My Lumpy Nosed Bear

AP here:
Exactly three weeks ago Tonka and I went to see Dr. Roa. In getting him out of the truck I accidentally bumped his head on the back of the truck. Once inside the waiting area Tonka's Aunt Gina came to see him and remarked that he had a knot on his nose right at the bridge. I assumed that it was from our less than graceful exit from the truck. Three weeks later the knot is still there and this past Saturday Tonka got sick. Now my boy hardly ever throws up and I can count the times on two hands that he has thrown up in the past 5 years so off to GAVH we went.

 Dr. Gerity took a look at him and other than the fact that he is definitely having an allergic reaction to something causing his feet to itch and his fur to stain the only thing that could be upsetting him would be some of his medication.  We discussed stopping some of the meds and putting him on something to settle and coat his stomach and then she turned her attention to his lump. Now Tonka has not been able to breathe right out of the right side of his nose since April so the thinking has been that perhaps there is a polyp or tumor that is blocking the passage. The presence of the lump could be whatever is in there pushing up and trying to find a way out, so basically coming up through the bone. Cancer nasal tumors destroy bone and can erode a hole out. The other disturbing trend lately is whenever he stands in his wheels his tongue turns a dark pink. This could be due to something occluding blood flow as well.

The thought of this of course was very upsetting so I made an appointment with internal medicine and Dr. Klaser to take a look and biopsy it. We discussed the possibility of being able to do a needle biopsy instead of a rhinoscopy but to be prepared for that if the lump was too hard to use a needle. A needle aspirate allows a Dr to take a small sample to look at. It is less invasive then a surgical biopsy and there is no anesthesia involved. Anesthesia always involves some risk and recovery time. We were lucky and Dr. Klaser found a softer spot on the lump to do the needle aspirate.

At first glance it appears to consist of mostly cyst cells but some cells were grouped together that looked a little off so we will wait for the final report from IDEXX which should be back in a few days.  So once again in looking for a quick and neat answer to a Tonka problem - well its just not happening. I am relieved that it wasn't a definitive nasty tumor full of cancer cells as that would have shortened our remaining time together dramatically. I am still at a loss about his breathing problem and at this point he basically has very little air flow in the right nostril at all. It doesn't appear that this lump is the cause but again we shall wait for the report to come back.

Holding on to hope......

and T Man sticking out his tongue to Cancer!

Once again it is all in his head....

Tonka here:
On July 9th I went to see my good friend Dr. Roa because AP thought maybe I had hurt my knee or hip. 
Seems I can't hold a stand with my back right leg anymore. I don't think I hurt it trying to get up or flipping over but AP wanted to be sure.

hanging on the porch getting ready to go see Dr. Roa

AP made me wear my help em harness since I can't stand up to help her get me out of the truck. I hate wearing it so I hope my leg gets better quick.

and.... I'm in the truck

wheeling around the lobby looking for my girlfriends

I got to see all my friends before my appointment and then Dr. Roa came in and checked me over while I was in my wheels and then out of my wheels. He made me move around and pushed and pulled on me and told AP he could not find anything physical to be the problem. He thinks it's all still part of my silly brain not talking correctly to my legs. He said I should get back to therapy and see if that helps. That made me happy cuz now I will get to see my girlfriends once a week again and AP was happy that I am not broken.

When we got home I took a long nap and then got to go out on the porch for awhile. I love laying on the porch. My friends Megan and Cayden came by and hung out with me for awhile.

loving the porch

Megan and Cayden

Later that night after dinner AP gave me a frozen peanut butter kong for being such a good guy all day. I love Peanut Butter!

Zip Line to the Park...

AP here:
With all the medical posts I have done I thought I would take a detour to non medical (ish) post.

As Tonka can no longer hold a stand it is difficult for me to get him out of the truck now. In the past
I could go in the side door stand him then hurry to the back to catch him underneath and lead him down the ramp.

I needed to come up with something to get him up and hold him up so I could get to the back and lead him forward - unhook- and take him down the ramp - so I made a zip line type deal that would use the back portion of his help em up harness.

This morning we tested it out....

Leaving the House

In the truck

We drove to the park to meet Aunt Carol and Nala and the zip line did not work out too badly for a first run. I made a little movie about it...

Once out of the truck he got to wheel around with Nala

Crossing the Field

Checking out the Park with Nala

All in all he had a good morning!

It is not a tumor...

AP here:
With the breathing problem getting worse and his inability to get comfortable I was becoming more worried that we were dealing with a tumor in his nose and that perhaps he had a broken rib. There are always options for diagnostic tools in our immediate vicinity as we are very fortunate to have not only specialists less than 20 miles away but also an MRI machine at VIoC. Tonka had 2 MRI's when he started having difficulty walking and both showed nothing abnormal at the time. An MRI requires full anesthesia and since he just had such a lengthy surgery I decided that perhaps we should just do some x-rays to get started. I had the x-ray of his nose from May which showed how congested his right side had become.

Several Dr.s had looked at the x-ray and since it did not show any bone loss at that time the thought was it was just a sinus infection. From April to mid-June he was on 2 rounds of Amoxicillian and Baytril as well as an antihistamine hydroxyzine  and Flonase as an inhaled steroid. None of the medication seemed to help so now I wanted a new x-ray to see if anything had changed.

We scheduled an appointment at GAVH for June 25th and Caitlin happened to be working that day so that worked out perfect. Tonka loves Caitlin and she would be able to help. They gave him a 1/2 a dose of a sedative and took x-rays of his nose, his chest and shoulders and abdomen.

Groggy

No broken bones or fractures  were apparent so that left either a muscular or neuro muscular problem.  The nose looked the same as it had in May so no overgrowth that would indicate infection and no destruction that would be indicative of tumor. The theory became that it could be a polyp and unfortunately with canine noses a CT, MRI or scope would be the only way to know for sure. Dr. Woodburn and I discussed the fact that since this seemed to all be muscular we should try some muscle relaxers and pain medicine and see if that would help.  He also made sure I understood that this could also be caused by a brain tumor. I could tell a difference already as he was more relaxed from the sedative and his muscles were no longer twitching under my hands. He was groggy all day and slept really well and that night we did not have the bizarre grimace breathing episode.

He seemed to be more relaxed on the meds but still not breathing well especially when laying on his left side. Then one day out of the blue his right hind leg no longer wanted to support his weight if I put him in a stand. This gave me something new to worry about and I thought that perhaps he had tried to get up and fallen and torn something. I called and made an appointment with the surgeon that removed his tumors Dr. Roa at CVSS to rule out anything orthopedic. The first appointment I could get was 2 weeks out so in the meantime I started icing the leg just in case.

While working on a blog post I happened to look up the proper spelling of metoclopramide which is the official name for reglan. This is a drug that is given along with chemo to help with motility and nausea. It occurred to me as I looked it up that I had researched the Palladia up one side and down the other. I had even joined some canine cancer groups to specifically ask about it but I had not really looked into the Reglan. This was the first site I landed on http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684035.html
The first thing I saw was the huge warning box and in reading through the symptoms my stomach turned and my heart sank.......  These symptoms were some of the things he had been exhibiting and upon reading further it was contraindicated if there was a history of seizures. That hit me hard and I looked back through his history that  I had given when we started down the chemo road to make sure I had not forgotten to include that. His seizures had always been so infrequent it was not always the first of his medical problems to think of. It was listed in his history so I had not forgotten which made me feel a tad bit less sick but no less angry with myself for not having researched it before letting him take it. Tardive Dyskinesia is the name of the disorder and when I started looking for that in animals I did not find much but I did find people on the canine cancer group whose dogs had developed the same symptoms.Everything I read said the symptoms could disappear once off they medicine or they could be permanent. Thankfully he had only been on it a week but the problem with Tonka is he is so sensitive to medication that a week on something that does not agree with him is a week too long. Hopefully I can wean him off the muscle relaxers and the symptoms will be gone.