# Update: Poor Biscuit is back in ER



## vinhle68 (Mar 19, 2012)

Hello SM Family,

We are sad to report that poor little Biscuit is back in ER again and is in critical condition and under close observation. He started to experience very light and minor seizure activities yesterday and we rush him into the ER right away. His condition throughout last night was supposedly minor with several repeat of light twitching of his head, overly salivating at the mouth, and occasionally runs around in a clockwise pattern. 

However, the light seizure continue throughout today and at around 6PM PST when we were on our way to visit him, things turn for the worst where the seizure started to worsen and more constant where the emergency staff had to make a quick decision to fully sedated him so the activities would stop. The sad and heartbreaking part is when Ann and I came in to visit him, while we thought he was completely out due to the medication, he actually try to wake up because we thinks he senses us there mostly for his momma, and it was hard to see how he was twitching uncontrollably. His mouth was clapping as well. Ann broke down in tears and all I can do is consulted her.

At this point we are told to wait it out and hopefully the heavy medication will stop the seizure and allow Biscuit to rest. It's going to be a long and tough night for the both of us not knowing what will be the outcome. There is hope that tomorrow he would be stabilize enough for us to transfers him down to the ER facilities more closer to home and that we will be resuming the treatment with the original neurologist.
I'm sorry for the long email but I felt as I need to share this with someone. Please join us in prayers for our boy to tough it out through this. 

Blessing...rayer:


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## AshleyAndSophiePup (Aug 24, 2012)

Oh, sweet Biscuit. I'm so sorry y'all are going through this with him, I couldn't even imagine the pain and heartache you and your wife are going through. Y'all will be in my prayers.


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## Sylie (Apr 4, 2011)

Oh Vinh, I am so sorry. I hold dear, sweet little Biscuit close to my heart and hope he will be okay. He is such a sweet adorable little puppy...I wish you can find a way to heal...or at least control this illness.


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## Katya (Nov 14, 2012)

I am so sorry to hear about Biscuit 
Will be keeping you and your little boy in my prayers tonight


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## Zoe's Mom88 (Apr 25, 2011)

Vinh and Ann. I am in tears reading that Biscuit is again not well. I know how hard this is for you both. I pray he will recover and you will have him home with you again. I really am so very sorry. Please keep us posted. Prayers and hugs to you and sweet Biscuit.


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## Snowball Pie's Mommi (Oct 16, 2008)

Dear Vinh and Ann ... my heart and prayers go out to you and your beloved and darling Biscuit. I am so sorry you have to go through the pain of seeing your precious little fluff baby suffer with the seizures. 

You are not alone ... so, please do not apologize for anything. Your SM family is here for you. Please keep us updated. I will pray that you will be able to transfer Biscuit closer to your home and neurologist tomorrow. 

I love the name Biscuit. I have a close friend whose dog is also named Biscuit.

Hugs and prayers for all of you.


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## CorkieYorkie (Apr 10, 2012)

Oh no, keeping biscuit in our thoughts 

Courtney, Ozzie & Lisa 


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## aksm4 (Nov 28, 2011)

im so sorry Biscuit is in my prayers tonight xoxo


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## Grace'sMom (Feb 22, 2012)

Praying for Biscuit.

It can take time to find the right meds and doses to manage the seizures.... which sadly means they end up like this again  Will be praying that his doctors find the right combo for him soon!


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## eiksaa (Jun 8, 2012)

Thinking of your baby.


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## michellerobison (Dec 17, 2009)

Oooh, lots of prayers and hugs for Biscuit for a fast recovery.I'm so sorry for you and Biscuit going through this..


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## Lynzodolly (Sep 15, 2012)

Sweet loving thoughts and prayers go out to you and your wife Ann from one poorly puppy owner to another I pray all will turn out good for wee biscuit xxx


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## tmbs (Dec 10, 2012)

I am new to this forum, but am so sorry to hear about your poor pup and will be praying for him.


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## hoaloha (Jan 27, 2012)

Vinh and Ann, I am so sad to hear that Biscuit is in the ER. It brings back painful memories and I know you guys are scared, anxious, and sad. I hope that he will make it through and that the vets can control his seizures. :HUG:


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## mysugarbears (Aug 13, 2007)

Vinh and Ann, i'm sorry to hear about Biscuit...hopefully he can get stabilized enough to be transferred to a closer ER. I will continue to keep Biscuit and your family in my prayers. :grouphug:rayer::grouphug:


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## socalyte (Nov 15, 2010)

Vinh and Ann, I am adding my prayers to the others that Biscuit will be all right and get through this stressful time. My little Maltese named Dolly had seizures after she got pancreatitis, so I know how horrible it is to watch. Please let us know how Biscuit is doing when you get an update. Our hearts ache for you.


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## edelweiss (Apr 23, 2010)

Sending you Vinh & dear Ann all my heart-felt concern today! I am so sad to hear about your little guy landing in the ER again. I know you must be so distraught! It is so difficult to feel helpless, but there is always hope! He is a little fighter, for sure.
Try to keep positive as it will help him---pups are so in tune w/our feelings.
We ALL send you a group hug and will be praying diligently for wisdom for your care gives, skill and much strength for you both. Please keep us up-dated.


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## Leila'sMommy (Oct 20, 2012)

Oh, poor little Biscuit! I am praying for him now and for y'all. I hope the medication will get the seizures under control. 


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## maggieh (Dec 16, 2007)

I'm sorry you are going through this with sweet Biscuit. Hoping he had a restful night.


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## pippersmom (May 21, 2012)

I am so sorry about Biscuit. Praying that they find the correct medication and he recovers quickly. Your post brought tears to my eyes.


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## Furbabies mom (Jul 25, 2011)

Oh no! I'm so sorry the Biscuit is back in the ER. Praying for the Dr,s to have the wisdom to treat this little one, and that he'll recovery.


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## ckanen2n (Jan 2, 2012)

Oh Vinh and Ann, I am so sorry to hear about Biscuit's seizures. Praying he is stabilized and the neuro can get this under control! Kisses for your baby!


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## Snuggle's Mom (Jan 3, 2008)

Oh, I was truly sorry to hear about little Biscuit not being well again. May today find him feeling better and hopefully the meds will kick in to get him better. Praying for all of you for a positive outcome.


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## Tanner's Mom (May 27, 2005)

Oh, poor little guy. Prayers for him & you.


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## Zoe's Mom88 (Apr 25, 2011)

Just checking in. Prayers that his meds will be adjusted and he will feel better ASAP.


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## revakb2 (Sep 8, 2006)

Prayers for Biscuit and both of you.


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## maltese manica (Nov 6, 2012)

Praying for Biscuit. hugs to all of you at this time.


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## Ladysmom (Oct 19, 2004)

I am so sorry Biscuit is so sick. I will pray for a good outcome.


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## wkomorow (Aug 26, 2011)

I am so sorry that Biscuit is not feeling well; I hope the medicine helps.


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## Maidto2Maltese (Oct 19, 2004)

Oh I'm soooo sorry your little Biscuit is having such a hard time. My heart goes out to you and your wife as you await the Drs getting to the right meds to help him!
Sending out prayers for you all!


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## MoonDog (Jun 6, 2011)

I'm so sorry for what this poor little baby is going through right now. I'll be praying for Biscuit as well.


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## Sylie (Apr 4, 2011)

Please let us know how Biscuit is doing today.:grouphug:


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## Maglily (Feb 3, 2009)

I'm so sorry to hear this about Biscuit, I hope and pray he's doing better.


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## ladodd (Jan 8, 2012)

My thoughts and prayers are with you. I pray your sweet little boy recovers quickly and is back home soon.


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## vinhle68 (Mar 19, 2012)

Hello SM Family! 

We're deeply grateful for the overwhelming loves, hugs, supports and best wishes for our little boy Biscuit! And especially for us, his parents as well as Biscuit and us rough it out in the next few days.

Here is the latest on Biscuit conditions. Well he hasn't made any forward progress as far as decreasing the seizure activities. The only thing that keeps him from the constant seizures is heavy dose of PropoFlo to fully sedate him to stop the seizures. At one point between now and last night, he actually seem to gotten a little better by getting on all fours and was able to do his business but as soon as they lower the dose level of the PropoFlo, his seizures would return within 1-3mins. PropoFlo (propofol)

We got this assessment at around 8AM PST this morning and we told that we need to make a decision to elevate Biscuit treatment to the next critical level. The Neurologist and medical experts has assess and consulted on Biscuit condition and they now recommend we start to administer the drug called “Cytosar” http://www.bvns.net/up/file/BVNS_cytosar.pdf

They are going to start administer this drug and see how Biscuit respond in the next 12hrs. If his condition improves and the seizure decrease or stop all together, they will decrease the doses accordingly. They need to monitor and assess Biscuit’s conditions and responsiveness from today until at least Thursday. They are hoping for the best and that this step will actually be a positive help for our boy. If that is not the case, then they said to consider a decision to allow them to step into doing surgery on our boy. They said this is one of the last resorts where they will see if there is any chance or anything that can be done to eliminate the potential inflammation that is causing the seizures.

Ann and I are preparing for the worst and we’re still praying for our boy to make it out of this. We’re also hoping to get more perspectives and feedback on any known experiences and whether there maybe any other form of options and treatments we don’t know about that could give our boy a chance. If you wish to message me privately here is my email address [email protected]. Biscuit has been with us since he was born and was a healthy, lovable, and spoiled by his parents for good years. And suddenly in a short period of time, he went through some very rough experiences. We are heartbroken to see our boy suffer like this especially Ann. We are forever grateful to everyone for your overwhelming support, love, and hugs!


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## Lynzodolly (Sep 15, 2012)

Dear Ann and vinh I have a very poorly boy myself with IMHA but I'm lucky he didnt have the seizures ..
I hope and pray your baby comes through this keep your chins up ad trystay as positive as you both can my prayers are your tonight xx


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## pippersmom (May 21, 2012)

I am so sorry there hasn't been any improvement yet and will continue to say prayers for Biscuit.


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## Sylie (Apr 4, 2011)

:crying::grouphug: I can't even speak. I look at that beautiful, funny little face and....:crying 2:


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## Furbabies mom (Jul 25, 2011)

Praying for Biscuit , you and your wife. There is probably someone here who can help you, regarding the meds and different options. Hopefully someone will see this thread that has some experience with some similar situation.


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## mary-anderson (Jan 12, 2010)

So sorry your precious Biscuit is not well. I will pray they can find the proper treatment for him.


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## Snuggle's Mom (Jan 3, 2008)

I was truly sorry to read the latest post regarding little Biscuit. Saying prayers that a solution will be found for him that will enable little Biscuit to respond to the meds and that he will not have to undergo any surgery.


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## MoonDog (Jun 6, 2011)

I'm thinking of you both as you go through this with Biscuit. Hold tight to each other and try to be strong for your boy. I pray that God will restore his health and that he'll be feeling better soon.


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## Zoe's Mom88 (Apr 25, 2011)

Ann and Vinh. My heart goes out to you both. I know this isn't easy. There are a few different meds they can use, so hopefully the one you posted will be the magic one. Praying it will be determined soon which will work and Biscuit won't need the surgery but at least its an option if need be. Hugs to you both. Please keep us update.


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## babycake7 (Jan 30, 2012)

Sending you and your wife and precious Biscuit positive energy and prayers.


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## edelweiss (Apr 23, 2010)

I sure hope Pam will jump in here & offer her advice---she really is our SM Guru when it comes to this particular issue! She has a broad medical knowledge & a wealth of experience w/this sort of neurological issue!
Oh, my heart is heavy with you.


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## Ladysmom (Oct 19, 2004)

edelweiss said:


> I sure hope Pam will jump in here & offer her advice---she really is our SM Guru when it comes to this particular issue! She has a broad medical knowledge & a wealth of experience w/this sort of neurological issue!
> Oh, my heart is heavy with you.


I agree. Pam went through encephalitis with her Lola and is very knowledgeable. 

I am so sorry for Biscuit and his worried mommy and daddy.


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## LoveLucy (Mar 18, 2012)

So sorry that little Biscuit (and his two humans) are going through so much. I'm also keeping him in my thoughts and hoping they find the right meds to give him much needed relief.


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## Snowball Pie's Mommi (Oct 16, 2008)

I have been thinking about all of you throughout the day. My heart and prayers are with you. I pray the right meds will work for Biscuit soon.


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## Summergirl73 (Sep 18, 2011)

Lifting up prayers for you all.


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## Zoe's Mom88 (Apr 25, 2011)

Thinking about Biscuit and hoping he is on the mend. My heart goes out to you all.


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## Maisie and Me (Mar 12, 2009)

rayer:rayer:rayer: for your precious baby boy and for you and Ann:wub:


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## Mia's Grammy (Jul 27, 2012)

Yall are in our thoughts and prayers.


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## Malt Shoppe (Jul 20, 2011)

Vinh & Ann....please know we all hurt with you over Biscuit's health issues. He's so precious. Many are praying for him and you.

I pray they can help this little guy. We know how hard it is to see them sick; it's devastating. I feel so bad for what you are going thru.


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## Snowbody (Jan 3, 2009)

Just came on and saw that poor Biscuit is going through these terrible seizures. I"m praying that he will respond to the new medication. It has to be so very hard to see him going through what he has. Don't give up hope and I know, if the time comes, you will put him ahead of all else. This just isn't fair. :smcry:


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## mysugarbears (Aug 13, 2007)

Vinh and Ann just came to see if there was an update on Biscuit and to let you know that Biscuit, you and Ann continue to be in my prayers. :grouphug:rayer::grouphug:


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## Lynzodolly (Sep 15, 2012)

My thoughts and prayers are with you and Ann and poor wee biscuit xxx


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## edelweiss (Apr 23, 2010)

Holding out hope for our little guy and his loving family. . . please take care of each other & let us know how you ALL are. . . hugs.


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## Isabella's Mommy (Nov 20, 2012)

I will keep Biscuit and your family in my thoughts and prayers. 


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## socalyte (Nov 15, 2010)

Ann and Vinh, little Biscuit is still in my prayers-- as are you. I know how hard this is, but medicine can help and miracles do happen. Hugs to you both.


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## vinhle68 (Mar 19, 2012)

Hello to all of our extended SM family! I have just got caught up to everyone's prayers and well wishes for Biscuit and for us, and it really took a big weight off my shoulder and knowing that there is always hope for our little boys through everyone caring and positive outlook. 

Here is the latest on our boy Biscuit. From my last update, Biscuit did experience one moderate seizure episode around 8-9am this morning and this is roughly 1hr after they started to administer the new Cytosar chemotherapy medication. Since then and throughout the day and until our last visit this evening which is around 9-10pm he has not experienced any further seizure repeats! Just this update alone is giving Ann and I hope, as well as the team of experts treating Biscuit, that it could be a positive response to the new medication. However it is still too early to tell and we are now looking forward to every hour and each day progressing. 

We were able to speak to his current specialize medical doctor, and his original neurologist today to get a fair assessment of the current and future outlook for our boy. They all are hopeful, in high spirits, and at the same time gave us an honest and fair assessment. Biscuit condition is extremely serious and considers threatening with little chance of full recovery. However, they did give him a fair 50/50 chance to have a positive outcome from the treatment. The have also prepare us for the worse case which is to decide if we want to proceed with the risky surgery if and once we reach that stage. 

The great news is that during our afternoon visit today, Biscuit was fully sedated and sound asleep resting with no further indication of seizure activity. When Ann started to comfort him, we can tell even in his deep sedated state, he can feel, hear, and smell the sense of his mom and he was indirectly responding. A little while afterward during the visit he actually forces himself to open his eyes so he can just peek at his mommy! We both were overwhelmed with a moment of relief, and then naturally of course were down to great grief seeing out boy in this condition. But we did follow your recommendation and try our best to contain our sad feelings and try to be as positive and encouraging as we comfort the little guy. 

During the late evening visit, we were astound that Biscuit was actually seem to be progressing positively and he was actually lying there still 75% sedated but his eyes was open and he was simply lying there staring around. Again, he immediately show signs that he recognize his mommy and me and we can tell as we start to talk and comfort him, his eyes and ears moves which indicate he's responding. We had to take a break from the visit to make way for other activities but when Ann return again for a last few minutes of time with him, he was actually trying to stand up with his two front paws but he keep slipping cause of the anesthesia. LOL it was funny and heartwarming to watch but also sad at the same time. The nurse was actually worry cause the last time he tries to sit up was because we were leading into a seizure episode. However that did not happen and once we got home we call back to check on him and still he is free of any repeat of seizure activities. This is very promising everyone and we're hopeful and praying that the Cytosar is actually having a promising and positive response. What the doctors are intending to do is to start lowering the level of PropoFlo as Biscuit continue to response well to the Cytosar. The goal is to take him completely off PropoFlo. 

Ann and I originally had plan to flight with Biscuit into New Orleans to visit Ann's family for Christmas and to also celebrate her youngest sister's wedding. We did consulted with the doctors on this and it is recommend that Biscuit should not travel anytime soon so we are making arrangement either cancel the trip all together or depending on how well Biscuit gets, we could possibly have him stay with the medical staff for 2-3 days while we fly in, celebrate the wedding, and get home to our boy. We're not fond of this plan especially to be away from our boy for 2-3 days when he needs us most so we're still considering a full cancelation. This is not flying well with my in-laws but in my opinion, they will have to understand and accepts our decision! 

I'll post some pictures we've taken from the afternoon and evening visit so share with our extended SM family! Biscuit send his love, hugs, and thanks for all of your well wishes and prayers! :aktion033::chili:


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## edelweiss (Apr 23, 2010)

Oh my, how could you not love & pray for the well-being of that little, helpless tyke! God have mercy! 
Thanks Vinh & Ann for posting an up-date. Be assured that you are doing a top-notch job (as is your medical staff) for your little Biscuit. Great parental skills! 
I know the pressure you feel under in having to decide what to do about the family situation---it is a very difficult call and whatever you decide, we will support you! 

Prayers to continue for Biscuit, you both, and the medical team. If you can just buy a little time it can help w/the healing. I love it that the staff is so honest w/you. I pray that you will have the strength to follow your heart in all your decisions. We are pulling for you 100%! Warmest hugs.


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## Snowball Pie's Mommi (Oct 16, 2008)

Thank you for the update, Vinh and Ann. You are such loving and devoted parents to your precious sweetheart, Biscuit. It has got to be such a comfort for him to know you are both there for him. I am looking at the pictures ... and, even though he is so sick, he is still gorgeous. He looks like a little angel ... which he is. I wish I could give Biscuit a kiss and hug in person. 

I pray the new medication continues to work for Biscuit ... it sounds so hopeful. If you make the final decision to not make the trip to New Orleans ... then maybe you can visit the family at a later date. I certainly understand and support you wanting to be with Biscuit, especially with him not feeling well ... he is your family, too.

I am sending love, hugs, and prayers to all of you.


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## vinhle68 (Mar 19, 2012)

Sandi! and all! Guess what???!!!! 

We just called ER for our late late last evening follow up on Biscuit  He is actually standing on all fours!!!! Oh my....we're just sitting here mixed with joy and anxiousness on how he will be tomorrow.

The nurse did say that he did vomit once and they are responding with a lite medication to help with that. Overall no further repeated seizures. Biscuit will be seen and assess by a new neurologist tomorrow and this person is also working closely with the original neurologist. They will decide how much more of the PropoFlo to lower depending on our boy condition! I'm exhausted right now but I'm too happy to sleep! lol 

I have to return to work tomorrow cause we have some major projects on the radar but Ann is free to visit Biscuit throughout the day. As soon as she send me any update, I'll try my best to pass it along to my SM family!


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## mysugarbears (Aug 13, 2007)

Oh Vinh that is wonderful and to also read that he has had only one seizure during the morning is the best news! :chili: It's amazing what the power of prayer can do and Biscuit, you and Ann have so many praying. Biscuit is such a beautiful little boy and like Marie said he looks like a little angel and what parents you are to your little boy, he is so very lucky to have you and Ann as his daddy and mommy. I know it's hard to decide what your going to do about going out of town with your baby sick. Is it possible that Ann could go alone to be there for the wedding, just know that whatever you and Ann decide we're all behind your decision 100%. Hugs to you, Ann and most of all Biscuit. :grouphug:


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## Maidto2Maltese (Oct 19, 2004)

I was so happy to read yesterdays update and THRILLED!!! to see the one this AM!!! Be assured the prayers are going out that little Biscuit continues to improve!!


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## maggieh (Dec 16, 2007)

Continuing to send prayers for you and your precious little baby!


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## TLR (Nov 13, 2011)

Just seeing this and have read through the whole thread. I needed a box of tissue to get through it but wanted you to know I am thrilled that Biscuit is responding positively to the treatment and that I will keep him in prayers as well as you and your wife.


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## Maglily (Feb 3, 2009)

What an adorable little guy....thank you for the update and I'm so glad to hear good news! We were just talking about that at work yesterday...of family living so far apart, you'll have a better idea of what's feels best for you closer to the date.


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## Zoe's Mom88 (Apr 25, 2011)

Vinh, that is such great news!!! My eyes teared with joy. Prayers that he continues to get better and that he will be home with you soon. Please keep us posted !


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## Furbabies mom (Jul 25, 2011)

What wonderful puppy parents you are! I am happy that the treatment seems to be working. Biscuit , you and your wife are in my prayers. Get well soon, baby boy!!


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## edelweiss (Apr 23, 2010)

:good post - perfect:good post - perfect

:cheer::wavetowel2::wavetowel2:

:ThankYou::ThankYou:rayer:rayer:


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## Just A Girl (Oct 13, 2012)

Oh poor baby! Bless his little puppy dog heart! I am glad to see there is improvement! I hope he continues to improve. I will keep him & your family in my thoughts. :heart:


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## aksm4 (Nov 28, 2011)

awwwwww he is adorable , praying he continues to get better and better xoxo


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## Snuggle's Mom (Jan 3, 2008)

That news that your shared with us was absolutely fantastic and so very encouraging for little Biscuit!!! He is such a sweetheart and we are all pulling for him and you too that he continues to improve. Thanks for sharing those pictures of Biscuit. Bless his little heart!!


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## MoonDog (Jun 6, 2011)

Thank you God for hearing our prayers!


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## Grace'sMom (Feb 22, 2012)

Hoping Biscuit is still doing well this morning


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## maltese manica (Nov 6, 2012)

That is awesome news!!! way to go Biscuit!!!


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## ladodd (Jan 8, 2012)

I'm so happy that you got some encouraging news. I thought about him first thing this morning. I will continue to pray for your sweet little boy and that you and Ann be given the strength during this difficult time.


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## The A Team (Dec 1, 2005)

Hoping and praying that your sweet Biscuit recovers completely....what a horrible experience you've just been through!!!


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## Summergirl73 (Sep 18, 2011)

So happy to hear that Biscuit started his day off well  . How are things going now? Fingers crossed for more good news!


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## chichi (Apr 12, 2007)

I am so sorry to hear about little Biscuit, But am so happy that it sounds like he is improving a little bit. I will pray that he continues to get better and you can bring him home.


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## summer (Dec 3, 2010)

I'm really sorry to hear that your baby has been sick. I pray that he feels better soon. Have they come up with a diagnosis yet? 

I read that rosemary can cause some toy dogs to have seizures. I have no clue what your baby eats, but Many dog foods do contain rosemary. But of course there are many things that can cause seizures. I thought though I should pass on the information about rosemary because many people aren't aware of it. Feel better biscuit. Hugs


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## Ladysmom (Oct 19, 2004)

summer said:


> I'm really sorry to hear that your baby has been sick. I pray that he feels better soon. Have they come up with a diagnosis yet?
> 
> I read that rosemary can cause some toy dogs to have seizures. I have no clue what your baby eats, but Many dog foods do contain rosemary. But of course there are many things that can cause seizures. I thought though I should pass on the information about rosemary because many people aren't aware of it. Feel better biscuit. Hugs


Unfortunately, Biscuit was diagnosed with encephalitis recently:

http://spoiledmaltese.com/forum/52-...l-info-biscuits-recent-seizure-condition.html


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## Sylie (Apr 4, 2011)

I am so happy to hear that dear little Biscuit is doing better. I continue to hope for all full recovery, or at least management of this condition.

I know it doesn't really count, but I give you full permission to cancel your trip. Seeing how he responds to Ann's presence, I think it is really important for both of you to be there for him. If you were to take this trip, and Biscuit went down hill, whether or not it was due to you absence, you would feel guilty forever. You would break down in sobs and pain for years to come...possibly after the marriage you attended ended. (Sorry, I have been to weddings of marriages that lasted less than two years.) Perhaps, you can promise to attend their first, or tenth anniversary instead. I'm just offering an opinion...just in case it helps.
Oh, the pictures were wonderful to see. Biscuit has such a sweet little face...his aunties just love him to pieces. 
Be well, sweet baby.


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## Zoe's Mom88 (Apr 25, 2011)

Hoping all is well with Biscuit tonight. My prayers are with all of you. Please keep us posted. HUGS!!!!!!


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## Snowbody (Jan 3, 2009)

Sounds like Biscuit is doing better. :wub::wub: You must be so glad considering all the seizures from before. I know it's all guarded but praying that he does well. I don't think I could leave at this time while Biscuit's going through this. Would you really enjoy yourselves? I think not.


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## vinhle68 (Mar 19, 2012)

Good Evening SM Family!

Another day another update on our boy Biscuit. We just got back from an hour visit with our boy. Things are definitely looking promising each hour and day forward. Biscuit is blessed to have all of the support and prayers from his SM Aunties and Uncles! 

He is also blessed today with the involvement of another Neurologist Dr. Rebecca Windsor and she is adding some new perspective to the diagnosis, prognosis, and additional treatment options. The great news is that she doesn’t believe surgery is necessary for Biscuit at this time. 

She said her goal is to get Biscuit completely off the PropoFol Anesthesia because she doesn’t like the idea of having him on that for lengthy period simply to contain the seizures. So as of today she has introduce a second anti-seizure medication Phenobarbital and another drug which I don’t have the name yet but will update once I can talk to the doctor. 

This morning as the doctor started Biscuit on the new treatment process, they also try lowering his PropoFol level down to .25% in which Biscuit did experience a mild seizure, so they immediately brought him back up to .50% which eventual stop the seizure from repeating. 

At the time we got in to visit him today, we found out that as of 4PM today he was completely off the PropoFol and has not experience any seizure! Yay!!! I translate this as great forward process! :chili:Having said that the new treatment and meds continue to heavily sedated Biscuit but he seem to be resting comfortably and his vital signs are all normal. He is having slight problem cycling fresh air into his lung probably due to his sedated condition and when he shifted his head in the wrong position, it interfere with the airflow. So to help with this the boy got a device that flow oxygen right next to him! What an amazing staff of professionals! SAGE staffs are very professional, sincere, and cares about their customers’ love ones. :aktion033::aktion033::aktion033:

Ann and I actually brought 2 sets of Holiday Gift Sets for the morning and evening staff today! Just to show our gratitude, appreciation, and mostly accommodating and tolerating us! 

It’s funny someone say pets are tuned to their owners cause every time Ann walk in to visit and Biscuit hears her voice, we notice he immediately try to response even in his sedated stage! It warms our hearts each and every time we see Biscuit responding to our present so it’s a long but promising path ahead and we can’t wait to get our boy home with us. 

p.s. yes we are now 99% sure we will be canceling the trip so we can be here for our boy during his critical fight for his life. Thanks for all of your perspectives and encouragements.


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## Lynzodolly (Sep 15, 2012)

Vihn and Ann my dear friends I have left you a long detailed message on my thread welcome home Albert from which you replied to me with the kindest sweetest message .. Come on little biscuit !! We're all rooting for you little baby  keep your chin up both of you my heart is so heavy for you both xxx


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## Leila'sMommy (Oct 20, 2012)

Aww, that sweet little boy! He sure is a fighter! I'm still praying he continues to improve and can be back home with you soon. He looks so sweet laying there in those pictures. Thank you for sharing them with us. From the looks of his hair, it looks like it's also being cared for too. I would've expected it to extra messy from the seizures and laying around. I know it's not important compared to the seriousness of what he is going through, but the little things can also help you know the total puppy is being cared for. I'm glad they were able to wean him off the propofol and hope the antiseizure medications work well for him.


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## lols82 (Nov 13, 2012)

What a gorgeous little fluff. I hope your little Biscuit gets better really soon, and I'll keep Biscuit in my prayers x


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## TLR (Nov 13, 2011)

So glad to hear Biscuit has been siezure free with the new medication. Lets hope as the sedation levels off, his oxygen increases and he can come home soon. My prayers are with all of you.


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## Zoe's Mom88 (Apr 25, 2011)

Vinh and Ann, I am so happy for the good news and no surgery!! Praying that the meds work and he will be home with you soon. I really enjoyed seeing the pics of him....he is so sweet. Biscuit is a lucky boy to have such a great Mommy and Daddy. Hugs!!!


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## Furbabies mom (Jul 25, 2011)

I'm so happy that Biscuit is responding to the meds, and no more seizures. He is so beautiful and he has fantastic puppy parents!! Praying that he continues to improve , and gets to go home soon! My prayers continue for Sweet Biscuit.


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## Ladysmom (Oct 19, 2004)

Wonderful news!


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## mysugarbears (Aug 13, 2007)

Oh Vinh and Ann that is wonderful news that Biscuit seems to be improving. It's just the best news ever, continuing prayers for you, Ann and Biscuit. Please give a gentle kiss to Biscuit from his Auntie Debbie and hugs to you and Ann.


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## Bibu (Jun 3, 2010)

Oh my goodness! I just read your entire thread now and your updates and from what it all started with, Biscuit seems to be doing really well now. I am not an expert in any of the medicines they are giving him but I'm sure you are in excellent hands. The pictures of Biscuit are so tender and they make me want to lay in the cage with him and cuddle. We'll be checking back for updates on little Biscuit but until then stay strong as he's a tough boy!!!


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## Malt Shoppe (Jul 20, 2011)

Vinh & Ann....so good that Biscuit continues to improve.

I totally understand your decision to cancel the trip; I made the same decision once when my precious Maltese, Truffles had seizures. Actually it was the advice of the vet since we had been traveling alot (w/Truffles).
I fully agree; I'd have to stay with my beloved baby too.
I had another Maltese suffering from seizures; she was put on Phenobarbital and it helped her.
I pray that precious Biscuit continues to improve. Love your sharing of pictures of him; he's so cute.


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## SammieMom (Nov 13, 2010)

Vinh & Ann - I read your story today, (and Marj's link) hard not to be :crying: I am so sorry your sweet boy is in hospital. The photos of Bisquit -- OMG, so sweet :wub: So happy the new Vet was able to get him off the anesthesia. :thumbsup: Will be praying the seizures stop. You have done an amazing job getting best care for your boy, and you stay so focused and strong giving positive vibes throughout your visits. Biscuit is lucky to have you for parents. 
Hoping today is even a better day. :wub:
xxxx


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## Madison's Mom (Dec 26, 2007)

Praying for Biscuit's continued improvement.


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## MoonDog (Jun 6, 2011)

Vinh and Ann, it sounds like your boy is in the best of hands! How I hope and pray for a day very soon that he'll be strong enough to go home with his Mommy and Daddy.


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## Lynzodolly (Sep 15, 2012)

Prayers still for biscuit , uncle vinh and auntie Ann from wee Albert , and lyndsy xx


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## vinhle68 (Mar 19, 2012)

Day-4 since seizure's repeat on Biscuit!  As you can see I'm in a joyest mood as ever! I have great news on Biscuit to share with his SM Uncles and Aunties.

Dr. Windsor latest update was that Biscuit is now on all fours, not 100% steady yet, but he got up and try to stagger around inside his mid-size cage!:clap: :yahoo:mostly bumping and tipping over as we goes. 

Due to his great progress and responsiveness to the new medication, probably due the Phenobarbital, the doctor have also remove him off of the Valium all together. The greatest news of the day is that if he continue the forward progress and no further seizure relapse, he will be coming home with his Mommy and Daddy this Friday! :dothewave:


Most joyest to hear is that Biscuit is eating like a champ! hahaha after 3 days of no food I can see why Fatty is chowing down some grubs! The staff is only feeding him liquid food and most likely that will be what he'll eat for a few weeks until he is strong enough to eat solid food.

Dr. Windsor also add that the amount of Cytosar (chemotherapy) drug being administered is so very little, she don't think we have to worry about all of the potential side effects or pre-caution when handling and taking care of Biscuit. 

She also add that he's not completely out of harm's way yet and the road to recovery will take time and great cares for our boy. Biscuit will need to come in every two week to continue the chemotherapy sessions, and as time pass and his condition continue to improves (meaning no seizures) the period in which he needs to perform the chemotherapy will gradually be extended further apart.

We had intended to visit him today but Ann change her mind as she did consult with Dr. Windsor about potentially adding unnecessary stress to Biscuit at this critical recovery time if he sees her. So we agreed to hold off visit until Friday when he can come home with us. A huge weight and worry is now off our shoulders and have turn to joy and anxiousness to soon be with our pride and joy and having him home again with us.

None of this would be possible without the overwhelming supports, prayers, and well wishes from Biscuit's SM Aunties and Uncles! :cheer:

We'll post new pictures of our Biscuit shortly when he's coming home this Friday! 

Loves and hugs....Vinh & Ann & Biscuit!


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## Ladysmom (Oct 19, 2004)

Great news! I will continue to pray for you, Biscuit and Anne.


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## mysugarbears (Aug 13, 2007)

Vinh, that is just wonderful news!!! :chili::chili: :chili: I will continue to keep you, Ann and Biscuit in my prayers. :grouphug:


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## Madison's Mom (Dec 26, 2007)

Fantastic news!


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## Zoe's Mom88 (Apr 25, 2011)

Vibh and Ann....I am crying right now reading your post. YIPPEEE!! I am so happy and overjoyed with his progress. This is fantastic and I cannot imagine how happy you both are that he will be home soon. I think the vets who are managing him right now are fantastic. For the past week I have waited for your posts to see how things are going. So happy for you all and cannot wait until your baby is home with you both again. YEAH!!!!!!!!!!! Hugs to you!!!! : )


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## vinhle68 (Mar 19, 2012)

Awwe Barbara, it's a blessing to have you as a friend here and thank you for keeping all of us, especially Biscuit, in your thoughts and prayers! God blessed you and your little love ones.

We'll continue to provide update on Biscuit as we approach Friday and beyond.


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## edelweiss (Apr 23, 2010)

:cloud9:

I know you are both on cloud 9, and w/all feet firmly planted in hope! :chili::chili:
I had a little guy on phenobarb almost the entire (almost) 17 yrs. of his life. The vets kept trying to change it, but finally decided it wasn't worth all the trouble it would bring on when they did that! That was a long time ago & I know they use other drugs today that were not available then, but I am very happy for the results. He did continue to seizure, but not as often until the end. He lived a LONG & relatively happy life! :thumbsup:

So, Friday will be a big day here! I know you are so ready to bring Biscuit home. It really is amazing how he is responding! Praying for happy days.


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## hoaloha (Jan 27, 2012)

I'm so happy that biscuit is doing better!!! What a strong little Fatty  hehee! I hope he continues to make great progress


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## maggieh (Dec 16, 2007)

That is wonderful news!!! I hope your baby continues to improve day by day!


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## Furbabies mom (Jul 25, 2011)

:chili::chili: great news!!! It will be wonderful to have Biscuit home with you!!!Hoping that he continues to improve!!


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## pippersmom (May 21, 2012)

That is fantastic news! :aktion033: :chili:


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## TLR (Nov 13, 2011)

Wonderful news, I know Friday can't get here fastest enough.


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## SammieMom (Nov 13, 2010)

Vinyl-
So happy for you all. :wub: Sounds great this little guy can be home for Christmas now with you and Ann :aktion033: I know you have a ways to go but thank goodness he is being taken off some of the meds. 
xxxx


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## wkomorow (Aug 26, 2011)

How fantastic, he is doing better


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## Snuggle's Mom (Jan 3, 2008)

That is just the very best news ever and I am sure that Biscuit will indeed improve with each and every day. Waiting to see some "coming home" pictures of little Biscuit. Your news is so very positive and encouraging!!


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## Bibu (Jun 3, 2010)

Oh yey!!! That is so exciting and I'm sure you can't wait to snuggle up with him again!


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## vinhle68 (Mar 19, 2012)

Quick update for everyone. Doc just called saying she's putting Biscuit back on IV to get some more steroids, cause he is just lying there and not standing on all fours. He was standing today most of the day and was eating up a storm but for now he's just simply lying still. Well this did not go well with Ann so we think we'll going to pay him a visit and see how the boy's condition is. I'll update everyone shortly.


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## Ladysmom (Oct 19, 2004)

vinhle68 said:


> Quick update for everyone. Doc just called saying she's putting Biscuit back on IV to get some more steroids, cause he is just lying there and not standing on all fours. He was standing today most of the day and was eating up a storm but for now he's just simply lying still. Well this did not go well with Ann so we think we'll going to pay him a visit and see how the boy's condition is. I'll update everyone shortly.


Ahhh, I am so sorry. I know how hard this is on you and Ann. We are all Team Biscuit here so we will continue to pray for him.


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## SammieMom (Nov 13, 2010)

Bless his heart. :innocent: Maybe he perks up with your visit. Get well little Biscuit.:wub:


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## Zoe's Mom88 (Apr 25, 2011)

Hopefully Biscuit is just missing the two of you and will perk up when he hears and sees you both. I feel like all will be well with him. Prayers and hugs to you all. Please update as soon as you can.


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## Snowball Pie's Mommi (Oct 16, 2008)

Vinh, I just read your update. I continue to pray Biscuit will get better. Maybe he is just lying there because he is tired from standing more today? I am so sorry for what you, Ann, and sweet Biscuit are going through. I hope he can still go home with you tomorrow.

Sending love, hugs, and prayers to Biscuit, Ann, and you.


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## vinhle68 (Mar 19, 2012)

*False alarm!*

Oh I feel really bad for what I think could be false alarm! :w00t: Gosh I think both Ann and I are at a point now where we're suspicious and panic everything we hear something unpleasant. :wub:

We decided to call the night shift nurse first before heading up to visit Biscuit and she said he seem fine and he was sleeping at the time we called. She said his vital signs seem normal and that he sleeps most of the day and still eating like a champ. Every now and then he gets tired of sleeping and he'll get up to try to walk around but mostly stumble about more like it, and then go back to sleep. 

So we still thought it woudl be best to not visit him tonight and possibly add more stress to the boy when we leave so we'll wait for tomorrow news from Dr. Windsor to see if she will give us the green light to discharge Biscuit! 

We're really sorry if we've cause any tension for the great Aunties and Uncles!


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## Lynzodolly (Sep 15, 2012)

Hi vinh and Ann ... Hope you had a peacefully night , I hope biscuit an come home soon did you get my pm about alberts symptoms you were wanting to know  my prayers ad alberts are with you xx


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## edelweiss (Apr 23, 2010)

I know from experience the stress of the "ups and downs" Vinh, esp. of the seizures from our little Kirby! It is hard not to go up high w/the highs & down low w/the lows---when every fiber of our being is living and breathing each breath they take. Oh, I so hope little guy can come home this wk-end, but I know you will do what is best for him when the call comes. Sending your courage & HOPE!


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## aksm4 (Nov 28, 2011)

Still praying for little Biscuit oxoxoxox


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## Zoe's Mom88 (Apr 25, 2011)

Continued prayers for Biscuit. Hopefully today your news will be more positive and you can take your sweet baby home. My heart goes out to you both.


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## Madison's Mom (Dec 26, 2007)

Praying little Biscuit gets to come home to you today!


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## lmillette (Apr 23, 2012)

My prayers are with you and Biscuit. Hoping he gets discharged to go home with his family. Please keep us posted on his progress.


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## Maglily (Feb 3, 2009)

Thinking of you and Biscuit and hoping he's doing better today.


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## Furbabies mom (Jul 25, 2011)

Praying for Biscuit, today.


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## CorkieYorkie (Apr 10, 2012)

So glad you guys are taking sweet little biscuit home!!!


Sent from my iPhone using Petguide.com Free App


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## SammieMom (Nov 13, 2010)

Vinh-Ann--Sending healing prays for sweet little Biscuit today! rayer:rayer:rayer:


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## vinhle68 (Mar 19, 2012)

*Latest on Biscuit*

Hello Team Biscuit!  I got tied up in a key project at work so I have not been able to update everyone. 

We are now looking at possibly taking Biscuit home today Sunday 12/15/12. He was suppose to be discharge yesterday but they we got a call that the doctor made a minor oversight and gave Biscuit an overdose of Phenobarbital which is why they thinks he's being so unsteady and un responsive. So they immediately increase the Steroids dosage to help stabelize him. I understand that sometime minor mistake like this could happen but it didn't go well with Ann at all. 

Secondly I am started to have more concern about the treatment methods and whether it is the right combination that will help our boy. I'm getting addtional opinion and one that is highly recommended to us was to consult with a Dr. Allen Sissen, supposedly one of the top Animal Neurologist based out of the Boston MA area. We're gathering data to have a thorough consultation visit with him as we speak and he is recommending that we'll fly out to Boston with Biscuit so he can better assess the situation and determine the appropriate treatment. Base on the initial information we've provided to Dr. Sissen, he said the steroids dosage being administered is too low and not agressive enough to help Biscuit and that Biscuit could be at a critical stage that needs immediately response with the correct medication dosage. Hearing this from Dr. Sissen is now highly concerning me and I'm making plan to probably head out to see him as early as Tuesday 12/18/12.


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## Lynzodolly (Sep 15, 2012)

Oh vinh and Ann I hope you get the answers and help you need my thoughts and prayers are with you ,, poor baby biscuit we love you Albert says come on wee mate get better  xxx


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## lmillette (Apr 23, 2012)

Poor sweet boy. I'm thinking and praying for you and Biscuit. Please keep us posted when you can.


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## Ladysmom (Oct 19, 2004)

I am so glad you are taking Biscuit to Dr. Sisson. He's the best in his field.


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## edelweiss (Apr 23, 2010)

Vinh, I was hopeful Pam would jump in as she is well-versed in this kind of critical care.
I concur w/what I know that Dr. Sissen is your BEST bet. I know that Sammie (SM user name: Piccolina) used him too w. good success although she lost her baby in the end due to a choking hazard rather than the illness. She was seeing good results. She flew w/her baby & met w/Dr. Sissen. You may want to PM her---she is also in CA.
I know Ann must be near the edge, and with good reason! Give her a big hug from me & know that you remain faithfully in my prayers.


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## Zoe's Mom88 (Apr 25, 2011)

Vinh and Ann. So sorry that happened....you can deal with that later but at this point taking him to Boston to the specialist is great. Hugs to you, Ann and sweet Biscuit. I really believe once all is stabilized he can live life with his Mommy and Daddy. Please keep us posted.


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## zooeysmom (Aug 1, 2011)

Dear Vinh and Ann, 

I havn't been on much lately, but I have been praying for you and Biscuit. I hope that Dr. Sissen will be of help to your sweet baby.

Love,


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## ladodd (Jan 8, 2012)

Prayers to you, Ann, and the sweet boy. I hope that you can make arrangements to see Dr Sisson.


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## vinhle68 (Mar 19, 2012)

*Welcome home Biscuit!*

Happy Saturday SM Family! Aka: Biscuit’s Team! 

I’m happy to report that Biscuit is finally home with his Mommy and Daddy! :walklikeanegyptian: :walklikeanegyptian: :walklikeanegyptian: 

He is still weak, heavily sedated, and still not fully 100% yet mostly due to the recent severe seizures. The doctor said his eye sight is not 100% and that it will take a few days’ possibly even 1-2weeks to see if the vision improves. 

We’re told to only feed him small portion of soft food and to monitor is peeing and pooping activities and schedule. He’s still very unstable on all fours mostly stumbling and falling as he goes. We were told that if his strength is not fully recover, and that he lies down all the time, then to give him several sets of therapy exercises per day to stimulate and condition his muscles.

Currently he is prescribed (3) meds; two type of anti-seizure Keppra and Phenobarbital, and increase 2x dose of Prednisone steroids. He has been seizure free since last Wed which is great news and progress. arty:

It's true that once your pet come home from a long period away, he gets very anxious and excited, and pees and poops constantly. :HistericalSmiley:

If anyone wants to know about the full diagnosis and prognosis, please let me know and I’ll be happy to post them. Don’t want to bore everyone with too many details. We're finally happy and at rest with our boy home by ourside. Now the road to recovery begins and getting Biscuit ready for a flight trip to Boston!


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## edelweiss (Apr 23, 2010)

Oh Vinh & Ann I am so happy for you and your baby today!!!!! Welcome Home little guy! 
I love the pix and esp. the first one---holding in loving arms will also bring a measure of healing.
I think I speak for everyone here when I say we can't get enough info on your baby and this illness---it is an education we would not choose but one we ALL need to know as much about as possible, so fire away! To me that is the essential importance of a forum such as this. 
Please know we hold you up in prayer as you prepare for your trip to see the good doctor. Team Biscuit will be there w/you, well, in spirit at least! I know you are doing all you can and I commend you both! Blessings & traveling mercies!


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## pammy4501 (Aug 8, 2007)

Hi there. Your Bisciut is adorable. Has the vet told you he has GME or NME? If you are planning on seeing Dr. Sisson it sounds like that might be the case. I had a dog with GME and it is treatable, but can be difficult to control. Dr. Sisson has a very aggressive GME protocol. He has had remarkable success with it. The aim of this therapy is to control the brain inflamation with prednisone and chemotherapy drugs. Here is Dr. Sissons info:

The Team

Here is a forum for dog owners of GME dogs. This specific forum is a Sisson board. They will send you info on the protocol when you join the group. 

NewGMEDogs : NewGMEDogs

It's good that you have seen a Neurologist. But they don't all have the same approach to GME treatment. It is a reliefe to me that they started the Cytosar. Cytosar is one of the chemo drugs that is an immuniosupresant. GME is in most cases an auto immune disease that causes the encephalitis. Did Biscuit have an MRI? I hope so. But, if not he can still be treated. Dr. Sisson will need all of that info. 

Here is some more info on GME:

Granulomatous Meningoencephalitis

Please feel free to PM me if you have specific questions. I sincerly hope you can find answers for your little Biscuit. This is a devastating disease.


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## Lynzodolly (Sep 15, 2012)

Awww wee biscuit glad to see your home with your mamma . An papa , come on little man pick up like Albert has u can do it  ... So glad no seizures since Wednesday ann and vinh  prayers are with you xxx


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## Snuggle's Mom (Jan 3, 2008)

Oh God Bless little Biscuit. So glad that he was able to come home with you. My Prayers will continue for him and you too.


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## maggieh (Dec 16, 2007)

So glad your baby is home! Prayers that he continues to improve.


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## Summergirl73 (Sep 18, 2011)

Biscuit you sweetheart, we are all SO glad you are home! Nothing better than the love of your parents to heal you right up. Big hugs to you tiny one.


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## Maidto2Maltese (Oct 19, 2004)

Ahh seeing little Biscuit at home brought tears to my eyes! What a lil' darlin'. Will be continuing the prayers for him.
He's so blessed to have such awesome parents!! :thumbsup:


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## MoonDog (Jun 6, 2011)

Welcome home sweet boy! God has blessed you with wonderful parents who are taking such good care of you. I will be praying for your full recovery every single day. You are a very precious little boy. :wub:


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## Ladysmom (Oct 19, 2004)

What a sweet boy! I am so glad he is home and in your arms.


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## DeniseA. (Dec 5, 2012)

keeping you all in my prayers! The little man is truly blessed to have such awesome parents!


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## TLR (Nov 13, 2011)

Welcome home Biscuit. Seeing him in your wife's arm is very comforting. Prayers continued for Biscuit.


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## Zoe's Mom88 (Apr 25, 2011)

So very happy to see Biscuit at home with his Mommy and Daddy. I am sure he feels best their too. Hoping your trip to Boston will bring about a final solution for this sweet baby once and for all. Hugs to all of you.


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## Lynzodolly (Sep 15, 2012)

Prayers still sending xx


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## vinhle68 (Mar 19, 2012)

*Bisucit discharge summary from Dr. Windsor*

[Information Purposes]
SM Family, this is a full summary of our recent visit with Dr. Windsor.

Biscuit was presented for seizures. Based on his breed and MRI findings, we are most suspicious that he has auto-immune inflammatory disease in addition to the hydrocephalus and Chiari-like malformation. Although the hydrocephalus is severe, congenital malformations are typically more static, whereas auto-immune disease progresses if not treated aggressively. There are two main forms of auto-immune brain disease – granulomatous meningeoencephalitis and *necrotizing encephalitis*. Necrotizing encephalitis tends to effect the front part of the brain (the cerebrum) and cause seizures, blindness, and circling, whereas GME tends to affect the back of the brain and the spinal cord in the neck and cause balance issues and pain. Based on the MRI and Biscuit’s symptoms, it is possible that he has necrotizing encephalitis, which can unfortunately carry a poorer prognosis. In addition to doing an MRI, we often collect spinal fluid to look for inflammation consistent with auto-immune disease. Dr. Vitale opted not to collect spinal fluid in November because a spinal tap would have been risky with the malformation at the back of his skull. He was started on prednisone at the time for inflammation. Because he was started on prednisone already, collecting spinal fluid now may be inconclusive because prednisone can alter the results.

Even with spinal fluid, it is difficult to tell which differentiate the type of auto-immune disease without a biopsy, and the treatment is the same. Treatment involves suppressing the immune system with prednisone and other medications (most commonly Cytosar, and injectable chemotherapy medication used at a lower dose than used for cancer). We gave Biscuit high doses of steroids, Cytosar, and seizure medications while in hospital and were able to get the seizures under control. The anti-seizure medications often cause severe sedation, and he will likely be very sedate and uncoordinated over the next couple of weeks as the medications clear his system. He is currently on Phenobarbital and Keppra for seizures, but we may be able to taper and discontinue the phenobarbital if he has no further seizure activity. We opted to keep him on phenobarbital for now because it is a stronger anti-seizure medication than Keppra.

Biscuit is currently still blind which could be residual from the seizure activity or from inflammation in the part of his brain which processes vision. He is unable to walk yet and still tends to circle to the right. Circling is also a common symptom of a problem in the front of his brain. We need to give him more time to see if these symptoms will resolve.

AT HOME INSTRUCTIONS:
Activity restriction: Please keep his activity restricted over the next 2-4 weeks as he recovers. He should be confined to a well-padded crate or small confined area when he is not closely supervised. He should be carried outside 3-4 times daily to go to the bathroom. Do not allow him to move around excessively or roam around the house unattended. When you are home, it is okay for him to be out of the crate if you are holding him or doing his physical therapy exercises. Absolutely NO running, jumping, climbing stairs, or playing with other dogs for next 4 weeks.

Urination: Biscuit has been urinating on his own. If he has not urinated in over 24 hours, please call us. Please monitor his urine for blood or odor, as these could indicate a urinary tract infection.

DIET: Biscuit will be less coordinated when eating over the next few weeks. Please offer him small amounts of canned food by hand several times daily.
WATER: Because Biscuit doesn’t have normal vision, you will need to bring the water to him to drink.

REHABILITATION: Please follow the rehabilitation instructions provided. We may recommend long-term physical therapy depending on his recovery over the next couple weeks. ***Physical rehabilitation sessions should be conducted 3 times a day. Massage: Each session should begin with gentle massage of the limbs. Massage from the toes up to the hips. 

Patterning: Next, patterning of the legs may begin. Each leg should be moved through a normal walking pattern, upwards to “break” the rigidity. (ie. Curl the toes first, then flex the ankle, knee, and hip sequentially). Each leg should be gently patterned for 20 repetitions. The patterning exercises should be follow by standing exercises. 

Standing: Place him in a regular standing position with light support for balance. Allow him to sink to the ground, and then repeat 20 times.
Medications: Phenobarbital 16.2mg (1/4gr) Tab qty. 30. Rx: Give ½ tablet twice daily. *It is important to give this medication approximately every 12 hours and not miss a dose. Missing a dose can cause breakthrough seizures.

WARNING: Stopping this medication abruptly can cause severe seizure activity. *Common side effects of this medication include increased appetite, drinking, and urination. These effects typically persist while taking Phenobarbital and often cause weight gain. *Side effects that are common in the first 1-2 weeks include sedation, sleepiness, and difficulty walking in the hind limbs. These signs should become minimal or go away after 7-14 days. * Rare but severe side effects of Phenorbarbital include liver and bone marrow damage. Liver and bone marrow function can be monitored with routine bloodwork, and any damage is typically reversible when Phenobarbital is discontinued. *Phenobarbital causes some other changes on bloodwork that are not typically problematic. **Phenobarbital causes elevations in liver enzymes (i.e. ALT, ALP) on bloodwork, which is NOT the same as liver damage. Please consult with us before making any changes based on blood work abnormalities. **Dogs on Phenobarbital also have a falsely low thyroid level. Low thyroid level in a dog on Phenobarbital does not mean the dog has hypothryroidism (a common metabolic disease in dogs). * BLOODWORK RECOMMENDATOINS: We recommend rechecking a complete blood count (CBC), biochemistry panel, and Phenobarbital level 2 weeks after starting Phenobarbital. Follow-up rechecks (CBC and biochemistry panel only) are recommended every 6-12 months after that.

Keppra (100 mg/mL solution): Give ½ mL by mouth three times daily. Prednisone 5mg qty. 30 Rx: Give ½ tablet twice daily. Phenobarbital 16.2mg (1/4gr) Tab qty. 30. Rx: Give ½ tablet twice daily.


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## edelweiss (Apr 23, 2010)

Thank you Vinh for posting this! It is very sobering to say the least! We are all interested & learning through your process w/Biscuit---it is the least we can do to follow him in his difficult journey! My heart goes out to each of you as you suffer w/him every single moment.
SM has seen this before, but we never can know enough. I thank you for your willingness to share w/us your particular situation. All of us know that at any given time we may be in your shoes and it benefits us greatly to share w/you and learn from your experience. Biscuit is a brave little soldier, and we stand amazed at his desire to continue to survive. May God grant you Vinh, and Ann unsurpassed strength as you continue your fight for his life. Blessings, love & mercy to you.


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## Grace'sMom (Feb 22, 2012)

I'm glad Biscuit is home..... I keep praying for him. 

You are blessed to have him  He is also so blessed to have you.

I wish you all a wonderful Christmas together


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## wkomorow (Aug 26, 2011)

So glad the little one is home - all three of you have had a rough time.


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## pammy4501 (Aug 8, 2007)

vinhle68 said:


> [Information Purposes]
> SM Family, this is a full summary of our recent visit with Dr. Windsor.
> 
> Biscuit was presented for seizures. Based on his breed and MRI findings, we are most suspicious that he has auto-immune inflammatory disease in addition to the hydrocephalus and Chiari-like malformation. Although the hydrocephalus is severe, congenital malformations are typically more static, whereas auto-immune disease progresses if not treated aggressively. There are two main forms of auto-immune brain disease – granulomatous meningeoencephalitis and *necrotizing encephalitis*. Necrotizing encephalitis tends to effect the front part of the brain (the cerebrum) and cause seizures, blindness, and circling, whereas GME tends to affect the back of the brain and the spinal cord in the neck and cause balance issues and pain. Based on the MRI and Biscuit’s symptoms, it is possible that he has necrotizing encephalitis, which can unfortunately carry a poorer prognosis. In addition to doing an MRI, we often collect spinal fluid to look for inflammation consistent with auto-immune disease. Dr. Vitale opted not to collect spinal fluid in November because a spinal tap would have been risky with the malformation at the back of his skull. He was started on prednisone at the time for inflammation. Because he was started on prednisone already, collecting spinal fluid now may be inconclusive because prednisone can alter the results.
> ...


 This is all very very familiar to me. My dog Lola ended up having NME which was confirned on necropsy. We used Potassium Bromide (KBro) for seizures. Please watch the liver enzymes with the pred and phenobarb. It can shoot them up and off the charts. My only observation of this regieme is that the pred dose seems on the low side to me. And I am not seeing the continuation of the Lufonimide or Cytosar. It is the only thing that will keep his immune system in check. The goal witht he pred is to get the inflamation under control and then to wean off of it all together. Are you still planning on seeing Dr. Sisson? He will bump that pred dramatically. You are on the right track. Keep up the good work.


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## SammieMom (Nov 13, 2010)

God bless Biscuit. So glad he made it home to mom and dad.


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## Furbabies mom (Jul 25, 2011)

So glad that Biscuit is home with you. He'll be continually in my prayers, and pray that he continues to improve.


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## Piccolina (Dec 25, 2009)

Vinh and I have been communicating in private since this thread first showed up.

I have been giving him all the information of my experience at the visit in the Animal Hospital in Boston with Dr. Sisson so that they are well equipped and know what to expect.

I am very glad that they decided to go to Boston and be seen by the best: Dr. Sisson.


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## vinhle68 (Mar 19, 2012)

*Thank you!*



Piccolina said:


> Vinh and I have been communicating in private since this thread first showed up.
> 
> I have been giving him all the information of my experience at the visit in the Animal Hospital in Boston with Dr. Sisson so that they are well equipped and know what to expect.
> 
> I am very glad that they decided to go to Boston and be seen by the best: Dr. Sisson.


 
Picoolina have been a huge blessing just like everyone here who have shared concerns and optimistic to help get Biscuit better! Ann and I are both lucky to have found SM otherwise we would probably still be lost right now. :ThankYou:


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## vinhle68 (Mar 19, 2012)

*How to check for liver enzymes*



pammy4501 said:


> This is all very very familiar to me. My dog Lola ended up having NME which was confirned on necropsy. We used Potassium Bromide (KBro) for seizures. Please watch the liver enzymes with the pred and phenobarb. It can shoot them up and off the charts. My only observation of this regieme is that the pred dose seems on the low side to me. And I am not seeing the continuation of the Lufonimide or Cytosar. It is the only thing that will keep his immune system in check. The goal witht he pred is to get the inflamation under control and then to wean off of it all together. Are you still planning on seeing Dr. Sisson? He will bump that pred dramatically. You are on the right track. Keep up the good work.


Thank you Pammy! for this great tip and suggestion. What is the process to check the liver enzymes? Is this something the Vet would look for from standard bloodwork and test results?


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## Snowbody (Jan 3, 2009)

Praying for Biscuit and happy he's home. :wub::wub:


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## vinhle68 (Mar 19, 2012)

*Sharing some delima*

Happy Sunday Everyone,

We need some advice on an important issue. We have been getting a lot of tips and suggestions on increasing Biscuit’s Prednisone (steroid) doses to a higher dose to help fight the potential inflammatory progression in his brain. 

In fact in Dr. Sisson published medical newsletter, he has specifically noted that his method for treating this would be a more aggressive dose of steroids to combat the inflammation. 

We also know that generally traditional Veterinarian tends to take the more conservative approach by prescribing lower dose of steroid, which seem to indicate marginal benefit and possibly the lower doses only true effectiveness is to contain the seizure. Of course Ann and I am no expert when it comes to this matter and we’re definitely not doctors. Having said that what we do know is right before for Biscuit 2nd relapse of more severe seizures, the Prednisone doses were decreased. 

Also we spoke with another Maltese owner in the GME forum who had a dog that went through almost the same symptoms and illness Biscuit is facing and she spoke to Ann for a long conversation today sharing historical information and such. She said that at her dog was 3.5yrs but was close to the same weight as Biscuit and at the time of treatment, Dr. Sisson prescribe at least 20mg per day (10mg twice a day). 

Biscuit is currently only on a 5mg per day (2.5mg twice per day). We are seriously debating if we should just make the call and increase his Prednisone (steroid) to 10mg per day (5mg twice per day) but we're afraid if we do it without a direction from Dr. Sisson or Vet, we could be causing more harm than good.

On one side we are seriously worries that the longer Biscuit goes on with the wrong amount of medication he could be heading for more severe brain damage. Even Dr. Sisson has pointed this out. 

However, without an official consent from a Vet or Dr. Sisson to increase the dosage, we fear that making the call ourselves could even worsen Biscuit already unstable and critical condition! Gosh...this is stressing both Ann and I out and we can’t wait to be able to see Dr. Sisson.

To make it worse Dr. Sisson earliest available appointment is this Wednesday in which we will be contacting his secretary first thing tomorrow to secure the appointment. The harder part is finding flights FROM/TO Boston and back home. Ann has been searching and she said getting to Boston might be possible, but getting home would be tough. Gosh...things never seem to fall your way when you need them most! 

One good thing out of all this is that our new lady friend from the GME forum has provided us with the contact to her Vet, the one that has worked with Dr. Sisson in the past, and we have booked an appointment for a consultation with her tomorrow.

A little update on Biscuit. He's still tend to tilting his head to the right and circle tightly to the right as well clockwise. However when he roam around the house he can actually walk unsteadily and wobily but pretty straight at time at very slow motion. We also started to pay more attention when he is in a deep sleep. His breathing tends to shorten but at a more rapid rates, which usually end up with him waking up sharply and extending his tonge and pants heavily. When this usually happen either he has to poops, or thristy, or simply just panting which is an expected side effect from the meds. Every now and then he'll wake up and start opening and close his mouth like he has something stuck in it that is bothering him, but we can't tell if this is actually a lite or mild seizure happening. But we noted the incident down with date/time so we can provide the info to the Vet and Dr. Sisson.

We have created a confined comfortable spot next to where Ann sleeps on the floor with him but he hates being inside. The only thing he does inside the confined space is pees! lol some time poops. I got some pics so show how he tried to climb out of his confined space today. :HistericalSmiley:


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## pammy4501 (Aug 8, 2007)

I would not alter the meds without consulting the vets. There needs to be close attention paid to lab values (as I was mentioning earlier). How soon are you planning on seeing Dr. Sisson? Are you aware that he takes long distance consultations? Perhaps you and your current vet could arrainge this? There isn't one clear answer on this disease. Dr. Sisson is one approach. There are others. I saw Stacy Sullivan at Animal Specialty Group in Los Angeles. She was wonderful, and very well versed in Dr. Sissons work. She is alot closer and very good for us. She did right by my dog. Here is her contact info:

Stacey Sullivan, DVM :: Veterinary Neurology + Neurosurgery

And here is a short article she wrote about GME.

Immune-Mediated Encephalitis :: The Case of the Loopy Shepherd


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