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Hi everyone,

Penny is 2 years old and has suddenly come down with some mysterious behavior. She has always been extremely hyper and kind of nervous - always licking, panting, barking, etc, but she is the sweetest girl in the world.

She has been having "episodes" where she stumbles, falls over, has trouble walking straight, etc, and ends up vomiting and defecating/urinating uncontrollably. Each episode lasts about 5 minutes, though the last one was more like 10.

Here is what has happened so far:

Incident #1: Penny was stumbling around, acting almost drunk. Vomited and defecated around the house. Lasted 5 minutes.

Incident #2: Same day, about 20 minutes later at the vet's. Stumbling, vomiting, defecation. Lasted 2-3 minutes.

Incident #3: 2 days later. Holding paw up strangely; stumbling, vomiting, urination. Lasted about 5 minutes.

Incident #4: 9 days later (yesterday). Happened while we were not at home - vomit and diarrhea found in her kennel.

Incident #5: Same day, later in the evening. Stumbling, vomited 4 or 5 times, defecated, urinated. Got the stumbling on video this time. Lasted 10, maybe even 15 minutes.

Blood sugar, blood panel, and abdominal x-rays looked fine.

Last week, we had a bile acid test done. Penny's pre was 26.1 and her post was 56.0, so abnormal but not indicative of a shunt.

Other than acting somewhat lethargic (possibly due to the sudden warm weather) and having some loose but controlled stools, she has been fine in between episodes.

After talking to our vet, we are going to do an ultrasound to check for a shunt, and if that's negative we plan on treating Penny for MVD with diet and meds (assuming she's stable and not getting worse). If she isn't stable, then we will take her to a neurologist to check for something like meningitis or encephalitis.

Any other thoughts on what this could be? I'm worried I'm going to make the wrong decisions and do the wrong tests, and only find out what's wrong once it's too late. All of this just came on so suddenly. Any help is greatly appreciated.
 

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:crying:I'm so sorry. Poor baby. Did your vet check about seizures? That's all I could think of.
 

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Any change in the diet? Did she eat something different? We had a 7 month puppy whose owner fed a few almonds and was walking into walls and acting lethargic, and got diarehhea. Of course I have to ask this , has she had any vaccines lately?
 

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Discussion Starter #6
Ultrasounds are not that reliable for detecting liver shunts. Since her BAT results were so low, I'd get a Protein C test to rule out a liver shunt.

Comparative Coagulation -- NYS Animal Health Diagnostic Center

If a shunt is ruled out, I'd be very concerned about GME:

gme

Where do you live? Anywhere near a vet school?
Ugh GME sounds awful. We live only an hour or so from Tufts.

Is a shunt possible with her BAT levels? We have our fingers crossed that it's MVD but I'm worried her symptoms are too severe for that to be realistic.

Emergency vet mentioned it could be epilepsy, but the neurologist wants to rule out liver abnormalities as a potential cause first.
 

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I don't have a clue...thought about seizures popped in mind, but really don't know. I hope and pray the Vet finds out exactly what it is quickly and Penny gets well.
 

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Any change in the diet? Did she eat something different? We had a 7 month puppy whose owner fed a few almonds and was walking into walls and acting lethargic, and got diarehhea. Of course I have to ask this , has she had any vaccines lately?
She had her kennel cough, lyme, and lepto vaccines about 3 wks before it started. We did titers for everything else (parvo, distemper, and something ekes I can't remember) and those came back fine.

She was kenneled the weekend before the first incident, so she would have eaten different food then.
 

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Ugh GME sounds awful. We live only an hour or so from Tufts.

Is a shunt possible with her BAT levels? We have our fingers crossed that it's MVD but I'm worried her symptoms are too severe for that to be realistic.

Emergency vet mentioned it could be epilepsy, but the neurologist wants to rule out liver abnormalities as a potential cause first.
If she was my dog, I'd get a Protein C test done, then, depending on the results, get a referral to Tufts.

Lady has been epileptic for 10 years and what you describe is not typical. Idiopathic epilepsy is usually a progressive disease, usually starting with a few seizures a year.

A vet school will be able to do all the proper diagnostics, then put everything together.
 

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I would see a neurologist. It sounds seizure-like.
Treating for MVD is kind of silly...it is extremely rare for a dog with MVD to have any symptoms. While unlikely a shunt a Protein C is a better test than an ultrasound.
 

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You said that her last episode was captured by video. Can you post it? Maybe some of the others may have knowledge to what may be happening by seeeing the video.
I hope she's okay.
 

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i'm so very sorry you and penny are going through this. i agree that a visit to the neurologist is in order, her behaviors seem very similar to seizures i've experienced with my first maltese. i hope its nothing too serious and is easy to control with medications/diet. *hugs*
 

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i would get a referral....sounds like its progressing fast so i would seek specialist. a csf tap is in order or mri.
 

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Discussion Starter #14
Hi everyone! Thanks so much for all your ideas and warm thoughts for Penny. Made appts with Tufts. We're going to an internal medicine specialist there to rule out all the liver issues. Then, we'll probably do a neuro consult and see if they feel any tests are appropriate.

I realized today, with probably 90% certainty, that all of the episodes followed relatively shortly after a meal. We're going to start monitoring her eating more closely in order to help confirm this if she has another spell.

Fortunately, Penny is her same energetic and sweet little self in between these episodes. Hopefully it stays that way!
 

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Hi everyone! Thanks so much for all your ideas and warm thoughts for Penny. Made appts with Tufts. We're going to an internal medicine specialist there to rule out all the liver issues. Then, we'll probably do a neuro consult and see if they feel any tests are appropriate.

I realized today, with probably 90% certainty, that all of the episodes followed relatively shortly after a meal. We're going to start monitoring her eating more closely in order to help confirm this if she has another spell.

Fortunately, Penny is her same energetic and sweet little self in between these episodes. Hopefully it stays that way!
I am so glad you are taking her to Tufts! When is your appointment?

What are you feeding her? Dog with liver shunts cannot handle the ammonia red meat produces and can become very symptomatic after eating.
 

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If your dog has those symptoms after eating and perhaps has a shunt, I've read that low protein, low purine foods works best. Maybe some chicken breast and white rice would be better right now.
 

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Will be keeping you in my prayers and positive thoughts for the right answer to this puzzling question... Hopefully it will be something easily treatable and this will be a nightmare you can soon forget... *fingers crossed*
 

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Ugh GME sounds awful. We live only an hour or so from Tufts.

Is a shunt possible with her BAT levels? We have our fingers crossed that it's MVD but I'm worried her symptoms are too severe for that to be realistic.

Emergency vet mentioned it could be epilepsy, but the neurologist wants to rule out liver abnormalities as a potential cause first.
Marj and Jackie are right. If you want a more reliable, less expensive test you should have a Protein C test done. An ultrasound is only as good as the radiologist reading the ultrasound and liver shunt is not an easy thing to find even for the very best radiologists. If you are that close to Tufts and your dog's symptoms are not liver related but more likely neurological I would suggest making an appointment with Dr. Allen Sisson at Angell Animal Medical Center in Jamaica Plain. He truly is the best of the best and has a great deal of experience with Maltese and other toy breeds suffering from neuro issues like epilepsy and GME. If you are closer to the western part of Massachusetts and don't mind driving, the best of the best for liver issues is Dr. Sharon Center at Cornell University Vet School. I live in Massachusetts and although I live very close to Tufts I myself would go to Angell or Cornell because I know that they are the very best in the northeast for liver and neuro. I don't dislike Tufts and would go there in a heartbeat for orthopedic issues.
 
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