Friday, July 15, 2011

Zephyr's Follow-Up MRI and Cerebrospinal Fluid

Even after anesthesia Zephyr was still ready for some pool time.  He also had fun running a little and rolling in the grass. 
This Tuesday Zephyr went for his follow-up MRI and a spinal tap to look at his Cerebrospinal fluid (CFS, fluid from the brain).  Things went well.  Zephyr is a lot better, but not 100% yet.  His MRI came out totally normal, nothing abnormal at all, it looked really good.  YAY!!  It's possible he still has scar tissue because often that won't show on an MRI.  Unfortunately his spinal fluid showed some abnormalities.  The CFS is taken from the base of the head and top of the neck and it showed that there is probably still some inflammation in his brain and that the encephalitis is probably still active.   It had a white blood cell count of 8 (normal is less than 5), the protein was 32 (normal is less than 25).  There is also some overpopulation of lymphocytes and macrophages, which I guess are types of white blood cells that occur when there is a problem.  She said his fluid isn't really bad, but definitely abnormal.

Because of this Zephyr has to continue with his treatment for awhile.  His blood work came back looking "boring" as Dr. Knowles put it  :-) , which is great since he's taking prednisone and phenobarbital.  Since the blood looked good he had another chemotherapy treatment this morning.  It's a little strange having to wear a glove to give your dog pills.  Zephyr is really good with taking pills no matter how I give them.  But when they're wrapped in Muenster cheese, as they always are, Zephyr is usually waiting anxiously for his meds.  After he recovers from this chemo treatment he'll probably take a mild chemotherapy drug, Procarbazine, long term, probably months.  We've also gone back to the prednisone twice a day.  So, this is disappointing.  He was so close to being normal in the fluid.  :-(  She said that when he was first sick if they would have been able to look at his spinal fluid his white blood cell count could have been up to 300 and it's 8 now.  Even if that's an exaggeration it's a huge improvement, which is great.

Astro had fun playing at my parents house while we were waiting to hear about Zephyr.  I did take Astro in the pool and he swam for the first time.  But, he did not really like it and I have the scratches and bruises to show for it.  I think we'll have better luck in a natural pool with a more gradual drop and where he can see the bottom better.
There's a possibility that the abnormalities are there because his body just hasn't cleared all the yucky stuff from the original illness out yet.  She also said that it's possible that he could just go on to heal on his own without more chemo or other medicine.  She said who knows what happens with dogs who have this disease and don't have the follow up work.  But there's no way to know these things and it's just as likely that the encephalitis is still active and that if we don't continue treatment it could come back.  Obviously I can't take that risk.  It's a bummer because he could be taking these nasty medicines when he doesn't really need them.  I'm taking the most aggressive treatment option, the Dr. and I thought it would be best even though he was almost normal.  She thought a lot about whether to give him another dose of the chemo verses just starting him with the mild chemo drug.  I think we're just trying to make sure we do everything possible to get rid of it and not risk it coming back.  Unfortunately I'll never have a 100% guarantee of it not coming back.

My cousin Mike came over to hang out for the day, which was really fun.  Astro decided it was much more fun and safer to hang out with him since clearly I had gone crazy and tried to drown him in the pool.
We're still not sure what's causing the seizures.  It could be scar tissue or inflammation from the encephalitis.  I think maybe she leans toward it being scar tissue, but there's no way to know.  I did learn that inflammation is an actual physical substance of cells, etc., verses swelling which is caused by inflammation.  I had been wondering about this because I could tell she used the terms differently.  It seems like even if he still has a tiny amount of inflammation in his brain it could disrupt things and cause seizures.  Especially combined with his brain still healing and possibly having scar tissue.  We did up his phenobarbital from 45mg 2/day to 60 2/day since he still had one seizure a week ago on 45.

Zephyr loves to hang out on the big middle step of the pool.  When he was there Astro was much more comfortable and actually came in a few times.  When you're in Phoenix in the middle of July, even on a cool day of 103 you're in the pool a lot.  It was actually really fun and relaxing, especially with the good news about Zephyr.
I'm really glad that I had this done.  Overall I think the news is good and this has definitely given us information that has allowed us to give Zephyr a better chance at complete recovery.  I think it will really help me now that I know more about what's going on and where we're at with this.  It's too bad though because he was so close to normal.  She did tell me one dog with this had to have 3 MRIs before it was normal, so that made me feel better.

After a big day Zephyr finally crashed out.  Anyone want to make bets on when the shaved patch will be all grown in?  It's from the spinal tap and actually goes up a little between his ears.  I have to put sunscreen on it to protect his pure white skin.  I tried a bandanna, which looked really cute, but it kept flopping back and not covering the top part.
He'll have to take it easy again in a few days when his white blood cell count is low.  Poor boy.  He's been feeling great though and I've taken him on some longer walks and down to Pumphouse Wash where he and Astro get all nutty in the tall grass.  It's really hard to leave him home when Astro and I are going to do things he would love.  I'm learning lots of patience with all of this.


gyeong said...

Yay for a normal MRI. It sucks he still has to take more meds, but I'd play it safe too to give him the best chance for a full recovery.

K-Koira said...

Well it sounds like over all more good news than bad news, which is great! And for the MRI to be normal is pretty awesome. And best of all is that he is feeling pretty good.

The Barn Door said...

Glad things are looking up for Zephyr. I'd rather be in the pool in Phoenix at 103 than here in Indiana at 85 and 70% humidity. Already looking forward to getting back there in the fall. I'd swim with Zephyr and Astro anytime!!!

houndstooth said...

I wish I were there in the pool with them! It's hot enough here that it would be a very welcome change!

I'm glad to hear that things are showing improvement, even if it's not as much as you were hoping for! Hopefully the extra diligence will pay off and he'll have it beaten soon!

Sue said...

So pleased the MRI was normal. Shame his counts weren't normal, but they are obviosuly almost there. Hope he can get through the treatments and come out the other side a healthy lad.

That pool sure looks inviting.

Song and I are sending you and the boys hugs.

Greyhounds CAN Sit said...

So near and making lots of progress:) I hope everything continues so well, you and Zephyr sure deserve a break! Fingers and paws crossed for only good news from now on. It's wonderful that he can relax in the pool and go for some longer walks.

Never Say Never Greyhounds said...

A spinal tap sounds so awful. Makes me cringe. Great pool with a nice step for dogs. I hope all tests come back boring soon.

Michelle said...

Yay for a good MRI!! Progress is being made for sure. :) We will keep you guys in our thoughts!

My guess on the fur growth is 2 1/2 months. :)

Grey Lady said...

Zephyr looks so cute even with the shaved patches. Try to stay cool!

Jennifer said...

Glad the MRI came back normal! Hugs to the pups...