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I'm trying to find answers after putting my 14/15yo

I'm trying to find answers...

I'm trying to find answers after putting my 14/15yo chow/retriever mix down a week ago today. I have reached out to my regular vet and Neuro but I am just not getting specific answers relate to conditions and their progression. Sunny was diagnosed with LarPar in 2013. He had the tie-back surgery successfully. Prior to this he was diagnosed with Atypical Cushings and Htypo-T. After his LarPar surgery, Sunny had his first vestibular event after his thyroid meds were altered. He resolved but still had the head tilt. After a year or two, that resolved. Around this time, the vet clinically thought they would adjust his thyroid meds again because he was elevated. And, yet again, within two weeks, Sunny had another vestibular event. This time, the immediate event resolved but there were lingering aspects. His head tilt remained and when he was inverted by the Neuro, the nystagmus was present. Sunny was circling often and so we opted for an MRI. The MRI was unremarkable. No tumor. Sunny started getting hind leg weakness likely due to the LarPar and generalized neuropathy that is often frequently associated. He was still circling occasionally. He started becoming incontinent few months after this (fecal at first, urinary came on more slowly). He had labs done in Sept 2017 and all looked good for the Cushings and HypoT. Sunny wasn't very active although he did take short walks. He had muscle atrophy and as his incontinence continued he was wearing a male wrap almost all the time now along with a Help em Up harness. He started having frequent UTI's and any change in his diet caused loose stools. It was a challenge to manage. In early Feb, I took him back to regular vet where they remarked that he had dropped even more weight (now 35 lbs). I didn't see it at all. Interestingly, the vet didn't recommend lab work be done - but I did request fluids for him. I can't explain why I didn't insist on blood work - other than I was so blown away by his weight loss I wasn't thinking.. I brought him home and stated feeding him scrambled eggs, and all sorts of good meats. That of course led to more loose stools. Sunny was now starting to have really bad sleep/wake cycles, and get stuck in area where he seemingly couldn't navigate out of. He would get stuck if a foot caught tile or if he had a stool - sometimes his legs would go straight and he couldn't bend them to get back up. Soon, his front legs were getting weaker. He kept shifting his weight (I thought was just arthritis). He would lay down with his front legs straight out in front and his head carriage was low almost like he was so weak he couldn't bear his weight anymore or hold up his head. We started sub-q's (advice of hospice doc) and increased his Gabapentin to 3x daily. I was giving him Tramadol at night to help with sedative. I'm sure he had some arthritis but X-rays from last year didn't show anything debilitating. I'm just at a loss. What would have caused this decline so quickly? Did he have CCD? Neuropathy? Neuromuscular issues? Cushing's? All of the above? His quality of life was the real issue in his case - he would just lay outside and not even lift up his head to sniff the cool air. Car rides didn't do anything for him anymore. I eventually called a hospice doctor out who felt he was ready at any time. I just wasn't, until I saw how truly unhappy he was. Do you have any feeling as to what caused the weakness and whether it was CCD or what the progression of Peripheral Neuropathy looks like? Thank you.

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Customer reply replied 4 months ago
Sunny early Dec 2017: https://www.youtube.com/watch?v=JCfaG43smRESunny end of Dec (see attached photo with back to camera)Sunny in early February laying on his right side on dog beg (attached photo). As February progressed, he refused to lay on either side anymore and would get quite anxious if someone tried to get him to lay on side.Sunny Feb 2018: https://www.youtube.com/watch?v=cBDeYf6Jn1gMore videos of Sunny around February 2018:https://www.youtube.com/watch?v=rWgBgqf0yOkhttps://www.youtube.com/watch?v=5ReqjAQcfSghttps://www.youtube.com/watch?v=dXVq913YtOohttps://www.youtube.com/watch?v=fyYo59O4j4I
Customer reply replied 4 months ago
I have some other videos from probably last summer, where Sunny is turning he turns, then adjusts, then turns....maybe 3-4 times then he'll lay down (I can send if helpful).
Answered in 1 day by:
3/8/2018
benedetta7
benedetta7, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 496
Experience: Companion animal medicine and homeopathy
Verified

Hello, this is dr. Benedetta, and I would like to help.

It is always difficult to reach any conclusive answer as to what caused what exactly, especially in a case where there are multiple known pathologies, that have been going on for years, plus the normal aging process.

5 years is a good long run for a dog with lar par and peripheral neuropathy, on top of Cushings and hypothyroidism, and recurring vestibular episodes.

From what I can gather from your description of events, the progressive weakness and inability to control his movements are likely related to his peripheral neuropathy, which is a progressive condition, and can progress at a variable pace, meaning it can stabilize for while, but then deteriorate quickly over a short period of time.

There no changes on radiographs for neuropathy

The restlessness, insomnia, disorientation, lack of interest in life, incontinence can all be signs of CCD. which is also progressive, like Alzheimer in people.

So my feeling is that there is no clear answer, but the peripheral nephropathy made him a "down" dog, made him weaker and weaker, and that combined with CCD, which caused him to lose his engagement with his surroundings, caused a steep decline.

A necropsy can give you more specific answer as to the degree/amount/quality of degeneration of tissues, but in general, I think this is a case of several degenerative diseases that finally summated and caused the steep decline.

It sounds like you took amazing care of him for a long time, and honestly these diseases are difficult to manage and impossible to cure. He was blessed to have such a dedicated owner!

Let me know if this helps, or if you have more questions!

Benedetta Sarno, DVM

PS: i can see the phots, beautful Sunny!

I cannot open the vieso on my current computer

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Customer reply replied 4 months ago
Hello and thank you for your opinion. I can find no information or very little about the actual progression of neuropathy - peripheral or otherwise. What happens, specifically? Is the muscle atrophy part of the atypical cushings, or the neuropathy? Motor neuron disease? He dropped half his weight in two years, but no tumor was found as of last May. His muscle wasting was severe within 6 months. As of last March no significant arthritis either. What caused the weakness in the front legs and the low head carriage? Was that a typical progression of neuropathy? He did have some mild shaking in back legs, and some knuckling of back feet - but if you turned them over he could place them back properly (although there seemed to be a gradual delay in doing so). Can CCD progress quickly? Can Vestibular events cause brain damage or lesions or something else? I know there isn't a cure for Vestibular events - when they inverted him last year he still had mild nystagmus. Thank you.

The neuropathy is basically a degeneration of the neurons which are innervating the muscles. when those nerve ends degenerate, die and are no longer delivering impulses to the muscles, the muscles will start atrophying. This is relatively quick process, from losing innervation to muscle atrophy, like in a matter of weeks.

whether the peripheral neuropathy strike can be variable, usually start with the extremities, but in Sunny's case sounds like it started going to the muscle of the neck head and torso too.

Then Cushings also makes muscles weaker, which is why Cushing dogs often have pot bellies. But it does not cause the knuckling and neurological deficits that you describe.

Muscle atrophy can explain most of the weight loss, although the fact that he had runny stools for a long time probably also contribute to weight loss, as for some reason he wasn't absorbing nutrients.

CCD is really like alzheimer, progression is variable. However, in his case, you are describing signs over 1 year, so that is not superfast pace,especialy combined with all the other pathologies.

as for vestibular, we do not really understand what causes geriatric vestibular disease in older dogs. as you know, in some cases, some signs can linger, like a head tilt, which suggest there has been some damage along the nerves that innervate the inner ear. I am not aware about vestibular disease causing brain lesions.

But CCD, like Alzheimer, does come with brain lesions. So it is very difficult to parse out what caused what, as I said in the beginning.

To me, it sounds like the main pathology was the peripheral nephropathy, which is , unfortunately, intractable

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Customer reply replied 4 months ago
Thank you, ***** ***** able to view any of the videos that show him struggling to move? It's almost as if he was willing his body to move but the neurons weren't firing. Awful awful to watch.

sorry, i am unable to view the movies on this computer.

but you description sound just right. yes, it must have been awful

benedetta7
benedetta7, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 496
Experience: Companion animal medicine and homeopathy
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Customer reply replied 4 months ago
Sunny's cognitive decline was likely happening before it became apparent to me - but it wasn't a year long. Last fall, he started sleeping a lot more - even into the early afternoon. He would sometimes miss meals in the morning so I'd try feeding him when he woke up and then again at dinner. But, I didn't always get food into him. It wasn't until early February where the up at night issues started to progress - up and down and up and down - from about 11-6AM; I was giving him Tramadol at night as a sedative and even started using Benadryl to help sedate him. They worked for a few hours. He was fecal incontinent for a lot longer than he was urinary incontinent. That started slowly in the fall, and got progressively worse by end of Feb (when I helped him cross over). His episodes of getting stuck and unable to turn around really started to increase in Jan/Feb too. So, from that perspective, the possible CCD really progressed quickly in Jan/Feb. At the beginning of Feb, he was still trying to get up and meet people at the door, by end of February, no. Does that sound typical of CCD?
Customer reply replied 4 months ago
Thank you.

sorry, i thought you meant february 2017 as the beginning of the CCD signs.

so no, that does not sound like typical CCD progression, it sounds a faster process like a brain tumor, or some other degenerative process.

i know he had an MRI, but that was a while back. so it is possible there was an intracranial process that developed in the meantime and progressed quickly.

Thank for the positive rating, I appreciate it!

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Customer reply replied 4 months ago
The MRI was done in May 2017. I understood CCD dogs to start sleeping a lot more at first - which is the start of their mixed up sleep/cycle patterns. He started sleeping a lot in fall 2017, going to bed at night and sleeping even until next afternoon often. I didn't think anything of it other than I was glad he was getting rest. His head tilt made it hard for him to lay on either side comfortably, he would change side preferences every few months. At the beginning of Feb I have a picture of him sleeping flat on his right side. By mid-February 2018, he refused to lay on either side instead preferring to lay sort of curled with head on one paw or between front paws. February 2018 is when he seemed to decline fast. It's like he aged 3 years in a month. But, I can probably see the CCD signs starting back in Oct, and progressing until end of Feb where rather than sleep all night - now he was sleeping more in the day and agitated all night until around 5-6AM when I would give him another Gabapentin. Mid-February is when the low head carriage and front leg weakness started.
Customer reply replied 4 months ago
It would be great if you could see the videos - you can't even view the links I provided to YouTube?

so about 6 months of clear CCD signs, and a fast decline probably due mostly to peripheral neuropathy in February.

what a tough case, poor Sunny!

with CCD, we also don't have any good treatments. sometimes anxiolytic drugs can help with the sleep patterns, but Sunny had so many other things going on that i am not sure different drugs would have made a difference.

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thanks fir the bonus, that was very generous of you!

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Hi,

I'm just following up on our conversation about your pet. How is everything going?

benedetta7
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