Tyler's illness/ paralysis
Update 23 July 2007
Tyler, who is now 3 years old, was always active and used to play a lot with Leo and Piper and sometimes Ruby and always ran up and down the stairs. At the beginning of May (around the 10th?) he suddenly couldn't get up the stairs anymore, I don't know if it was hind leg weakness or whether it was neurological. It did somewhat coincide with him getting into a box of Fisherman's Friends which contain liquorice powder, menthol, eucalyptus oil and capsicum tincture. He didn't have many lozenges, maybe around 5.
Then he became unsteady on his feet, approx. end of May and in June, he would stumble over uneven ground and even fall on his side occasionally. In June my vets sent bloods off and did x-rays and all came back normal. Bone density was fine, blood calcium levels were fine.
Some pictures of when it started. Tyler was still able to stand on his hind legs and these pictures show how sweet he is, how he used to come over to me and try and grab me so I would pick him up and cuddle him.
Blood test 07/06/2007- I've put ferret normals in brackets...
Total Protein 66 g/l (51 - 74)
Albumin 40 g/l (26 - 41)
Globulin 26 g/l
A/G Ratio 1.5 g/l
Urea 13.8 mmol/l (1.9 - 7.49)
Creatinine 100 umol/l (< 75.0)
Sodium 144 mmol/l (128 - 158)
Potassium 5.87 mmol/l (3.9 - 5.5)
Chloride 110 mmol/l
Na/K Ratio 24.5 ratio
Calcium 2.44 mmol/l (1.99 - 2.94)
Phosphorous 1.12 mmol/l (1.03 - 3.06)
ALP 48 iu/l (34 - 66)
ALT 55 iu/l
GGT 1 iu/l
GLDH 10 iu/l
Bile Acids 39.0 umol/l (0 - 8)
Cholesterol 4.0 mmol/l
Triglycerides 1.35 umol/l
Total Bilirubin 1 umol/l
AST 58 iu/l
Amylase 200 iu/l
Lipase 75 iu/l
Creatinine Kinase 191 iu/l
RBC 8.75 x10^12/l (6.7 - 12.1)
Hb 14.1 g/dl (12.0 - 18.0)
HCT 0.45 % (0.43 - 0.55)
MCV 52.0 fl
MCH 16.1 pg
MCHC 31.0 g/dl
Platelets 369 x10^9/l (297 - 910)
White Blood Cells 4.60 x10^9/l (3.5 – 7.0)
Neutrophils 56% 2.58 x10^9/l (1.5 – 5.9)
Neutrophils (Band) 0% 0.00 x10^9/l
Lymphocytes 34% 1.56 x10^9/l (1.7 – 2.9)
Monocytes 0% 0.00 x10^9/l (0 - 1.17)
Eosinophils 10% 0.46 x10^9/l (< 0.35)
Basophils 0% 0.00 10^9/l (< 0.14)
Blood Film Examination
Blood smear prepared from EDTA sample was examined. Red cells appear normocytic and normochromic. A mild relative eosinophilia is seen. No abnormal white cells are seen. Platelets appear adequate in number and normal in morphology with no evidence of platelet clumping or EDTA clots seen.
Haematology looks ok. Otherwise urea/ creatinine and bile acids look slightly raised, though nothing spectacular!
Tyler when his hind legs were already severely affected, probably the week before he became paralysed
In July, his walking/ ataxia became worse and he walked very unsteadily and fell over more. On the 10th I took him to an exotics specialist, Mr Lance Jepson, who visits a local vet practice, Fenton Vets in Haverfordwest, twice a week. After an hour he confirmed what I was thinking, that it was a neurological problem (as opposed to a heart problem). He took blood and tested for Toxoplasma, Neospora and E.cuniculi because those can cause neurological symptoms. Tyler tested positive for toxoplasmosis but we still don't know whether the toxoplasmosis is causing (all of) the problems. ADV crossed my mind but the protein electrophoresis results were normal, no raised gammaglobulins, TP was within normal range and Mr Jepson said that he would expect Tyler to be more sick if it was ADV. Still, saying that, he didn't dismiss ADV completely. Tyler was started on clindamycin for toxoplasmosis and on prednisolone on Tuesday the 17th. He had deteriorated between the 13th and 16th, over that weekend he could only crawl with progressing difficulty and by the 17th he was paralysed.
Tyler when he was paralysed. At first he tried to move with his nose, he tried to pull himself along with his nose, and as a result it became quite sore. It soon healed though.
Blood test 11/07/2007
Biochemistry (Protein Electrophoresis)
Total Protein 82 g/l
Albumin 23 g/l
Globulin 59 g/l
Alpha globulin 23.9 g/l
Beta globulin 12.7 g/l
Gamma globulin 5.9 g/l
Toxoplasma antibodies POSITIVE 1:32
Neospora antibodies <1:25
E.cuniculi < 1/80 Titre
Mr Jepson palpated and manipulated his head, neck, spine and abdomen and Tyler shows no pain at all. He can hold his head up and look around. He holds his urine and faeces. I put him into the litter tray throughout the day and also during the night and he does his business then so at least he's not incontinent. Only a few times have I been too late and he soiled his bed. Appetite is fine. Mr Jepson kept asking if he was still eating and I joked that he would have to be unconscious to stop eating. ;-) I really can't see him ever going off his food. ;-) No fever. He can still scratch himself with the back legs so this reflex or what it is still works.
Appetite still fine ;-)
Tyler is also very stiff. When I pick him up, he feels stiff, Pete said it feels like rigor mortis. Mr Jepson showed me some exercises I should do with him so I've been doing range of motion exercises regularly with him and my friend Sandy suggested massaging him twice a day from head to toe to get the circulation going. She also pointed out that Tyler could develop bed sores and that he needs to be rotated every so often, paralysed people should be rotated every 2 hours so I'm rotating him every 2-3 hours. Repositioning the body also allows the fluid in the lungs to be resorbed rather than build up to cause a pneumonia (that's from Sandy, too). Tyler is on very soft bedding, thick blankets or pillows. I keep calling him my prince on the pea.
Peppy is fine.
It just doesn't make sense to me, I have been searching the Internet so much to find out which illness can slowly lead to paralysis, and of course I'm worried what'll happen next. Tyler is my special boy and I can't imagine being without him. He is not in pain, alert, so at the moment euthanasia is out of the question.
Update 8 September 2007
It's been a really bad time for me. One minute I was hopeful that Tyler could get better, the next I thought he would surely die and would just cry my eyes out. But right now I am very hopeful that he'll recover.
With Tyler I've done so much researching into neurological problems, of course canine or feline ones. I mean he tested positive for Toxoplasmosis but that doesn't mean that this is what is actually causing (all of) the problems. At first he looked like the cows with mad cow disease so I thought he had some sort of encephalitis. Especially when we went downhill so quickly between the 13th and 16th of July. Over that time Tyler quickly lost use of his legs. By the 16th or 17th he was paralysed. So the disease progressed slowly at first over 2 months and then quickly. Of course I was scared that the paralysis was going to extend to his breathing so I slept with him, also to put him onto the toilet throughout the night. But the paralysis just stopped. He did develop some breathing problems and had episodes during the first month of his paralysis where he did mouth breathing and looked a bit distressed. I don't know what caused this. Maybe stress because it happened a lot at the vets, he also did it when he was sat/ laid in a certain position, I think when he was sat on all 4 legs or laid on his back. He would stop the mouth breathing when lying on his side. But about 5 weeks into his paralysis the mouth breathing stopped. He hasn't had it for the last 2-3 weeks.
His stiffness is also gone. 3-4 weeks after the paralysis started, he became more supple. At first the range of motion exercises were hard to do and I was scared I would break his legs because everything was so stiff like it couldn't be moved or bent. But between the beginning and middle of August, the stiffness went and the range of motion exercises are now very easy to do.
Towards the end of August, about 5 weeks after the paralysis started, he started moving a little. He can extend his front legs (the left works better than the right) forward and pull himself out of his bed or out of the toilet (it is a very low entry toilet). He can push himself with his back legs. But once he has used his legs, they all extend backwards (if you know what I mean) and he is finding it hard to move them forwards. He sometimes manages to move the left front leg forwards again but not the back legs. It's like the co-ordination isn't working. When he is sat on all 4 legs, he also manages to shake his whole body. And he moves around in his bed, he doesn't like lying on his left side so he will move around into a position he likes. It's not a huge improvement but a start and I guess from not being able to move his legs at all to what he can do now is a pretty good progress.
Tyler in his comfy bed
Anyway, some illnesses I thought he may have. In July I and the vets thought maybe encephalitis or even a brain tumour or lesions in his upper spine. But when the progression of his illness stopped and he didn't get worse, we dismissed those 2. Then I thought it could be degenerative myelopathy (multiple sclerosis). Until I came across "acute canine idiopathic polyneuropathy"/ "acute idiopathic polyradiculoneuritis" (Coonhound paralysis) (Guillain-Barre). The symptoms were almost spot on for Tyler. I did more reading and there is something called "protozoal polyradiculoneuritis", it is caused by infection with Toxoplasma gondii.
In August 2005 Tyler became very ill with a sudden high fever. He couldn't walk for a few hours, I thought he was weak from the high temperature. He was shivering and salivating. But once the fever went down a bit, he started crawling and within a few hours he was walking again. Could this have been toxoplasmosis? I mean could he have reacted so violently and could it have caused problems again 21 months later (starting this May), this time causing slowly ascending paralysis?
Update 20 September 2007
Tyler can crawl a bit better now. When it's dry outside, I take him into the garden and put him by the back fence and he manages to crawl across towards the back door, with great difficulty because his legs aren't communicating well and also because the front right leg is still quite lame. It is the only foot that he can't put down properly but he'll walk knuckled under (on the upper part of his foot). Because of this, he has a tendency to fall over onto his right side. But if I steady him by the tail, he can crawl pretty well and fast. :-)
Sleeping beauty :-)
Update November 2007
Tyler did really well in October and became very active. He could only crawl but very well and steadily, he didn't fall over anymore and could turn around and manoeuvre really well. After breakfast and dinner he always crawled around, in the mornings he crawled all around the lounge, kitchen, utility and hall and at night he even wanted to go upstairs so I would carry him up the stairs and he would crawl around the landing and ferret play room and bedroom. He was getting very strong and enjoyed crawling around.
I took Tyler back to see Mr Jepson around end of October and he couldn't believe the improvement in Tyler, Tyler kept crawling around the consultation room.
Then on the 10th of November I started weaning Tyler off the prednisolone. Both Michaela and Mr Jepson had mentioned that it may be a good idea. He was on 5mg tablets morning and night and I went down by 1/4 tablet per week (3/4 tablet at night and 1 tablet in the morning, and week two we were down to 3/4 night and 3/4 tablet morning). But within a few days of cutting him down, he stopped moving. He'd been crawling around so much and then just stopped. I thought maybe his body will adjust to being weaned off the pred so I persevered but after 2 weeks I thought there's no point continuing this so I put him back on the full dose. Thing is he hasn't got back to how he was before I tried to wean him off. He is still not keen on crawling around and has only crawled around a few times by himself, if I want him to crawl I have to put him into the utility room so he crawls back into the living room. He is getting cumbersome/ sluggish, if I put him down in the utility, he has problems with starting to move (getting going), moves with great difficulty. I don't know if he's stiff or in pain? Before I tried to wean him off, if I didn't wake up at night when he needed the toilet, he would crawl into the toilet by himself. Now he just pees in the bed. I don't know what to think.
Tyler with Stripey
Update February 2008
This deterioration continued December and January, in February Tyler became a bit stronger again. At night I fed him in the kitchen and after dinner he would crawl around the kitchen, utility and hall. A little at first but then more and more so I was getting hopeful again.
Then I got a phone call from Mr Jepson on 22nd of February. I was wondering why and he asked how Tyler was and I said no different, maybe a bit better and stronger. Then Mr Jepson said that cameras are following him at the moment, he said he is getting filmed and they're following him for a few months at the moment. So I thought he wanted me to come into the practice at Haverfordwest so they can film Tyler. Next he says he's arranged for Tyler to have a CT scan! I was so shocked, it is as part of a promotion for the hospital. I was so speechless as anyone can imagine. This sort of thing doesn't happen every day and especially not to me. Of course I have all sorts of thoughts and emotions, if the scan shows cancer or some incurable illness then it means I will loose Tyler (put him to sleep). Which will be tough. But we have this saying in Germany, rather an end with fright than fright without an end. Part of me wishes I had had him put to sleep last summer when he went so bad with breathing problems. Then it would be all over now. But in a selfish way if it happened now it would be better for me because I'm so exhausted that I find it hard to feel emotions plus he is not my Tyler anymore, not the Tyler he was before this happened. He hardly ever wants to cuddle anymore for example. So letting him go now would be a lot easier than it would have been last summer.
Update 13 March 2008
Yeah, right, of course letting Tyler go now would be a lot easier. Not. Tyler's appointment was on the 10th of March at 2.00 pm. It was at Liverpool University Small Animal Teaching Hospital. We got there okay, an hour early, it took us 3 hours 45 minutes to get there and it was a lovely place and we met some very nice staff and people with their animals. There was a camera crew and they filmed me but I'm not the sort of person who feels comfortable being asked questions in front of a camera. My face was beetroot red and when I'm nervous my German accent is worse so I was trying so very hard to talk clearly and I don't want to know how awful, stiff and unnatural I sounded. At the moment I'm so tired and my brain is sluggish and then having to think of answers with a camera pointed at me... I kept telling myself, just be normal as if there wasn't a camera but as usual it's one thing to want to do something but another to actually do it.
I was in denial the whole day and also during the weeks leading up to the appointment. I was telling myself that they wouldn't see anything on the scan and that we could then figure out what was wrong and treat it. Pete and I sat in the waiting area, I held Tyler and we chatted to other people and everybody loved Tyler. Then at around 3.00 pm. Mr Jepson came to fetch Tyler, he was having an x-ray and an MRI, Mr Jepson thought that would be better than a CT scan. The next 3 hours flew by, me still in denial and waiting for a good outcome. Then the camera crew came back to the waiting area and they didn't look good at all so our hearts sank and we thought bad news. Mr Jepson called us through and we saw the MRI. Tyler had *3* prolapsed disks in his neck, all in a row. You could see so clearly how they were compressing the spinal cord. It was so fascinating to see but so devastating. With no hope of recovery I asked Mr Jepson if he could put Tyler to sleep which he did. I didn't know what else to do, I couldn't have taken him home and then made an appointment in a week or so to put him to sleep.
Since then I've just been numb. My emotions are shut off. I just couldn't cope with this now, it is so incredibly painful to think about that I just don't think. Whenever my mind wanders in this direction, I force myself to stop. But it's getting harder. I just don't want to let myself go because I think I would just completely break down. After loosing Willow and Spike this is just too much now. Our lives revolved around Tyler. I wake up at night now and just think "Tyler" and it's like somebody is stabbing me in my chest. Before when I woke up, I would sit up, turn the bedside light on and put Tyler on his toilet. Pete misses taking him up into the bedroom at night or putting him on the toilet when he hoovers. There's just such a huge gap now. And I can't even think about how Tyler used to be and how he'll never do this and that again.
Tyler's last picture at home Sunday 9th March with Hedgy
[Long story cut short, we took Hedgy in last autumn because she had an eye and respiratory infection. I was hoping this would be fixed quickly but it wasn't and then it got cold so she is staying with us until it gets warm again. She's running around downstairs at night quite happily, nobody bothers her. She took a liking to Tyler and I saw that she had crawled into the toilet with Tyler and just laid down next to him. So I took the picture and then got Tyler out of there because he was not as fond of Hedgy as Hedgy was of him...]
Last miscellaneous thoughts...
A lady called Wanda from the skunk list said from the beginning that Tyler's problem sounded like IVDD. That was also Mr Jepson's first thought. But I guess I didn't want to listen because I didn't want Tyler to have this but rather a treatable illness. And because Tyler never showed pain and then the paralysis reversed, Mr Jepson even wondered about Tyler having a different problem. I mean when Tyler became paralysed, he tried to move himself along with his nose- with 3 prolapsed disks in his neck???!!!
A week after loosing Tyler...
I am really beating myself up that I had Tyler put to sleep. I just keep thinking *HOW COULD I*. The pain is so bad at times that I feel like screaming. Oh, if only I could turn back the clock. Tyler had such a bad day, he had a very frightening car journey, then he gets taken from me, wakes up very cold after his long MRI, he looked awful when I saw him for the last time and for the crowning finale he gets put to sleep. I just keep asking myself why I let this happen or should I say why I asked for it. He should have gone back home alive, back to his familiar surroundings, his warm bed, his safe place where he was happy. Instead the last things he experienced alive were bad things. And this hurts so much at times that I just can't bear it.
The last time I felt like this was when Bella was put to sleep. The vets put her in a plastic container (modified plastic gallon bottle) to anaesthetise her before the lethal injection. She hated the smell of gas, was scared, and frantically tried to get out of there. And because the bottle had to slowly fill up with gas before it affected her, it took so long. I felt awful that she was sick and had to go through this and that this ordeal was the last thing that happened to her.
I can just hope that I saved Tyler from a worse fate, that maybe his disks would have deteriorated more and caused him agony in the end and that I saved him from that.
More thoughts 20 March 2008
I keep wondering why Tyler developed the 3 prolapsed/ herniated disks. He of course used to run up and down the stairs a lot but I thought of another thing. The ferrets have a 2 storey condo in their play room with a bed compartment at the bottom and one bed compartment 18 in/ 46 cm above the floor. Tyler kept climbing into the top compartment and used to sleep there almost every day. I'm sure some days he would repeatedly climb in there and jump back down. I'm wondering whether half climbing, half jumping back down could have stressed his spine.
28 March 2008
We saw Mr Jepson again on the 21st because I still had so many questions. Of course with my bad memory I found it hard to take it all in and remember it but Pete can hopefully recall everything and I hope I get it right here. If there is anything wrong, please correct me. We have not got much experience at all with spinal disk, spinal cord and nerve damage and problems so to take it all in, understand and remember it all correctly is difficult.
I was wondering why Tyler never showed pain and Mr Jepson said that his pain pathways could have been affected.
I asked whether all 3 disks would have gone by the time he was paralysed or whether one could have caused the paralysis and the others were caused when he tried to move himself along with his nose or when he started to crawl again. Mr Jepson said he hadn't thought about it but the latter could have been possible.
I think we decided that the prolapsed disks didn't happen through trauma but because of a genetic "weakness" or something. I asked whether Tyler going up and down stairs and climbing in and out of the condo could have caused it and Mr Jepson said it shouldn't have because wild skunks climb a lot but if Tyler was genetically predisposed then it could have had a detrimental effect on his disks. Also his size and weight probably played a role.
I asked how the paralysis could reverse when the spinal cord was damaged. Mr Jepson suggested that the various nerves might have started to grow back and made connections. Sometimes nerves can grow around blockages and repair connections. (They may not have connected the way they were originally connected and the brain would have had to work out how everything works.)
The spinal cord was so badly compressed by the prolapsed disk that the Cerebrospinal fluid (CSF) was hindered or even not flowing past that point resulting in nerve damage due to lack of nutrients. Also the spinal cord was compressed to 1/3 of its original diameter. The spinal cord was dying due to physical damage and also because of lack of nutrients from the Cerebrospinal fluid. This would have made Tyler deteriorate, something that could have happened in the future is that the nerves to the diaphragm could have died which would have resulted in Tyler to not be able to breath and to suffocate. I wonder whether the problems breathing that he had in August 2007 were due to nerve damage to the diaphragm and whether the nerves "fixed themselves". (Tyler had a homoeopathic remedy, Apis 30c, every now and again and I'm wondering whether that helped with the nerves regenerating themselves. But again I don't know much or anything about homoeopathic remedies...)
But anyway, hearing about how Tyler could have suffocated makes having him put to sleep a bit easier. It makes me feel like it was the right decision. But it still hurts a lot, I miss him so much, wonder "WHY". Why him. I'm still beating myself up because maybe he could still be here if I'd had the myelogram done when Mr Jepson recommended it. I'm just feeling despair and at the moment find it hard to keep going. It's not just Tyler, Tyler was just the last straw, that he was taken from me on top of everything else.
Time line of Tyler's illness (approximately)