Its a weiner wonderland.

I've just spent the past week in the neurology lab. No, it wasn't to evaluate my head, or my cat's (who I'm pretty sure thinks he is a Labrador puppy). I'm actually really enjoying this rotation. Of course, it helps that one of our attending clinicians is hot, has an awesome sense of humor, is fun to hang out with and is super nice. Did I mention that he was hot? I've actually been learning quite a lot and having fun doing it. Oddly enough we've only seen one wiener dog with a ruptured disc this week. Its been incredibly slow.

Well, sort of.

See, the first day I volunteered to take Lulu as my case. Lulu was a mess. Lulu is still a mess. And there is next to nothing we can do for her. See, Lulu came in for hind-end weakness. Some sort of spinal problem right? Not so much. She had already been started on steroids to no avail. An MRI showed increased contrast uptake in the muscles around both hip joints. Odd. She was started on antibiotics to treat for any possible infectious cause of myositis. It would have been all well and good, well, if she would have responded to treatment. They took muscle biopsies from the biceps femoris which just came back as atrophy (which was of course from the near immuno-suppressive doses of steroids she was on). So another MRI was taken. This time the inflammation in the muscles around the hip joints was even worse. The odd thing was that it was uniformly bilateral and only really affecting certain muscles. Over the next few days we managed to rule out every cause of focal myositis that we could think of. Infectious . . . no, titers came back negative. Autoimmune . . . no, there was no response to high steroid doses with azothioprine. Neoplasia . . . maybe, but doubtful because it was so uniformly bilateral. Metabolic disease . . . no, she was too old (3 years) to start showing signs and the rest of her body was unaffected. Then we went in surgically to take specific biopsies of the affected muscles. After waiting for days we finally got our answer.

Lipid storage myopathy.

So we were wrong. Very wrong. It was a metabolic disease. One which has only been documented in 25 dogs. Ever.

And now here's the problem. She has no muscle mass left from being recumbent and on high doses of steroids. She is still incredibly painful. And, worst of all, there is no definitive treatment for this disease. We're not even sure what causes it. All that's in the literature is supplementation with riboflavin, co-enzyme Q10, and l-carnatine. And even that is questionable since its been so rarely documented. So now we have Lulu on a crash course of steroid weaning (since they're probably worsening the problem) and we're praying and hoping she doesn't go into an Addisonian crisis. Maybe, just maybe, if we can get her through this she might be able to make it. But who knows. We're not sure if any case of this has even been successfully treated. Its just a waiting game now.

Lulu is a great dog. She is a sweetie and a real trooper. I've gotten rather attached to her and I don't know how I'll handle things if it looks like she's not going to make it. Its hard enough when you can treat a disease and owners choose not to, but when even the best you can do may not be good enough, well, to me that's even worse. She doesn't deserve this. She deserves a cure and a happy healthy life. But no matter how hard we try our medicine will not be good enough. All we can do is wait. And pray.