Ataxia in a Dog: What Turned Out Not Being An Adverse Drug Reaction After All—JD’s Story

When your dog suddenly becomes unsteady on their feet, it is a scary thing to witness.

The medical term for it is ataxia but that is not a diagnosis. It is simply describing the situation. What can cause ataxia? The problem can originate in:

inner ear
brainstem
spinal cord
brain

There can also be systemic causes such as changes in red blood cell count, electrolyte disturbances, heart issues or toxins.

Source: VCA Hospitals

JD’s story

At the time this happened, we were trying to tackle JD’s mysterious swelling above the eye. At first, it looked like a bug sting. However, it cam coming back again and again. The latest working diagnosis was and infection.

The day started perfectly well. JD’s swelling was completely gone, and he was doing great and having a good time.

JD was on antibiotics

It was about the end of the second week of the new antibiotic combo. The initial plan was to run a two-week trial and, if that works, continue for another four weeks in hopes that this would take care of whatever was causing the swelling to keep coming back for good.

JD was on a combo of Metronidazole and Amoxil.

I got on the phone to the vet to update her on where we were at and discuss whether we shall indeed continue the meds for another month and whether we should stay with the same dose or go a bit lower.

The vet was pleased to hear that swelling was fully gone and asked whether JD had any issues being on all those antibiotics. He was unaffected by it; no stomach upsets, no bad stools, no decrease in appetite. We never really had problems with antibiotics other than once, after Jasmine’s horror, and then when she had to get some really nasty kind for her resistant UTI.

We agreed to continue the long-term treatment to put this problem to rest.

The first sign of a problem

That was Monday; a perfectly great day.

On Tuesday morning, JD went potty and then joined Cookie and me for our morning walk. He typically left about halfway through to check on daddy. Sometimes he stayed with him; sometimes he came back to check on “the girls” again. This time, he stayed with daddy.

When Cookie and I came back, they all went into the office for breakfast. He got his food and morning dose of meds.

“I think he looked kind of funny when he was coming back here,” hubby said. “As if he had a hard time walking. Maybe I’m seeing ghosts.”

I don’t believe in “seeing ghosts.”

Is arthritis suddenly bothering JD?

If hubby thought he saw something, then I believed he saw something. We took JD out to walk him back and forth a bit so I could try and see it too. It was very subtle, but something wasn’t quite right.

“Maybe his hips are acting up,” hubby thought. It was cold and rainy; it would likely make sense that the cold could affect the joints.

As JD started moving around in the office, it was clear he was having a hard time doing so.

It became much less subtle than earlier. Except the more I was looking at it, the less I believed it had anything to do with his hips. He wasn’t favoring the legs; he was kind of stumbling. It looked more neurological to me than anything else.

I don’t think it’s the joints

We took JD out on a deck again; he seemed to have mostly “walked out of it.” I decided to try the neurological test, when you take a dogs foot, turn it over and watch whether and how fast they correct it. JD did correct it on both hind legs but I felt that maybe he took longer with it than I’d figure would be normal.

Regardless of that, I was already convinced it was neurological rather than musculoskeletal. But why?

What is happening?

Having had our share of adverse drug reactions in the past, I figured that the place to start would be going over detailed sheets of all potential side effects for both.

Sure enough, I found that Metronidazole COULD have neurotoxic side effects.

Neurotoxic effects include encephalopathy, cerebellovestibular signs and periopheral neuropathy. Reversible CNS dysfunction may produce signs including ataxia, recumbency, opisthotonus, positional ystagmus, muscle spasms and occasionally seizures.

A reaction to Metronidazole?

Could it be that was what was going on?

I left a message for the treating vet but given last experience figured I wouldn’t hear back any time soon. I called Jasmine’s vet as well, and he, as always, was there for me.

I filled him in on the situation, wondering whether this could be happening because of the meds. We quickly discussed the possibility of it being the hips or other similar problems, but because he knows me for a long time, he took my word for it when I said and really didn’t believe that was the case.

He said it was indeed possible that the Metronidazole could be doing this.

If that was the case, the problem should go away once the meds were withheld. He felt that within about 24 hours after the last dose we should be seeing improvement. If that was the case, he’d skip two days and return to the meds at a lower dose.

This all made sense to me, while I was waiting to discuss the matters with the treating local vet. I just wished we’ve known before I gave him the meds in the morning.

JD’s declining

As the day went on, JD’s front end became affected.

There was no doubt this was a neurological problem. We did have a support harness in our first-aid kit, so I pulled it out and put it on JD. This turned out being a lifesaver.

Later that evening his treating vet called. I explained what was going on and what my suspicion was. We discussed whether it could be from the original infection, but the swelling was gone, there was no fever …? I also brought up the possibility of potential ingestion of one of the mushrooms that are all over the place, but that didn’t add up either.

Talking with JD’s veterinarian

There were no other signs other than the inability to use his limbs properly.

The vet didn’t feel it was either the infection or the mushrooms, given the circumstances. She wasn’t fully buying that it was neurological, though, “I’d have to see him determine whether this is pain,” she said. I have seen pain, I’ve seen soft tissue pain, I’ve seen cruciate pain, I’ve seen hip pain, I’ve seen spinal pain … I was very sure this was not pain.

We agreed that it could be from the meds and decided to give it time to improve unless something changes. If it did, we’d bring him in.

It stood to reason that if the night dose caused the initial signs, that additional dose that morning could make things worse. It stood to reason that if that was the case, things should improve by morning.

With the working hypothesis of JD’s neurological problems being from the meds, we were hoping things will get better as the Metronidazole clears out of his system. If the theory was correct, we should see improvement by the next morning.

No improvement

By the end of the day, JD didn’t get better but didn’t get worse either.

I made sure he stayed hydrated; he’d have too much of a hard time drinking, so I’d mix some water with a bit of liver powder into a small bowl, and he could drink that while laying down. Did that throughout the day to make sure he gets enough liquids. He was eating normally. He didn’t want to go potty at the end of the day, so we took him back in to deal with what comes next when it does.

I did hope there would have been some improvement, though, and after he had refused to try and go potty we discussed whether we should take him to the vet after all. At that time we’d been told there is no “antidote” to Metronidazole neurotoxicity, but he could get IV fluids to try help flushing it out of the system faster. Eventually, we decided to wait until morning unless things got worse.

Note: There IS actually an “antidote” for that as I found out from my toxicology veterinary friend the next day–IV valium.

Unless he had to try and get up, he was comfortable.

He had his dinner and curled up with daddy for the night. His breathing was peaceful; there was no indication that we should treat this as an emergency.

In the middle of the night, he finally had to go pee. It was quite an ordeal but even though stumbling, he did manage on his own. There was still about 8 hours to go; there was still good hope thing will improve.

No improvement by morning

Then the morning came.

I didn’t have to wait to see what he’s going to be like getting up. Just as he was still laying there on the bed, I knew he did not improve. In fact, my guess was that he got worse. I noticed when I got closer his front left leg moved as if he was lifting it to get a belly rub. But something about that didn’t look like a purposeful movement.

I took Cookie out so hubby could attempt getting JD to go potty as well as see what things look like. After a lot of struggle, they made it off the bed to the door … and that was it.

The day before, when talking to the local vet, we have made a tentative appointment for later in the day in case things didn’t improve as they should.

I didn’t think we should wait for another half a day.

I called the vet to let them know that I wanted to bring JD in on an emergency basis instead. “You can bring him in but it’s up to the vet to decide whether he should be treated as an emergency,” was the response. Well, we were going.

Emergency vet visit

To load JD into the truck, hubby had to virtually carry him.

While JD still managed to go potty on his own at night, now his front end wasn’t working pretty much at all. They were mostly just hanging, crossing each other, paws knuckling … We did manage to load him up and get him settled. Hubby took off to the vet while I stayed behind with Cookie. Having two dogs in there with JD in his condition wasn’t a good plan.

That was when I first had the feeling JD might not be coming back.

A lot of this was too reminiscent of Jasmine’s last days … Cookie too knew something was very wrong. Normally, she’d be quite upset with somebody going for a ride without her. Not that morning.

I was concerned whether JD can make the trip safely enough in his condition. If he tried to move around, he could fall quite badly. Fortunately, they did manage, though getting JD from the truck to the vet’s building was another major ordeal.

Having the ramp and the support harness was a lifesaver. I don’t know what we’d do if we didn’t have those things.

At the clinic

As the technician saw hubby and JD struggling to get in, she ran out to help. “Now,” she said, “I’ll get the vet to see him NOW,” and she helped them to the exam room.

“I am very concerned about his neurological function,” she said. So were we.

Because crazy liver values could cause this as well, the first thing they did was to draw blood and then the vet started the neurological exam. It wasn’t looking good, but we knew that. At this point, there was pretty much zero chance that this could have been caused by the meds.

The best we could do was to hope that his liver values were indeed high.

But there was no nausea, no vomiting, no diarrhea, no jaundice … no nothing which would point to a problem with the liver.

With JD virtually unable to walk at all, we were sitting at the vet’s waiting for the blood results, hoping his liver values were high.

In the meantime, the vet called up a neuro specialist to consult on what was happening. The specialist definitely didn’t believe all this could have been caused but a reaction to the Metronidazole but then, neither did we anymore.

Gloomy diagnosis

The most likely scenarios, unless the blood showed something significant, were either infection or cancer in the brain or in the spinal cord.

We were really hoping the blood was going to offer a better reason.

But the results came back and everything was normal. There was nothing remarkable there at all. That hopeful theory was out the window.

Exam notes

Here were the findings as the vet wrote them in her notes.

Neuro exam:

decreased proprioception in hind legs- 1+
ataxic in hind end, worse on the left
right front- 3+ proprio
left front- 1+
ataxic on all 4 limbs
a positive tricep reflex front right and left
patellar reflex on left is exagerated
right side down- patellar reflex is also exagerated

Cranial nerve exam:

pupils are dilated bilaterally and are minimally responsive to direct light
menace is present on both sides
palpebral present both eyes
actively swallowing
visual
facial nerves normal
tongue normal

The vet kept repeating she was very concerned about his neurological state.

Poor prognosis

She said we could go and see a neurologist; she’d get us an appointment for the next day. They’d keep him for two days to run diagnostics to see whether they can do anything about this. She was listing the possibilities. The look on her face and tone of voice said more than her words, though.

JD’s odds were slim.

Perhaps an abscess was behind the swelling and spilled? Perhaps cancer was there and bled or threw an embolism?

Should we go through with figuring out what this is exactly and maybe be able to do something about it? And that something maybe working? JD was insured, finances weren’t an important part of the considerations. It was the poor odds and putting him through all kinds of stuff perhaps for nothing. Appointment the next day meant JD having to remain in this state, or getting worse till then. Then it meant a day’s worth of drive. And then two days in a hospital. And then, if they could attempt to treat, further stay in the hospital. Knowing JD, he was likely to die of grief the first day. He was distraught over the state he was in enough as it were.

How far should we take it?

How far should one keep going and when should one stop?

Just because we could keep trying, did that mean we should? Should we keep poking and prodding and putting him through all that perhaps for nothing? Should we hold on to him in spite of his misery?

JD was miserable and would have been even more miserable.

Because JD was hubby’s buddy, I made it hubby’s call, even though we discussed it in length. Having seen Jasmine being so miserable her last days, only to get worse, seeing the odds were just about the same this time, JD had a happy life. He got the spend the night cuddled up with hubby. Prolonging his misery didn’t make sense to either of us. Not with the odds as slim. Right or wrong, we decided to set him free of his body and join Jasmine over the Bridge. It was the decision we could best live with. It was the decision we found most compassionate and selfless.

With all the available technology and medical advances, one could keep going to almost no end.

When the chances are good, and one can afford it, it makes sense to take full advantage of all that is available in veterinary medicine nowadays. But to keep going for the sake of keeping going wasn’t something we wanted to do to him.