Just an amusing coincidence, before I talk about MG, and what this diagnosis meant for Hobbes and for us. Today I go to the neurologist for an EMG of my right hand (carpal tunnel syndrome--no longer a work-related injury thanks to Harvard <grrrr>). Anyway, an EMG consists of sticking needles into my hands to test how my nerves respond--just like they did to poor Hobbes at Cornell! I'm sure he is feeling vindicated this morning!
Again, I'm not a doctor, so my take on MG will be simplistic at best. I am obviously more concerned about its impact than I am with the chemical reasons for its occurance. Acquired MG in a dog is an auto-immune condition. His body is making antibodies against a chemical that allows his nerves and muscules to communicate. A dog that is born with MG does not have the necessary receptors that allow this communication to occur. That means that a dog with acquired MG has these receptors, but exhibits all of the physical characteristics of having MG. No one knows how dogs acquire MG. Some believe it has something to do with their innoculations; their bodies have an adverse reaction to their rabies or distemper shots. While Hobbes did react poorly to his rabies vaccination, no one can say definitively that this shot caused his body to attack itself, resulting in the MG.
What are the physical signs of a dog with MG? It will vary from dog to dog, depending on whether the MG is localized or systemmic. For many it manifests in ME only, meaning that the only muscles affected are those in the esophagus. For others, ME may not occur, but the dog may exhaust completely after brief periods of exercise, or they may be completely lethargic. Any muscle group can be affected. Hobbes' MG, for example, initially was localized in his esophagus. This may be why the blood test for MG, which looks for those antibodies in the blood, came back negative. As time passed, however, Hobbes' MG spread to his legs, which is why he would stop walking and had to be carried home. If you watch Hobbes for any period, you will also notice that his facial muscles are also affected--particularly his eyes. He blinks a lot, and his eyelids droop, even when he is clearly wide awake.
What does this mean for Hobbes? As I mentioned earlier, he takes additional medication to manage his MG, administered three times daily, reinforcing the need for Hobbes to have three meals. We can take him for walks now, but we have to be careful because he still tires easily. Hobbes will also never have any vaccinations again. No rabies, bordatella, etc., to prevent further aggravation of the condition. Of course, that also means that no boarding facility will ever take Hobbes--not that they would anyway. Otherwise, his daily life is pretty much normal, well, beyond eating in the box.
Hobbes' prognosis is unknown. Research shows that most dogs with acquired MG will go into remission. That doesn't mean the ME goes away, but the rest of the muscle weakness abates. For those dogs that do not go into remission, the same research shows they likely will get some form of cancer. Hobbes has shown no signs of remission at this point, and he was diagnosed about 6 months ago. We are still hopeful, though, because remission may occur as much as two years after diagnosis. What ever happens, we will continue to take care of the little pest as long as he is with us, because we love him.
One final note. In a previous post I discussed Hobbes hip problems, and our initial concern that he has hip dysplasia. It is possible that the very loose joints are due to the MG, but we really don't know. Whether the looseness is caused by MG or HD, however, we still need to be vigilant, because the same damage to the joints will occur.
We had an eventful night with Hobbes on Sunday, so I thought I would share it with you. When Hobbes eats something he shouldn't, or when enough esophageal fluid builds up, we all get very little sleep. This is because Hobbes' regurgitation is always worse at night, and these two factors exacerbate the situation. If Hobbes eats something (he is partial to grass, dirt, hair) when he is not in his box, it usually gets stuck in one of the pockets in his esophagus. One blade of grass can bring on a blurping episode--it is really amazing. When his esophagus becomes irritated, it tries to get rid of this foreign matter.
Initially, Hobbes will sound like he is having a hair ball--hacking, but not expelling anything. Then, after about 20 minutes, he will finally spew something up. Along with the grass/dirt/fur will come a volume of slimey, cloudy liquid, usually with some foam. That is esophageal fluid. Most of us just swallow the stuff without thought--Hobbes' get stuck, and then comes out the top.
This process can continue for up to an hour, or until Hobbes' gets everything out. As he is blurping, my husband and I are armed with paper towels, sponge, and squeegee and dust pan (yes, squeegee--you ever try to wipe slime up with a paper towel? It just doesn't work!) We wipe up the area inside Hobbes' x-pen; change his pillow if we need to (he has two long pillows so he can sleep with his head up, if he so desires), and try to go back to sleep. Inevitably this will happen at around 3 in the morning.
The goal of any owner with a mega-e dog is to prevent this regurgitation from occurring, because this is what causes aspiration pneumonia. Unfortunately, because Hobbes has acid reflux, there is little we can do to stop it entirely. All we can do is try to prevent them by getting his food and jello down to his tummy, giving him his antacid, and trying to prevent him from ingesting weird things.
Yes, we did wind up taking Hobbes to another dog show, but this time it had absolutely nothing to do with him. His sisters Sasha and Jada were invited to participate in the Samoyed National Specialty dog show rescue parade, held last September (2007) in Lancaster PA. This event, organized by the wonderful ladies from MidAtlantic Samoyed Rescue (the group that rescued both Jada and Kody) celebrates all sammy rescues--giving them their moment in the ring. My husband and I were both really excited to take part (hubby LOVES sammies). Of course, we had to bring Hobbes along, because he would need to be fed during the few hours we were away from home.
We got to Lancaster, and hung out with the parade coordinators for awhile. Unfortunately, we were not allowed to go into the show arena, because our dogs were not officially competing. The person running this show was not very nice, and certainly not fond of "dogs of color" as Jada and Hobbes were known (we thought that was hysterically funny!)
Dinner time rolled around. We set up the x-pen and fed the girls. Then, Tom (my husband) and I took turns holding up Hobbes while the other one fed him. Then, between the two of us, we had to keep him upright for 20 minutes after the feeding. Made us really appreciate the Hobbes Box! Finally, we were ready to give Sasha and Jada their moment in the sun.
Because Tom and I each had to lead one of our dogs in the ring, we recruited some folks to watch Hobbes. At this time he still had his shaved leg, being only one month after his visit to Cornell. We told lots of people his story, and they were fascinated. He got lots and lots of attention, which he, of course, felt was only right! Some folks there knew all about lappies (sammy people tend to be the people who also know about lappies), and one gentleman had owned the first lappies in PA! We also had the opportunity to meet Jada's brother and his owner. He and Jada were by far the most stunning dogs there--the sammie/lappie mix is just amazing. In fact, someone said they had talked to Hobbes' breeder a couple of years prior, and told her that they should create the perfect dog, a new breed which was a mix of the two.
While Tom and I were waiting to go into the ring, the most amazing thing happened. A beautiful male sammy started to sing to Sasha! He was staring at her and making "woo woo" sounds, while Sasha played coy and refused to give him the time of day. It was adorable! Our names were called, and we took our stroll around the ring. Sasha just loved the attention, running from person to person seated around the ring to say hi. Jada, on the other hand, slowly walked around with her head down and tail between her legs-she was so scared, poor baby. As we left the ring, Sasha walked over to her boyfriend to say hi, but he ignored her. Served her right for playing hard to get!
We collected our special ribbons and gift bags for the two girls, and back home we went, tired, but happy about our day spent at the dog show.
It's hard to be enthusiastic about blogging when you haven't had a good night's sleep in days. I don't have to tell parents about this. You develop a second sense--hypersensitive hearing--that wakes you whenever you hear a certain kind of noise. For parents, this might be a baby's cry or cough. For us, it is the sound of Hobbes gagging. I can sleep through phones, motorcycles, thunder, pretty much anything. But the second Hobbes hacks, I am awake. It must be the maternal/paternal instincts in Tom and myself; we are driven to protect Hobbes.
Not that we can do anything to prevent or stop these episodes. Esophogeal fluid builds up in Hobbes pockets, or his acid reflux kicks in. I don't think I have mentioned this before (forgive me if I have), but along with his esophagus not working, the sphincter that connects the esophagus with the stomach also appears not to work. So, when he lies down, stomach acid flows back up, and sometimes out. That's why he is on pepcid, among other medications, to reduce the acid and help protect his esophagus.
These episodes occur either around 12:30 or 3 a.m.--almost never during the day, because Hobbes is up and relatively active. When they do occur, he makes sounds like he is trying to clear his throat, which in a manner he is. Then he may or may not offer up a puddle of slimey stuff. We cheer him on--go Hobbes! Spit it up! Because when he does, he is fine, and we can clean it up and go back to sleep. We may lie awake watching him for half an hour at a time, multiple times during that night. And, it usually takes two or three nights for Hobbes to finally surrender his bodily fluids.
Poor little guy. He doesn't like this any more than we do. He looks up at us--asking forgiveness and begging us to make it stop. Of course we don't blame him--we never could. And we wish we could make it stop, but nothing really can. All we can do is squeegee the mess up and go back to sleep.
My husband and I are very different personalities when it comes to "stuff" laying around. He is a very neat person, but doesn't mind making piles. I am a very neat person. Period. Some might say compulsive, perhaps (which is a very difficult thing to be, if you have three dogs and two cats!). I don't like piles on counters.
Last Saturday was a beautiful day. Tom was working in the garage, getting our lawn mowers ready to roll (we have two acres, and will likely have to mow by next weekend), and I was inside doing what I do every Saturday--cleaning. Windows were open and a wonderful breeze was blowing. Shortly after Hobbes' lunchtime feeding, Tom brought in the mail--an election flyer for a local candidate and our water bill. True to form, he left them on the kitchen island counter. I spent the rest of the afternoon moving this little pile around as I needed different sections of the counter to clean and do other things. Finally, I got so sick of the election flyer that I folded it up, threw it away, and immediately forgot about it.
The next day, Tom began pulling out the checkbook, check card receipts, and bills in order to balance our checking account. He then asked me if I knew where the water bill was. Oops! Had I accidentally thrown it out with the other junk mail? I began digging through the garbage, while he looked in drawers and other places I put things when they are in my way. No luck. I thought for sure I had either thrown the darn thing away, or put it somewhere for safe keeping, only to discover it months after it is due.
What does this have to do with Hobbes, you may ask. Everything. For a dog who has issues consuming things, he loves to chew and eat anything and everything he can get his furry paws on. In this way he takes after his sister Jada, who can eat rocks, dirt, pretty much anything and suffer no ill effects. You probably see where this is going. The beautiful breeze that was blowing through the house also blew the water bill off of the island and onto the floor. Manna from heaven! We didn't see signs of the bill until Sunday afternoon, when we realized Jada and Hobbes must have shared the yummy orange piece of paper. Probably the only time in their lives that they will cooperate and share <sigh> An aside: My mother loves to tell the story about me and my older brother, happily sharing the bottle of baby aspirin--the only time she ever saw us (or caught us, I should say) doing so, and it had to be with something poisonous to us. The same could be said of the water bill and Hobbes, although at this point we have seen no signs of pneumonia. This does explain why he was coughing so much Saturday evening--he was having the same reaction to the water bill that he has to water...
It seems that I tend to add entries to this blog after Hobbes has had a bad night. Maybe I am more inclined to write when I am half asleep. Who knows. Needless to say, Hobbes had a bad night last night. We were up at 1:30 and 3:30--awakened by gagging and hacking. Poor little guy.
One of his issues, which we can do very little about, is his acid reflux. As I mentioned in a previous entry, Hobbes' sphincter between his stomach and his esophagus doesn't close. When he lays around for an extended period, like at night, his stomach acid creeps back up into his esophagus, and sometimes right back out, in the form of a puddle of slime. Most dogs with this condition are given an antacid of some kind. We tried to give Hobbes Prilosec, but it made him sick, so we've stuck with good old-fashioned pepcid (which is also much cheaper!) What pepcid doesn't do is heal the lining of the esophagus, which is damaged by the continuous acid assault.
Some people give their animals Nexium, still others use a drug called carafate. When administered, carafate coats the esophagus and protects it from damage. The challenge with using this medication is that it has to be given at least an hour before the dog eats, or two hours afterward. Which means the dog has to be in their "box" when the medication is given, and for the 20 minutes or so afterward. Tom and I just can't do it. We both work--this would add an additional hour or so onto each feeding, which would mean a three hour lunch, and getting up at 4 a.m. to feed Hobbes breakfast. Considering our lack fo sleep as it is, the latter just isn't an option!
Thanks to another Lappie owner who also has a dog with mega-e (but not MG--her condition is idiopathic, or of unknown origin), we have an alternative to carafate--slippery elm. It sounds disgusting, and looks even worse, but Hobbes loves it, and it seems to help calm down his tummy. Here is the recipe:
1 tsp powdered slippery elm, added to 1 cup boiling water. Reduce heat and stir over low heat until mixture begins to congeal (this doesn't take very long, and it will thicken further as it cools.) When cooled a little, add 1 tsp honey, and a few drops of molasses. Give 2 tsps after dinner, or more frequently if needed.
I understand that slippery elm also has been suggested for people who have IBS and other gastro-intestinal issues. I can't say it works every time for poor Hobbes, but it doesn't do any harm, he loves how it tastes, and seems to offer some relief.
Hobbes is a very busy boy! He has made the rounds to more dog shows than all of our other four-legged children combined. Kinda amazing, considering the baggage (literally and figuratively) he has to tote with him! This show, however, was a special one for him. Tom decided to take Hobbes back to the Finnish Lapphund national specialty held in Massachusettes a couple of weeks ago. That meant packing up the box, his x-pen, crate, jello, meatballs, and all his meds, along with the things my husband would need for two days away from home.
Hobbes got to see some of his brothers and sisters, and was the center of attention (at least for some, including a young man who is 7 and three-quarters years old) when Tom pulled out Hobbes' box and fed him in the arena during the show. By all accounts, Hobbes was a wonderfully-behaved boy (obviously putting on a show for his adoring fans, because he is nothing if not bratty at home!) Tom noted that even Hobbes' breeder commented on how well trained he is (snort!) We can attribute this to Hobbes being way out of his element. He behaved equally as well at the Sammy national show last September.
The day after the show, because the drive back was so long, Tom made arrangements to stop at his sister's home in New Jersey to feed Hobbes lunch. So yet another group of our family, including Hobbes' human cousins Marissa and Jason, got to meet the special boy.
Enough about Hobbes--in his absence, I got a vacation!!! Since his diagnosis almost a year ago, Hobbes has been a constant in my life. I am certainly not minimizing all the help Tom gives, but I tend to internalize things more than he. So, much of my mental and physical energy has been expended figuring out how to handle Hobbes' condition, and then actually managing it. For two and a half days, I didn't have to feed him, worry about him eating grass--any of the things I am concerned about on a daily basis. What a relief! I even got to sleep in until 8 a.m. on Saturday--unheard of with Hobbes at home!
So, Saturday evening Hobbes came home. Did he miss his sisters? You bet! Did they miss him? Probably not so much. Did I miss him? Yes--but I will admit that those 48 hours were a slice of heaven.
It's been awhile since I blogged about Hobbes. Frankly, things have been going so well that I haven't been compelled to report anything. Now that we are in the full throws of late spring, our biggest challenge is to keep him from eating grass and rabbit poop. Yum!! Unfortunately his sisters are not very good role models, as they both chow down every time we let them out in the yard. The good news is that Jada, Sasha, and Hobbes are essentially indoor dogs, who enjoy the luxury of air conditioning most of the day, and therefore do not have lots of opportunities to manually trim our back lawn.
There is one thing about Hobbes that is just wierd. He is a chicken. While he pretends to be alpha in our house--bossing around the poor girls unmercifully--he is petrified of everything new and different. So when anything new comes into his territory, he barks like crazy to try and hide his fear. For example, he went batty when my husband brought a garden hose nozzle into the house yesterday. Tom put it on the ground, and it took Hobbes 5 minutes to even walk near it. This is in contrast to how he behaves when we take him places outside of his experience. As I mentioned in an earlier posting, when Tom took Hobbes to the lappie show, he behaved beautifully. So, we only see the fearful behavior when something unknown invades Hobbes' territory.
This fear, and need to pretend to be in control, resulted in a very funny incident last weekend. Tom and I took Hobbes to meet Jeanne, a local artist who created a sculpture of Kody for us, and is working on an urn for Kody. She had never seen a lappie, and we thought it would be good for Hobbes to get out. After a short time outside, we went into Jeanne's studio, with Hobbes, and spent about 45 minutes talking about all sorts of things. During this time Hobbes was exploring, and apparently began to feel quite at home, because when Jeanne's husband came into the studio, Hobbes decided he didn't belong there, and barked ferociously at him! It was funny and kind of embarassing at the same time. Poor Hobbes
Well enough about Hobbes for today, because the big news in our world has to do with Jada. We took her to the vet because she had an eye infection about a month ago. Our vet noticed a sty under her lid, but we tried drops first to see if that wouldn't get rid of the discharge. It didn't, so we scheduled surgery, during which I asked Mark to give Jada a dental cleaning as well, since she would already be sedated. All was fine, but the surgery did not eliminate the eye infection. So, about two weeks later I took Jada back in. Mark determined that she had a seeping cataract, and so would stay on her drops for the rest of her life. During the same appointment, I asked Mark to look at a little spot of inflamation on Jada's lower jaw, between her teeth. I thought it was some irritation from the dental, but he thought otherwise. I brought Jada back the next week for a biopsy, and while we are grateful that she didn't have cancer, she did have a highly aggressive and destructive tumor that was attacking her bones. Within four days she was in surgery, and had just under half of her lower jaw removed. It sounds horrible, but I am so amazed at how adaptable our dogs are. She was up and about shortly after surgery, and has shown few signs of slowing down, despite her missing teeth. She does look a little funny, because she has only one lower canine left, and her tongue sometimes hangs out. But, on the positive side, she gets only wet food for the next 4-6 weeks (yum!), much to Sasha's annoyance.
This type of tumor is not super unusual in dogs of Jada's age (9 and older), but I have to admit that it most certainly wasn't on our radar. We were just lucky that the dental coincided with the tumor really starting to grow, because I was more inclined to pay attention to her teeth. We caught it very early, and thus was able to save more of Jada's jaw than might have been possible had we noticed the growth even a month later.
Warning--some may find this entry unpleasant to read. For those of us with pets or very small children, reading and talking about this stuff just doesn't bother us any more--we become immune.
Hobbes had been doing very, very well, hence the lack of entries in this blog (no entries means nothing to report, which is always good!) Life in and out of the box was moving along nicely. Unfortunately, about three weeks ago, Hobbes began to have very soft stool. I say unfortunately because he also has very long fur--I'll say no more. This has happened to Hobbes before, so we just monitored it, and hosed off the yard when necessary. But then Tom noticed blood in the stool. Very unpleasant, although we were fairly sure it was probably just a touch of colitis. Sasha will have bouts of colitis on occasion, and while startling, it is easily treated. So we called our trusty vet Mark, who had us put Hobbes on Imodium.
Unfortunately, no luck. So Hobbes had to make a trip to the vet's office--the first in many, many months. Mark took a blood sample, which he sent off to a lab. While Hobbes pancreas is just fine (yeay), he has inflated levels of folate, a symptom of Small Intestinal Bacterial Overgrowth (SIBO). That means that the bacteria levels in his small intestines--the section that connects the stomach with the colon--is inflated. That can be caused by lack of muscle activity to push matter, and along with it bacteria, through the system. Lack of muscle activity in this area might also allow bacteria from the colon to move backward through the intestines, back into the small intestines. Wow, this sounds surprisingly familiar--sorta like megaesophagus!
Unfortunately, trying to manage Hobbes' diarrhea may not be easy. At this point he is on a med to try and regulate the bacteria level in his intestines, but it doesn't seem to be working. Mark thinks this might be caused by an auto-immune reaction to his food. That would be a disaster, since it has taken us so long to get into a food production down to a routine. Whatever it is, we will try everything we can in order to avoid the next step, which would be a biopsy, and perhaps even surgery.
On Sunday, November 30, 2008, Hobbes will turn 2. That may not seem like such a landmark to you, but for Hobbes it is a miracle. At the age of 4 months, when he was first diagnosed with mega-e, we were told that he had 6 months to live. Boy, did we show them!!!
So, on this auspicious occasion, I would like to share those things for which we give thanks that are Hobbes-related.
1. Our wonderful team of vets. Without Dr. Griffiths, who diagnosed Hobbes, and Mark Koshko, who has stuck with us through all sorts of odd Hobbes ailments, Hobbes would likely not be with us today.
2. The neurologist, Dr. Baker, and the vet students at Cornell's Companion Animal Hospital, who took such good care of the poor 7-month-old when he was left with them to diagnosis his hip problems. He turned out to have acquired myasthenia gravis, and knowing this has improved Hobbes' life dramatically.
3. The Yahoo mega-e support group. The people on this list have lived with this condition, some for years. They told us about the Bailey chair (or Hobbes box as we call it), meatballs, and jello. And they reminded me that I wasn't alone. That was critical.
4. Our squeegee. O.k., this is odd, but if you have ever tried to wipe up a pile of slime with a paper towel, you understand. Using a squeegee to clean up after Hobbes has made our lives so much easier, and saved a fortune in paper towels.
5. Hobbes' muzzle. We purchased a basket muzzle for Hobbes a couple of months ago, and he does not go outside without it. It makes eating snow, rabbit poop, leaves, sticks, etc. virtually impossible (although it is not impervious to snow as we have recently discovered). A single blade of grass can trigger a regurgitation episode--the muzzle was a god-send.
6. Finally, last but not least, we are grateful for Hobbes himself. He is a bratty, obnoxious, mouthy bully, but he is also a lap dog who is sweet, loving, and adorable. He loves life, despite the hours he spends in his box every day. He is king of his domain, and lives for meatballs, jello, and chasing his girls around the house. What more could a 2-year-old ask for.
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