Here is the tricky bit-- autoimmune or toxic? This dog is a mouse hunter, and eats her catch. A neighbor used mouse bait containing bromethalin, a known neurotoxin causing brain swelling (https://www.animalhealthfoundation.net/blog/2013/03/owners-beware-poisoning-from-this-rodenticide-is-tough-to-treat/), and it is almost certain that she ate some of the local mice. The Cornell neurologist (a resident) pooh-poohed the owners concerns on this, and wants to treat the dog with a lifetime of immunosuppressive steroids-- is convinced the cytosar is the reason for her excellent response.
When I saw Trudy, she looked fantastic, so I wanted to address the presumed autoimmune component of her disease-- started her on a fresh food diet, Pentagenesis (deer antler velvet with colostrum and thymus), Plena Curae Curcumin & Boswellia, and recommended a Panacur "detox"-- double dose fenbendazole, repeat in two weeks. I was also thinking that a microbiome replacement treatment was in order.
I met with the client (but did not see dog) again after her Cornell recheck on May 12 (attached neurologist's report to the case file) she was much the same, no marked improvement or degeneration. Neurologist tried to pressure owner to double the pred dose or add on another steroid, but owner refused. The parasitic serology was equivocal, so they opted to run it again, and keep her on clindamycin in the meantime. Of course, I can't do MBRT while she's on antibiotics. I added Beta-Thym, a beta-sitosterol supplement at that time.
After reading on CAVM about some folks successfully resolving MUE with homeopathy or herbs, I am second guessing my approach of focusing on immunomodulation. It is clear the neurologist expects the dog to relapse when the long-acting immunosuppressant wears off-- which will be 6 weeks from 4/20, so towards the end of this month. If the episode actually had a toxic etiology, then she should never look back. Meanwhile, the neurologist will pressure her to keep up the steroids, and her iatrogenic damp heat will worsen as summer comes on.
Is there any way to figure out a management direction for this dog without letting her symptoms recur? I never saw her with acute symptoms, so would have to choose homeopathic or herbal therapy based upon others' descriptions of her unmedicated state. I know the neuro resident wants to keep her on high dose pred at least another six weeks, but we could switch her management to my colleague Curtis Dewey, who is also a Cornell neurologist, but does TCM in his private practice (Chi guy), so is presumably less rigid in his thinking. Should I start reducing the pred and see what emerges? I saw here that a previous case did great on Chai hu blah blah blah, but that dog ultimately had a brain tumor (MRI on this case showed inflammation/swelling but no tumor).