vestibular episode is much more likely. I'm sorry that I don't have any magic for your dog. Please respond with further questions or concerns if you wish.
Customer: replied 3 years ago.

Dr. Salkin~ Thank you so much for your email! I have been so worried all day at work and your information has put me at great ease for the 1st time in a long time. I can easily "live with" him like this, I just don't want to be selfish if he is living a miserable existence, which doesn't seem to be the case to me, but dogs are so stoic. I have just been on this emotional roller coaster for what seems like an eternity now - reading that vestibular generally lasts about 3 weeks and most all dogs return to normal, etc. The ups and downs are so frustrating and I'm just not seeing the results I'd hoped to see by now - which led me to question the dreaded brain tumor I've read so much about.. The only other concern I have is that I have read numerous times that vestibular episodes usually don't occur more than once in a dog. Is this the case? I understood your response to mean that he had another attack last night. Can this happen repeatedly? Just worried about his safety more than anything - last night he was inches away from the fireplace mantle when he fell over. Btw - he seems "OK" today - he's not quite as wobbly as he was right after it happened last night. Really no change from the past week or so before that, however - but he is up & staggering around, which is somehow comforting to me at this point. I have also been having acupuncture and vet chiropractic done on him the past few weeks- not really sure if I'm just throwing my money away since I don't think it's helped a great deal, but I suppose it can't hurt. With regard to the Gabapentin - unfortunately, it was abruptly withdrawn the other day. My vet said that unless he was prone to seizures to begin with (which he wasn't) withdrawing abruptly should not cause seizures. I still wonder about that after last night, though. Again - thank you so much for your response. I will definitely check with my vet about a current culture & sensitivity test. I know when he was in last week, she flushed his ear out - which she does about once a month. A few months ago before all this happened- he had e-coli bacteria in that ear that was cleared up with antibiotics.

 

Again, your response is very reassuring and you are much appreciated for taking the time to discuss this with me. Lisa

Expert:  Dr. Michael Salkin replied 3 years ago.
Hi Lisa - Thank you for the update. I believe you're referring to the "old dog vestibular syndrome", an idiopathic (unknown cause) condition which usually remisses in a few days to weeks, and "often never recurs". In actuality, it does. Many of my patients have more than one vestibular episode. In your dog's case, I believe that active infection/inflammation exists and so repeated vestibular episodes are likely. Be sure to ask your vet about anti-nausea medication such as maripotant (Cerenia). These anti-emetics are helpful in people and we postulate they should help our dogs as well. I think acupuncture is a good modality to try. Goodness knows, we have little else in our armamentarium. I admit, I'm not a fan of chiropractic. We'll never know about the gabapentin, but he's better so we won't worry about that further. Feel free to continue consulting if you wish.
Customer: replied 3 years ago.
Dr. Salkin~ Again - I thank you so much for your time and useful information. You're doing a great service to pet owners and it is much appreciated! It's such a relief to have my suspicions confirmed that it is "just" ear problems and not something much worse. This I can live with and will continue to work with the vet to get it resolved. As a side note - I've noticed he seems to get more "agitated" in the evenings lately and is up pacing/roaming around the house and panting heavily - but otherwise seems to be fine. Right at 8pm last night, just like the night before last when he had his "episode", I was on the floor petting him while he was standing and I felt his body loosen up and he felt like he was going to fall over again. Luckily I was right there and just braced him and soothed him & it seemed to pass. Very strange. We all slept fairly well last night (thank goodness!) and he was up and around early this morning. I am longing for the day where I see him walking more upright and his balance & coordination return. Plus, I don't know how long my back will take carrying his 65 lb. bod up & down the stairs each night/morning. Ha! But I know that I'll do it until my back breaks, if needed. I didn't mention earlier that not only is he completely deaf (this happened suddenly about 6 months or so ago), but his eyesight seems to be very poor, which makes the situation all the more difficult for the poor guy and for me. But it is what it is and I'm just glad to see some improvement and just to have him around. 13 years is a long time & he's been there for me through thick and thin - now it's my turn. As far as an anti-nausea med - he was on (generic) Meclizine when this all started. Perhaps this will help again? I will ask the vet about the Cerenia as well. I tried to upload a picture of Chazz for you, but it said the file was too large. Thanks again!
Expert:  Dr. Michael Salkin replied 3 years ago.
If the meclizine was helpful, I see no reason not to use it again. I'm not sure what the significance of the timing of his restlessness (evenings) is, unless a drug you're using is wearing off (or kicking in) at that time. Remember that restlessness and panting are signs of discomfort in our dogs. Perhaps he's becoming dizzy as people do with vestibular disease; perhaps he's having syncopal episodes (fainting) secondary to a heart arrhythmia - is there any history of heart disease? Senile deafness is common; in his case that and chronic infection are responsible for his deafness; I can imagine that the lenses of his eyes are quite "grey" at his age, but if the greyness reflects nuclear sclerosis of the lenses (a hardening and clouding) rather than cataracts, he can see OK. Finally, I know a good acupuncturist and chiropractor for your back!
Customer: replied 3 years ago.
What you described would completely make sense. Although there has been no extensive workup done on his heart, the vet said it was in good condition during his last exam not too long ago and bloodwork was completely normal, with the exception of hypothyroidism which we're now treating. Naturally, I hope it's just dizziness as opposed to heart complications, but I will definitely mention this to the vet to look into further. I know this probably sounds silly - but a week or two ago - I just coudn't muster up the energy to carry him upstairs to my room at bedtime, so I blocked the stairs (always blocked now) and left him downstairs for the night. He actually woke me up in the middle of the night with his crying/whining until I carried him up. Even now in the evening when I go upstairs for a short time and he notices I'm gone, he is waiting down below, crying. He has gotten so attached to me this past month or so it's unreal - especially for a somewhat aloof dog such as himself. He has never been vocal, so hearing this just breaks my heart. It's crossed my mind that his evening agitation could partially be attributed to some sort of separation anxiety - thinking I'm going to leave him alone all night? I shudder to think what he does when I'm at work all day. He also whines sometimes when I open the back door to try to let him out and he just stands there at the door and won't go outside, or when he's standing right there and my 2 Brittany pups are let in from the back yard. He'll kind of cry/whine at them for a minute. Wish I could figure it all out. On top of this, I just feel like I'm giving him so many pills & am not sure if any of them are causing adverse effects or if there is something that could benefit him more, etc. Yes, his eyes are very cloudy - it seems that he can see better out of one eye than the other. Not sure if it's because his head is tilted so far out of whack, but many times he doesn't seem to see me until I'm inches away, then he seems to lose sight of me all of a sudden and turns around, heading the other way, looking for me. He can now make it back into the house from the back yard, barely. Some days are better than others for sure. His back legs also seem to be very weak and wobbly and he often has to "catch" himself before losing his balance. I notice he always seems to be hungry and drinks much more water than he used to - I have just attributed this to the medication. When he's restless at night, I often consider giving him a dose of Tramadol he was prescribed for back pain a few months back, but am not sure if this will only worsen the agitation. I do give it to him sometimes in the a.m. now that he's off the Gabapentin, as I think his back is still bothering him a bit and perhaps his ear(s) is hurting, etc. If only they could talk! I can email his latest medical records to XXXXX@XXXXXX.XXX, if this is still a valid address & if you ever have time to look them over - only 3 pages. (wouldn't let me upload here - says it's the wrong file type) So you're a jeweler too? Fascinating! I know I've wasted enough of your time and again - I appreciate your insight & suggestions to hopefully get to the bottom of this. Take Care. Lisa
Expert:  Dr. Michael Salkin replied 3 years ago.
Dogs do experience separation anxiety - your observation may be spot on! Of course much of what you've related to me may be attributed to senility as well. His increased hunger and thirst can be directly attributed to his being on a corticosteroid such as prednisone; if he's not on steroids at this time, we have to be concerned with diabetes and/or Cushings - both of which either of you need like a hole in the head. We're not allowed to correspond outside this site - the email address you provided doesn't render correctly in your response; you would have to copy and paste the records into your message to me. Thank you for the kind words, Lisa. Feel free to keep me posted.
Customer: replied 3 years ago.

He is still on the Prednisone - the vet actually upped his dosage to 15 mg twice a day for a week and it was just lowered back down to 10 mg twice a day, so hopefully that does explain his recent increased thirst and hunger, etc. I actually researched Cushing's disease previously and he does display many of the symptoms, so it is definitely worth looking closer into. It might also explain the delay in his ear infection healing and recurring and him possibly being recently diagnosed with hypothyroidism? Panting being a common symptom is very scary, as well. If he does have this disease, would him taking corticosteroids on a daily basis just make things all the more worse if his body is producing too much to begin with? I also read where abnormally high corticosteroid levels can cause muscle, tissue and ligament weakness - would this might also explain his prolonged ataxia? I don't notice any hair loss or protruding belly & I remember the vet saying not long ago that she couldn't feel an enlarged liver. I have all his recent (5/11) test results I'd love to show you, but when I scan them, it converts them into a pdf file & I am unable to copy or paste. Not sure what to look for in the test results to see if it could indicate Cushing's - but I suppose the readings could have changed recently anyway if he's in the early stages of the disease.

Thanks so much! Hopefully he doesn't have this - although it doesn't look to be terminal - just hard to diagnose and potentially expensive.. I'll definitely ask my vet about it.

 

Expert:  Dr. Michael Salkin replied 3 years ago.
While on steroids, patients will exhibit all the symptoms of Cushings. You won't be able to differentiate whether the symptoms are from iatrogenic causes (your giving the prednisone) or true Cushings. I see no point in testing for Cushings. I wouldn't treat a dog of his age and current medical state even if he had Cushings - managing this inevitably terminal disease (90% are caused by a pituitary tumor and 10% are caused by an adrenal gland tumor) is no picnic and is quite expensive. Yes, steroids delay healing and make treating infections difficult (steroids are immunosuppressive). His vet will tell you that he has to be off prednisone for 2-3 weeks to accurately measure cortisol levels - our way to diagnose Cushings. If the prednisone is helping him, don't take him off it and test for something that is inappropriate to treat in his case. Sorry for the trouble in getting the test results to me. The site is currently working on ways to make it easier for customers to send us images and information.
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 13096
Experience: University of California at Davis graduate veterinarian with 42 years of experience
Dr. Michael Salkin and 8 other Dog Veterinary Specialists are ready to help you
Customer: replied 3 years ago.

I just cannot thank you enough for your time and help with all this. I guess I've gotten so wrapped up in trying to find a way to get him back to his old self, I don't really think logically sometimes. I will say that he had a really good day yesterday & it keeps me going. Up & around alot & it seems maybe a little less of a head tilt - sometimes you don't know whether it's the placebo effect or really happening. Ha! I know I need to brace myself for the inevitable, just not ready to let him go. But when will I ever be? Hopefully it's not Cushings and I so appreciate you explaining all this so clearly. You have truly made me feel better about all this somehow, regardless of the outcome and I truly appreciate it. He & I have gotten closer than ever since I've been trying to nurse him back to health. It's great how dogs sense that and respond positively. I feel in my heart that it's helped him recover to the point he has now - albeit not a whole lot-it's something. He's never been a very affectionate dog, so I'm enjoying the closeness now. You have helped me more in the past few days with this than anyone else ever has & I thank you. Your patients are SO fortunate to have you as their vet! I'll keep in touch from time to time, if that's OK.

 

Thanks again & the best always,

Lisa

Expert:  Dr. Michael Salkin replied 3 years ago.
You're quite welcome. He's lucky to have you. Keep in mind that if he weren't drinking like a fish and eating you out of house and home prior to your giving him prednisone, then he isn't Cushingoid. Feel free to return to this chat - be sure to save it by clicking the save link on your page. Talk to you later.

Thank you for your kind words, accept, and generosity. I appreciate it!
Customer: replied 3 years ago.

Thanks for your comforting response. Before starting him on Prednisone back in September of last year, he just ate and drank normal amounts. I really just started noticing excessive hunger & thirst over the past week or so, which seems to correspond with the time frame that the vet had increased his Prednisone dosage. He's been back down to a total of 20mg/day for a few days now, not to mention the 750mg of Cephalexin he's been on for about a week or so - so hopefully there's a correlation there. I re-read some info on Cushings again yesterday and one article talked about pet owners bringing their dogs in to the vet for urinating on the carpet constantly, when this was never a problem before. That had about convinced me this disease was the culprit, (on top of other similar symptoms) since he has been going on the carpet alot lately and before, I think he would've soon burst before doing that. Thank goodness for carpet cleaners! But botXXXXX XXXXXne, he's drinking alot more now, for whatever reason, so of course he has to go more. When I'm home in the evenings, I just automatically let him out often - to get some exercise & sniff around, if nothing else, so he has way fewer accidents. I had also noticed more of a pot belly on him recently, but he's always had a slight one, being short & stocky and he has been eating like a pig lately. I am keeping it in check though - the last thing he needs is to add more problems by being overweight and/or diabetic. I do notice recently that when I give him a rawhide to chew on, it definitely preoccupies him and I can get more done upstairs at the house without him constantly crying and searching for me. Ha!

 

I definitely saved our chat (& printed it for Chazz's ongoing file I've put together - Smile) and will touch base again soon.

 

Again - I just can't say enough kind words to express my deep appreciation.

 

Lisa

Expert:  Dr. Michael Salkin replied 3 years ago.
Yes, Lisa, his inappropriate urination is directly related to overfilling secondary to his polydipsia (excess thirst) due to his prednisone. Secondary urinary tract infection (UTI) is also a common sequelae to steroid use and will result in "accidents" in the house. Hopefully, the cephalexin has prevented a UTI. The pot belly and polyphagia (excessive hunger) are similarly the result of his prednisone. The rawhide is a perfect solution and good dentifrice to boot. Keep up the good work.
Customer: replied 3 years ago.
Thanks! I meant to mention the vet wants me to give him Famotidine, along with the Prednisone, to try to prevent ulcers. I tried giving it to him for 2 days last week, but he vomited both days. Once I removed the Famotidine, no vomiting. I have to admit that I have just stayed away from it altogether now. Is this wise?
Expert:  Dr. Michael Salkin replied 3 years ago.
Your common sense approach in simply stopping the famotidine was appropriate. Prednisone alone - in anti-inflammatory doses - isn't considered ulcerogenic; it is so when used concomitantly with an NSAID or at high immunosuppressive doses (which you're not using). If you haven't noticed undue vomiting and/or diarrhea you may dispense with the famotidine.
Customer: replied 3 years ago.
You're great! Your quick responses are incredible & much appreciated!
Expert:  Dr. Michael Salkin replied 3 years ago.
I've been chained to my laptop by gnomes.
Customer: replied 3 years ago.

And a great sense of humor?! Really?!

 

Wish you were practicing in Oklahoma, but seeing as how (I'm assuming) you're in Hawaii - you'd have to be certifiable to ever leave paradise, for this place especially! We're fighting almost a month straight now of 104-106+ degree temperatures! Unbelievable.

Expert:  Dr. Michael Salkin replied 3 years ago.
I once came to Norman, Oklahoma to scribe for a dressage show. It was 104-106 degrees. I think I'll stay on the big island of Hawaii.
Customer: replied 3 years ago.

So- horrible night last night. Chazz started panting and pacing around the house around 10pm and it basically did not stop until about 2am. I actually made the mistake of leaving him downstairs with my husband. I had already begun noticing some agitation and unsteadiness at this time, but he (Chazz) had dozed off for a while - seems like carrying him up the stairs just makes him worse sometimes anyway - so I left him down there to sleep. I woke up hours later to noises and found that he had somehow managed to make it past the blocked stairwell and get all the way upstairs - this has happened once before. I'm sure he injured himself at some point. By the time I found him, he was in the guest bedroom and seemed so confused that he was walking into corners and into any opening, just standing there until he'd start roaming around again, bumping into furniture, etc. I thought for sure he would collapse at some point, so wobbly, getting himself so agitated and walking in circles like that, but he didn't. He didn't whine or cry during any of this. I tried getting him to lay (or even sit) down, but he wanted none of it. After a while, I carried him back downstairs & let him outside and back in, where this behavior continued to go on, but he did take breaks between, lying down on the tile in the kitchen, seeming to calm down a bit. I layed with him petting him for hours, then I finally fell asleep on the couch around 4 or so. Today he seems much more wobbly and unstable on his feet (than he usually is in the daytime) & is sleeping. I was unsure last night whether to give him a Tramadol or even Meclizine in case he was dizzy. I haven't given him the Meclizine for many weeks now, as I mentioned before. I ended up giving him a 1/2 Tramadol, because I had given him a full dose hours earlier at dinnertime. I called my vet this morning, but she is out of the office today. The ups and downs are killing me. It actually crossed my mind last night about whether I'm just being selfish here and just seeing what I want to see when it comes to his recovery and whether or not I should consider euthanization, he looked so miserable. Is there any light you can shed from your experience why he seems to be improving during the day, but worsens at night? I know we discussed possible dizziness or one of the drugs kicking in or wearing off - just not sure what I'm missing here or what to do. He basically takes all the same meds in the pm too - then most evenings lately, gets worse a few hours later. Last night was actually worse than when all this began over a month ago. Is there anything I can do (i.e., give him) in the evenings to try to prevent this, or more importantly, what can I do (give him?) to try to calm him down and get him to lie down and rest if he's in the middle of one of these episodes? Is this par for the course for a vestibular dog and something we'll just have to live with every night - or does it sound like something else may be going on that I need to have checked out? Gotten to the point where I don't even want to take him to the vet, etc., in the car - as he doesn't do very well, which makes sense I suppose. Don't know if this is a mixture of dizziness and pain or something going on in his brain, or what. The craziest part is - he was doing great early yesterday evening, chewing on his bone, relaxed and seemingly fine - this is why euthanizing seems seems so outlandish (not to mention impossible) to me most all of the time, but a very harsh reality in the middle of the night, helplessly watching your dog go through this. Any advice is, as always, appreciated. Funny - I always try to make my comments brief in the interest of your time, but I want to make sure I don't leave anything out that might be relevant &/or helpful. Thanks again!

 

Expert:  Dr. Michael Salkin replied 3 years ago.
Oh dear - if you're confused about what you're seeing, imagine my frustration thousands of miles away trying to sort him out! A central nervous problem - over and above his known inner ear disease - shouldn't manifest only at night. I can't help feeling that he's reacting to a drug coming or going in his system. I'm inclined to have you just stop all his meds for a couple of days and see what transpires - you can always start up again if there's no change in his night behavior. The other reasonable thing to consider is acute anxiety disorder secondary to his altered sensory abilities - in this case the only change I can think of is your "absence" during the night - so separation anxiety would be his type. This is treated with psychoactive drugs - clomipramine usually - but can take weeks to kick in - if it'll work at all. I understand your frustration - I wish I had some magic for you. I know you're considering quality of life issues, and I believe that's appropriate.
Customer: replied 3 years ago.

Thanks again. Just reading your replies calms my nerves somehow. I am more than willing to follow your advice and take him off the meds. I have actually considered this many times, but am afraid of some rebound reaction, I guess - especially since one is for his thyroid I really often wonder if he even needs to be on it - since I read how their levels can fluctuate at any given time. Testing hasn't been done to see if his levels are even back to normal yet. Not sure if he's in pain as well, as far as the Tramadol. Also, I guess I just have it in my head now that we're still trying to kick an ear infection, that taking him off the ceph would just be counterproductive. But I suppose taking him off everything for just a few days would probably be the best way to try to solve this, if you think it's safe. Truth be told, each time the vet has added another med, I just cringe - I hate giving him all these pills. I totally agree that there is a secondary anxiety disorder going on. If you get a chance, please check out ehow dot com and look up "sundowning syndrome in dogs" (Cognitive Dysfunction Syndrome) that I just came across! (not sure if copying & pasting the link will come through to you OK) This is exactly what went on last night and many others!! I never thought this situation with him would get to the point of controlling my life & thoughts, but again, he has always been here for me & I've always felt that dogs were put on this earth for us to enjoy & nurture. I simply cannot give up on him. Just a few minutes ago - he was just standing in the kitchen looking up at me wagging, so go figure. Still "off" today more than I've seen him the past several days, but not the same dog I was up with all last night. Something I keep forgetting to mention is recently, the bone at the top of his skull is protruding more, to the point where I can see it sticking up out of the top of his head - right between his ears. I can literally feel the point of the bone - it's very hard. I've been attributing this to the way his head & ear have been tilted, but now I don't know.. I will skip all his meds tonight and for the next couple days and keep you advised, if this in fact what you'd recommend. Thanks again for not only helping us both, but allowing me to somehow relieve my own anxieties by writing all this down and attempting to work through it in my own mind, not to mention your patience and caring and all your personal time you've taken with me. It just means so much, regardless of the outcome of this and I will forever be grateful. No vet has ever taught me so much in such a short period of time.

 

Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you for your kind words. "Sick thyroid" is a common syndrome in dogs and cats. They're really not hypothyroid - their thyroid levels decrease with illness; to differentiate a sick thyroid dog from a truly hypothyroid dog, we test the free T4 and/or the TSH level. If he were receiving an excess of thyroid supplementation, however, I'd expect hyperactivity and possibly gastrointestinal distress throughout a 24 hour period rather than just at night. To be more exact, thyroid levels are at their highest 4-6 hours after administration of the pill, and that's when I'd expect untoward symptoms. Taking him off the AB for a few days isn't critical...you can pick up where you left off if drug withdrawal isn't effective. The reason you're feeling and seeing his occiput so easily now is that the musculature on either side of the bone has "wasted" - this is yet another result of chronic, high-dose steroid administration (as well as cranial neuropathies and some auto-immune diseases involving myopathy (muscle disease)). I'm quite familiar with cognitive dysfunction (which my daughter accuses me of suffering from). Unfortunately, there are no effective treatments in dogs - in spite of what claims you might find on the internet. Keep in touch.
Customer: replied 3 years ago.

Thank you. I can't imagine there being anything wrong with your cognitive abilities. Smile To be clear, what is the "AB" - all his meds? Do you feel that he could be suffering from CDS/Dementia, based on the identical symptoms? I'm not expecting a miraculous recovery at this point, I'm afraid - just want to try to make him (& the family) as comfortable as possible, I guess. All the websites mention "may get stuck in corners and can't find their way inside, stare into space, seem confused, panting, eliminating in the house - all at night/sundown". Do you not think that Anipryl could alleviate any of these night time symptoms?

 

Sorry.

Expert:  Dr. Michael Salkin replied 3 years ago.
We use AB as an abbreviation for antibiotics. I don't know why I would expect you to know that. See, an example of my cognitive dysfunction! You're right, of course, that his symptoms mimic CDS, but I could make the case that his symptoms also fit advanced liver disease...except the fact that liver disease doesn't distinguish between day and nighttime restlessness and pacing. The majority of our dogs over 10 years of age exhibit at least one symptom of senility. So if we just look at the odds, it's likely that he's senile. Should we try anipryl? Well...selegiline never worked for people, so I don't know why we expect it to work for dogs. There are no peer reviewed articles showing appreciable effectiveness for either CDS or Cushings - the two indications for its use. I have no idea how it got approved for those uses. I consider it snake oil. I'm such a heretic.
Customer: replied 3 years ago.

Thanks for making me smile. Well-he's starting it again tonight. It has everything to do with him getting up & looking for me - making sure I didn't leave him downstairs by himself. After so much time has passed, he stands at the foot of the stairs crying and whining, getting more & more agitated. Thanks for the clarity on the AB - I figured but am too scared to assume anything anymore. Ha! I guess my botXXXXX XXXXXne is - if I don't see any improvement over the next few days, weeks(?), do I continue taking him to the vet to try new methods of treatment (of course my budget has become quite modest over the past month or so with his care), or do I just need to sit back & let nature take it's course? My biggest fear is not having done something when I could/should have, even the tiniest thing that could've yielded great improvements. I did not give him any of his night time meds - so hopefully we'll see a difference. He's lying around alot more tonight between searches so far than he was last night. All of a sudden I'm kind of at a loss and maybe reality is finally sinking in, I just need to be sure there's not something I could be doing. Not sure how many more nights both he and my family can go through this.

 

Thanks for your candidness on the Anypril. I would take your word over any website. It really helps to know beforehand.

 

As always, my sincerest thanks.

Expert:  Dr. Michael Salkin replied 3 years ago.
Is it worse to have him upstairs and less anxious than downstairs and becoming more agitated by the hour? Do you have help carrying him upstairs? Has he become an unacceptable burden to the family? Terrible questions to come to grip with, I know. I don't know of any new methods for your vet to try barring advanced imaging and surgery - both inappropriate in my opinion. I don't feel he's a medical case anymore, rather, a surgical case as I mentioned many responses ago. In time, the correct direction becomes clear - as you're noticing. You're welcome, as always.
Customer: replied 3 years ago.
Last night ended up going really well & he basically slept through the night - no pacing, panting and agitation. It seemed to help when I went over to him & petted him throughout the evening when he would wake up. No, no one helps me carry him up & down the stairs - my husband has a heart condition and I hate asking him to do it. Chazz weighs more than my son, who's only 7. I'd rather him be upstairs with me, regardless - not feeling abandoned on top of everything else. No, he's far from an unacceptable burden to the family - never will be to me - I guess what I was trying to get at was my husband and son (& dog, of course) not sleeping well every night - I don't want to be responsible for that & also keep Chazz alive if he's miserable. Thank you for the suggestion of taking him off the pills temporarily - I am certain this is what helped us all get some sleep last night. He's less wobbly today & seems content. I know things will work themselves out & worrying (& bugging you) will not change the outcome. It's just so difficult coming to terms with something like this, which is basically what hap-ened to me yesterday. Thank you SO much for being there for me on a personal level when I needed it most. No one else in my life really understands and thinks he's "just a dog". Thank you, again.
Expert:  Dr. Michael Salkin replied 3 years ago.
Your reassuring him throughout the evening may just be the ticket. It occurred to me that the tramadol (being a narcotic) can have a paradoxical reaction in patients - instead of the expected sedation, excitement is noted. Tramadol is, then, the medication I'd like you to avoid for a few days to see if he continues to have better evenings. Continue not giving everything else as well, and if things go well, bring one drug back at a time. Let me know how it goes.
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Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you once again for your kind accept and generosity.
Customer: replied 3 years ago.
No, thank you. In this short time, you've saved me probably hundreds of dollars in vet bills, not to mention trying to load him up in the car in this heat, etc. and have been more informative and honest than any other vet I've had all these years.

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