# Episodes of stumbling, vomiting, urination/defecation



## PCB (May 26, 2010)

Hi everyone,

Penny is 2 years old and has suddenly come down with some mysterious behavior. She has always been extremely hyper and kind of nervous - always licking, panting, barking, etc, but she is the sweetest girl in the world.

She has been having "episodes" where she stumbles, falls over, has trouble walking straight, etc, and ends up vomiting and defecating/urinating uncontrollably. Each episode lasts about 5 minutes, though the last one was more like 10.

Here is what has happened so far:

Incident #1: Penny was stumbling around, acting almost drunk. Vomited and defecated around the house. Lasted 5 minutes.

Incident #2: Same day, about 20 minutes later at the vet's. Stumbling, vomiting, defecation. Lasted 2-3 minutes.

Incident #3: 2 days later. Holding paw up strangely; stumbling, vomiting, urination. Lasted about 5 minutes.

Incident #4: 9 days later (yesterday). Happened while we were not at home - vomit and diarrhea found in her kennel.

Incident #5: Same day, later in the evening. Stumbling, vomited 4 or 5 times, defecated, urinated. Got the stumbling on video this time. Lasted 10, maybe even 15 minutes.

Blood sugar, blood panel, and abdominal x-rays looked fine.

Last week, we had a bile acid test done. Penny's pre was 26.1 and her post was 56.0, so abnormal but not indicative of a shunt.

Other than acting somewhat lethargic (possibly due to the sudden warm weather) and having some loose but controlled stools, she has been fine in between episodes.

After talking to our vet, we are going to do an ultrasound to check for a shunt, and if that's negative we plan on treating Penny for MVD with diet and meds (assuming she's stable and not getting worse). If she isn't stable, then we will take her to a neurologist to check for something like meningitis or encephalitis.

Any other thoughts on what this could be? I'm worried I'm going to make the wrong decisions and do the wrong tests, and only find out what's wrong once it's too late. All of this just came on so suddenly. Any help is greatly appreciated.


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## Snowbody (Jan 3, 2009)

:crying:I'm so sorry. Poor baby. Did your vet check about seizures? That's all I could think of.


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## Ladysmom (Oct 19, 2004)

Ultrasounds are not that reliable for detecting liver shunts, as low as 60%. Since her BAT results were so low, I'd get a Protein C test to rule out a liver shunt.

Comparative Coagulation -- NYS Animal Health Diagnostic Center

If a shunt is ruled out, I'd be very concerned about GME:

gme

Where do you live? Anywhere near a vet school?


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## MalteseJane (Nov 21, 2004)

I was thinking about seizures too.


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## Pure Paws (Mar 29, 2010)

Any change in the diet? Did she eat something different? We had a 7 month puppy whose owner fed a few almonds and was walking into walls and acting lethargic, and got diarehhea. Of course I have to ask this , has she had any vaccines lately?


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## PCB (May 26, 2010)

Ladysmom said:


> Ultrasounds are not that reliable for detecting liver shunts. Since her BAT results were so low, I'd get a Protein C test to rule out a liver shunt.
> 
> Comparative Coagulation -- NYS Animal Health Diagnostic Center
> 
> ...


Ugh GME sounds awful. We live only an hour or so from Tufts.

Is a shunt possible with her BAT levels? We have our fingers crossed that it's MVD but I'm worried her symptoms are too severe for that to be realistic.

Emergency vet mentioned it could be epilepsy, but the neurologist wants to rule out liver abnormalities as a potential cause first.


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## Rocky's Mom (Apr 10, 2010)

I don't have a clue...thought about seizures popped in mind, but really don't know. I hope and pray the Vet finds out exactly what it is quickly and Penny gets well.


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## PCB (May 26, 2010)

Pure Paws said:


> Any change in the diet? Did she eat something different? We had a 7 month puppy whose owner fed a few almonds and was walking into walls and acting lethargic, and got diarehhea. Of course I have to ask this , has she had any vaccines lately?


She had her kennel cough, lyme, and lepto vaccines about 3 wks before it started. We did titers for everything else (parvo, distemper, and something ekes I can't remember) and those came back fine.

She was kenneled the weekend before the first incident, so she would have eaten different food then.


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## Ladysmom (Oct 19, 2004)

PCB said:


> Ugh GME sounds awful. We live only an hour or so from Tufts.
> 
> Is a shunt possible with her BAT levels? We have our fingers crossed that it's MVD but I'm worried her symptoms are too severe for that to be realistic.
> 
> Emergency vet mentioned it could be epilepsy, but the neurologist wants to rule out liver abnormalities as a potential cause first.


If she was my dog, I'd get a Protein C test done, then, depending on the results, get a referral to Tufts.

Lady has been epileptic for 10 years and what you describe is not typical. Idiopathic epilepsy is usually a progressive disease, usually starting with a few seizures a year.

A vet school will be able to do all the proper diagnostics, then put everything together.


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## jmm (Nov 23, 2004)

I would see a neurologist. It sounds seizure-like. 
Treating for MVD is kind of silly...it is extremely rare for a dog with MVD to have any symptoms. While unlikely a shunt a Protein C is a better test than an ultrasound.


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## poochie2 (Jan 14, 2010)

You said that her last episode was captured by video. Can you post it? Maybe some of the others may have knowledge to what may be happening by seeeing the video.
I hope she's okay.


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## tamizami (May 1, 2007)

i'm so very sorry you and penny are going through this. i agree that a visit to the neurologist is in order, her behaviors seem very similar to seizures i've experienced with my first maltese. i hope its nothing too serious and is easy to control with medications/diet. *hugs*


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## dr.jaimie (Mar 23, 2004)

i would get a referral....sounds like its progressing fast so i would seek specialist. a csf tap is in order or mri.


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## PCB (May 26, 2010)

Hi everyone! Thanks so much for all your ideas and warm thoughts for Penny. Made appts with Tufts. We're going to an internal medicine specialist there to rule out all the liver issues. Then, we'll probably do a neuro consult and see if they feel any tests are appropriate.

I realized today, with probably 90% certainty, that all of the episodes followed relatively shortly after a meal. We're going to start monitoring her eating more closely in order to help confirm this if she has another spell.

Fortunately, Penny is her same energetic and sweet little self in between these episodes. Hopefully it stays that way!


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## Ladysmom (Oct 19, 2004)

PCB said:


> Hi everyone! Thanks so much for all your ideas and warm thoughts for Penny. Made appts with Tufts. We're going to an internal medicine specialist there to rule out all the liver issues. Then, we'll probably do a neuro consult and see if they feel any tests are appropriate.
> 
> I realized today, with probably 90% certainty, that all of the episodes followed relatively shortly after a meal. We're going to start monitoring her eating more closely in order to help confirm this if she has another spell.
> 
> Fortunately, Penny is her same energetic and sweet little self in between these episodes. Hopefully it stays that way!


I am so glad you are taking her to Tufts! When is your appointment?

What are you feeding her? Dog with liver shunts cannot handle the ammonia red meat produces and can become very symptomatic after eating.


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## Nikki's Mom (Feb 13, 2008)

If your dog has those symptoms after eating and perhaps has a shunt, I've read that low protein, low purine foods works best. Maybe some chicken breast and white rice would be better right now.


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## maltlovereileen (Jan 19, 2009)

Will be keeping you in my prayers and positive thoughts for the right answer to this puzzling question... Hopefully it will be something easily treatable and this will be a nightmare you can soon forget... *fingers crossed*


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## maggieh (Dec 16, 2007)

Thinking of you and hoping for very positive outcomes - and answers quickly!


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## MaryH (Mar 7, 2006)

PCB said:


> Ugh GME sounds awful. We live only an hour or so from Tufts.
> 
> Is a shunt possible with her BAT levels? We have our fingers crossed that it's MVD but I'm worried her symptoms are too severe for that to be realistic.
> 
> Emergency vet mentioned it could be epilepsy, but the neurologist wants to rule out liver abnormalities as a potential cause first.


Marj and Jackie are right. If you want a more reliable, less expensive test you should have a Protein C test done. An ultrasound is only as good as the radiologist reading the ultrasound and liver shunt is not an easy thing to find even for the very best radiologists. If you are that close to Tufts and your dog's symptoms are not liver related but more likely neurological I would suggest making an appointment with Dr. Allen Sisson at Angell Animal Medical Center in Jamaica Plain. He truly is the best of the best and has a great deal of experience with Maltese and other toy breeds suffering from neuro issues like epilepsy and GME. If you are closer to the western part of Massachusetts and don't mind driving, the best of the best for liver issues is Dr. Sharon Center at Cornell University Vet School. I live in Massachusetts and although I live very close to Tufts I myself would go to Angell or Cornell because I know that they are the very best in the northeast for liver and neuro. I don't dislike Tufts and would go there in a heartbeat for orthopedic issues.


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## Snowbody (Jan 3, 2009)

There isn't any rosemary in any of the food she's eating is there?


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## almitra (Apr 24, 2009)

Hoping for the best for your baby...plase keep us updated.


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## uniquelovdolce (Mar 10, 2010)

i hope she gets better and u find out whats wrong.


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## Jane and Franklin (May 23, 2010)

Hi,
Just reading your thread, and thinking that's almost exactly what my little boy has done 6 times that I have seen. Not the pooping or vomiting though, but the staggering, stumbling and urinating. Although Franklin has done that on an empty stomach. The 6 times were spaced over 13 months, but in March of this year he had 3 in 9 days EEK!

When you say urinating, do you mean losing control of her bladder, or that she's peeing a lot?

Also managed to get the last one on video (www.photobucket.com) video search- Franklin episode. Sorry, but I'm not great with putting in links that actually work. 

It started just days after he turned 4. Does your little one act weird just before it begins? Like being anxious and clingy? Franklin started staggering, and circling, peeing, started staggering again and ended up walking backwards and falling onto his tush. Poor baby. This was first thing in the morning, without breakfast. He's done it 5 more times that I've been there to see, but I think it's happened more because the last couple he hasn't been clingy and freaked out. He's had these episodes both day and night, on an empty stomach and shortly after eating.

Franklin has high alk phos, lipids, cholesterol and lipase. It was suggested by his IMS that hyperlipidemia can cause neurological symptoms, so he's now on Royal canin digestive low fat to see if the lowered fat content will help his lipase and trigs. She's seen the video, and agrees that it isn't epilepsy in the traditional sense. I described the symptoms on another forum, and they matched someone elses experience. Psycho Motor Behaviour Epilepsy is the name for what their little one suffered with. Other ideas were Hepatic Encephalopathy (where ammonia from proteins in food builds up and plays havoc with their system, and causes neurological problems, among many other problems- please forgive the explanation, I only started googling that earlier this week.)

Hepatic lipidosis was also mentioned on that forum as a possibility. It's not in my head yet, so I won't even try. Maybe someone else can elaborate.

What does Penny eat, and have you had any other blood work run on her? And here's a question for everyone out there... Considering maltese are prone to liver issues, do they have their own "normal range", especially in comparison to just normal ranges from labs?

Thank you and good luck with Penny, I really hope it isn't anything serious,
Jane and Franklin


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## PCB (May 26, 2010)

Thanks for all the support everyone. I asked my vet to do a Protein C test, so he's researching it now. I'm still going to do the ultrasound in addition to that.

RE her food: She is on Iams Small & Toy (bad, I now know). I asked the vet about switching herm but he wants to wait to see what happens with her liver tests.

We dropped off a stool sample today because her stool has been poorly formed and mucosy (though not consistently) since this all started. Could a parasite cause this?

Penny unfortunately had another episode this morning. About 10 minutes after eating her breakfast, I noticed her "high kicking" around, then doing the stumbling. I sat down on the floor with her and held her for about 5 minutes to try to keep her calm. She was able to walk normally then, and was hovering by the door like she needed to do her business. We went outside and she had a normal poop. Back in the house, she was still staggering a little - then proceeded to vomit and pee. She seemed very "with it" and in control of her actions the whole time.

Jane & Franklin - My mom actually emailed me a link to your thread on k9cushings a few days ago because it reminded her of Penny! She is very clingy normally, so I haven't noticed anything out of the ordinary there when her episodes start. Her cholesterol was also high when they did the blood panel, but I'm not sure what else was tested as part of that. Has Franklin had his bile acids checked? I'm going to go look at his video now - I have no idea how to get mine online but if I figure it out I'll let you know. Hope he is feeling better lately!


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## missiek (Jan 2, 2010)

Oh poor thing! My heart breaks for her. I hope the vet can find something to help her!


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## Ladysmom (Oct 19, 2004)

Did you print out the information I gave you on Protein C test? That should give your vet everything he needs to know about it, i.e where to send the sample, etc.

I hope you get some answers soon.


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## uniquelovdolce (Mar 10, 2010)

i hope u find out whats wrong n that she gets better ..


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## mss (Mar 1, 2006)

How is she doing?

I'm coming in late here, and just tossing out an idea. --I was wondering if the problems started around the time you opened a new bag of food? I have occasionally bought bags only to notice they were way past their expiration date. If there is mold or something in that bag, perhaps that might be affecting her.

My little mini schnauzer's liver failed in her senior years. The vets never figured out why--by the time she was seen at the vet school, all they could do was recommend diet and medication to help keep the ammonia levels down. It made a great difference right away and gave us more time to have fun together.

One of the vets who saw her at the vet school was wonderful--I read that he is on the faculty at Cornell now--but I think his focus now is kidneys. But anyway if he's at Cornell, it must be a great school.


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## Snowbody (Jan 3, 2009)

Was wondering too if there's any update?


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## PCB (May 26, 2010)

How frustrating- I typed out a long response, clicked reply, got an error, and lost it all. Unfortunately I am strapped for time, so here is the short version!

Penny is doing well. No episodes/symptoms since last Friday AM, and her stool has returned to normal. Her visit to Tufts ruled out a shunt, and we are awaiting results of a blood ammonia test to see if we should look into MVD further.

mss- Symptoms have occurred over two bags of food, but thanks for the idea. We actually switched her off Iams after our visit to Tufts. Interesting about your dog - makes me even more curious to see what her ammonia test shows.


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## Snowbody (Jan 3, 2009)

At least a shunt is ruled out so that's great. So glad she's been doing so much better since Friday. When did she switch to the new food and what did they suggest as a food? Hoping you'll have some answers but at least things are going in the right direction. Still sending thoughts and prayers. And yes I've had the dreaded, _where the heck did that post go that I just wrote,_ happen. Sooooo maddening.:angry:


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## CeeCee's Mom (Sep 14, 2006)

I too am glad a shunt is ruled out~Since your baby is doing better, I hope all the tests come back with good results. Please keep us informed!


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## maltlovereileen (Jan 19, 2009)

Sounds like the best news you could hope for!!!! Yeah!!!! Thanks for the update!


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