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Post by Deb & Gabbie on Oct 9, 2023 9:42:22 GMT -7
[Original subject line: Confusing diagnosis]
Hello everyone!! My Coton de Tulear, Gabbie, is 5 yrs old and her vet said she had IVDD on March 19th. Gabbie presented with a lower head, unable to lift her head without yelping in pain. The vet said it was cervical IVDD. She was put on Gabapentin, Carprofen and Methocarbamide. She didn't have any trouble with her back legs. She would still yelp in pain when moved or picked up, in spite of the medications.
On April 16, I rushed her to Dogwood Neurology. I saw one of the head neurologists and he also thought cervical IVDD, he couldn't touch her without her screaming in pain. He kept her overnight and was going to have her get an MRI in the morning. A different neurologist (not a head neurologist) was at the hospital that night and she had to have additional pain medication to get her out of pain so he could examine her. He did the MRI and a spinal tap and said it was normal and said perhaps she has a soft tissue injury. His discharge papers said if she presented with problems with her back legs to take her back to vet.
In August, she started having trouble getting up from a laying down position and walking very gingerly and slow. I thought maybe it was the Gabapentin, so stopped it.
In September [date?], she had an episode of severe pain and I took her back to Dogwood through the ER.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
Weight 12 lbs?? 5 y.o.
4/16: suspicion of neck disc, but MRI/spinal tap normal
10/9/2023 yelps w/owner lifting right front leg
gabapentin ?mg ?x/day Stopped in August]
The same Dr. that was in the hospital the night she was admitted, was the one working the ER. He took her back to watch her walk, came back and said she has nothing neurologically wrong, the MRI and spinal tap, were normal back in April. He started saying, she should see an ortho surgeon, get an abdominal ultrasound, it could be pancreatitis. I asked him how she could have pancreatitis, she hadsno issues with her GI, no abdominal pain and how does pancreatitis cause pain in her neck. His response was, it can happen. He basically said she needs to go through these tests to rule out what is causing her neck pain and difficulty with her legs. Needless to say, I am so confused.
Her vet is still treating her as IVDD and she has been getting cold laser treatments, 2 x a week. She is definitely not in as bad shape as she has been previously, but her back legs are concerning me [describe!]. She yelps when you lift her right front leg and her vet said that is because it is pressing up into her neck. I don't know where to turn.
This neurologist rambled off so many things from a GI tumor, pancreatitis, bone issues, unbelievable. He basically said in veterinary medicine, it is one of those times they don't know what is going on. I am going in circles. I don't know if I contact the original neurologist, if it will do me any good as they are in the same practice. It cost me $435 when I took her in this second time. I couldn't send it in to my insurance because he didn't do anything. Any thoughts out there?
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 9, 2023 11:18:02 GMT -7
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 9, 2023 12:35:45 GMT -7
Welcome! Is your name Deb? Mine is Paula and we are glad you have joined us. It is a prudent thing for your vet to act like this is a disc episode in the neck until there is another disease that can be confirmed to be the cause of the pain. I'm sorry you've not yet been able to get a firm diagnosis from a neuro specialist. Since this board only deals with IVDD, naturally when you describe things that sound like IVDD, that is what we first think about. There are other diseases, of course, which can mimic what IVDD looks like. And this is why we wait on a vet for their diagnosis. I know it surely is scary to hear all those diseases mentioned!! It may be helpful for you to understand that all vets follow the same process of coming up with a diagnosis. First they consider all the diseases that look similar to symptoms of IVDD: broken bone, bone tumor, bone infection, infection of the intervertebral disc, infection of the spinal cord, etc. Then comes ruling out some of those diseases with examination, tests, imaging. The MRI is the gold standard of imaging because it shows hard tissue like bone AND soft tissues of both spinal cord and discs. The spinal tap confirms or rules out infection. After ruling out as many diseases as possible, the vet puts in order the final 2-3 diseases it likely could be. The top disease is the diagnosis and dictates the treatment. It think it is good to have a 2nd opinion from a different neuro. Seek out one of the "head" neuros, for example Dr. Isaacs. Until you have a different diagnosis than from your local vet, continue to assume this is a NECK disc episode. The STRICT rest is to prevent the suspicion of a bad neck disc from doing further damage of only pain to that of nerve damage. As I mentioned above, anything that looks like IVDD, because we are not vets, we tend to view things as IVDD. Getting a confirmed diagnosis means the treatment Rx'd can match the actual problem. Does Gabbie avoid putting any weight on the front right leg due to pain?
Dr. Isaacs (Neurology, ACVIM) discussing root signature pain here: dodgerslist.com/2020/08/20/nerve-root-signature-painHave you had Gabbie on STRICT rest since Sept (date?) to allow a suspicion of neck disc to heal and if escaped disc material is pressing on the nerve root to shrink back enough to no longer irritate? How to provide STRICT rest at potty time, eating, etc to protect a healing disc: dodgerslist.com/2020/05/14/strict-rest-recovery-process/How much does Gabbie weigh? What pain meds is she currently on ( name, ?mg ?x/day)
Is she on an anti-inflammatory? Date started ?mg ?x/day for ? days |
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