Diary of Nigel's Ordeal

It all started mid February, 2008...

February 13, Wednesday. Nigel was lying in his bed in the living room and when I entered the room, I noticed his right eye was closed, while the left remained open. I said, "Hey Nigel?" and he opened the eye and looked at me, alert as usual. He did this again a couple more times throughout the day and he would occasionally rub the right side of his face on the floor, on his bed and also with his paw. Thursday he did it again so thinking he had something in his eye, I called the vet to make an appointment and almost immediately, the behavior stopped. I took him in anyway and nothing was found in the eye. He never repeated the behavior.

February 20, Wednesday. We took Nigel and Divot to the vet for their annual check-ups. Both had senior blood panels done with complete physicals and were pronounced "healthy and in great shape," especially considering they are now called seniors. The only area of concern noted by the vet, were a couple of Nigel's teeth. There was one that was of questionable health and the vet thought we should clean them and check out that questionable tooth. One reason I was quick to agree was because the questionable tooth was the large tooth that is directly below the right eye and the vet and I both thought that perhaps the tooth was bad and maybe causing some pain, thus the closing of the right eye the previous week. This seemed to make perfect sense so I made an appointment for Nigel to have his teeth cleaned.

March 3rd, Monday. We dropped Nigel off for the dental appointment at 7:30 a.m. Several hours later the tech called and said he had done just fine. The tooth was not problematic as thought, but one lower front tooth was loose and they extracted it. We picked him up at 3:00 p.m., and he was very alert but agitated and certainly wanted to get out of there and go home. On the way home he whined on and off and this continued at home and I thought he was whining because he was thirsty or hungry. But, I was unsure and uneasy because sometimes he would whine loudly, almost urgently and he had this unusual look; he looked as if he was imploring me to do something.

I called the vet's office and spoke with the tech and she said that some dogs have that whiny reaction when coming off of pain meds. As soon as I felt it was safe enough, I started giving him food and water in small amounts. The whining subsided and then stopped as his hunger and thirst were finally abated. He was still unsteady on his feet and his left front paw seemed to be dragging a bit - we could hear the nails on the tile and we figured that he was still under the influence of the pain meds. We noticed that they had trimmed his nails and we thought perhaps they had left one a little longer than the rest, thus causing the sound of those nails on the tile. One definite problem that concerned us was when he would go out the patio door for potty time, rather than going around the house to the right - heading for the lawn, Nigel was walking out straight, heading toward the pool (which would be his left) and walking along the edge of the pool. We thought it was the meds making him clumsy and a little wonky so when taking him out we walked between him and the edge of the pool and we just turned him toward the grass. Nigel remained a bit agitated and didn't settle down to rest until 9:00 p.m. that evening, which seemed very late considering the anesthesia and pain meds he had been given.

March 4, Tuesday. Nigel still seemed a little under the influence and I told the tech this when she called to check in on him. She found that to be rather odd and made a note of it. When going out to potty, Nigel was still determined to walk along the edge of the pool, rather than turning to the right toward the grass. That evening Nigel was sitting on Mike's lap and Mike noticed that his skull had a strange feeling on the right side, just above the eye socket. It felt as if the skull was bulging on that side making the area immediately above his right eye seem very concave and not symmetrical with the left side. We were alarmed by this but as we examined the area, Nigel did not seem to be in any pain.

March 5, Wendesday. I called the vet first thing in the morning and wanted him to look at Nigel's head, and he was still not acting right -- as if he was still under the influence of the pain meds. Also his left front paw was still dragging and his overall coordination just seemed "off." First we took both dogs for a walk as is our usual morning custom and Nigel was running with Mike so we thought the unsteadiness of the meds had worked itself out with fresh air and exercise, however, when Nigel attempted to jump up on a curb he stumbled.

The vet explained that the skull had not changed shape but that the muscle was atrophied. I thought it odd that one side would atrophy so rapidly but there was really no explanation for it. Considering the hands-on method of grooming a Norwich as well as the amount of time our dogs are handled, I couldn't believe I could miss such a thing. Nigel is very nervous at the vet's office and at that point he wasn't stumbling at all and so the vet couldn't see my point about his loss of coordination. Nigel's "flight" mechanism is in high gear when at the vet so he appeared to be quite normal -- just interested in getting out of there so we were not able to address that issue. That afternoon I decided to give Nigel and Divot a bully stick because I wanted to see if he had pain in his mouth -- something had to explain why he just didn't seem "right." I noted that he seemed clumsy with his stick and almost confused as to how to lie down and manipulate it for chewing. I got the video camera out and started filming him. I also noticed that when he finally did lie down to chew, he was using his mouth and right paw to manipulate it while his left paw was just there propping him up -- he was not using it to hold the bully stick. This is very unusual as dogs hold things with both of their paws. I could see he was having difficulty manipulating it and found it odd that he was not doing what comes so naturally to him. That evening, Nigel seemed a little agitated and paced around the house a lot. Mike was on a business trip and I thought maybe he was looking for him.

March 6, Thursday. I awoke to a nightmare -- a completely different dog. It was as if Nigel had become a geriatric, senile dog overnight. He was stumbling around and bumping into walls and furniture, and would sometimes topple over when sitting down. When standing still, he would sway. I noticed that when he would walk down a hallway, he would walk leaning against the left wall rather than down the middle as usual. He could not seem to walk a straight line when in a large, open room -- he would veer to his left until he was against a wall and seemed to use it as his guide. Nigel seemed confused and had a vacant look in his eyes yet he looked frightened at the same time. Within a short time he started to walk in circles -- larger at first and then tighter. I dared not let him even walk outside so I carried him out and placed him in the grass. He was very unstable and seemed overwhelmed by the open space around him and just stood looking confused. He wandered aimlessly through the house on unsteady legs, unable to sit or lie down for more than a few minutes at a time. I feared that he had suffered a stroke. I called the vet and they said they would see him as soon as I could get him there. While getting ready, I continued to get video in case miraculously he didn't do this at the office again. I needed answers and I needed them now. I got Nigel to the vet and they could see immediately that there were neurological problems. The vet did some preliminary reflex tests in which we found that the left side of his body was weak and definitely not fully responsive. Nigel paced around the exam room, pressing his left side against the walls, and walking in tight circles. Also it seemed as if he did not have vision in his left eye or it was greatly diminished. The vet, very concerned with his preliminary findings, referred me to the Veterinary Neurological Center in Phoenix. Thankfully I was able to get an appointment for the next morning at 10:00. Mike cut short his business trip, and came home immediately. He was shocked at Nigel's condition which had deteriorated rapidly in just 24 hours. From the time I discovered Nigel's deteriorating condition that Thursday morning, he did not stop pacing or sleep for more than a few minutes at a time.

March 7, Friday. We took Nigel to the Veterinary Neurological Center in Phoenix where he had more reflex tests and an MRI. They also did a spinal tap. The MRI showed a mass at the base of his brain on the right side as well as substantial swelling around the mass. We are unsure of the origin of the swelling or what caused it. The neurologist felt that it was the large amount of swelling and accompanying pressure that was causing the motor problems and confusion, and not the actual mass at this point. His suggestion was to try for immediate relief by a shotgun approach using Prednisone, an antibiotic and an anti-fungal to bring the swelling down. This shotgun approach was suggested because we have no way of knowing what the cause of the swelling is. Nigel received a shot of Prednisone at that time. The neurologist suggested we repeat the MRI in 3-4 months to see if there is any change in the size of the mass, using the first MRI as our baseline. The location of the mass makes it impossible to do a biopsy and it's location makes it inoperable as well. A concern is that the mass has a somewhat round shape and also a "finger-like" shape growing from that. The neurologist's report stated: "... our primary suspicion is neoplasia, namely lymphoma. Although less likely inflammatory process (immune-mediated meningoencephalitis) or infections granuloma cannot be ruled out... Our plan will be to gradually taper the Prednisone over the following few months pending his response to treatment. Unfortunately, should the mass represent a neoplastic (cancerous) process, he will eventually become refractory to treatment at some point in the future. Our goal will be to give him a good quality of life for as long as possible."

We liked the neurologist and found him to be very kind and gentle with Nigel, while being very thorough and straightforward with us. We asked him if there was something that might have happened during the dental procedure and he told us that the mass had probably been there for at least 3 or 4 months. He did indicate that the stress of the anesthesia and or procedure may have exacerbated the problem and sped up the process. This was one of the most awful days in our lives. From early that morning we had received phone calls from family and friends, all wishing Nigel the best and waiting for updates. There was an outpouring of love and we will never forget the strength it gave us. Prayers had been said, candles were lit, positive thoughts, and healing mantras had been recited -- all for Nigel and many of those by people who had never met him.

We left the vet's office with Nigel, still rather shocked at the findings. Our healthy, robust dog suddenly seemed so fragile and old. When we brought him home he was still coming out of the effects of the anesthesia but he still wandered and paced compulsively, looking lost, lying down to rest only for a moment or two, and not sleeping at all.

Saturday 3/8/08.
Nigel stands on still
unsteady legs.

March 8, Saturday. I started Nigel on his 3 meds. Within 4 or 5 hours his wandering and pacing had subsided a bit and by evening, he was able to sleep -- he even dreamt while lying under an end table. At the first sounds of the yipping of his doggie dream, we looked at each other and tears welled in our eyes. Nigel was resting and that meant he was getting some much-needed relief. He still paced most of the night however and slept very little.

March 9, Sunday. Nigel began showing definite improvement. He was much steadier on his feet and was making progress with being able to maneuver around walls and objects. His posture was still rather squat, and his left front paw was still dragging but he had stopped swaying and he seemed more restful.

In Summary

The neurologist does not believe that the dental procedure caused any of this but the stress of the light anesthesia given for the procedure possibly exacerbated the problem and sped up the process. The mass has probably been growing for at least several months and behaviors such as the right eye closure were clues as to what was going on. There were other subtle clues and signs along the way but who thinks an occasional bump into a doorstop is a clue to a growth in your dog's brain? Because the pressure and mass are on the right side of the brain, the left side of the body is affected such as with a stroke victim. The neurologist explained that Nigel's ability to run but to not be able to maneuver or walk with coordination at a slow pace was like trying to ride a bike at a very slow speed -- you're wobbly -- but by picking up the pace, it's easier to get all those necessary movements under control and ride smoothly. The neurologist explained that running is one of the most natural things for a dog - it is hard-wired into a dog so that's one of the reasons he was running along that morning yet stumbling on the curb. As to why Nigel was walking up against walls and walking next to the pool, was because he was using them to guide him. The walls created a safety guide for him to walk against to keep himself from falling and the visual line of the pool and surrounding cool deck was being used to help him walk a straight line when outside. I find this to be amazing -- he had begun to compensate for his disability immediately. At this point we do not know the exact nature of the mass nor do we know the cause or nature of the swelling that surrounds it. Nigel is responding to the drugs and we know that has brought him much needed relief. We are hopeful for a continuing trend toward positive response to the drugs. We will definitely re-do the MRI in mid June to compare that with the one that was just done. We simply have to wait and see what the new image will tell us.

Packmates and best
friends. Divot cuddles
with Nigel under my
desk one week after
his MRI. 3/4/08

Divot was very patient when Nigel bumped into her, sometimes even tumbling upon her. When I had to walk Divot alone in the morning, she would mope along at the end of her leash behind me. Nigel has always been at her side since the day we brought her home 7 years ago and she does not understand walking without him near her. She gently sniffs his face and head and we have to wonder if she is sensing any chemical abnormalities or perhaps just being encouraging to her pack-mate. These moments are cherished and sweet such as the one pictured at right. While Nigel and Divot are best friends, preferring each other to any other dog, they really don't snuggle. Nigel kind of acts like Divot is the "little sister with cooties" if you know what I mean. He loves and trusts her but doesn't really want to be that close to her, unless of course it's his idea. This day however, 1 week after Nigel's MRI, was very different. He was lying under my desk (Divot's usual spot) and she just crawled in and snuggled in next to him. He didn't get up and leave and they just stayed close, heads together for 20 or 30 minutes while I lay on the floor, snapping photo after photo.

Follow-up -- Week of March 10, 2008

Nigel napping on
the afghan my mother
gave to me.

Nigel is responding well to his meds. As of March 12, he reached a plateau. He is about 90% steady on his feet and has regained control in walking around objects. He is sleeping a lot and that's good for the brain. (He has really taken a special liking to the last crocheted afghan that my mother made and presented to me after a surgery several years ago - see photo). We are still seeing a definite weakness in the left side of his body, especially the left front paw, which he sometimes folds under as he is sitting or standing. The vet instructed us to right it for him in the hopes we can help him to "re-wire" it. At this point we are unsure as to whether or not he has complete vision in the left eye. Sometimes we are confident that he does and at other times, we are unsure. Since his MRI he has been on restricted exercise. As of the end of the first week of treatment, we are starting to see light and life in his eyes again, for which we are thankful. The Norwich eyes are so expressive and to see them without expression is sad indeed.

I contacted Marina Zacharias www.naturalrearing.com and she recommended some supplements to feed the brain and to cleanse the liver. My vet also suggested that we boost his Omega 3's' and give him green tea as an anti-oxidant.

Week of March 16, 2008

The neurologist instructed me to lower Nigel's evening Prednisone dosage. This is good news! He has also given us permission to resume light exercise for Nigel. Divot joins us in our happiness for this return to normalcy. Nigel is still at the same plateau -- about 90% of his coordination and ability. He is different in personality though, but it's hard to define -- he's just not the same. He seems like a 14 year old dog rather than a 10 year old. He seems to find it difficult to take instruction and we are guessing that it's due partly to the medication and partly to the illness. He is hungry all the time and begs constantly due to the Prednisone. I have always been vigilant about keeping both dogs' weight down so I am finding healthy "filler" for Nigel in the vegetable category but I can't seem to curb his hunger.

Week of March 24, 2008

The neurologist has instructed us to cut down Nigel's Prednisone dosage again so he is at 5mg. per day, which is half the original dosage. This is encouraging! He seems to be gaining more stamina on his morning walks and seems more alert. There are some days however that he just seems to lack energy and I let him walk a little and then carry him the rest of the way. I have determined what it is that made him seem so different to us. Norwich Terriers have a delightful habit of tilting their heads when something interests them and when you talk to them. In fact Nigel would always tilt his head if Mike and I were talking to each other, as if he were in on the conversation. What is different about Nigel now is that, since this whole ordeal began, he has not tilted his head when we speak to him. This makes me sad because it makes you feel so connected to your dog as if there is no communication barrier. Our hope is that he will regain some of his funny personality as time goes on.

Sunday the 30th will be his 10th birthday.

Friday, March 28th, 2008

We had a head tilt! This is progress!

Sunday, April 6, 2008

Last week was the best week Nigel has had since this whole thing began in early March! We were given the okay to lower his Prednisone dosage again and he is now on 1/4 of the dosage he started on (2.5mg/day) and he is off the antibiotic. With the lower dosage of Prednisone we are able to see much of the real Nigel again - he's less "foggy.'" He has more energy and yes, he's gotten some of his sass back. He is still constantly begging for food, which is normal Norwich behavior but the Prednisone has made it more intense. His weight is stable - he's not gaining so I'm very pleased with that. Nigel has resumed his regular exercise and last week we saw much more strength on the left side of his body as well. He is still dragging (slightly) the left front paw but that's really the only visible sign of any of the ordeal at all. Nigel is such a strong dog and to see him regain his abilities and his spunk has been a gift to be cherished.

Wednesday, May 7, 2008

Nigel continues to be stable these days. He seems to have a normal amount of stamina and has maintained his abilities from a month ago. I had a 30 day follow-up with the neurologist today and he has given us the go-ahead to cut his Prednisone dose to every other day now so that's good news! One of our main problems with him at present is the effects of the Prednisone. With such a low dosage, he's not overly thirsty anymore, but he thinks he's starving. He forages for food all the time. He used to enjoy some time sunbathing on the patio each day and then in the evening, we'd all sit on the patio together enjoying some quiet time but no more. He is foraging around the yard constantly, eating spent flowers, leaves and sticks. So far I have been able to maintain his weight, as difficult as it has been to look into those pleading eyes.

Tuesday, June 24, 2008

Nigel is doing incredibly well these days. In my last consult with the neurologist in mid May we were given the okay to take Nigel on vacation with us. We went a couple of weeks ago and he seemed to be feeling very good and strong. In fact, he has been acting quite normal for about a month now. As usual he was very happy to be out and in the middle of things and he got to meet some new people and be petted and admired. Besides acting normal, we can definitely feel that the shape of his skull is much more symmetrical so that's physical proof that the swelling and pressure is down or possibly even gone completely.

With Nigel showing such amazing progress over the past 2 months, Mike and I have begun to feel apprehensive about doing a follow-up MRI as was originally planned. The reason behind our concern is that it is believed that anesthesia was the biggest potential culprit behind the rapid swelling around the (then unknown) mass at the base of his brain. You may recall reading that it was the swelling that caused the neurological problems he was experiencing, not the mass itself. The mass was not even 1/4 of the size of the swelling that surrounded it. For all we know, it could be a benign mass that may not cause him further problems. Due to the position of the mass, a biopsy cannot be performed nor can surgery so that will remain a mystery at least for now. That being understood, coupled with Nigel's excellent progress, we were concerned that anesthetizing him again to perform the MRI could put us back to square one and this would be very hard on his entire system. Our regular vet said that this is certainly a logical and valid concern, and when I spoke with the neurologist again this morning, I brought up this concern and he too thought our concerns were valid. I asked if it would be in Nigel's best interest to continue to taper him off the meds and if he should begin to display neurological problems, then of course repeat the MRI at that time to gain additional information and change course if needed. The neurologist thought that was a perfectly good course of action considering how well he's doing. So, we are beginning the process of weaning him off the Prednisone and we will see how he does. We are thankful for the progress he's made and are amazed at how resilient these little dogs can be.

Never Stop Looking For Answers

Nobody knows your dog like you do. You may not have the education and expertise of a vet, but you know the subtle nuances of what is and is not normal in your dog. While I missed some of the initial signs (which I painstakingly wrote out for you to be aware of) I would not stop until someone looked at my dog. Perhaps at first they thought I was a little overly concerned -- I don't know. But Nigel is my responsibility and I knew something was wrong. Pursue your concerns and if you don't feel heard, move on until you do. Your dog is depending on you.