Some of you may remember when we took Jessie to Purdue Small Animal Hospital in the early morning hours last November.She had trouble standing, walked in circles, had a head tilt, and her eyes flashed back and forth (nystagmus). They had a neurologist, Dr. M, look at her. The symptoms were similar to old dog vestibular disease, which affects the peripheral nervous system and resolves without treatment. However, based on his exam, Dr. M said her central nervous system was involved and recommended an MRI. He thought it was likely that she had a brain tumor. It was a tremendous relief when we learned that the MRI was normal. Her blood pressure was high and he thought she may have had a stroke. She was prescribed medicine for her blood pressure.
She had another attack seven months later, on June 1st; not as bad as in November. My vet said recurrences of old dog vestibular disease isn't common, but it happens often enough that he wasn't concerned. I was worried and e-mailed Dr. M with some questions. I wasn't sure he would remember Jessie but he replied the same day, answering my questions and suggesting a TEG (thromboelestogram) to see if she was hypercoagulable (clotting faster than normal). I agreed and she was tested a few weeks later. Dr. H, a cardiologist, interpreted the results for Dr. M; she was mildly hypercoagulable. Dr. H gave Dr. M three treatment options; daily injections of enoxaparin, clopidogrel (generic for Plavix), and a small dose of aspirin (21mg). Dr. M decided to try aspirin. Jessie had another TEG a week later and was still hypercoagulable, but Dr. M wanted to keep her on the aspirin.
She had another stroke ( we knew that's what they were now) on July 1st. It was worse than the last one and almost as bad as the one in November. Even though it was Sunday I called the emergency clinic at Purdue, hoping someone could prescribe the amount of clopidogrel recommended by Dr. H. The ER doctor paged Dr. M, who called in a prescription. The dose was 1/2 tablet a day. Jessie was tested again on July 17th and was still hypercoagulable, so the dose was changed to 3/4 tablet a day (she can have up to 2 tablets a day if necessary). Her blood pressure was 160. They said if it was that high or higher on the next visit, the amount of amlodipine she was taking would be changed.
July 28th, she had a very mild stroke. The nystagmus only lasted about 30 minutes and she was mildly uncoordinated. A recheck had already been scheduled for August 2nd. Of course she still tested hypercoagulable. Her BP was high, 173. Dr. H felt the amount of clopidogrel she was taking should be effective and wanted to try to lower her BP to see what effect that would have before retesting her. He also offered to do a more sensitive test called a platelet aggregation test, for free. Dr. M did not charge for his exam that day, only for the TEG test. Her BP medicine was increased from one tablet a day to 1 and a half tablets. We came back two weeks later and her BP was 100. The platelet aggregation test showed normal coagulability!!!!
We are very grateful to Dr. M for all his help, and to Dr. H for doing an expensive test for free. We made several trips to Purdue, but it wasn't too hard on Jessie; just a blood test each time. Through all of this, she only missed a few walks each time she had a stroke. We're still very concerned, but it's been more than nine weeks since the last stroke, so we're hopeful she won't have any more. She will be retested in three months. They're not sure why she was hypercoagulable. She has mild protein loss through her kidneys, but her last UPC was .4, which is in normal range. She also has pancreatitis, which can cause this, but only during a severe flare up. For anyone who may be interested, this link explains the different causes;
PV0412_Kittrell_CE.pdf (application/pdf Object)
She has just turned 14 and in spite of all her problems, is happy and active, and thanks to some great doctors at Purdue, we should be able to enjoy her for awhile longer.