I don’t have anything to post on Boltz today, we are waiting for additional spinal tap test results to come in (if you recall, there were 3 tests). So, far everything has been negative and bloodwork is all in normal range. I have copied one of the reports here to see all the things that have been ruled out in this challenging time trying to get a diagnosis. The Vet put him back on prednisone as his condition was declining since we weaned him off of the prednisone to do the spinal tap. Now, we are closely monitoring him by camera and visual checks to assess if prednisone is working. Staff are diligent in reducing any distractions in the wolf yard that might impact his ability to comfortably rest. I hope to have more answers by the Monday Working for Wolves webinar at 5 pm Central time. There are still spots available for this webinar if you would like to register check our our Programs – Webinar tab on the website at www.wolf.org.
So far, the test results we are getting don’t show any abnormalities in the bloodwork. As I said in previous logs, he is otherwise in good health and doesn’t appear to be having a pain response, but his strength in his back legs is compromised. We received some preliminary results on the spinal tap and according to the lab report
” No obvious infectious etiologic (causing or contributing to the development of a disease or condition.) agents, malignant neoplastic cell populations (cells that could potentially invade and metastasize into cancer) , or atypical particulate matter are identified. The critical thinking and waiting game on additional samples continues.
Bolz did well through the procedure that started with a drugging at 3:50 and the reversal drug at 6:22 pm. He will have 2 shave marks, the lumbar area didn’t yield clear enough fluids for a sample, so the vet needed to go higher on the spine. She successfully got enough samples to run all 3 tests – The Neurologic RealPCR, Fluid Analysis with Cytology, and Aerobic and Anaerobic cultures and we got enough bloodwork for a full panel, CBC and the Degenerative Myelopathy DNA test. He got a good dose of Cefazolin antibiotic to reduce the risk of the spinal injection site getting infected.
Boltz has been transitioned off of steroids so we can move forward with additional testing, including a spinal tap and bloodwork to be conducted on Thursday October 15th. We will also draw enough blood to repeat a CBC, Full Blood Panel and complete the DNA test to determine if he has the mutated gene associated with Degenerative Myelopathy (DM) in dogs. The Veterinarians required at least a week of no steroids before the spinal tap because of the tendency for steroids causing a higher white blood cell count. But, transitioning off of steroids needs to be done slowly over time to reduce any additional side-effects. Boltz had a bit of a challenge during the transition, but is now seeming to rest more comfortably. This condition continues to be challenging to diagnose because he has moments where he has limited control over his back legs, then he has moments where he is mobile. The symptoms don’t fit a clear diagnosis to point to one thing, which is why we are choosing to do the spinal tap. We are going to concentrate on three tests, a Neurologic RealPCR, detecting any indication of one of the tick-borne organisms could be causing the neurological disorder. Even though we have tested for tick issues in bloodwork in the past, their presence may have been below the limits of detection in bloodwork but may be identified in spinal fluid. The second test is Fluid Analysis with Cytology, which would provide details on proteins and more importantly cell types and appearance that could help identify cancer cells. The last test is Aerobic and Anaerobic cultures, to indicate if there are other bacterial infections. The procedure will require a full immobilization, so I will post after the procedure on Thursday to let you know how he did, but we don’t anticipate seeing any results until early next week.
Boltz is feeling better today than he did over the weekend. His hind quarter mobility and stability continues to be the main symptom as we try to narrow down the influences of various treatments. He is alert, behaviorally interactive and defending ravens from his deer leg. Other than responding to some external stresses that can be part of life on a public exhibit (vehicles, traffic, noise from garbage trucks etc.), he generally rests on or in the den or in the straw beds adjacent to the building. His resting patterns are pretty consistently defined as long periods of rest. This is good for his overall well-being and may contribute to healing. We also believe that his ability to rest comfortably is a good indication that the condition is not painful. It’s been our experience with pain issues (including Grizzer’s ACL issue), that there is a lot of repositioning to find the appropriate pain-free position. When Boltz rests, he curls up in the hay and falls asleep. As you may imagine, all of the events over the last month can impact a wolf’s trust. In an effort to help improve that trust, today during wolf care, he welcomed a trail of Venison Cakes as a treat and a motivator to get him comfortable with coming into more confined spaces and take treats from the staff. We are planning for the next set of medical tests that will require an immobilization. This time, it will be much smoother thanks to the move into the Pack Holding Area that is adjacent to the Wolf Care Center. Because we used Glucocorticoids (e.g., dexamethasone, methylprednisolone, prednisone) in treatment, we need to wait for a bit of time before doing the next tests. Glucocorticoids are known to increase the white blood cell (WBC) count and this is one of the key components needed to assess infection or the potential for other conditions. I am using the surveillance images with the date and time stamp so we can track his posture, alertness and overall condition on a daily basis.
What a difference a few days make, Friday, we thought the prednisone wasn’t really helping, so we had a plan to slowly wean him off. Over the weekend, Boltz’s transition off of prednisone had some issues. While the Wolf care team logged their assessment as “looking better than a week ago” on Saturday, the Sunday check showed more instability. They reported some swaying, stumbling and crossing of his back feet, which is symptomatic of Degenerative Myelopathy. But, research has shown that DM is not typically impacted by prednisone. So if he declines off when he is weaned off of prednisone, it may not be DM. We are developing a treatment plan that includes additional testing, but we want Boltz to be stable before doing another immobilization. We will also take the time to research all options that we want to test so we maximize the opportunity of this next medical exam. He remains alert, has a good appetite and is very attentive to the actions in the Exhibit Pack, the wolf yard and with Grizzer’s movements. As with Grizzer’s webcams, I will turn them on and off throughout the day.
Boltz had a vet check on Tuesday and while we think he has improved since he was removed from the Exhibit Pack on September 15th, there isn’t enough of an improvement to indicate that the prednisone treatment is working. Every decision we make has to be balanced between risk and benefit. Initially, we put him on prednisone while he was in the main enclosure in hopes to find some relief to this condition that would have allowed him to stay in the pack, at least until we could narrow down a diagnosis. When it became clear that the initial dose of prednisone wasn’t effective, we reassessed risks and benefits and made the move to the Pack Holding Area. Now, we are again reassessing and are in the slow process of transitioning him off of the prednisone treatment. Since we made that decision, we do notice that he is much less anxious and resting more comfortably. The surveillance cameras are tremendous in revealing how long he sleeps and how often he may change positions. This mornings review of the overnight footage revealed that he went to bed about midnight and didn’t get up until the wolf care staff arrived at 8 am. He was alert and stretching several times through the night, but no indication that he was uncomfortable in his resting position.
What are the next steps? Thanks to some advice from Walter, a long-time ambassador wolf supporter, we located a research paper from the University of Florida concerning research on Degenerative Myelopathy in German Shepard dogs. While we don’t know if Boltz has DM, we feel it is appropriate to act on some of the recommendations based on that research. According to their study:
“DM progresses at different rates and “stress” plays a role in its advancement. Minimizing stressful situations is important where possible.”
For Boltz, moving him into a quiet safe environment and minimizing activity in the wolf yard has definitely decreased stress. Other than a few moments of anxiety when someone pulls up to the back driveway, he is either calmly relaxing on the den, within the straw beds of the protective kennel or found sleeping in the thick straw inside the den.
Another statement from the paper shows some possible pharmaceutical treatments that may help:
” Over the last 2 decades, we have found 2 medications which appear to prevent progression or result in clinical remission of DM in many (up to 80%) of the patients. These medications are aminocaproic acid (EACA) and n-acetylcysteine (NAC).”
During or Vet check on Tuesday, we discussed these treatments with our Vet and have been in contact with a pharmacy that cooperated on the University of Florida study to determine dosages and delivery methods. Being able to get Boltz to take medication is important, powders and liquids are a challenge for a wolf that is neophobic (fearful or mistrusting of new stimuli) or more inclined to scent roll on things that smell different. Most of our med delivery is done in a pill form, often hidden inside a chicken leg with a tab of butter as binding agent.
The paper also suggests some nutritional supplements that may help his overall immune system. We have ordered the following and will be starting them as soon as they arrive. We have reviewed dosage recommendations, potential contradictions with the treatments and any possible side effects. With all that work done, we have developed a new daily regime for Boltz that will include (quotations indicate direct quote from research paper):
B-Complex: “They may help in neural regeneration”- Grizzer has been on Vitamin B supplements for years and seems to do well with them.
Vitamin E: “It is a potent antioxidant and reduces fat oxidation and increases the production of HDL cholesterol. At higher doses it also reduces cyclooxygenase and lipooxygenases activities, decreasing production of prostaglandins and leukotreines. As such, it is a potent anti-inflammatory drug. This drug slows the progression of DM and corrects for low serum and tissue levels. In DM, there does appear to be a deficient absorption and tissue-binding protein which accounts for the low serum and tissue concentrations of vitamin E.” When Aidan was initially diagnosed with Discoid Lupus, he was started on a Vitamin E supplement as well.
Vitamin C: “Vitamin C works with vitamin E and helps regenerate vitamin E, potentiating its antioxidant effect. Vitamin C supplementation does no
harm, since the excess is excreted through the kidney.”
Selenium: “Selenium is an important mineral which has antioxidant properties similar to vitamin E. Vitamin E can replace the requirement for selenium in the body, but selenium cannot substitute for vitamin E. In addition, selenium does not cross the blood-brain barrier like vitamin E. On the other hand,
selenium may help allow vitamin E to be more effective.”
Coenzyme Q: “Coenzyme Q also called Co-Q-10, is a natural substance that assists in oxidative metabolism. Since DM patients suffer from nervous system problems, muscle wasting and need aerobic endurance, a 100 mg Coenzyme Q daily dose has been recommended.”
We are planning two additional tests that require bloodwork, but need to have a period of time where he no longer has an influence of the prednisone in his system. As always, I will keep you posted on when we proceed. I have been turning on the webcam when he is out and about, but the recent cold, rainy weather has him seeking comfort in the straw beds within the protected and roofed area next to the building that is out of camera view.
Rest is probably the best medicine for Boltz and this afternoon’s image on the webcam definitely shows his ability to be comfortable. While I don’t know exactly what is going on in his body, it is clear that the pain response seems minimal. He has no problems resting for hours at a time, either on the den when it is sunny or in the straw bed under the protected roofline of the adjacent kennel (complete with a viewing window to see activity). His main stress points are people entering the wolf yard and if the Exhibit Pack has some active dominance with growling. We try to keep both to a minimum.
Boltz has gone through the weaning process from a higher dose of prednisone to a maintenance dose. We have reviewed the hours of surveillance footage to make an assessment if the treatment has improved conditions and if there is an optimum dose that can be correlated with improvement. Unfortunately, if the condition is Degenerative Myelopathy, research shows that prednisone has a limited impact on the condition. We had hoped to have enough stored blood to go forward with a DNA test to see if Boltz posses the mutated gene associated with DM in dogs, but it would require more bloodwork. Since additional blood sampling would require immobilization and knowledge of that DNA would not yield any changes to our treatment, we have decided to not put Boltz through another chemical immobilization at this time, unless we need blood for an additional purpose, such as a white blood cell count or if he has a decline in his condition.
Our veterinarian is connecting with some universities that are currently doing research on DM in dogs and may be trying some alternative treatments. He has been active over the weekend, frequently climbing on and off the pack holding area den. This movement has helped his mobility, and he is responding to the pack activities on the other side of the fence.
We are most impressed with some video footage gathered by the surveillance cameras on Sunday evening, when he at the shared fenceline with Grizzer and did a full tail wag. This is the first time we witnessed a strong social greeting to Grizzer.
We have an update on Boltz. His Blastomycosis test came back negative. Based on all the other results, the Veterinarians have narrowed down the list to two likely diagnosis. The first is Degenerative myelopathy (DM). It is a genetic neurologic disorder with symptoms of loss of coordination and decreased muscle strength typically beginning in the hind limbs. Canine Degenerative Myelopathy (DM) is a progressive disease of the spinal cord and ultimately the brainstem and cranial nerves. While there is no definitive test for DM, there is new research that has determined a gene associated with a risk factor for that disease. We are working with our Veterinarians to submit a blood sample for a DNA test to see if Boltz possesses this mutated gene.
While DM is not considered a painful disease, wolf care staff will definitely assess quality of life parameters to ensure Boltz’s physical and psychological needs are met. As you can see in the photo posted this week, he is resting comfortably in the Pack Holding area. One of our health assessments is the clarity of an animals eyes, and in this photo, he appears very alert and clear. He is continuing a dose of prednisone as an anti-inflammatory medication, but we are transitioning down to a maintenance dose always mindful of the effectiveness of prescription meds versus the risk of long-term use.
Another remote diagnosis is a round cell tumor, which can present itself in a variety of ways. Boltz’s recent MRI didn’t reveal any visible tumors of the spine or the brain that may contribute to his neurological symptoms, but we will continue to monitor bloodwork to assess any increase in white cell counts. Thank you to all that have inquired about his condition and donated to his fundraiser. We are still accepting donations to assist with the many tests that were conducted, his ongoing medical care, adjustments and staffing to keep him and Grizzer comfortable in retirement. Follow this link to donate https://www.facebook.com/donate/363942581650869/
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