Saturday, October 11, 2008

Back To Dr. Norwood

Carmella saw Dr. Norwood for the first time in over a month. I got her up early this morning and she had her first bath since she had been diagnosed. She can finally now get into the water without fear of disease-progression. It was still pretty new to her and so she was a little nervous about getting rinsed off and then dried with a hair dryer, but got through it and felt spry and renewed, barrelling down the hall in the house, and when my ride got here to go to the vet she bounded up for that rare ride in the car.

When we arrived a little early there were several other dogs in the waitingroom, and my friend who lives near me brought her cat at the same time to have her claws clipped. The office is divided in half in the center of the room with a seperate entrance for cats and the other for dogs, so we had to sit across the room from each other and shout over the central office cubicle in order to talk, so we did little of that.

A small Bichon Frise came in and Carmella whined and pulled at the leash as though it were a rabbit she wanted desperately to get to, and then a large black male dog entered not long after that appeared to be part Labrador and possibly a little bit of Newfoundland. Both he and Carmella were straining and wimpering loudly, wanting to play. Christian soft rock played from a speaker mounted at the top of the counter, and I noticed that they were also selling scented candles as a sideline. I suspected that the economy left them with less regular business, so they were trying to supplement what losses they had taken due to that. Felicia came over and petted Carmella and commented on how good she looked. Then said to me, "You are one of the most determined women I've ever met."

"Yes, but Carmella really is a miracle" I responded.

It wasn't long before Carmella was called back, and Gwen came in and took down the information about what her current situation was. I reminded her about the anticonvulsant and that Carmella needed to be wormed again (I'd seen one crawling right out of her yesterday), and asked if Dr. Norwood had said any more about publishing her case history. She said he hadn't said anything else to her since the day the drug reps had come.

Carmella jumped up on her and darted around the room in excitement. She seemed to be able to feel the love coming from her and from the other staff and she remembered all of them. Gwen took her into the other room where there was a scale and weighed her. She weighed 31 pounds (1 more than last week). Her weight has more than doubled in the time they'd been seeing her!

After awhile Dr. Norwood came in. He had cut his hair and looked refershed from his trip to Aruba. Around his neck hung a large shark's tooth on leather string. He was not wearing his usual glasses. He came in smiling and Carmella went over and jumped up on him right away. He asked how she was doing and I told him she got through the procedure with no problems, that Dr. Muller used saline with the NDV instead of the delutant, and that aside from the usual jerking everything was going well.

Then I asked about his publishing and he said that he would like to do it jointly with Dr. Muller rather than seperately, but that he hadn't gotten in touch with him yet about that, that he was going to soon.

He said as for the anticonvulsant that he could write a prescription and I could get it filled at a regular pharmacy since the same drugs are used in humans.

I asked about a minor thing about Carmella's nose (some intermittant snorting that developed over the past few weeks that sounded related to congestion) and he said that most likely it was allergies but if it got any worse to let him know. He said there was not much they could see up the nose without putting a scope up it anyway.

Then he left the room to look at some books regarding Phenobarbital and Klonapin, saying he'd come back with a prescription.

I waited for some time and he did not return. Then the male vet tech came in and told me that Dr. Norwood had decided not to prescribe an anticonvulsant after all, but would just monitor to see if there were any seizures that came on later. My mouth fell open. I said didn't he know that myoclonis is a form of seizure, and he said that he took it to mean a Grand Mal seizure. I told him that having had this myself in the past and both me and my son seeing neurologists this had been explained to me by doctors as a form of seizure and that they do prescribe anticonvulsants for this too. I asked why Dr. Norwood offered to give Carmella Klonapin before she was treated and now that we don't have to worry about masking it that he does not want to do it when it's appropriate. I told him on no uncertain terms that Dr. Sears, the Distemper expert had recommended it and that he was not going to be happy about her not having it, that the jerking was interrupting her sleep, and I'm sure it's exhausting. He said he was just passing on what Dr. Norwood told him to tell me and kind of shrugged. Then I asked if he remembered about the worming shot and he looked like a deer in the headlights.
He flipped through Carmella's chart absent-mindedly. "Didn't she just have it?"

By that time I was starting to really get annoyed. "Yes, over a month ago. A worm just crawled out of her butt yesterday, so she needs to be treated for it again."

"They get those from fleas. Have you seen any fleas on her?"

"No, not recently, but she did have a few before I got her on flea drops. She's on Vectra 3D. Also she's on heartworm preventative that's supposed to also cover other types of worms. " I described what came out of her yesterday as a white worm with a triangular head.

"That only protects against round, hook, and whipworms, not tapeworms. That sounds like tapeworms."

"Gwen wrote that all down and I told them over the phone that she had worms again and needed it again. Are you not reading the chart? Also, would you please have him come back in here (Dr. Norwood)?"

He said OK and then went to get the worming stuff from the back.

He took a long time. Then Gwen came in and said they were getting ready to close and could I come out to the waitingroom, and I told her I was waiting for Carmella to have her worming shot and to talk to Dr. Norwood about something else.

"She hasn't been given that yet?"

"No, the vet tech didn't seem to know anything about it. I had to remind him. Somehow he's not getting the message of what's been written down here."

She went back and hurried him up and soon he came in with the injection. Gwen held Carmella and he gave her the shot, saying it might sting a little. Carmella wimpered slightly and then it was over.

I went out, settled up my bill with Felicia at the front desk, and then saw the friend I'd come in with standing near the side exit door.

"Aren't you done yet?" That seems to be her mantra. This woman has gotta-go-gotta-go syndrome. It doesn't matter where we go, she's always "gotta-go."

Gwen said, almost; that I just needed to speak with the doctor for a minute.

I went back into the room and Dr. Norwood entered soon after. We had the same conversation I'd had with the vet tech regarding Myoclonis and he claimed it was muscular, not seizure. He said he'd show me the book. In a minute he came back with a medical book to show me the definition of myoclonis. Although it did not list a cause it alluded to it, referring to a "disorder involving motor neurons" and that it "originates in the CNS." I pointed out how all that is true and it is not mutually exclusive of seizure, that upon EEG patients with myoclonis show seizure activity in the brain. He may have meant well but he didn't seem to fully understand what causes myoclonic jerking. Granted he is a GP of veterinary medicine but I think my human GP would know the answer to that question. The issue is really that he has never had a case of myoclonic jerking, only seen Grand Mal seizures.

Then I also told him about Carmella's incessant need to chew on people all the time and how it coincided with the time period in which the jerking began. He responded that we don't have any way of knowing whether it is due to something that resulted in the brain or not. He seemed to feel that if he didn't know then he was going to assume it was behavioral. I said that I'd trained many dogs and that she was very intelligent and I'd successfully trained her to do other things, but this so far I've been unable to break her of. I also said that it did not seem to transfer to long-term memory if she stopped once in awhile. She'd go back to it again as if she'd never learned not to the next time.

Then he brought up the possibility of liver damage. "I don't want to fill her up with drugs", said Dr. Norwood. "I usually give this to dogs that are having convulsive falling down, foaming at the mouth type symptoms. I usually give it for a full year."

"Dr. Sears says it will take 4-6 months..."


"...before we'll see any improvement in the jerking and that she should be given treatment for neuro symptoms in the meantime until the NDV started allowing her stem cells to create new myelin. He says this will help all neuro symptoms. He might not even think a whole year is necessary."

"Let's just see if the treatment works and that's all we can do" Dr. Norwood said edgily. "I can show you the protocol. It says for seizures. Maybe he just meant as a preventative."

"Talk to Dr. Sears and lets get this clarified."

"OK, I'll talk to him on Monday".

If it looks like it will be OK to prescribe it can you call it in? My friend was going to pick up her own medication at the pharmacy today so we thought we'd get Carmella's at the same time, but it's always iffy as to when she can bring me out here."

"Yes, I can do that. I'll call him Monday and let you know."

I thanked him and he asked me to schedule another check-up for Carmella at 6 months. We agreed that she might aught to have antibody tests to confirm a clean bill of health in the body and another spinal tap through Dr. Muller every year for the next 3 to confirm the virus is gone in the CNS.

My friend, V had taken her cat home and then come back and was waiting for me in the parking lot. The door was locked and I had to get Gwen to unlock it for me.

"V left to take her cat home."

"She's very antsy" I said motioning out the exit. She's waiting out in the car."

"She doesn't like to wait around?"


I came home, put Carmella back in the kitchen, and went to Sams Club with the same friend, came back, and let Carmella out in the back yard to run around while I vaccuumed and mopped the kitchen floor. It was kind of hot and stuffy in the house so I opened the front door and turned on the ceiling fan. When the floor was dry I let Carmella back inside. I washed a load of dog towels and her two black cushions. Now everything smells fresh. Carmella's fur is nice and soft, and she's all comfy and cozy.

Be sure to take a look at Carmella-cam and watch her live in the kitchen. You may catch her doing something really cute!

Next order of business is to try to find a vet school that does the test on the strain of Distemper found in Carmella's cerebrospinal fluid. There's a researcher in Italy who told me he'll do the test for free and I'd just pay shipping but it turns out shipping to Italy for something that needs to get there soon is around $111.00. Also, they may consider sending active Distemper virus through the mail a bio-hazard. Their list of prohibited or restricted items to that country is pretty extensive and open to pretty broad interpretation. Uh...I think I'll pass on sending it there, LOL. I'll keep checking with US university vet schools. Maybe Auburn does it (in Alabama).

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