I was on the road for most of today driving to Portland. Bayla and Kiki got their long awaited eye clearances today. Both were clear and the ophthalmologist stated that they had the eyes of two year old dogs. Diet, diet, diet.
While I was driving for those five hours I was on the phone consulting with various veterinarians, from internal medicine to holistic, to exotic animal. Over the last few nights I developed a working hypothesis regarding what is going on with the puppies, and why this presentation is so very bizarre: I believe we are now dealing with a two step problem, and we are now in the realm of complex medicine, something I happen to be very good at diagnosing and unravelling. Where my first theory was:
Shot reaction --> mengial swelling (e.g., focal meningitis)--> spinal cord compression
What I now believe to be happening is this:
Shot reaction --> mengial swelling (e.g., focal meningitis)--> spinal cord compression AND focal myasthenia gravis. Two separate problems, both treatable.
This, then, is the diagnostic plan regarding what's going to happen over this and next week:
Mini's blood test for myasthenia gravis will take "about a week", meaning we will have a definitive answer no later than early next week.
I am now consulting with a board-certified internal medicine veterinarian. She's very good and I have worked with her before on difficult cases. The plan is that I take videos tonight of the puppies and their gait and posture etc. for neurological evaluation by her tomorrow and concurrently write up and submit a case history. When this video is done I will post a link to it here and I will email a password to anyone who wants to see it. (I don't need to discuss how anyone malicious could use this video to absolutely obliterate my chances of ever selling a puppy to anyone ever again, so please don't repost or share it.)
If this is suspected to be myasthenia gravis, we will order a medication to treat it. If any puppy responds to treatment within minutes, we will have a definitive diagnosis in conjunction with mini's blood test. If these dogs are positive, the prognosis for complete recovery in any puppy is good to very good. This condition is treatable. It may resolve completely. I have no way of knowing yet.
If this is not myasthenia gravis, I will schedule a neurological consult at Angel Memorial or another suitable practice for complete evaluation, including an MRI to visualize any spinal cord abnormalities if any can be seen, and continue differential testing. To be blunt, the list of possible causes for what is going on is extremely short. There are simply not that many things it could be.
I am in almost daily communication with Dr. Dodds, and she is proving to be both generous and selfless with her time and tremendously helpful.
The news tonight is mixed:
Ash continues to be unable to rise or stand, but is apparently free of all pain. I see slow improvement. In these cases, it seems that the pain always resolves days before motor function returns; this was the case with Mini.
Blue Boy is also unable to stand and is still having some pain. I have increased the class and effect of his pain medication with excellent results.
Mini continues to improve and her odd rear gait is still present but less so. I see her improving slowly but steadily. Since she was the first affacted, I am using her as a sort of barometer in regards to what to expect.
Lani is still slightly weak in the rear but can get up and walk and has no apparent pain.
Neo suddenly developed a limp today and is slow and lethargic. Whatever this is is now affecting him. I have placed him on Sedrol 2x/day as of this morning.
Tali suddenly developed a limp today but is not slow and lethargic, and of course this is two days before her owners were to pick her up. Again, this is is now affecting her. I have placed her on Sedrol 2x/day as of this morning. (Sedrol is a steroid.)
Mari still has no clinical signs. I expect her to develop them any day.
To the buyers: I cannot thank you enough; you have shown more patience, kindness, support, and understanding in these very difficult times than anyone has the right to expect. I promise you I will get to the bottom of whatever this medically complex issue is and I will find a way to deal with it. I promise you I will find a way to get you healthy, happy, normal puppies. I also promise you that I will not sell you a sick puppy, but let's wait on that discussion until we have both a diagnosis and a treatment providing complete recovery.
There IS progress; tonight not one puppy has been screaming in pain because they changed positions, which is a first. I am absolutely confident that motor function will return and will do so completely, but slowly.
I am so very sorry this is happening; I know how disappointed you are at not having your puppy yet, and I am absolutely devastated that I am putting you all through this. I will continue to post updates as they develop. I understand that no one signed up for this, so my offer to let anyone out of the contract for a full refund still stands. I am horrified about the emotional trip I am taking you on, and it's the last thing I wanted to do. If you've had it, I will completely understand.