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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 31099
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My mixed breed dog (Golden Retriever/Lab/etc. mix) is almost

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My mixed breed dog (Golden Retriever/Lab/etc. mix) is almost 17-years-old & suffering from a definite neurological condition. We just haven't been able to get a diagnosis or any definitive answers (or, in some cases, any answer at all) as to what could be causing all of the different symptoms he is experiencing. I should start by saying that he has been unable to walk on his own for quite some time now & requires the assistance of 2 people to help walk him around, which we do quite frequently throughout the entire day (as well as overnight). It is not just because he has lost strength in all of his limbs, but because he has a tendency to want to curl his front paws under & to cross his back. Sometimes these issues are more pronounced than other times. Sometimes his walking is actually quite "good", while other times it is a huge struggle. There seems to be no reason for the change from one state to the other. What is most unusual is not just his propensity to want to walk in only one direction, but that this direction CHANGES. Sometimes he favors the right & it is impossible to get him to turn to the left; other times it is just the opposite (favors the left, can't get him to turn right). The change always occurs after he has had a long sleep. However, he can have a long sleep & wake up wanting only to go to the left, and have another long sleep & still wake up only wanting to go to the left. And then perhaps the next time when he wakes up from a long sleep, he only wants to go to the right, & it could continue this way (right) for a couple of days straight. Again, there seems to be no particular reason for this change in direction either. Nothing different about his sleeping habits. He ALWAYS sleeps on his right side, & in the same position, which is "upright", not completely on his side. (He will NOT lay on his left; if we place him on his left, he has an absolute fit about it. He, however, has never really been much for laying on his left, even before his problems began). I should comment that he is, understandably, very frustrated with his condition. He likes to do things on his own, to be up & doing when he wants, so being confined to his beds leads to a lot of crying. As much as we do get him up & walk him around, sometimes he is simply insistent on staying up (we cannot fulfill that desire constantly!) & so he will cry almost non-stop about his situation until he wears himself out, if we do not get him up. He does not wear himself out easily (we do not know how he has the energy), but sometimes we simply cannot get him up over & over again. Of special note is that, along with this, we have noticed a definite correlation in the type of distress he displays at these times, with the direction he is wanting to move in at the time. If he is wanting to walk to the left, his crying is "calm" (even though constant). If he is wanting to walk to the right, he squirms & flails something awful, tearing up the training pads we put on his beds & crying wildly. He is extremely difficult to calm in these times. The only way of doing so is getting him up. All of our local veterinarians whom we have spoken with have never heard of a dog who has a tendency to want to walk in one direction experiencing a change in this direction. They say that if a dog favors one direction, it is always that direction. Do you have any idea what could be causing that symptom especially, & also all of the others our dog is experiencing? It is a huge mystery to us, is very distressing, we want so badly to help him, & to at least have better, more helpful answers. He has had blood work done in the past month, CBC which was almost perfect, & red and white blood cell test was also very good, nothing of concern. Back x-ray showed no major problems. He did not have a neck x-ray which we wanted him to have (apparently it is not easy to do), as we feel that is at least where some of his problems lie. He hangs his head way underneath him when walking. Other symptoms of note are mouth-smacking at times, as well as a head & shoulder jerk at times. Also, drinking water when standing up is difficult for him, but when he is wanting to walk only to the left, he gets much better drinks of water. It is near impossible to help him get a good drink while standing up when he is favoring the right side. Left side, in all regards, ***** ***** a much better condition for him to be in. We dread him waking up wanting to go right. His appetite is for the most part pretty good, by the way. In his younger years & before any of these problems started, his demeanor was always extremely calm & laid-back and extremely gentle & well-behaved, wanting only to please us in everything. He is another member of the family, very dearly loved, & we would do absolutely anything for him. My apologies for writing so much, but I wanted to give every bit of information I could think of. Any help you could provide is greatly appreciated. Thank you.
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 1 year ago.
I'm sorry to hear of this with Brownie, Michele. His aimless walking and vocalizing (calm whining) in association with his lack of conscious proprioception (curling his front paws under) and ataxia ("drunken sailor") in his rear limbs localizes his disorder to his forebrain - cerebrum and/or thalamus. Because he'll walk (circle?) in either direction, his encephalopathy (brain disorder) is expected to be global; in other words, affecting more than one part (and side) of his brain. (Circling in one direction is more indicative of vestibular/balance disorders.) The most common finding at his advanced age is brain tumor. Blood work won't be helpful. MRI is needed to investigate his brain but I'd be circumspect about subjecting such a geriatric patient to this stressful and costly advanced imaging. Please respond with further questions or concerns if you wish.
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Customer: replied 1 year ago.
Thank you for responding. I do not like the response, but I had prepared myself for reading the worst possible…As I have the opportunity to ask more questions for Brownie, I would like to do so. I don’t really know quite how to go about asking the first, but I would like to know what to expect in the future if, indeed, it is a tumor he is dealing with. When we look in hindsight, there are symptoms that have come on very gradually (we could say 2 years + time), but the more recent ones like getting stuck in corners (when he was still able to get around on his own) and the paw curling and leg crossing, and wanting to circle in one or the other directions (yes, you are correct with using the term circle for him) and head hanging (and crying, which still seems at least partly frustration/anxiety related to us) have come on and progressed very rapidly. Secondly, is there anything that we can do for him? Obviously I understand about the MRI (I do not want him to have anesthesia) and also that surgery would not be an option for him (if we had certainty). I have read about the use of Prednisone. As we do not have certainty, is that still an option that would be of any help to him? Or is there something else? I know that Prednisone is not a cure for anything, and I am also really not a particular fan of it (Brownie’s mama and a sister took it for other cancers, so we have experience with it), but if it would be of help to him, I wanted to ask. I do not know if he can even take it, however, because of the medication he is on now, which is Gabapentin (interaction?), Methocarbamol, and Rimadyl. He was originally prescribed Tramadol, but we requested Gabapentin because of a previous concern with minor seizure-like activity he had when he was younger (short-lived episodes of a Parkinson‘s type head shake that would come out of the blue), and most other pain medications (like Tramadol) you would well know have the possible side effect of seizure. Thirdly, if it is a tumor, why wouldn’t there be any indication in blood work of such a major illness? And is there any way possible that it could “simply” be dementia along with a neck problem (intervertebral disc disease), or is the symptom of circling in both directions what absolutely makes brain tumor an almost certainty? Thank you for your further responses. Again, it is greatly appreciated. I would like to tell you that Brownie’s mama was a stray who gave herself to us and “surprised” us with six puppies about a month after we took her in. So, we’ve been very blessed with best friends. He is our last of the family and my very best. Thank you again for your help.
Customer: replied 1 year ago.
Thank you for responding. I do not like the response, but I had prepared myself for reading the worst possible…As I have the opportunity to ask more questions for Brownie, I would like to do so. I don’t really know quite how to go about asking the first, but I would like to know what to expect in the future if, indeed, it is a tumor he is dealing with. When we look in hindsight, there are symptoms that have come on very gradually (we could say 2 years + time), but the more recent ones like getting stuck in corners (when he was still able to get around on his own) and the paw curling and leg crossing, and wanting to circle in one or the other directions (yes, you are correct with using the term circle for him) and head hanging (and crying, which still seems at least partly frustration/anxiety related to us) have come on and progressed very rapidly. Secondly, is there anything that we can do for him? Obviously I understand about the MRI (I do not want him to have anesthesia) and also that surgery would not be an option for him (if we had certainty). I have read about the use of Prednisone. As we do not have certainty, is that still an option that would be of any help to him? Or is there something else? I know that Prednisone is not a cure for anything, and I am also really not a particular fan of it (Brownie’s mama and a sister took it for other cancers, so we have experience with it), but if it would be of help to him, I wanted to ask. I do not know if he can even take it, however, because of the medication he is on now, which is Gabapentin (interaction?), Methocarbamol, and Rimadyl. He was originally prescribed Tramadol, but we requested Gabapentin because of a previous concern with minor seizure-like activity he had when he was younger (short-lived episodes of a Parkinson‘s type head shake that would come out of the blue), and most other pain medications (like Tramadol) you would well know have the possible side effect of seizure. Thirdly, if it is a tumor, why wouldn’t there be any indication in blood work of such a major illness? And is there any way possible that it could “simply” be dementia along with a neck problem (intervertebral disc disease), or is the symptom of circling in both directions what absolutely makes brain tumor an almost certainty? Thank you for your further responses. Again, it is greatly appreciated. I would like to tell you that Brownie’s mama was a stray who gave herself to us and “surprised” us with six puppies about a month after we took her in. So, we’ve been very blessed with best friends. He is our last of the family and my very best. Thank you again for your help.
Expert:  Dr. Michael Salkin replied 1 year ago.
I would expect more of the same plus seizure activity in the form of either partial seizures (previously called petit mal) or generalized seizures (previously called gran mal). At that point anticonvulsive medication stronger than the gapapentin might be prescribed but seizures resulting from brain tumor are difficult to control with any medications. Prednisone is also prescribed in an attempt to control the inflammation associated with neoplasia. You would need to stop his Rimadyl in that case because prednisone + Rimadyl is a ticket for gastrointestinal ulceration. If a tumor metastasized from elesewhere, blood work might be informative as to its source but tumor within the skull can only be found through cerebrospinal fluid testing or MRI. Circling is pathognomonic (specifically indicative) of forebrain disorder.You're quite welcome. Thank you for your kind accept. I appreciate it. Please continue our conversation if you wish.
Customer: replied 1 year ago.
Thank you again for your responses and for allowing me the opportunity to question further.Is there a similar medication that is/can be prescribed in place of Prednisone that has the same effect of reducing inflammation, but with fewer adverse side effects?After reading your response regarding forebrain disorder, I wanted to read more about forebrain disorder and came upon an article that said epilepsy, autoimmune inflammation, tumors, and strokes are the most common conditions affecting the forebrain. Autoimmune inflammation stood out to me. Does it mean autoimmune inflammation related to a larger autoimmune disease such as MS, Lupus...?, or is this meaning something autoimmune within the brain only? Please forgive my ignorance. I am not a doctor, but I try very hard to understand through reading.My interest and reason for questioning is because: When 14-years-old, we had to one night take one of Brownie's brothers to the ER. We had taken him to our regular vet clinic two days before because he just wasn't acting well. They did not find any cause for it, sent him back home with us, he continued to get worse, and had begun head pressing when we took him to the ER. When examined, the doctor determined him to have a high fever, she could not get to the bottom of the cause, brain infection was mentioned, the fever fluctuated and they could not control it, and after a few days fighting it, he just couldn't pull through and we lost him. The bunch were always inside upstairs house dogs, well-supervised when outside, fenced in back yard, were not exposed to other dogs/animals except on trips to the vet, but of course we still could not keep all animals out of the back yard even if fenced in. Rabbits frequent a lot and leave behind their "mark", the bunch unfortunately had a taste for it, and the humans weren't always quick enough... That is the only thing we could think of as a potential cause. Since the experience with him and reading after, I read that a high fluctuating fever is a hallmark sign of "Systemic Lupus Erythematosus". For some time before that night Brownie's brother had experienced similar symptoms to Brownie's - difficulties with walking, getting stuck in corners, along with crying if someone didn't help right away - just not to the same extent as Brownie. Another of Brownie's brothers showed symptoms consistent with Myasthenia Gravis (however, didn't test positive for it). He also suffered some type of brain episode on passing. His mama was originally diagnosed with Vestibular Disease... Maybe there has been autoimmune disease in the family? Maybe Brownie's condition is autoimmune related? It has been almost 3 and 4 years since we lost his brothers, 2 since his mama, and I am still questioning. It is, truly, distressing not to know what was wrong with them and what is wrong with Brownie.Thank you again.
Expert:  Dr. Michael Salkin replied 1 year ago.
Nonsteroidal antiinflammatories aren't prescribed because they don't address cerebral edema seen secondary to brain tumors as well as prednisone and some tumors are prednisone but not nonsteroidal-responsive. There are both systemic autoimmune disorders which affect the forebrain and autoimmmune conditions of the the brain itself. We don't recognize a familiar predisposition for autoimmune disorders of the brain; at least at this time we don't have studies that suggest such familiarity. The other advantage to prednisone, however, is that it will address a steroid-responsive autoimmune brain disease such as granulomatous meningoencephalitis although that disease is best addressed with a combination of immunosuppressive drugs. You're welcome.
Customer: replied 1 year ago.
Thank you again for responding, and for all of your efforts to help through the information you've provided.We are going to see to getting a prescription for Prednisolone for Brownie. In addition, due to your comment, with further reading I've familiarized myself with the other disease you mentioned as well as immunosuppressive medications that are used in combination with Prednisone/Prednisolone. I am hopeful we will be better able to help him due to this conversation with you.Again, I am much appreciative.
Expert:  Dr. Michael Salkin replied 1 year ago.
You're welcome, Michele. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience.
Customer: replied 1 year ago.
I will do that. I really appreciate your wanting to be kept informed. Hopefully we get the prescription on Friday.
Expert:  Dr. Michael Salkin replied 1 year ago.
I appreciate it. I'm in Yosemite for a continuing education seminar 3/3-3/6. I'll be in and out.
Customer: replied 1 year ago.
Dr. Salkin,I had wanted to be able to give you more of an update today. As it is, the someone we had hoped to speak with yesterday for the prescription for Brownie we found out has taken a few days off, and another person we left a message with this morning, with high hopes of hearing back from, we have yet to hear from. So, in the meantime, Brownie continues to wait for something more helpful than what we have been providing him. It is very frustrating. I hope we will be able to get somewhere on Monday. I will keep you informed. Thank you again for your desire to be updated on him.Michele
Expert:  Dr. Michael Salkin replied 1 year ago.
No worries, Michele. I'll be home after 8PM tomorrow and will look for your next post.
Customer: replied 1 year ago.
We finally were able to get a prescription for Brownie today, for Prednisone. I had requested Prednisolone, but he was prescribed Prednisone. I know that you also wrote of Prednisone in your messages, but I have read in many, many places that Prednisone/Prednisolone have the same effect and that Prednisolone is better tolerated by dogs. So, that was my reason for requesting it for him. However, we were told differently today, that this is true of cats, but not of dogs. Could I ask what YOUR thinking on it is? I would just like to know. Also, we were told that there is usually a washout period of about a week after stopping Rimadyl, but that this is conservative, and we were given the okay to start giving the Prednisone to Brownie this Friday, after stopping his Rimadyl today (the last time we gave it to him today was around noon). Could I ask your thinking on that as well? Do you also see it as a safe timetable? Finally, after you mentioned the disease Granulomatous Meningoencephalomyelitis and other immunosuppressive medications, I read about GME and also, specifically, Azathioprine (as well as some other drugs) being used successfully in combination with Prednisone to treat it. Of course, you and we don't know what Brownie has for sure, I am not sure if you are thinking that he could have GME, or that maybe his brother did, or that Brownie (and siblings) may at least have something THAT WORKS A LOT LIKE IT? I could certainly believe in that - that they could have had, and he could have, something that works a lot like it. But, what I'm meaning to ask I guess is: You never having seen Brownie (I know) and none of us knowing for certain what he does have, would you still ever consider at any point treating him with both Prednisone and Azathioprine? The reason I ask is because I read this line somewhere: "Azathioprine has been administered in combination with corticosteroids to allow the dose of the steroid to be reduced to avoid undesirable side effects of prolonged steroid administration" (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113901/). And also because of this study that I found and read (the, what seems to be, rather positive results of it and also what is stated about the safety of the combination in this case): http://www.ncbi.nlm.nih.gov/pubmed/20946080. We were told today, on mentioning Azathioprine, that both it and Prednisone are heavy duty drugs and that Azathioprine has big time side effects (especially to consider using it with such uncertainties). If that is the case, though (i.e. big time side effects), why would it be used as an "alternative" to Prednisone, something said to allow the tapering off of Prednisone to avoid the undesirable side effects of IT, if it is just as bad or worse than Prednisone? That just doesn't make any sense to me... I have attempted to look up the side effects, and what I found (the most usual at least) did not appear any worse than Prednisone.Over the past two days, we have been noticing that Brownie is closing his eyes very tightly on sleeping, as opposed to having the slits that we usually see him have during sleep, and he is not wanting to fully open them when awake. This is something very new. We haven't had anything new for quite some time now.I appreciate anything you can offer in response, very much. Thank you.
Expert:  Dr. Michael Salkin replied 1 year ago.
Prednisone is metabolized into prednisolone. Cats don't have as much of the enzyme that is needed for that metabolic step; hence, prescribing prednisolone to cats makes more sense. Waiting until Friday is being too cautious. A 48 hour washout period should suffice. No, I wouldn't treat as if GME were present. That would be an unusual finding in Brownie's breed and at his age. The side effects of azathioprine are different than those of prednisone. Azathioprine can be considered if the adverse side effects of prednisone are prohibitive but that would risk a new set of adverse effects. His change in his eyes may indicate cranial nerve involvement in his disease process. You're welcome.
Customer: replied 1 year ago.
Thank you very much for your thoughts on everything.I would like to start giving Brownie the Prednisone tomorrow, but we may wait until Friday morning (just not sure yet). I have read, though, that to give it in the morning best fits in with a dog's natural body rhythm. Perhaps I read too much. (What I read on my own is maybe not always correct...)I will give you an update after he has had a little time on it. I hope so much that we will do only good for him with it, and so much better than we've been doing so far for him. Thank you again.
Expert:  Dr. Michael Salkin replied 1 year ago.
You're quite welcome. I believe that the prednisone dose will be recommended to be split into two doses - one in the morning an one at night and that will make timing according to body rhythm moot.
Customer: replied 1 year ago.
Thanks for letting me know. We were called back yesterday and spoke over the phone to get the prescription filled, it was then being put together, but we won't be actually picking it up until (probably) in the morning on Thursday/today. We weren't told at the time how it was expected to be given (once, twice, three times a day). But I'll pretty much be expecting to see two times on the bottle now...thanks again.
Expert:  Dr. Michael Salkin replied 1 year ago.
No worries.
Customer: replied 1 year ago.
Brownie was prescribed a 40 mg per day dosage of the Prednisone, one tablet cut in half to be taken twice a day (as you suspected). He began taking it on Friday, so has had three days on it. The only thing that has happened in those three days is that he has become very restless (much more so), along with being more thirsty and urinating more (both of those of which we expected). We were not told anything of how soon to expect any improvement, but there has not been any sign of improvement in these three days. Obviously, it is having some kind of effect, because of the negative symptoms we are seeing. We do not know what to do. If we are supposed to be seeing improvements already, I don't know if he needs to stop taking it, or if we are expecting too much too soon and we need to still give it more time. I know that he cannot stop taking it abruptly. I can tell you that in the three days before, when we took him off of the Rimadyl in preparation for taking the Prednisone, he had become much calmer than he had been before when he was on Rimadyl. Now, after putting him on the Prednisone, he is the most restless he has ever been. I apologize for expressing personal feeling in this message, but it is absolutely heartbreaking going through this with him and feeling helpless to know what to do, how to help him. Again, anything you can offer further, I greatly appreciate it.
Expert:  Dr. Michael Salkin replied 1 year ago.
I believe that the 3 days is a trial to see if any positive change occurs at 40 mg prednisone daily. It may not and you'll be asked to report that. Prednisone can cause all sorts of behavioral changes and restlessness can be one of them.
Customer: replied 1 year ago.
He was actually given a bottle of 20 pills, I was just meaning that he has taken for three days thus far. It is not always easy to question and discuss with them, and one can feel very left in the dark in some regards. I hope you will understand.Thank you.
Expert:  Dr. Michael Salkin replied 1 year ago.
i understand. Keep me posted, please.