Friday, December 22, 2017

My Dog and Vestibular Disease

One of my dogs got hit with vestibular disease last week.  "Got hit" is the right term. She's recovering now, but this has been a very hard week on all of us.

Indy is a 14 1/2 year old Shih Tzu.  She has always been a bit of a tomboy, meaning she has always been active and ready to run and play.  On Tuesday evening last week, she was her normal self, chasing the laser light around the house at full speed, barking, pouncing, and having a great time.  When we went to bed around 11:30 she settled in to her bed.  About 1 am, though, I woke to a strange scrabbling noise.  Indy was flopping around on the floor next to her bed and then threw up.  I picked her up but she couldn't stand, couldn't control her movements, and looked like she was having a seizure.  I did what any responsible dad would do: I panicked.  Actually, I got dressed as fast as possible, wrapped her in a blanket, loaded her into the car, and headed to REACH, the emergency veterinarian for the Asheville area.

The staff at REACH was great, as they always have been for us in the past.  The doctor evaluated Indy with vestibular disease.  This is a sometimes-nasty condition that is not uncommon in older dogs.  It is not that well understood, but appears to be a condition in the inner ear or possibly the part of the brain that deals with balance.  The dogs basically suffer from vertigo.  In most dogs, they will have difficulty walking, have a head tilt, or suffer from nausea.  In Indy's case, it was really severe.  She would lie on her side, legs stiffly out, a panicked look in her eyes, and sometimes would try to roll over.  It appeared that anything to her left was like falling off the cliff, and "up" was somewhere over her right shoulder, no matter where her shoulder happened to be.  The doc gave her some medicine to treat the nausea and told me that the only thing to fix the vertigo was time.  Most dogs would see improvement in a couple of days, with recovery in about two weeks.  So back home we went.

As it turned out, Indy's recovery was much slower, probably due to the severity of the attack.  She showed almost no sign of improvement on Wednesday.  On Thursday, she was calmer, but still clearly suffering from vertigo and unable to even sit up.  On Friday, we took her to her regular vet, who had already read the report from REACH and confirmed the diagnosis of vestibular disease.  He was concerned about her lack of progress, though, and said we'd have to revisit Indy's situation in a few days.  If she wasn't improving by then, we should think about putting her down.  Worrisome, to say the least.

By this time, we were pretty exhausted from the 24/7 care.  She couldn't eat or drink normally, which meant we had to watch her closely and provide water and food when she was ready.  For water, we used a syringe to squirt it into her mouth while she lapped it up.  Our vet recommended baby food mixed with pumpkin from a can (just pumpkin, not pumpkin pie filler).  We used the beef baby food. The pumpkin provided Indy with fiber to help keep her system functioning.  She loved it.

Urinary events and bowel movements were very problematic since Indy couldn't stand and was extremely averse to soiling her bed or normal in-home environment.  We put puppy training pads on her bed, which required one of us (me) to sleep on the floor next to her bed so I could change the pad and clean her up when something happened.  Urinary events were generally accompanied by a good bit of wailing, not from pain but from distress.  Bowel movements were a different matter since she basically stopped them for a few days, which really worried us.

I mentioned 24/7 care.  To keep an eye on our patient, we made up a bed on the floor next to hers.  I've been sleeping there (correction: TRYING to sleep there) every night since this started.  Something happens every hour or two that requires us to do something: change pads/clean the dog after a urinary event, flip her over occasionally, give her water or food, console her when she whimpers, that sort of thing.  Janis and I have been tag-teaming: I take the nights, then she takes over early in the morning and I try to get a couple of hours of sleep in a real bed.  One or the other of us has been with Indy ever since this started.  It wears you out.

On Saturday evening, I had to take her back to REACH because she hadn't had a bowel movement in several days nor a urinary event in half a day.  She was miserable and we were worried that something more serious was going on internally.  We wound up seeing the same doc as the first time. After a thorough check, she reported that Indy's internals were functioning normally and that it was probably stress that kept things from coming out.  The doc was very concerned about Indy not being able to walk or even sit up, though.  She suggested giving Indy an acupuncture treatment to stimulate the muscles.  I thought, what the hell, sure, and so we did.

As it turned out, this was acupuncture augmented with electrical impulses.  Indy's reaction?  She went to sleep.  In the photo, I'm holding her head up and she's snoring.  The doc said we should see some improvement in 12-24 hours and sent us on our way again.

Sunday, though, was not a good day.  We saw no improvement at all.  In fact, by late in the day, I was starting to think about which day this week would be best for putting her down.

Monday, though, saw some changes.  Indy was able to sit up for the first time.  She did the normal dog head-shake, the kind where they're just getting the hair out of their eyes, which is not something you'd expect to see in a dog with vertigo.

Tuesday was better.  She sat up further, bracing herself on her front paws, although the rear legs were still immobile.

On Wednesday, Indy woke up with the attitude that she was sick and tired of lying around in her bed, and it was time to get up and go.  She had three self-initiated physical therapy sessions: one in the morning, one in the afternoon, and one in the evening.  Each session was longer than the last, and each was INTENSE.  This little girl worked her ass off.  And she continued into Thursday morning with a long session from 3-7 am.  Just wouldn't quit, even when I was trying to convince her to lie down and go to sleep, dammit.  The highlight, though, was that she was finally able to get her butt off the floor and actually stand up for a few seconds.  You have no idea how glad that sight made me!  You can see her determination in the photo:

Later on Thursday, she continued to make progress.  By the end of the day, she could actually walk about four feet or so.  It was a very crooked walk, but she was moving on her own.  She even got to her water bowl, where she drank, albeit with great difficulty.  Amazing stuff.

Now it's Friday morning and we have another milestone to report.  I took Indy and her sister Soozzee for their walk this morning.  No, we didn't make Indy walk - I put her into the doggie stroller and headed out.  A few minutes down the road, she started whining, so I put her on the grass, where she squatted and peed.  This was her first pee outside in over a week.  I put her back into the stroller and we went on a ways.  At a flat spot, I put her on the ground again and after stumbling around a bit, she actually had her first normal, outdoor poop since this all started.  Wow!  A normal poop and pee again!  Folks, we are movin' forward!

Speaking of pooping and peeing, until this morning, we have been using puppy training pads.  We're now changing over to doggie diapers.  She's mobile and we don't want to have to chase her around the house with the pads.  Actually, we're chasing her around the house anyway because she's like a toddler, bouncing off walls and furniture, and we are trying to prevent the hardest hits.  But after our experience this morning, the diapers are just a safety measure.  She may not need them very long.  We'll see.

If you're reading this because you're a friend of ours, it looks like Indy will be with us for a while longer.  Exactly how much movement she can regain still remains to be seen, but I am so encouraged by the unbelievable work that she has put into it.  I don't care if she's a bit wobbly for the rest of her life, at least she will be with us.

If you're reading this because you Google'd "vestibular disease" and landed here, it's probably because you have a dog or cat that's going through something similar.  It's a very scary time.  Vestibular disease hits hard and fast and the recovery process is all about time.  Somebody has to be with your pet 24/7 to provide them with water, food, change pads, and whatnot.  As they improve, your role changes from ICU nurse to physical therapist.  Fortunately for us, Indy is responding and recovering.  Most animals do; however, a few do not.  And sometimes what's initially diagnosed as vestibular disease can be something much more serious, like a brain tumor.  I hope that's not the case with you.  At any rate, this has been a very long post, and I hope it has provided some insight into how you might have to treat your dog or cat.

Meanwhile, I'm just happy that Indy is going to be with us for a while longer.

UPDATE - December 29

Unfortunately, things did not go well with our beautiful Indy.  Indy gradually was able to walk and even run, which gave us great hope.  However, she was able to do that by sheer force of will.  The vertigo never let up and, in fact, it gradually wore her down, both physically and in spirit.  After 15 days, she spent all her day lying on her side, occasionally struggling to do something, anything, but not having the strength to overcome the debilitating condition.  Our vet determined that it wasn't the milder form of vestibular disease, but almost certainly due to a tumor on the brain.  A fix is very delicate and iffy, with a long recovery.  So yesterday, rather than submit her to a long and painful process that had no guarantees of success, we took her in to the vet for the final time.  At 4 pm, she crossed over to the other side.

Good God, that hurts.

So if you're here because your dog may have vestibular disease, watch for the rate of improvement.  If Indy had the common kind, she would have improved significantly in the first 72 hours.  But she was one of the smaller percentage with more serious and permanent damage.  We lost our little girl.  I hope you don't lose yours.

Tuesday, December 12, 2017

Seeing Colors

I was recently listening to a podcast of a great interview.  The podcast is the Savvy Painter; the interviewer is Antrese Wood, and the interviewee was Frank Lombardo.  Frank is an outstanding artist who lives and works right here in my county (see his work on his web site), so it was cool to hear him on a national podcast.  Among the interesting things that came out in the interview is that he's somewhat colorblind.  Yes, you read that right: a fantastic artist is color-challenged.  That hits home with me because I am, too.  I'm what they call a "mild deutan", which is a type of red-green color blindness that makes it difficult to tell some colors apart.  This is particularly true when they're the same light/dark value.  Put a yellow and green, or blue and purple, of the same value next to each other, and my eyes won't see much (any) difference.  Change the value of one or the other slightly, though, and I see them clearly.  Not only that, but I can mix up paint to match the colors.

After hearing Frank talk about his color blindness (which is evidently much worse than mine), I've been thinking about how we see colors.  Frank noted that color vision comes from the cones in the eyes.  Most people have three sets, generally called the red, blue, and green cones.  A very few women have four sets: red, blue, green, and yellow.  Their color vision is really good.  But other animals have even more.  A mantis shrimp, for example, has 16 types of receptors and can see visible, UV, and polarized light (wow).

Having the physical ability to see colors, though, and actually seeing them, are two different things.  I've learned over the years that the more I paint, and have to see and match colors, the more colors I see.  Sometimes I'll see a range of colors in something that, years ago, I would've just passed by.  It's the same as any other physical ability: if you don't exercise it, it won't work for you.

So the other day, I was walking my dogs.  The sky was perfectly clear and the snow was on the ground reflecting the colors around it.

This is the scene that first caught my eye.  There was a brilliant blue sky, a seemingly equally brilliant blue reflection in the show, with bright highlights from the late afternoon sun.  But look at the colors a bit more closely.  Yes, the sky is brilliant, a cobalt blue higher up (maybe with a trace of red?), getting lighter and slightly more cerulean blue toward the treeline.  The reflection on the snow, though, is not as saturated as the sky.  It can't be: the sky is pure light, while the snow is a reflection, meaning that some light is lost in the process.  So the blue on the snow is a bit grayer and, to my (color-blind?) eyes, a touch redder, too.  And the highlights on the snow?  They're not white, they're actually very light yellow-orange, which is the color of the light coming directly from the sun. So if you want an extreme example of what can happen with a warm/cool color shift, here you are!

Once I saw that, I started looking around more to see what other colors jumped out at me.  Here's a shadow on the side of the hill:

I think you can see the orange light more clearly here.  Look at the shadow, though: how strong is that blue, and what color is it?  Okay, I'll help: here's a blown-up section of that shadow:

Pretty dark, darker than I would have thought.  And here's a clip of the sky that was directly above this blue shadow:

As you can see, the sky is a much clearer blue because it's pure light.  To paint the sky, I'd use cobalt blue.  To get the reflection, I'd use cobalt blue plus a warmer earth tone, maybe a touch of burnt umber or burnt Sienna.  

And then, finally, here is the bank above the shadow:

This was just beautiful to me: the yellow-orange light, the blue shadows, the bright blue sky, and I'm even seeing some reds along the top of the ridge line.

Cool stuff, isn't it?  The more you use your eyes, the more things you learn to see.  And the more I can see, the more pleasure I have in just looking at the world.