Meningitis And Myelitis

[vjui]

This is an ongoing saga of our sweet 9 year old little lady, Frappuccino. To recap her symptoms: 3 weeks ago she started having difficulty walking, and then refusing to eat. Our regular vet diagnosed some sort of problem with her neck. We tried conservative medications including Gabapentin, Tramadol & Robaxin, but the symptoms progressed. We sought a neurosurgery consultation and last Friday they did an MRI and a spinal tap. The MRI showed a myelitis at C2-4. They gave her intravenous steroids, and put her on Prednisone 15 mg BID. Yesterday, the neurosurgeon called with the spinal tap results: she also has meningitis. He says that there were no organisms found in the tap. Furthermore, the lack of neutrophils seems to indicate it is not an infectious etiology. Hence he is leaning toward SMRA (steroid responsive meningitis). However, there is a test for which he has to send CSF samples out to UC Davis. This tests for any nuclear material of any organism: bacterial or fungal. Apparently it is the definitive test to see if there is an infectious cause. From what I've read, a negative CSF test does not rule out an infectious cause, so I am going to authorize the office to send the CSF out for analysis.

 

Google may be a bad thing. Everything I've read on meningitis is really bad. The prognosis is poor, even with aggressive treatment. I'm scared to death. Does anyone have real-life experience with meningitis in greyhounds?

 

Frappy seems to be doing pretty well in response to the steroids. She is able to walk much better now and her pain is regressing. We do not have her on any other medications other than GI protectants and the steroids. I'm clinging to the improvement I see in her.

 

Thank you for your prayers--they are working!!

 

 

[kikibean]

I had a dog with meningitis and so did my friend. Her girl made a fairly decent recovery and was able to be weaned off the pred. She died of unknown causes several months after treatment of the meningitis.

 

RJ had a really hard time with it. He spent a week at the specialty vet and we brought him home for the weekend unable to walk still. He did manage to get up and about again, but we were never able to drop the amount of pred we were giving him (120mg per day). Any time we'd try and back it down, the symptoms would flare up again. I'd say we went on like that 2-3 months before he developed trouble breathing. X-rays showed something in his lungs - either fungal or cancer. Neither option was treatable due to the high amounts of pred he was on. He had also developed a huge sore on his tail the last week or so and was probably down to 45lbs from his usual 75 due to the pred.

 

The specialist told me that small dogs tend to respond better to the treatment for meningitis than larger dogs do. It doesn't sound like your girl is nearly as bad as RJ was, so hopefully she will have a better outcome! If I had a dog again diagnosed with meningitis that was as bad as RJ was, I would not treat it. My friend who had the girl with better results does not feel the same way.

[Finnsliz]

I know 2 greyhounds that have recovered from meningitis just recently. One from Fast Friends Greyhound Adoption Keene NH, his name is Gabriel. You might be able to follow his path to wellness on the website. The other was a very young (18mos) @ Greyhound Adoption Service MA. Both dogs are doing well. Thought I might offer some hope

[hikinghounds]

My boy Zephyr had immune mediated encephalitis, which I think is similar to meningitis but it is in the brain. I went with the chemotherapy treatment that reduces the inflammation and basically turns off the immune system to stop the inflammation reaction. He had aggressive chemo of 4 treatments, about 5 months, and 5 months of a daily less aggressive chemo that was tapered. He fully recovered and has no problems. He was 4 when this happened and is now 7.5. Sorry to hear your girl, and you, are going through this. I know it is very scary. Sending good thoughts to you both.

Edited September 3, 2014 by hikinghounds

[vjui]

I think Frappuccino just had a seizure. She looked like she was " running" or twitching in her sleep, but it was quite a bit more agitated than normal. She woke up and tried to stand up, but could not. She cried and fell down several times. Finally we were able to get her on all for feet. We are waiting for the neurologist to come in to the office this morning. I hope this does not indicate a progression of her meningitis. She was on Gabapentin from our regular vet for about a week and a half prior to the MRI and was not weaned off. I know that also can precipitate seizures. Please keep fingers and paws crossed for us.

[Batmom]

Sending best thoughts and lots of hugs.

[Burpdog]

Sending lots of prayers.

[vjui]

Frappy had another seizure while at the veterinary hospital this morning, so they decided to keep her overnight to give her intravenous phenobarbital. The e-vet said her neuro exam was normal. We did not actually see the neurologist, but he was there consulting with the e-vet. They mentioned that they only did an MRI of her spine. With the new onset of seizures, an MRI of her head may be indicated. This is clearly a progression of whatever disease process is affecting her. The evet now calls it a combination of myelitis, meningitis and encephalitis. Words cannot begin to describe how scared I am, but I know a lot of you understand and have gone through similarly scary situations. Thank you for your kind words of encouragement. They ran so much to us.

[3greys2cats]

My girl Sara had GME, Granulomatous Meningitis Encephalitis, she had the MRI and Spinal tap to diagnose, and had several(multifocal) areas of her brain and spine with inflammation, could not walk, seizures, looked like she was drunk, only given 50% chance of survival. We did a year of chemo meds(cytarabine) every 2 weeks, 4 injections 12 hours apart, phenobarbital, prednisone, Pepcid. She lived another 5 years fully recovered or in remission till the age of almost 11 years. I know how scary this is and just want to offer you some hope, try not to read stuff online, I know easier said than done, there aren't a lot of positive outcomes documented. I think Zephyr and my Sara lived the longest with this disease, without the Cytarabine(Leukemia drug), Sara would have died, we tried treating with just Prednsione to start, no effect and she had cluster seizures falling down steps and almost dying. Ask the Neurologist about Intravenous Cytarabine to get it into Frappy quickly. :grouphug

[EllenEveBaz]

[vjui]

Wow, 3greys2Cats, that sounds like what Frappy has. The neurologist is not willing to commit to a firm diagnosis other than to call it a myelitis/meningitis and now encephalitis. He is also not commenting on the prognosis. Although today, he said the presence of seizures does not necessarily indicate a more grave prognosis. She looked better today at the hospital. Still wobbly( she does what I call the model walk there she crosses one leg in front of the other, like a model going down a catwalk). She is frightfully skinny and has lost 10 lbs. I cannot wait to bring her home.

[3greys2cats]

No Neurologist can actually give a firm diagnosis without doing a biopsy of Brain and they won't do that and you would not want that, they can call it Inflammatory Brain disease, Meningitis, etc and with Sara they said "most likely" GME and treated as such to reduce Inflammation in brain, she was in ICU for a week and did not start walking without the Cytarabine injection, she was being wheeled out on a cart to go potty and held up by a harness. Hoping Frappy continues to do better, maybe you can bring special food for her and hand feed, I did that w/Sara, she would not eat what they gave her and got so skinny but gobbled hamburger, lunch meats, cheese. Sending prayers and hugs for Frappy and you.

[hikinghounds]

Have you asked about the chemotherapy treatment? It's considered the best treatment for immune mediated encephalitis, etc. Sara and Zephyr's symptoms and condition were almost identical. Like Sara, Zephyr would not have made it without this treatment. It's effective in stopping the inflammation and stopping the immune response that is causing it, as opposed to trying to manage it with steroids which is not always effective. Zephyr had 4 treatments of Lomustine over 5 months and then 5 months of Procarbazine that we started to taper off around 3 months. I really hope Frappy continues to improve. Sending healing thoughts and hugs to both of you.

[vjui]

Thank you all for your encouraging words of support. It means a lot to me to know there are other greys (and their humans) who have lived through this. Frappy has been home form1 week now. At first I was so encouraged: she seemed like a new dog. But within the last 3 days, she is back to stilted walking and only out to the front yard to pee. She is very ataxic and lethargic. Today, I was so alarmed I brought her back. The neurologist on call feels it is all due to the Phenobarbital. That at 1 week out, she is reaching therapeutic blood levels and that is causing all her symptoms. I sure hope so. They are telling me to wait it out 3 more weeks. It is going to be a very long three weeks.

[tbhounds]

Yes-phenobarbital can make them look drunk as a skunk! Her body will adjust--I was told 10 days to 2 weeks for my girl but, she wasn't steady for almost 3 weeks. Her appetite will increase too--I added a lot of veggies to her meals to avoid weight gain-to be honest I'm not sure it helped. If I was 10 minutes late feeding her she would chew my leg off :-). Glad your girl is improving---hang in there the pheno ataxia will resolve.

[galgrey]

Sending good thoughts to both of you.

[vjui]

As of today, Frappuccino has stopped eating and drinking. She is so woozy she fell over this morning while peeing. She's fallen and crashed into furniture several times today when we try to rouse her. She's literally as close to a coma as you can get. I have a call into the neurologist again. I think they are tired of hearing from me. I know the phenobarbital makes you feel wierd, but this seems like an overdose. This veterinary practice is very greyhound savvy: they have multiple greyhound patients. I just don't know what to do anymore. I'm at the end of my proverbial rope.

[tbhounds]

What dose is she on?? They might just have to tweak the dosage a bit.

[vjui]

tbhounds: she is on 10 mg Prednisone twice a day and one and a half tabs of Phenobarbital (off the top of my head, I don't remember how many mg) twice a day. I agree. It seems too much to me too, but the ER vet yesterday says it is appropriate for her weight. I know, she is a greyhound and they are more sensitive to meds, but this hospital is very very greyhound savvy.

[tbhounds]

Just as a reference -my girl was started on 64mgs of pheno twice daily.

[hikinghounds]

To me, this doesn't sound like it's just from the pheno. I would definitely be insisting on talking with the neurologist or bringing her in. Phenobarbital should actually increase their appetite. The thing is, many of the symptoms you are describing are also symptoms of the encephalitis and meningitis, not just side effects of pheno. For reference, Zephyr was on 10 mg of pred (which was low), 90 of pheno, along with his chemo treatment, and did not show the severity of symptoms that Frappy is having once I brought him home. He did have those symptoms when the encephalitis was active and he was at the hospital during the worst of it all and had not received his first chemo treatment. From what I've read, and was told by my neurologist, dogs that are receiving only prednisone to control the encephalitis/meningitis have to take a much larger dose of prednisone than 10mg to see improvement. I would really ask them about other treatment options than prednisone. Something that will lower the immune response, like chemo, or I know some dogs have been given cyclosporine. I have a blog, http://hikinghounds.blogspot.com/ that I wrote all about Zephyr's treatment. The entries start in March of 2011 and go on for about a year and a half. I know all dogs and situations are not the same, but I hope this info might help you when talking to the vet. Sending lots of prayers to you and Frappy!

Edited September 15, 2014 by hikinghounds

[vjui]

Thank you for the reference. My thought process is exactly that: I am worried it is progression of the encephalitis/meningitis. I have broached the subject of chemotherapeutic agents, but it seems that the neurologist sees them as the "third line" of treatment. In his experience, he only goes to chemo agents if the dog's symptoms return after weaning down the steroids. I don't know how aggressive to get with this neurologist. As I said, this hospital is very grey savvy, so he knows greyhounds. What should I say? Do they have to wean her off the steroid concurrently with the chemo?

[hikinghounds]

No, they don't have to wean. In fact they usually continue treating with the steroid while doing the chemo treatment. Zephyr actually started on a higher prednisone dose, I think 20mg twice a day. A few weeks after his first chemo treatment we started lowering the dose because his belly wasn't tolerating the prednisone well. I guess I would point out that Frappy has been going through this for a few weeks and hasn't improved a lot and now seems worse. My neurologist only waited 36 hours before we decided to do chemo. Obviously I'm not a vet, but I do think that the chemo, or maybe other immune suppressants that are more effective than steroids, are the preferred treatment because they have given better results. That's what I've read and the neurologist told me. It's hard to say if it's the side effects of the phenobarbital, but I think I would be contacting them especially since she has actually seemed to get worse today. Sorry you are going through this, I know how hard and scary it is.

Edited September 15, 2014 by hikinghounds

[tbhounds]

If you don't things are going in the right direction and you have concerns absolutely call the neurologist. No one will care for your girl as much as you do. Trust me-they won't mind you calling--actually they should encourage you to do so.

[vjui]

After a night of a near comatose state, we had Frappy admitted to the hospital this morning. I lobbied hard to get her Prednisone increased to 1 1/2 tabs twice a day and her phenobarbital lowered to 1 tab per day. I hated giving it to her as she was already so gorked out. Her eyes rolled back in her head and she could not stand, let alone eat or drink. We were somewhat successful early in the evening using the turkey baster to shoot water in her mouth (she did make a licking/swallowing motion), but when we tried it at 11:00, the water simply dribbled out the other side of her mouth. She did not pee all night, which had me worried. Because of her dehydration, I was worried about her kidneys shutting down. But at 5 am, she woke up, walked pretty steadily to the back yard and peed. She came in and drank water. I was ecstatic. I went back to bed thinking we turned the corner. Alas, this morning, my husband told me she was still pretty gorked out when he tried to walk her and that she fell over a few times. She had no interest in drinking water, let alone food. So he brought her in. The neurologist (from what my husband told me) thinks her symptoms are more related to the encephalitis than the phenobarbital since she is on such a low dose. She is admitted for IV rehydration and I was told they are going to switch her medications. I will call the neurologist later today to get more details. Please keep the prayers coming. We need them so desperately. Thank you.