JJ's Page...Please Pray For Him

JJ is our five year old French Bulldog. We are so thankful for all you have done for Winston. Unfortunately as Winston was recovering JJ had an emergency and we learned that he has some ongoing problems. It is easier for me to explain this in a letter form...I hope you do not mind. Also, just two weeks ago JJ developed a bacterial infection and is battling with that as well all over his body. He is on antibiotics to help with it, but it will take time. Please, please pray for his recovery.

It is with a very heavy and broken heart that I write this. As most of you know our Winston had to have emergency surgery in April and then developed an infection. It’s been a long road with him and he’s almost at 100%. However, yesterday something happened to JJ and we don’t know what. He was never out of our sights so it was not from a traumatic event or anything. It happened so suddenly. He lost the ability to use three of his legs, he couldn’t breathe on his own and his bottom half had no feeling. I rushed him to the vet and they immediately rushed him to the North Carolina State Veterinary Hospital, where he remains. I will never forget the pain in his eyes.

We strongly need your prayers right now. We can’t believe we’re going through this again, but we need to rely on our true friends and ask for your prayers. Also, if you could pass this on to your friends or repost we’d be so thankful. The more people that provide prayers, the better. We are crying out to God. We’re not asking why us again….instead we’re asking the Lord will you help us. He answers prayers and we need every single one.

We truly love each of you and thank you all for caring for Winston so much. We never thought within a few weeks we’d be faced with this again with JJ. It hurts so much that I can’t explain the pain to you. I’m at a loss for words.

Thank you for reading.

Love and Blessings,
Sharon
Winston, JJ & Gracie’s mom

P.S. Please feel free to pass this on to your friends through MySpace, Facebook, Twitter, email or whatever method you choose....we'd be so appreciative. We need all the prayers that we can get for JJ.

UPDATE: 06/26/09:

JJ's MRI and CT Scan results showed he has a congenital birth defect on his brain and a ruptured disc. His spinal cord--what little he has left--is filled with CSF (cerebrospinal fluid). He also has paralysis in his back legs. This is very serious and we have a lot of things to deal with. If he has to have surgery, which there is only a 50/50 chance for him, I don't know where we'll get the funds from since we just spent $6,000 to save Winston's life and over $4,000 on JJ for this hospital stay. Basically the doctors are putting him on "bed rest" for six weeks to see if he gets better without surgery and all we can do is pray he gets better. Surgery for him is too risky. He's home now and getting plenty of rest. We have to carry him when he needs to be moved or taken outside and he's on two pain meds every eight hours. He is also taking a medication to try to reduce the CSF. Despite all he's going through, and the occasional crying when the pain gets too bad, he's still the sweet little dog that always has been. Please, please, if you will, pray for him.

For now I'll keep updating this blog and Winston's website at www.wingrace.com. Thank you for reading and being our friend. We love each and every one of you.

God Bless,
Sharon & Nathan
Winston, Gracie and JJ

JJ, a 5 year old castrated male French Bulldog, was presented to the NCSU Small Animal Emergency service on 6/17/09 for further evaluation of a progressive hind limb paresis with ataxia, cyanosis, and respiratory distress. JJ's owners report that other than some skin issues (bacterial pyoderma), JJ has not had any previous medical problems and was completely normal until yesterday (6/16/09) when he was uninterested in eating that morning. Later that day, he became restless and his respiratory rate increased. Additionally, he was having trouble going upstairs and seemed weak in his hind limbs. Both his hind limb paresis and respiratory rate and effort seemed to worsen through the next morning and throughout the day (6/17/09). He was then taken to his regular veterinarian where

he would not stand, his respiratory rate and effort remained increased, and he had lost conscious proprioception in his hind limbs in addition to his ataxia. He was given hydromorphone for pain management for a suspected spinal injury and referred to NCSU.

JJ's owners note that he has never had any major medical problems in the past and additionally has not had any recent vomiting, diarrhea, or increased urination/drinking. They did comment that to their knowledge JJ had not urinated today (6/17), but he also had not eaten anything in 24+ hours and had had very little to drink. They did not witness any toxin ingestion or traumatic incident, although JJ is known to jump off of the bed instead of using the stairs provided. He was also very reluctant to lift his head up and was favoring his neck.

JJ does have a history of some dermatological problems that sound like a bacterial pyoderma. He has been receiveing 500mg of Cephalexin SID for the past 7-10 days, although he did not receive this medication this morning. JJ receives a monthly heartworm preventative (Sentinel, given 2 days ago) and is on a flea and tick preventative (Frontline Plus). His appetite had been normal until yesterday and he eats Iams Adult Lite dog food.

Physical Exam Findings:

A= QAR, anxious Hydration= <5% dehydrated T= 101.6 F P= 90 bpm R= 156 rpm MM= cyanotic

EENT/oral: eyes clear OU, no nasal or ocular discharge noted; bilateral stenotic nares

PLN: all peripheral lymph nodes palpate within normal limits

CVR: lungs clear over all fields, significant strertor and stridor; no murmurs or arrhythmias ausculted, pulses strong and synchronous

MSI: well muscled, full hair coat, BCS 7/9; small <1cm multifocal areas of erythema with crusts present mostly over the ventrum GI/UG: abdomen soft and non painful on palpation, no gross organomegaly appreciated; rectal exam: prostate of normal size and non painful, feces present- formed, normal

Pain Score: 0-1/4

Neurological Exam Findings (6/18/09): Mental Status - Quiet and alert

Posture - Normal, holds his neck tense and slightly extended

Gait - Ambulatory paraparetic

Palpation - No evidence of muscle atrophy

Postural reactions - Decreased CP in both hindlimbs, decreased hopping in both pelvic limbs. Normal CP in both forelimbs

Cranial nerves - Within normal limits

Spinal reflexes - Withdrawl reflexes normal in all limbs, normal patellar reflexes

Sensation - Panniculus present bilaterally; mild reluctance on range of motion of neck

Lesion localization - T3-L3, also possible cervical

Results of Diagnostic Tests:

1. CBC: unremarkable

2. Chemistry panel: hyperphosphatemia (7.4), mild hyperglycemia (132)

3. UA: USG 1.060, trace protein, trace blood, 2+ bilirubin

4. Thoracic radiographs: Unremarkable thorax; Breed associated thoracic vertebral anomalies; In situ disc mineralization

5. Cervical spinal radiograph: Numerous thoracic vertebral anomalies; consistent with breed; No definitive cervical abnormalities

Possible osteochondrosis of the humeral head, presumed right

7. Cervical MRI: Caudal occipital malformation syndrome is present with crowding of the cerebellar vermis at the foramen magnum. This is resulting in extensive cervical syringohydromyelia extending to at least T5 and beyond. The syringohydromyelia comprises up to 70 to 80% of the cross-sectional the spinal cord at multiple sites. Mild bilaterally symmetrical hydrocephalus is present.

Cervical discs are relatively well hydrated and there is no evidence of a compressive spinal cord lesion as result of disc disease.

There is a hemivertebra present at T3. Mild midcervical dorsal articular arthritis is present.

18. Thoraco-lumbar MRI: Thoracic hemivertebra and sacrocaudal anomaly consistent with breed. Extensive cervical syringohydromyelia extends from the caudal cervical region to the cranial aspect of L3 and is most severe in the cranial thoracic

region. In the least affected regions, the syrinx comprising at least 30% of the cross-section of the spinal cord and up to 70% in the most affected regions. Disc herniation L4-5 with hematoma over the body of L4. Disc material is slightly more left sided.

JJ's acute hindlimb weakness is the result of a extruded disc and subsequent hemorrhage compressing his spinal cord at L4-L5 disc space. This is the process that caused JJ's acute decompensation; however, the MRI revealed a malformation of the back of his skull

that has resulted in extensive syringohydromelia (fluid within the spinal cord). This fluid accumulation is a chronic process and likely has been developing dlowly sicne JJ was born. Because the synringohydromelia is so severe, we are not recommending surgery for

his disc hernition at this time, as JJ is walking and the risks of surgery are high.

Since JJ is walking, he will likely continue to recover from this disk herniation to some degree. It is very important to keep JJ cage confined for the next 4 weeks to ensure continued healing and no recurrence.

Unfortunately, JJ's long-term prognosis for his ability to walk is guarded. The fluid accumulation within the spinal cord has slowly atrophied JJ's spinal cord and therefore is walking with only a small percentage of his original spinal cord. This means that JJ has very little reserve, and if he has another injury, such as a disc, and/or as the syringohydromelia progresses, JJ will likely lose the ability to walk. We are starting a medication called omeprazole which helps reduce the production of CSF and therefore may help slow the progression. If JJ's condition worsens, we may need to make a difficult decision or trying to surgically decompress the disk despite the risk involved. We also could add in a steroid (prednisone), which also helps reduce the CSF production.

2. Omeprazole 10 mg: Give 1 tablet every 24 hours to aid in lowering CSF production.

3. Gabapentin 100 mg: Give 1 capsule every 12 hours as need for pain or hyperesthesia.

Activity: JJ should be strictly confined for the next 4 weeks. He should be kept in a cage or small room with a non-slick surface. During this time he should be carried outside and walked on a leash to go to the bathroom and then come right back to his crate. It is very important that he not undergo any vigorous activity, jumping, climbing stairs, running, or playing with other dogs during his recovery.

If you have any concerns with how your pet is doing, or would like to schedule an appointment, please contact the Neurology Service at 919-513-6692 or 919-513-6714 (fax). For after hours emergencies, call 919-513-6911. There is a veterinarian on call 24 hours a day.

NOTE: If your pet is in need of emergency aid and you are not able to get to the NCSU VTH quickly, please seek care at the nearest veterinary emergency facility. Take these discharge instructions and current medications with you so that the treating veterinarian will know as much as possible regarding your pets' medical condition.

Owner/Agent Faculty	Stacy Dillard, DVM Residents	Lindsey Rademacher, Student Clinical Technician
Dr. Karen Munana	Dr. Zachary Niman	Jane Tesh, RVT
Dr. Natasha Olby	Dr. Ryan Gallagher	Lena Smith, RVT
Dr. Christopher Mariani	Dr. Sarah Moore	Donna Webb, LVT
Dr. Peter Early	Dr. Stacy Dillard