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Post by Renee & Lola on Dec 28, 2019 9:57:09 GMT -7
Hi:). I’ve been reading everything on here for about a week and while it’s been very helpful, I could use some guidance please. My Lola was diagnosed 9 months ago with a soft tissue injury to her left front shoulder area. She is VERY playful and like many she gets the zoomies a few times a day. They told me to think of her as a toddler and she sometimes will get hurt. She will be playing, diving on a toy, or running and will come over to me holding her left front leg up flamingo style. She is shakey but never verbal. Never uninterested in her food. She has trouble getting comfortable due to the pain at that time. The event can last 15 minutes or up to 5 hours. Only once did it last a full 24 hrs. She gets very excited for dinner and she even continues to do happy circles on 3 legs. No lowering her head. Ears still perk up. Now the frequency of these events started out at about once a month. Over time, they have increased and can happen weekly.
I requested to have this looked at further and was told an mri would be necessary. I’m in the Buffalo NY area, so we only have one facility with an MRI/CT machine.
Dec 3rd I took her to this facility anticipating an MRI. Met with a regular vet (closest Neuro is 3 hours away)She informed me that she felt it was a cervical issue and NOT her shoulder. So she’s been misdiagnosed for 9 months. She did not do an MRI. She instructed me to either have Lola in her crate or on a lead while next to me on the couch. No running/jumping at all. 4 weeks is the duration recommended. I’ve done this. But last week she was turning around in her crate and she held her leg up again. It lasted 3 hours and I gave her 1mil of gabepenton as instructed. I’m at a loss and not sure she has been correctly diagnosed with IVDD. And if it is IVDD did we wait too long after her initial injury due to misdiagnosis for it to have the opportunity to heal correctly?
1. Weight 9lbs. Age 7 years old, Meds - gabepenton 1mil every 8-12hrs. (As needed - not currently necessary) 2.breed - chihuahua, Name - Lola, My name - Renee 3. Diagnosis IVDD by DVM 4. Vet visit/rest Dec 3rd 5. No current pain or symptoms 6. Walks fine on all 4’s. Very happy, tail wags all the time 7. No potty problems at all - ever. 8. Eats and drinks fine - never has been an issue.
Below is the report: Today on physical examiantion, Lola appears to be in good general health. She is ambulating comfortably and no lameness is appreciated today. That being said, she is repeatably painful with palpation of her caudal cerical spine. With Lola's signalment (age/breed) and clinical history, the most likely etiology would be a cervical myelopathy secondary to intervertebral disc disease or IVDD. Other possible etiologies include a vascular/stroke event, infectious or inflamatory cause or less likely a spinal tumor. We discussed that IVDD or disc disease affects the fibrocartilaginous disc that rests between vertebral bodies. The disc is formed of a softer inner center surrounded by a fibrous cortex and this condition occurs when the inner portion ruptures through the outer cortex and places direct pressure on the overlying spinal cord. There are breeds that are predisposed to IVDD including chondrodystrophic breeds, pugs and dachshunds noteably. The degree of compression on the spinal cord can usually be directly ascertained from physical examination findings. The first most mild clinical sign is spinal pain followed by loss of proprioception or sense of where limbs are in space. Proprioceptive deficits manifest as a change in gait, usually appreciated as a wobbly hind end while walking. Loss of superficial sensation and ability to walk can be followed by loss of deep pain or response to painful stimulus. Prognosis for this condition is directly related to loss of function. With very mild clinical signs medical management can be used to treat this condition and prevent further disc rupture, however with loss of motor or deep pain surgical decompression of the spinal cord is indicated. At this point, Lola is very minimally affected and medical management is recommended. We discussed that should Lola's condition worsen (weakness of the limbs or change in gait) reevaluation should be considered. Should Lola lose the ability to walk, she should be evaluated by a veterinarian immediately as this would be a surgical emergency. The most important aspect of medical management for IVDD is strict exercise restriction with containment in a crate or small pen. Lola should not be allowed to run or jump. This is to allow swelling of the affected site to resolve and to prevent extrusion of further disc material. After 4 weeks, Lola should be slowly returned to normal activity over a period of two weeks. Medication can be administered and Gabapentin will be prescribed to address Lola's neurologic disocmfort.
I apologize for the lengthy post - I’m just trying to be thorough as to not waste your time. Thank you so much!!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Dec 28, 2019 11:29:57 GMT -7
Renee, welcome to the Forum here at Dodgerslist.
Untll you have a different diagnosis, 100% STRICT crate rest 24/7 only out of the recovery suite for a very, very few footsteps at potty time is to protect the suspicious disc from further damage and the ensuing damge to the spinal cord nerves.
I would most definitely get a 3rd opinion from a neuro even if it it means a 3hr trip. Lola does not display the typical signs of a neck disc episode we observe on this Forum. As non of us are vets, we are not able to diagnose and give you the proof you need--- we can give you the guidance of seeking a specialsit vet now that you've seen two DVM vets each with a different diagnosis. -- While an $1000+ MRI or CT can aid the vet in pin pointing which of the diseases that mimic a disc episode, it is, an x-ray taken by a knowledgeable vet with good xray equipment or by a specialist who would likley have invested in good (more expensive with higher resolution) xray equipment, might help to rule out other disease. -- Xrays show only the hard tissue of bones, infected bones, etc. Xrays do not show the soft tissue of discs and spinal cord. Still a knowlegeable vet may be able to suspicion if this is actually a current disc episode in conjunction with a good neuro exam, the breed of Chi prone to IVDD and how Lola acts at the vet visit.
When there is a disc episode, the pain does not typically last for a short duration of hrs without pain meds on board. The pain lasts until all the swollen tissue around the spinal cord has been resolved. Anti-inflammatory drugs (steroid or a non-steroid (NSAID) are used to resolve inflammation. It will take the anti-inflammatory 7-30 days to do this. In the meantime pain meds are given to provide round the clock relief. Normally with a neck disc it would take 3 different pain meds to address each source of pain and all given ever 8 hrs. With a disc episode pain meds are never given "as needed" because this is typically a very pain disease with non-ceasing pain til the spinal cord swelling has been fully resovled---thus pain meds are needed round the clock every 8 hrs. gabapentin - for nerve pain tramadol - as the overal general analgesic methocarbamol - for the typical neck disc episode causing severe pain from muscle contractions.
None of here are vets, so we do not diagnose, but rather count on your vet's diagnosis. As you can now understand what is happeing to Lola is not the typical senario for a neck disc episode. It would be worth your while to make sure you are giving the right treatment for the a correct diagnosis by seeing a neuro specialist as there are a number of diseases that look like a disc episode but demand a different treatment.
So until you are certain it is not a disc episode, crate rest is to protect the suspicion of a damaged disc from very well causing potential nerve damage
Please let us know when you have a specialist scheduled and what he diagnosis.
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Post by Renee & Lola on Dec 30, 2019 11:53:46 GMT -7
Thank you for ur reply! You confirmed what I had been thinking. Not sure what my next move will be. Either neuro or ortho but I don’t want to end up needing two MRI’s. (One of neck, one of shoulder). I’m going to check with a local ortho to see how good their X-ray equipment is. I really appreciate the feedback!!
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