Labour Day Weekend Day 4 - Neurology Consult

Mum took me to this place after my date with the 4 B's,

She said I was going to see the Stumbling Doctor about my stumbling, (mum: she meant a neurologist.)

I waited patiently in the hoooge waiting area,

When will it be my turn??

Then a nice lady came and took us to a room. She listened to my SuperHEART, and violated my MUSCLE BUTT..... (mum: she had her temperature taken)


The lady told us that the Stumbling Doctor was coming soon. See the drawing of the weird Dog X Snake creature behind me on the white board?


The Stumbling Doctor came in, his name was Dr. Sanders. He was very nice, and he thought I was very funny because I dragged mum's backpack down from the chair and started opening the zipper while he and mum were talking. (mum: there was a small bag of cheese and one boiled egg inside.)

Dr. Sanders and SVS came highly recommended to us. My friend Darwin saw Dr. Sanders when she had an owie back, and my other friend Sam had his owie back surgery at SVS.

Dr. Sanders flipped my toes, hit my knees with a hammer, and looked at my eyes with a bright light. (mum: reflex exam.) Mum had her laptop there to show Dr. Sanders videos of me stumbling. I just waited patiently for the boiled egg and cheese,


Dr. Sanders drew some funny picture on the white board. He said this is a doggie brain, and the purple ball is something bad in the brain. (mum: Pituitary Macroadenoma (type of brain tumor that causes Cushings).)


That's not my brain! I'm sure my SuperBRAIN is prettier than that.

Then he drew an X on the Dog X Snake creature. He said that's where he got an ouchie response from me, (mum: Dr. Sanders got a bit of a pain response from Sunshade at the thoracolumbar/lumbar junction (T13-L1) in the spine.)


I got bored from looking at the drawings and listening to them talk, so I thought I would show them how great my SuperBRAIN was working so they could stop saying how I might have something bad in my SuperBRAIN,


I scored an egg. See, brain working perfectly! (mum: That's Atypical Cushings acting, not normal Sunshade behaviour.....)


Mum and Dr. Sanders talked some more (while I finished the cheese chunks), and then we left the clinic.

(mum: While we were in Seattle, I took Sunshade to see a Neurologist about her stumbling.

Well, the result is inconclusive. Sunshade passed the neurological exam. Dr. Sanders said he couldn't pin point or localize anywhere that he could confidently say ok, this is what's making her stumble. Basically, Sunshade's history didn't really fit with his findings to come up with a firm hypothetical diagnose. He said he could make sense that her lower back pain (probably a chronically herniated disc or DDD) is causing her hind legs to stumble, but couldn't tie that to front end stumbling. At any point on the spine where an injury happens, you would expect functions below that injury point to be affected, not above. The "X" in the picture below is the spot where a pain response was perceived. If Sunshade had a chronically herniated disc in her neck, then the front + back end stumbling could then be explained. Sunshade's neck was fine upon palpation.



Dr. Sanders said he could make sense that a Pituitary Macroadenoma (tumor in the pituitary gland that also causes Atypical Cushings) is causing the front + back stumbling, but usually a dog develops severe neurological symptoms and is gone within a year's time untreated. That puts Sunshade at 4-6 months untreated if she does have a tumour.

The diagram on the bottom shows a normal brain with a normal Pituitary Gland (red arrow). The diagram on the top shows a Pituitary Macroadenoma (purple ball) that's putting pressure on the brain. The blue area is the part of the brain responsible for motor function. A macroadenoma can interfere with the motor function signals causing retardation in the motor function of the patient.



Sunshade was rated normal in the neuro exam performed. Her first stumble happened over 3 years ago, so that didn't really fit the Pituitary Macroadenoma profile - UNLESS the stumbles that happened 2-3 years ago were of a different origin (ie, ortho), then we could say it's of two unrelated sources causing the same symptom (stumbling). In that case, a Pituitary Macroadenoma might still stand. Another possibility is that its a separate brain tumour, unrelated to the Pituitary (Cushings), but that's stretching it a bit.

Dr. Sanders did mention the stumbling could very well be from the built up of the various orthopedic issues that Sunshade has had throughout her life, and at age 11, she's dealing with what naturally (for her) comes with that age. Front end stumbling could just be from an 11 year old with tired biceps muscles from years of over compensating due to the bad elbow. Hind end stumbling from the thoracolumbar/lumbar sacral region of the spine. He must have felt those were the more likely causes as he got his colleague, Dr. Kirkby, an orthopedic specialist to examine Sunshade as well. Dr. Kirkby had similar findings as Dr. Sanders. He also seemed to feel the front end stumbling was due to muscular weakness and aging.

I asked Dr. Sanders if there were tests I should do that would play a factor in Sunshade's longevity. He told me at this point, the only thing he would consider would be an MRI. The MRI would be able to tell us if a Pituitary Macroadenoma is present. If she does indeed have it, then we can do radiation therapy. The success rate for radiation on this type of tumour is apparently very high. The radiation therapy involves 18-25 rounds of radiation over a 3-4 week period. According to Dr. Sanders, dogs treated with radiation therapy are often older dogs, and they go on living anywhere between 2-5+ years of quality life without major neurological problems. Almost all of those dogs pass away from old age or other unrelated illnesses.

11 + 5 = 16 (years), not bad for an Airedale (not nearly enough for Sunshade...). MRI would also give us a better picture at what's going on in her lower back. Dr. Sanders mentioned back surgery could be considered if the pros out weigh the cons, and if I was willing to take the risk since back surgery could make a patient worse than before.

As far as I'm concerned, there will not be any back surgery for Sunshade, doesn't matter what the MRI say. So for me to do an MRI, it would solely be for the possible Pituitary Macroadenoma. But would I be willing to put her thorough 18-25 rounds of radiation therapy? I have no idea at this point.... SIGH..

Here is the full report for anyone that's interested, (click to enlarge)





One thing that had me quite excited from our consult was that, neither Dr. Sanders nor Dr. Kirkby got any pain response from Sunshade's bad right elbow. Some of you might recall, she had the stem-cell replacement procedure done on the bad elbow back in April of this year. Well, I'm so happy to report that the elbow that had been my main source of worry over the last 10 years is now clinically sound, even after days of being active!!! Dr. Sanders was genuinely surprised to find out about Sunshade's bad elbow and the subsequent stem-cell procedure. He said the elbow felt excellent and he was going to tell Dr. Kirkby that the dog he just examined (Sunshade) had a very successful Vet-Stem procedure. Apparently Dr. Kirkby had been wanting to take the Vet-Stem course.

For anyone with a dog/dogs with arthritis, or Elbow/Hip Dysplasia, or torn ACL (repaired or not), Vet-Stem is a great procedure to consider.)