Trevor had his annual eye exam today. His eye vet pronounced his eyes unchanged from a year ago and said they looked completely normal. RELIEF, weepy gratitude, thank you universe!

In a synchronistic twist, the vet recommended a new dog eye supplement she had just heard about at a conference. It's called OcuGLO. It includes a lot of the same things I've been giving Trevor for the last year. The synchronistic part is that I just heard about OcuGLO a few days ago from a person in Taiwan whose mini-poodle has PRA, and I was just starting to look into it.

It's validating and encouraging to see an eye supplement designed specifically for dogs. According to the OcuGLO website:


I will probably be incorporating this into Trevor's supplement regime, in place of the equivalent human supplements I've been giving him. I'm planning to meet with my holistic vet in the next month to review Trevor's entire program.

In other happy news, today Rowan dropped down to 20mg/day of prednisone, down from a high dose of 60mg/day. I'm hoping that at the lower dose, his food-crazed "drug addict" prednisone personality will start to fade, and we'll get the old Rowan back.

Touki has happy news too. She's returning to the agility ring! She started acting like she wanted to work again, so I set up a few obstacles in the back yard for her. She threw herself at them with wild enthusiasm, so I decided to start practicing with her, and I entered her in all the Rancho Murieta trials. She's made it clear she has no intention of ever doing the dogwalk again, though, so it will just be jumpers and the occasional FAST class. We went over to Diamond Bar to practice today, and it was like one of the later "Rocky" movies. It's not easy to come out of retirement in middle age! After 10 minutes of jumping and weave drills, Touki looked like she needed the doggie equivalent of a martini. The spirit was willing, but the flesh was knocking bars all over the place. But [cue "Rocky" theme music] we're going to try to get her back into shape, and return to the competition ring in a blaze of glory! Or have some fun at least.

Finally, Trevor hit 600 MACH points at the NorCal Golden trial in Santa Rosa this past weekend, where he got his 31st and 32nd double Qs. Only 150 more points to go to finish his MACH! Now it actually seems achievable (knock wood).

Trevor now has 30 QQs, and he's less than 200 points away from finishing his MACH. His third birthday is in a few weeks, so I'm proud of how far he's come in just a year. But winter is upon us and the agility season is tapering off, so all we can do for now is continue chipping away as best we can.

Susie

I haven't written in a long time. As my sister put it recently, she hasn't been able to get back on her feet since we lost our sister-in-law Susie to breast cancer this summer. When I got back from Susie's memorial service in Vancouver (after spending a week there previously, when Susie was terminally ill in palliative care), I was not only profoundly depressed and way behind on everything in my life, I felt completely used up. It was like aliens had sucked the very life force from my body--I felt like I had no serotonin left in my brain. I found myself unable to deal with anything beyond life's basic requirements. I went to work, I came home and slept. Things have gotten slightly better in the last month or so, but only slightly.

Here is the memorial website I created for Susie. Her death is a cosmic knot that my subconscious will never stop trying to untie. I can't be reconciled or move on. I don't know where to go from here.

Obviously our family has to go on, but it isn't clear yet how we're going to do it.

Rowan

People have been asking me how Rowan is doing. He has an autoimmune condition that is most likely masticatory myositis. The other side of his head caved in and he seemed to be having problems with his jaw, so we increased him to the maximum dose of prednisone. That seemed to bring him relief. Now we are slowly reducing his prednisone and keeping our fingers crossed that he doesn't relapse. So far so good.

Otherwise Rowan is enjoying a normal doggie life, besides his all-consuming obsession with food. It's like living with a drug addict.

Here's a shout out to our awesome neurologist at the Animal Care Center in Rohnert Park, Dr. Diccon Westworth.

Trevor

When life goes to hell, hobbies are a godsend. October is a big agility month in Northern CA. We just got back from Carson City, where Trevor double-Qed all 3 days and got his most points ever in a single trial. He's now up to 26 double Qs and 480 points. Hopefully we can keep up the trend and finish his MACH. He will be 3 years old at the end of November. Good boy, Trevor!

PRA

Researching PRA continues to be my REAL hobby.

Recently I received email from a woman in Taiwan who just learned that her toy poodle has prcd-PRA. She found me through Trevor's website. She told me that her eye vet prescribed an antioxidant supplement called Meni-One Eye. This supplement was developed in Japan specifically for PRA because, as she put it, so many dachshunds there have the disease.

The main ingredient in Meni-One Eye is astaxanthin. It's responsible for the pigment in salmon and other seafood. I did a web search, and I could only find a few studies of the effects of astaxanthin on the retina. It's readily available in the US as a supplement, but I don't get the impression it's widely used for AMD (macular degeneration) or RP (retinitis pigmentosa)--any benefits it might have seem to be purely anecdotal at this point.

Meanwhile, the annual Vision Quest conference recently wrapped up in Toronto. Check it out. This year's hot topics:

• CNTF
• Gene therapy
• Stem cell
  
• Prosthetics (i.e, retinal implants)
  

Last year's Vision Quest "current state of research" presentation mentioned antioxidant supplementation as one possible therapy (not as a cure, but as a way of delaying onset). And in fact, the RetinaComplex clinical trial has shown enough promise to be extended another year. But at this year's Vision Quest, presenter Yves Sauvé put more emphasis on eating a diet rich in retina-friendly foods. See Nutrition and Retinal Degeneration.

Where does the truth lie? How can there be a PRA supplement offered in Japan that no one in the west seems to have heard of? Do any of these antioxidants actually make a difference, or are they just a way of making ourselves feel better?

It's impossible to say. I'm fascinated by the way that medical reality seems to be every bit as subjective and malleable as other kinds of reality. This is not to say that one never arrives at hard facts. But the path to getting there seems to be pretty circuitous.

In any case, I'm hoping to get together with my old holistic vet soon to refine Trevor's diet and supplement regime. We've been at this for a year. Trevor is about to get his annual CERF exam. It's time to take a step back and re-evaluate.

Just when Rowan seemed destined to remain a medical enigma, our on-vacation neurologist called in a prescription for prednisone. Presumably he received Rowan's muscle biopsy results and agreed with the lab that even though Rowan was negative on the masticatory muscle myositis (MMM) test and even though his atrophy is only on one side, MMM was still the most likely diagnosis.

I don't know how they distinguish between trigeminal neuritis (the idiopathic version that resolves on its own--no prednisone required) and MMM. Yet here we are. I don't know how we'll ever know for sure now if Rowan has MMM. Now that he's received prednisone, it will skew the results of future tests.

I picked up the dreaded orange pills from Rite Aid last night. It's hard to imagine Rowan being hungrier and more food-obsessed than he already is (insatiable hunger is one of the common side effects of prednisone). I just gave him his first half pill with a sinking heart. To treat an auto-immune disease like MMM, you have to give a strong enough dose to beat back the immune system. It's nasty stuff. But if you don't get on top of MMM as quickly and aggressively as possible, you risk ending up with a dog that spends the rest of his life on a feeding tube, because he can't open his mouth. So taking a "wait and see" approach is not an option.

Hopefully the prednisone will send the problem into remission and it will never come back. Yes, I feel like I've stumbled into an alternate reality where I'm a weekly guest star on the canine version of "House."

You know you're in trouble when the pharmacists at Rite Aid start asking you about your dogs, because the only time you go in there is to pick up exotic, expensive medications for your pets.

Update (8-10-09)

I talked to one of the other neurologists at the Animal Care Center today, since Dr. Westworth is still on vacation. Since we don't have a definitive diagnosis and since prednisone is such a heavy duty drug, I had a lot of questions:

• Why do we think it's MMM? Because both the MRI and the muscle biopsy showed presence of muscle disease (i.e., inflammation). Even if it's not MMM, it has the markings of an auto-immune disease, so prednisone would still be the treatment.
• Why don't we think it's trigeminal neuritis (the benign idiopathic disease that resolves on its own)? It would look different. TN is a loss of the nerve supply; TN doesn't look like muscle disease. The nerve tested normal.
• Could it still be an infection, in which case suppressing the immune system will make it worse? Yes, but it's unlikely given that there are no other signs of infection and no known infectious agent (plus Rowan's bloodwork was normal). But we should still watch Rowan carefully for any signs that things are getting worse--pain, spreading atrophy, stiffness, difficulty walking, etc.
• How long will Rowan have to be on a megadose of prednisone? Probably 2 months, then he'll have to taper off. If he tapers off too fast, he's at risk of relapsing.
• Will Rowan's head ever return to normal? Maybe, maybe not. It depends on the dog.
  
• How will we ever know if he's better, considering that his titer test was negative and his muscle may never return to normal? She agreed that it would be hard to tell, but the main thing is that he doesn't relapse. She also said that she still gives titer tests to dogs that have had prednisone. It's not a foregone conclusion that the test becomes worthless once the dog has had pred.

So there we have it.

We finally got the last of Rowan's test results yesterday. It was his muscle biopsy, to determine if he has muscle disease.

Dr. Westworth is on vacation for two weeks, so I got the report from one of the other neurologists. She said that the specialist who analyzed Rowan's tissue at the University of San Diego was confounded. He had "never seen anything like it before." It was "really unusual." All they could say was that it was consistent with the MRI--i.e., "there is inflammation." Obviously this doesn't tell us much.

Their best guess was masticatory muscle myositis, even though it's unilateral and Rowan tested negative for MMM on the titer test. But this could be because it's still early in the disease. Or, he could be having an autoimmune reaction to a low grade infection. No one can say. The plan is to wait for Dr. Westworth to get back and then decide where to go from here.

In the meantime, Rowan has shown no change since the dent appeared about a month ago. The dent is still there. It doesn't seem to be getting better or worse, and it doesn't seem to be spreading to the other side. He is still using his jaw normally. He is the same happy, energetic ball fanatic he's always been.

The mystery continues.

A week ago I was in Richmond, BC at my brother's house. His wife Susie had been battling breast cancer since 2002, and she recently had hip replacement surgery. She was having a hard time, so I went up to help. I overlapped one day with my sister, who had been visiting the week before. She was heading back to the east coast.

My sister spent Sunday showing me the ropes. I mastered the pill schedule and met the visiting nurse. I learned how to make smoothies. I unpacked my suitcase and prepared to settle in for the week.

Sunday night went badly. My brother was up with his wife all night. By morning, we called the doctor. It was determined that Susie's condition had deteriorated to the point that we couldn't take care of her at home. The visiting nurse spent all day trying to find her a bed in either hospice or palliative care. In mid-afternoon, an ambulance arrived to take Susie to the palliative care unit of the Richmond Hospital.

From that point on, things went downhill with dizzying speed. No sooner would we adjust to the latest changes than things would shift again. Susie's sister and brother flew in from the US. My brother, his and Susie's 3 kids (late teens, early 20's), me, and Susie's siblings organized ourselves into a round-the-clock vigil at Susie's bedside. Time stood still. We entered a different reality. Every day I took a book with me, but I never once opened the cover. We talked, we laughed, we reminisced, we cried, we sat in meditative silence.

On Sunday Susie could talk, albeit with effort. On Monday, at the hospital, Susie seemed to be aware of what was going on, but she only communicated when asked a direct question by the medical staff. On Tuesday her breathing became more labored, and she seemed to be slipping into her own world. By Wednesday morning, she was struggling to breathe at all. Shortly after noon on Wednesday, she breathed her last breath. It was her 54th birthday.

Susie was the world's greatest mom. She had a masters degree from Stanford, but her passion was family life. She loved to bake and make quilts. She loved her 3 rescue dogs, Troy, Riley, and Addie. She found the most joy in the simple things in life. If anyone deserved to live to see her grandchildren, it was Susie. I will never be reconciled to her loss.

If I didn't know better, I'd say that I have the subconscious goal of getting one of my dogs into a veterinary medical journal.

First I had Riggsie, a 2-year-old lab who was diagnosed with hemangiosarcoma in his hip (leg bone, technically). Then I had Trevor, only the 5th Golden Retriever in the US to test prcd-PRA "affected" on the Optigen test, and the first pre-symptomatic Golden to have his "affected" status confirmed by an ERG test. That alone should have confirmed my dogs' place in canine medical history. And Optigen, if you're reading this, I'm still waiting for my kickback. Ha.

But that wasn't enough for me. I needed some strong visuals. How about a beautiful young Labrador Retriever with a dent on one side of his head? I don't mean to be facetious, honestly, but sometimes I just have to shake my head in disbelief. Other people have a dog hobby called "agility." My dog hobby is researching obscure canine medical conditions.

Having learned so much about the canine eye through Trevor's PRA and about joint problems from Rowan's elbow dysplasia and OCD, I guess the universe decided that it was time for me to learn about the dog nervous system, which is a whole new level of weirdness.

Anyway, let's cut to the chase. Rowan spent all day yesterday getting tested. Here we can take a moment to imagine my bank account draining away. In my conversations with the neurologist last week, he made it clear that he suspected cancer. What else could be so local to that particular area, and only on one side? Yesterday Rowan had an MRI, spinal tap, EMG, and muscle biopsy. This was the surprising result:

• No brain tumor, no nerve sheath tumor.
• No infection, no abscess.
• The trigeminal nerve appears to be functioning normally. However, 2 of the muscles it controls (head and nose on left side) have extra fluid in them. They appeared as milky and swirly on the MRI. It's unclear how you could have a normal nerve but problems with 2 of the muscles it controls.
• No apparent problems with other muscles on the left side of the body.

I stress once again that so far (knock wood), Rowan has no symptoms other than the dent on his head. His jaw seems to be working fine. He continues to be my most energetic, happy, ball-obsessed, food-obsessed dog. In a household of retrievers, Rowan is the uber retriever.

They expect to have the spinal tap results back today. As I understand it, the spinal tap's primary diagnostic value is in determing whether he has lymphoma. They expect the muscle biopsy results back on Friday. That is where the neurologist (Dr. Diccan Westworth at the Animal Care Center in Rohnert Park, he has been awesome) seemingly hopes to see some indication of what's going on--theoretically, it could still be some type of myositis--polymyositis, etc. The likely treatment would be prednisone.

Or it could turn out to be an idiopathic condition that will never be diagnosed, that would hopefully resolve on its own. Let's hope for that. Medical obscurity, yeah!

Meanwhile, I'm still in Richmond, BC, where my sister-in-law's condition is steadily worsening. If you're reading this, please say a prayer for her and for the family.

Update: We just got the results on Rowan's spinal tap, and it was completely normal. Thank heavens. One more test to go (muscle biopsy). We should get those results either Friday or Monday.

Our "quick visit" to the neurologist in Rohnert Park on the way home from Ferndale turned into an all-day affair.

Rowan (who is 4 1/2) has a dent on the left side of his head, between his eye and his ear. It is first visible in photos on July 6, but I didn't actually notice it until around July 11, when it became more exaggerated. All anyone can say at this point is that it's almost undoubtedly related to his trigeminal nerve, and that the muscle on top of his head has atrophied.

It could be a benign idiopathic condition called trigeminal neuritis that resolves on its own in about 6 weeks. It could be an autoimmune disease called masticatory muscle myositis (MMM), or a related disease called polymyositis. It could be an infection, or the result of a head injury we don't know about. Or it could be cancer--a brain tumor, a nerve sheath tumor, or lymphoma.

Here are some photos. Front:


From the top:


From the side:



From the back:



The neurologist doesn't think it's trigeminal neuritis or MMM, because they are usually bilateral and include jaw problems.

Tests we've had so far:

• General bloodwork--nothing abnormal.
• Neospora caninum (parasite that can be in raw food)--negative.
• MMM: negative (though if he's in the early stages, it could conceivably turn positive later).
• Chest x-ray: clear.
• Abdominal ultrasound: clear.

Because it's on one side, the neurologist is worried that it's cancer. Our next series of tests will be this coming Monday. That will include an EMG, a spinal tap, and an MRI.

In a weird disconnect, I spent some time yesterday searching the web for dogs who had a similar condition. I found multiple instances of young dogs who had ONE side of their heads cave in overnight, just like Rowan. I only found one instance of a dog where the dents appeared on both sides. These incidents were typically reported on pet forums, where the frantic owners were asking for advice. In most cases there was no followup about what the final diagnosis was. But it has to make you wonder--did all of these dogs have cancer? Really? If the more benign diseases are always supposed to be bilateral, why are there so few stories of dogs whose heads caved in on both sides? None of it makes any sense to me.

I won't be able to accompany Rowan to the appointment since I will be in Vancouver visiting my brother's family. My beautiful sister-in-law is terminally ill after a long battle with cancer. She is the same age as me and is the world's best mom to 3 great kids. When something like this happens, there is no way to make your peace with it. It's something that you will carry in its broken state forever, like a piece of shrapnel lodged in your chest.

There was a time in my life when I tried to interpret events according to a larger cosmic pattern, when I wanted to believe that things were wending their way towards a happy ending that our finite human minds couldn't comprehend. But I've given up on that idea. We have the miracle of our lives, we have our memories, we have our loved ones (including our pets, of course), and we have our communities. Sometimes all we can do is endure.

I'm not really stranded, and I'm technically not in Ferndale. But it's Sunday night, and after 3 days at the Lost Coast trial, I expected to be home by now. Instead, I'm sitting in the Best Western in Fortuna watching a Tom Cruise marathon on TNT. And I'm not a Tom Cruise fan! Though I have to say, "Minority Report" has held up well.

Why am I sitting here? Because over the weekend, I made an appointment for Rowan to see a neurologist in Rohnert Park tomorrow (on the way home). About a week ago, I noticed that Rowan had developed a distinct dent on one side of his head. I tried to convince myself it was nothing, but when I showed Rowan to a vet at the trial, that person said to take him to a neurologist.

Normally I'd be freaking out, but so many things are going badly right now that I'm postponing my nervous breakdown. If I think too hard about everything that is going on, I'll just crawl into a corner, get into the fetal position, and stay there.

The main thing that is weighing on me is that we have two human family members who are very seriously ill.

On a more mundane note, Murphy's Law seems to be in full effect in my life right now. Everything seems to be conspiring to make me fall further and further behind. We're getting the yard redone, which has consumed a lot of cycles. Last week I got a flat tire and Trevor got a foxtail in his ear, requiring a trip to the emergency vet. Hours down the tubes. Then Rowan's dent appeared, requiring an additional day of vacation to visit the neurologist. A filling I just got a few weeks ago has failed spectacularly and painfully. Next weekend I'm heading up to Vancouver to spend several days with my brother's family. I'm feeling overwhelmed.

We had a lot of fun in Ferndale, though. The whole family went. It was the first time I'd ever been to the Lost Coast trial. Trevor QQed all 3 days, which was slightly astonishing. He now has 18 QQs. He only has 305 MACH points, but most of them he's gotten in the last 6 weeks. Hopefully we can just keep improving and getting more confident as a team.

Trevor says his favorite part of the weekend was the beach. Touki and Rowan say that was their favorite part too. They're lying around me in a happy state of exhaustion.

A few weeks ago, driving to an agility trial in the predawn hours, I listened to sportscaster Howard Bryant talking about the NBA playoffs on NPR. At that point everyone still thought that it would be Kobe Bryant vs. LeBron James in the finals, unless, as Howard Bryant put it (in a halting attempt to find the right words), "reality trumps the narrative."

Reality did trump the narrative, and Kobe vs. LeBron turned out to be Kobe vs. Dwight Howard of the Orlando Magic. Anyway. The phrase stuck in my head. I think it's safe to say that in my life, reality pretty much always trumps the narrative. Or to put it differently: narrative, what narrative?

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Single Dog Mom

I haven't written in my blog in ages. I was a single dog mom for two weeks and I was busy with a work deadline at the same time. Other than work, walking dogs, eating, and sleeping, the only thing I was doing was agility. I was determined to go to all the trials I had Trevor entered in, so the 3 dogs and I trekked from one godforsaken agility location to another. Our low point came when the dogs refused to walk up the see-through stairs of the Dixon Best Western. I had to lure them up with salmon treats one-by-one.

I recently looked at a training plan I wrote for my agility instructor at the beginning of May. I barely recognized it. It was all about Trevor's sniffing, broken start line stays, obstacle phobias, and so on.

Shortly after I wrote the plan, Trevor got neutered. His sniffing all but vanished overnight. His start line stay returned, with just a few minor lapses. I spent big bucks on a competition chute (since we'd had so many refusals), but I was too busy to set it up. I still haven't set it up. It kind of seemed like the second the charge for the chute went on my credit card, Trevor decided to put his chute phobia behind him. Now the naked chute cylinder is sitting in the back yard like a talisman, warding off evil agility spirits.

Trevor got neutered on May 11. He returned to competition Memorial Day weekend (5-23-09). Since then, he has gotten 3 new double Qs and almost 80 points. For us that's pretty good.  Trevor is still somewhat balky and creepy on the dogwalk, but we're making good progress on it in practice.

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Love at Any Age

My dad, who is the original dog lover in the family, will be 84 in August. A few years ago, he lost his beloved dachshund Rugby at age 14. Here is an old photo of Rugby with a wall of snow behind him:



My dad and Rugby had been inseparable, especially after my mom died. Rugby even co-signed my dad's email. So when Rugby died, my dad missed him terribly. He still had his rescue cat Fanny, and he tried to tell himself that that was enough. Being almost 84 my dad has his share of health problems, and starting over with a new dog after so many years with Rugby seemed impossible.

At first I pleaded with my dad to look for a new dog and I inundated him with rescue ads from craigslist. But he didn't seem to have the will to pursue it, so I gradually gave up and tried to respect his decision. But it still felt wrong to think of my dad without a dog.

About 6 weeks ago I called my dad, and he had some news. He was in touch with his local dachshund rescue. They had a middle aged male "tweener" named Otto that they thought would be perfect for him. He might be picking up the dog soon.

A few days later I got a frantic call from my sister. My dad had Otto, and things were going badly. Otto wasn't housebroken, and he had been on a destructive rampage since arriving at my dad's house. He was terrified of my dad's yard. My dad was getting discouraged. My sister ordered me to call my dad immediately to "save the adoption." As she expressed it, Otto got along with my dad's cat, this was as good as it was going to get, and we had to make it work.

I called, expecting the worst. Who knows, maybe Otto had even been returned to the rescue already. I braced myself. As soon as my dad picked up the phone, I knew Otto wasn't going anywhere. My dad sounded happier than he'd sounded in ages. He proceeded to tell me every cute thing Otto had done over the past 48 hours. Yes, there was that housebreaking thing, but he was sure they'd work through it.

After our phone call my dad found the old dog crate in the attic and set it up. He worked out his housebreaking strategy. He spent an entire weekend sitting outside reading the paper, watching Otto out of the corner of his eye, waiting for an opportunity to lavishly reward Otto for peeing outside.

Now a month later, Otto is 99.9% housebroken. He's good pals with Fanny the cat. He and my dad go on long walks on the canal every day. He spends hours exploring the yard that initially seemed so terrifying. Welcome home, Otto!