The start of this bout. The first full week.

Bonnie wrote that Goya started to have serious problems the week of December 5th. I want to describe what we did that week, to diagnose and set ourselves up to handle a 150 lb bag of potatoes, which is about what Goya was.

Monday 12/5 - We went to the local Orthopedic vet. This was the same vet that wasn't able to help much the previous time. However, our normal vet was unable to move forward, and we had to go through the Orthopedic vet to get to the next level of support. Given Goya's previous experience they didn't try anything beyond the initial test of Myasthemia Gravis (negative). They also ruled out brain and spinal issues again. Goya had already been on antibiotics for several weeks, and that pretty much ruled out tick borne paralysis. So the next step was to get Goya an appointment with a Neurologist. There were 2 possible Neurologists, one near DC and one at Ohio State. The DC neurologist couldn't see him, so we made an appointment at Ohio State on Wedneday.

Wednesday 12/7 - We headed to Ohio State in the morning. We had an appointment at around 1 pm, and Ohio State is about 4 hours away. We got to the clinic and got Goya carried in. There was the first chat with the vets, a Neurologist and an intern (this is a teaching clinic so there always seems to be a vet intern involved) that covered history etc. They had the previous information, and the little more we could tell them about this time. After checking for all the obvious issues, the Neurologist claimed that this really looked like coonhound paralysis to him. One of the reasons he was not diagnosed with coonhound paralysis last time was because he still had some motor capability. He was not down. This time he really was down. There is no diagnostic test for coonhound paralysis. However, since he was down, and since he didn't show positive for anything else, it meant coonhound paralysis was the diagnosis. The prognosis however was ok. He would be down needing nursing care for 6 weeks to 6 months, and then he would get better. We decided to nurse him and took him home. It was a long day.

Thursday 12/8 - We were back in the house and had Goya on the first floor. After being here for a day though he started to show real signs of distress. So we got a neighbor to help and loaded him in the car and took him to the orthopedic vet. It turned out he just had to urinate and defecate which he did as soon as he got into the vet's office. The vet checked him over and claimed he seemed to be just fine for a dog that couldn't move. We talked about what needed to be done. While Ohio State had sent us home with daily catheters, this vet thought a permanent catheter was a better option. Less likely in the long run to cause infection. The exact opposite of Ohio State vet's comments. We opted for the permanent catheter, because it was easier and our orthopedic's comments made sense. We also weren't sure we could maintain the level of sanitation necessary for a daily catheterization without bladder infections.

However, we weren't ready to handle this large dog and stairs at home. So we left the dog at the vet's for 4 days while we got the house ready for him.

Urine

Goya's first bout with coonhound paralysis occured in the summer and he and we could sleep outside. He also was stronger, and could drag himself across the grass, or to Bonnie's dismay the driveway.

This time it was December. In Pittsburgh, it is cold in December. He also lost contol of much more of his body. For example, he couldn't hold his head up. Everytime we took him to the vet he would urinate at the vet. Maybe he was trying to tell us something, maybe not. By the time we got home from Ohio State, we weren't planning on going to the vet every day. We also couldn't leave Goya out in the cold.

The vets at Ohio State recognized that this would be an issue and gave us a 5 minute lesson in daily urinary cathetorization. They then sent us home with a set of catheters, purple latex gloves (too small for Gary, and too large for Bonnie, but one size fits all). We were supposed to cathetorize Goya twice a day. The procedure was to expose the penis, and slip the catheter in until urine starts to come out. We should expect at least 1 liter of urine a day.

We ended up taking Goya to the Orthopedic Vet the first weekend, mainly because we just weren't ready to handle a 150 lb dog who couldn't walk. We needed the weekend to get our house ready to handle getting him out, and just sleeping in the livingroom. The local Orthopedic vet had a different opinion about urinary catheters, and we decided to follow his advice.

His advice was to put in a "permanent" catheter. A permanent catheter has a small balloon at the end. The catheter is inserted (by a vet-tech) and the balloon is blown up. I think the balloon is about the size of a marble when blown up. The balloon serves two purposes;

1. It keeps the catheter tube in the bladder because the balloon is larger than fits through the urethea.
   
2. It blocks the urethea from being a pathway for urine.

Ohio State thought that permanent catheter's were pathways for infection. Thus it was better for the dog to use a sterile use-once catheter every time.

Our orthopedic vet thought that permanent catheters were safer. His thinking was based upon his opinion that novices (like us) couldn't be careful enough to not introduce infections with the use-once catheters. Also the possible bacteria in our home were not as dangerous as the bacteria at the vets. So Ohio State was not considering the at-home aspects in their risk/benefit tradeoff.

We were incompetent to really judge the issue. So we selected our orthopedic vet's view as correct because it meant we had less to handle with an already difficult situation. However, this decision had implications we didn't forsee.

Before getting into the implications, I wanted to describe the apparatus. Goya has a thin white tube going from a bulbous piece into his penis and up to his bladder. The bulbous piece has a component that one can hook a syringe to, and using the syringe blow up a balloon at the end of the tube that is in his bladder. You can also use the syringe to deflate the balloon. Attached to the bulbous tube is another tube (about 6-15 feet long) that ends in yet another bulbous device that can attach to an IV bag. The IV bag fills with urine and can be detached easily. We detach the IV bag about once a day, to empty it. Goya produces about 800ml-1,500 ml of urine a day.

The first implication was that the urine wasn't always clear. Bladder infections were occuring. It was never clear that they were more/less prevalent because of the permanent catheter. However, we had to give antibiotics to Goya to handle the bladder infections. After 3 months we had a different vet come to our house, and he looked at the urine and said "lots of sperm in that urine". Thus we (and some of our vets) may have been interpreting unclear urine incorrectly. However, the vets were inspecting the urine with a microscope and counting bacteria, so my guess is we were doing most of the mis-interpretation. Goya has been on 4 treatments of antibiotics, and is about to start another.

The second implication is that we had to be careful with the handling of this tube. The first time we had a problem, occurred because I wasn't careful at about 3AM when Goya wanted me to roll him over. The tube for some reason wasn't free, and rolling him over caused his weight to pull the tube (with the balloon) into his uretha and block his uretha, and the tube. We had to go to the orthopedic vet the next day.

The vet replaced the permanent catheter and, chastized us for not collecting 2 liters of urine a day (thus we weren't forcing enough water down his throat). This chastizing pissed me off because we were making water available to Goya all the time, he just didn't want to drink it. Did the vet give us any instruction as to how to get him to drink 2 liters of water a day? NO. We were documenting what he drank (about 1 liter) , and it approximately equaled his urine production. Were we to squirt water down his throat? Hold him down in a tub? We had no idea, so we ignored the vets concern. Later when we got a vet to come to our house, this new vet was very comfortable with the amount of liquid that Goya was processing. We still don't know which vet is right, but we also don't know what we could do to get Goya more water.

Goya had one other time when the permanent catheter partially came out. At that time, we decided to try the at home vet solution because taking Goya to the vet was both hard on us (and I had broke my shoulder) and hard on Goya.

The at home vet was APALLED yes APPALLED that we had left the permanent catheter in for so long. Also Goya had a bladder infection. He left us with instructions on replacing all the equipment that attached to the catheter every week. He also left us equipment for replacing the current tubing and IV bag. He also put Goya on a round of Cipro.

Goya now seems to have his bladder infection somewhat under control. The vet thinks he needs another couple of weeks of antibiotics. He is still urinating at about 1 liter /day.

The only other issue I didn't discuss is that we have to tape the catheter to Goya, so that it doesn't flop about, and so it doesn't get kinks. We sliced some aquarium air tube and placed it over the relatively thin catheter tubing so that the air tube supported the catheter tube around bends, and the catheter tube didn't kink. However, we haven't figured out a good way to tape the bulbous catheter dohicky to Goya. The problem seems to be that the white bandage tape is optimized to not hurt humans when pulled off, and thus doesn't stick well to hair. Goya is covered in hair. His stomach is also more narrow than his rib cage, so the entire device and tape belt slides down his body. We need stickier tape, and haven't found any at any of our drug stores. Alas always problems. If stickier tape is the worst problem, then life isn't so bad.

Details of first bout with coonhound paralysis

This is my description of Goya's earlier experience with coonhound paralysis. Bonnie asked me to post it, because it described different aspects of our shared experience.

We believe Goya had his initial experience coonhound paralysis in the summer of 2003. The progression of the disease was fairly typical, he had a fast onset of the paralysis with a slow recovery. The details are below. At the time of the onset, Bonnie was on a business trip, and our kids were away. The main reason to go over this here, is that this experience eliminated many false starts in diagnosing Goya's current condition.

• One Wednesday in late June, Goya started to stumble. By Thursday evening he was having difficulty walking, so he went to the local Emergency Vet. They had no idea what was happening, but did notice he was having difficulty with his back legs. I had to drive across the state on Friday, and the Vets assured me that he would be fine.
• When I got back Friday evening, he couldn't move his back legs. I could still help him move by putting a towel under him and holding up the rear of his body. Rather than going back to the emergency vet, I waited until Saturday morning to take him to his normal vet.
• By Saturday he definitely needed help moving, but I was still able to handle him myself. Our vet did the standard blood work, and found nothing. However, this also meant that we probably didn't have an emergency situation. We made an appointment for Goya at the Orthopedic Surgery Vet for Monday morning. Bonnie would be home by then also.
• Over the weekend, Goya was sleeping on the first floor of our house because getting him up and down the stairs was difficult. He also had several accidents in the house because we didn't really know how to take care of him yet.
• On Monday morning the Orthopedic vet, was also convinced there was something wrong. It was pretty obvious by this point. He had 3 hypotheses since it didn't look like a spinal problem or brain problem but instead a peripheral nerve problem:
1. Myasthenia Gravis which is a general muscle weakness. It can start almost anywhere, but the main problem with this disease is that it can affect the esophagus causing a type of pneumonia. Goya showed no response to the in-house test (Tensilon). The more complete test for this disease takes about a week to come back from San Diego. The common treatment was to nurse and give an anticholinesteras medication. The side-effect we were told to watch for was a weakening of the heartbeat from the medication. The vet wanted to start this medication immediately, because of the pneumonia danger while we waited for the San Diego results.
2. Tick based disease. The most common is Lyme disease, but there is also Rocky Mountain spotted fever, and tick based paralysis. The diagnosis for this disease requires a blood sample to be sent to a testing center in North Carolina. The vet sent a blood sample to the lab, but since this is an enviromental situation, and the vets hadn't seen other dogs in the area come down with tick based diseases, and the vets didn't find any ticks on Goya, the vets thought this diagnosis unlikely.
3. Everything else.
• We started the Tensilon treatment, and Bonnie monitoring Goya's heart stopped the treatment when she couldn't sense his heartbeat anymore. Goya recovered from the treatment but still couldn't walk.
• We moved out to out back porch. Sears had a tent meant for a picnic on sale that we bought and set up on the back porch. The tent kept the bugs and rain away, and we moved out to the back porch, sleeping on air mattresses.
• After a several weeks all the test results were in, and were negative. We had exhausted the vet's capabilities in Pittsburgh, so we loaded Goya in the car and took him to Ohio state to see a neurologist.
• At Ohio state, they kept Goya overnight and did minor surgery to see if they could stimulate the nerves to move, and if not then to take a muscle sample to send to a lab in LA. In the process, they also thought it was Myasthemia Gravis, and gave him Tensilon. They did this even though they had the test results, and Bonnie told them Goya's previous experience on the drug. Sometime during the night they stopped the Tensilon, because they noticed a weakening of his heartbeat. At the end of all the tests, they told us they had no idea. It might be coonhound paralysis, or a missed diagnosis of a tick borne disease or some muscle myopathy. They said we had to wait for test results, and they gave us an antibiotic.
• 4 days later he was starting to walk. When we called Ohio State, they asked why he could walk. We were convinced that he had a tick borne disease and the antibiotic helped cure him. We are now convinced he just happened to recover from coonhound paralysis at the same time that we gave him the antibiotics.

Overview of Goya's history

Goya is mastiff, born in April 1997. He had a lot of allergies as a pup and, after several vets couldn't help with the allergies, at the urging of his breeder, we started feeding the BARF diet (biologically-appropriate raw food) when he was about a year old. That really helped with the allergies and he has been healthy and happy for many years. He is small for a male mastiff, about 155 lbs adult weight. He has his Canine Good Citizen's certificate and is just the most loving, perfect family member.

(Lisa Nicollelo is Goya's breeder, see her page at http://members.aol.com/gcmastiffs/
See some pictures of Goya as a young dog at Lisa's "extended family" page http://workingmastiffs.com/gcpups.htm, about half way down.)

In late June 2003, Goya suddenly lost control of his back legs and over the course of a few days, lost the ability to walk at all. We took him to our regular vet and then to an orthopedic surgeon and then to the vet school at Ohio State. No one could diagnose him. They did many blood tests and a nerve biopsy and his symptoms fit no pattern they could recognize. Coonhound paralysis was mentioned, but they kept saying he wasn't "down enough" (he could always lay sternally and roll over). Finally, after about 5 weeks of tests, they gave him doxycycline (just to shut me up) and within 4 days he was up and walking. He was on doxy for about 8 weeks, and 3 weeks after going off it, he collapsed again. They put him back on doxy and he recovered quickly -- this time he was on it for about 16 weeks. Then he was fine for a good long time.

He had weakness in the hind quarters in spring 2005 and we put him back on doxy and he never collapsed -- just got stronger in a few days. The vets still had no idea what was going on with him, but doxycycline seemed to be his drug of choice. (They always did full blood work-ups before putting him back on the antibiotic, to make sure it wasn't something else, but nothing ever came back out of the ordinary.)

Then, on Nov. 19th 2005 (the Saturday before Thanksgiving) he started looking weak in the back legs. He "tells us" he is starting to get weak by taking the stairs one at a time on the way down. I called the vet and they prescribed the doxy over the phone this time, so we started it on Saturday and gave him the right dosage until Wednesday night. We were going away for the Thanksgiving holiday and Goya was going to the kennel with our other two dogs (Cherry, the mutt, and Joe, the younger mastiff). We forgot to pack the doxy, so he didn't get four days of doses. The kennel lady said he was fine while he was at her house (she is very vigilant -- I'm sure she would have noticed if something wasn't right). We started giving him the doxy again. 10 days after coming home, on December 5th (I think), he was weak in the morning and needed help with a hand-held sling to go out in the morning. By the afternoon, he couldn't walk at all. That's when the latest, and most severe, bout began, and those details will have to wait for another post.

Why we're doing this blog about coonhound paralysis

My husband, Gary, and I, Bonnie, have a 9-year-old Mastiff, Goya, who was stricken with coonhound paralysis in early December 2005. Now, in late March 2006, he is still recovering and we hope that he will have a full recovery. Although we could find a lot of information on the web about diagnosis and prognosis, we could find very little practical information about how to nurse our dog and what to expect through the course of the disease. We hope that this blog will help other people who have dogs with this affliction.

It will take us a while to populate this blog with Goya's history with this disease, and it will probably be a mixture of current updates and remembering back to what was going on in December, January and February, but we'll try to remember to date our stories with the day they happened, so you can sort it out. (It's too bad we didn't think of this when this all started, but we didn't, so this retrospective will have to do.

Please feel free to comment and ask questions.
Especially if you have experience with a dog with coonhound paralysis, please help by sharing your expertise.