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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 25675
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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We have a 4 y/o Golden female. Diagnosed with Valley Fever 2

Customer Question

We have a 4 y/o Golden female. Diagnosed with Valley Fever 2 months ago.(Tucson) Been on Fluconazole(250mg) 2x daily for that time. Noticing an uncontrolled flinch-like movement, like a cringe movement in humans. And she ducks her head when we touch her head; left side. She does not scratch her ear. Ears are clear. Vet has put her on antibiotic as precaution against ear infection. She has also had a Parkinsonian-type tremor in her left leg at times for all her years as an adult dog. No trauma to head. No abuse. Gentle creature.
John
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.
Aloha! You're speaking to Dr. Michael Salkin
I'm sorry that your question wasn't answered in a timely manner. You appear to be describing a simple partial seizure (previously called petit mal) which is defined as abnormal sensory or motor activity affecting any part of the body (e.g. facial twitching). It's unclear to me why she's avoiding your touch but it's reasonable to assume that there is sensory alteration as well as motor activity associated with her partial seizures. These seizures may be related to a more general polyneuropathy which is causing her long-standing tremors.
Referral to a specialist veterinary neurologist (please see here: www.acvim.org) should be considered. Such a specialist is best equipped to perform the thorough physical and neurologic exam required in such cases.
The adverse effect profile of fluconazole does include hepatotoxicity and because a poorly functioning liver can intoxicate the brain (hepatoencephalopathy), checking Maizy's liver enzyme ALT would be prudent as part of her physical exam. Please respond with further questions or concerns if you wish.
Customer: replied 1 year ago.
First of all thank you Dr. Salkin. A neurologic matter does seem evident. The ducking head behavior in anticipation of touch may be evidence of pain, although once massaging her head the cringing ceases. Our vet did not seem concerned about pain. Maizy's liver function was checked last week and was OK. I would like to keep this conversation open for at least today, as my wife wants to read your report and think about it.Thank you again.JohnG
Expert:  Dr. Michael Salkin replied 1 year ago.
You're quite welcome, John. Thank you for the additional information. Was liver function tested by serum bile acids?
Customer: replied 1 year ago.
Don't know that. She had two tests that day; one for the Valley Fever which turned out to be negative; however Vet felt it could be false negative. Other test was for "liver function." Liver appeared OK on this test. We are attempting to find out exactly what type of test it was. I will get back to you. Thanks, again. JohnG
Expert:  Dr. Michael Salkin replied 1 year ago.

I understand. Liver enzymes - ALT, AP, GGT - identify hepatocellular damage and biliary stasis. Serum bile acids test for liver function.

Customer: replied 1 year ago.
Thanks. We are attempting to find out the details on her test. Requires call-back from Vet. What I understand you to say is that the liver can be functioning however damage may be hidden and require more thorough testing.
Expert:  Dr. Michael Salkin replied 1 year ago.

Yes, if I'm concerned that the liver is causing toxicity to the brain, I need to check how well it's functioning. I can assess damage but the liver has a lot of reserve and so the extent of damage doesn't necessarily correlate with function.

Customer: replied 1 year ago.
Thanks. These recent symptoms began about 2 weeks ago. I noticed her cringing and holding her head in a different manner. She seemed lethargic. Her expression to me, if I may anthropomorphize here, was: "I don't feel good." I have not seen this before. I spoke with a different Vet on staff who told me to take her off of the meds for 48 hours to see if there was a change. This conversation was on a Thursday, so by Sunday she had been off meds for 3 days. Her lethargy was gone. Her personality seemed to have returned. I can't comment on the seizures at this time. As I said she seemed better than she had been in a long time. I saw her Vet on the following Monday which lead to the tests. Since that time the seizures have seemed to be more prevalent. Her appetite is OK. Her digestive and urinary systems seem to be fine. She drinks water at a normal rate. Still waiting to hear back from our Vet's office.
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the additional information. Please clarify - her personality returned and her lethargy abated when off the fluconazole but she was put back on it and seizures never stopped and have increased in frequency/severity?

Customer: replied 1 year ago.
She was off all Fluconazole for 4+days. Vet felt we needed to keep her on Fl. Did one-a-day on our own until after the blood tests came back. She has been back on 2x since last Friday. Her energy level seems to be back to the lower level we saw when the new behavior began. Her personality, as I spoke about, seems subdued again. There is little or no interest in playing with dog she has always played with (Cattle Dog), for whom we are now house-sitting. We did speak with Vet late yesterday. Said again she was satisfied with liver test. Also wants to keep Maizy on anti-fungal for a while longer. She also said to watch for any change in behavior and to plan on another blood test in a month or so. Incidentally Vet did a tick test which came back negative.
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you. it certainly sounds as if she isn't tolerating the fluconazole well but I understand her vet wanting to continue treating with it. Please keep me posted concerning her neurological signs. I'll be away from my computer for a few hours but will reply as soon as I return if need be.

Expert:  Dr. Michael Salkin replied 1 year ago.
Hi John,
I'm just following up on our conversation about Maizy. How is everything going?
Dr. Michael Salkin
Customer: replied 1 year ago.
Thank you for following up. Neurological symptoms do not seem to be as pronounced as they were a week ago; although one time shortly after arriving one of the dogs we are sitting jumped up and nipped playfully at her favored side. She snapped back very aggressively. For several days we have been dog-sitting for 2 Cattle Dogs, as a I mentioned. She plays with them but not as aggressively as she has before when we have visited one of them. Appetite is OK; takes time to decide to eat and usually requires a little treating with chicken broth or cottage cheese. Thank you, ***** ***** your help.
Expert:  Dr. Michael Salkin replied 1 year ago.

I'm pleased to hear that there's improvement in the neurologic department. It's unclear to me if she reacted behaviorally to the cattle dog or hypersensitive on that side.

Customer: replied 1 year ago.
Looked to me like a "don't do that!" action. Snap, not a growl. I have been testing the wincing and cringing today. Not evident! Looks better; acts fine. Not real energetic but could be heat over here right now. We will be back in Tucson Monday and will follow-up with vet. We really appreciate your attention and concern. Maybe we should wrap this up now. Thank you again, Dr. Salkin.
Expert:  Dr. Michael Salkin replied 1 year ago.

Even better. That's good to hear. You're quite welcome. My best to Maizy!