Adverse Rabies Vaccine Reaction Relapse

Compared to the almost-coma-like, unresponsive ragdoll of a few weeks ago, Lilly has made great gains. Monday was a tad dicey, with a morning of dullness and lethargy, but she is doing better on several fronts. For example, she finally can wag again. Here is a report on today’s neurological exam and recheck.

Lilly received high marks for being bright, alert, and even a little attention seeking. She was funny and sweet and a little ornery with the neuro team.

Many physical signs of her brain inflammation remain — particularly in her left rear leg, but she is remarkably steady on her feet already.

Lilly is also suffering significant muscle “wasting” because of the steroids. I’m told it’s less about her current dose and more about how long she has been taking steroids now (since the end of January 2012). Her hips, ribs, spine, and even skull are visible now.

Lilly’s stamina is still awful, but she can walk our driveway from the house to the gate (up near the road) and back. It isn’t pretty. It isn’t fast, but she can do it. I try to take her for this very short walk 2-3 times a day, if she is up to it. Monday, for example, we didn’t even try.

Lilly’s incontinence is still rampant — on both fronts. I worry about toll on our well water and washing machine.

Other than one almost-normal night’s sleep Friday, she continues to wake us a lot at night for various reasons. Last night, she needed attention every 60 to 90 minutes.

I’m bleary today from fatigue. So, just a few quick notes on our newest plan.

Starting Saturday, Sept 1, and Sunday, Sept 2, Lilly will receive (in addition to everything we’re already doing):

2 sub-Q (under the skin) injections of cytarabine / cytosine (a chemo drug that has tremendous anti-inflammation properties for cases like Lilly’s)
10-12 hours apart
2 days in a row
Every 3 weeks
Until further notice

Our goal is to use this drug as a “bridge” while we try to wean Lilly off steroids (for the 4th time). The potential for success and the timeline for that process remains unknown. We’ll just take it one series of injections at a time.

Alas, because the drug is “chemo,” they cannot send it home with me to do the injections myself.

So, in addition to the clinical / medical realities of this decision, I’m grappling with the sheer logistics of essentially 4 separate trips to the neurologist in 2 days.

I need to decide:

If I will drop Lilly off each day and pick her up 12 hours later
If I will make 2 trips each day there and back home
If I will make 2 trips each day, but find somewhere to hang out / probably work in between trips to the veterinary hospital

If I left her, at least one of the days, then our neurologist could give her a quick exam to keep tabs on her progress … in addition to more formal, sit-down appointments every 6-8 weeks (assuming things continue to go well).

Many, many, many questions remain about how all this might turn out. Her prognosis is unknown. I’ll try to write more about those discussions between me, our family veterinarian, and our veterinary neurologist in the coming days.

But, let me say this out loud … I fear there is a chance we’re merely buying time. I remain heartbroken, but hopeful.

Lilly is still in this fight. I’m backing her with everything I’ve got (and many things I don’t). Our veterinary neurologist is knocking himself out, digging through the research, to find the right combination of meds to get Lilly through this immune system flipout relapse and into “remission.” Even then, she may require some immune-mediation meds for the rest of her life.

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