Laurie's Blogs.

Lately I’ve been seeing more initial assessment than I usually do.  I’m covering a maternity leave at my clinic and doing extra hours to fill in missing time slots.  This means that as compared to my normal schedule where I see my regular clients, or provide second opinions within my clinic, or the occasional sporting dog, I am seeing just regular, random new patients. 

One thing I’ve learned over the years is that the universe gives you multiples of ‘stuff’ when it wants you to pay attention.  I’ve found this time and time again, especially in the clinic, where I get a theme and a ‘run’ of cases.  So, the past two weeks the theme is lumbosacral disc disease.

Tons of them!!! (Okay, maybe 4… but in a two-week time span, that’s a lot!)

What was more interesting than the obvious L-S dogs with their typical hunched back, scuffing toes, tail tucked, painful to normal palpation, were the marginally symptomatic dogs.  

The one I want to talk about is a 4-year-old Labrador who is being used in part as a service dog.  A lovely, well-mannered dog with a sweet disposition!  No lameness, no pain vocalizations, no typical neuro signs.  His issue, he has spontaneous rear leg kicks.  They’ve been happening for over a year.  They occur sometimes even when sleeping.  The dog’s regular vet had no ideas, so the owner brought the dog to us.

Let’s go down the path of clinical reasoning.  What could it be?


My differentials:

1.Lumbosacral disc disease.  Could a sometimes pinch, sometimes inflammation in the area cause a sometimes-spontaneous nerve firing?

2.Pain somewhere in rear leg. Same rationale as above, but something I’ve not seen or heard of in association with a musculoskeletal problem.

3.Some other neurologic phenomenon (Degenerative myelopathy?)  Again, same rationale as above, but not something I’ve seen or heard of in DM cases.  Quite plausible, and in fact, I could easily have put it as differential number 2.

Clinical findings revealed no leg pain.  No neuro signs (no evidence of scuffing, no chewing/licking at a rear limb, normal gait, and normal posture).  The limbs had full ROM and no soft tissue tenderness or joint tenderness.  However, deep pressure to the side of the L7 spinous process could produce pain bilaterally.  As well, L7 just felt to be ‘deeper’ than in other dogs.  To then dive into a more detailed evaluation I tried two different techniques that presumably compress each L7 nerve root via closing one L7/S1 facet joint at a time.  The result?  Each of these tests resulted in a pain response.  As such, my physical diagnosis was of suspected lumbosacral disc disease.

Treatment for his initial appointment consisted of laser therapy, mobilizations to L7, and the SIJ (it was a wee bit tender as well) and the home program prescribed consisted of tail pulls and the sternal pelvic tilt exercise.  I’ll see him back in 2 weeks.

Now, wouldn’t this be an interesting correlation… If this owner has noted something that most folks would likely dismiss?  Perhaps she has caught this issue in a very early stage, and perhaps we can slow down its progress dramatically!  (That’s my goal!)

It also takes me back to when I had the good fortune to be speaking at VetFest in the UK along with other well respected clinicians and researchers and got to sit across from my favourite researcher Ronaldo daCosta!  I asked him what he was researching now.  He said, “Lumbosacral disc disease in Labrador Retrievers.  However, we are having a hard time finding any Labs that aren’t affected.”  He said that they had evaluated about 30 so far and ALL of them showed some sort of neuro defect on examination.  Well, well, well…

So, I don’t know how this case will end, but I am most pleased with the thought processing leading up to this presumptive diagnosis.  I have also recommended she look into radiographs and seek a holistic vet to prescribe a natural anti-inflammatory product that the dog could be on for long term purposes.

There you go!  I hope that gets your wheels spinning too!  I’ll let you know if the prescribed program makes a change in kicking frequency when I see him again in 2 weeks!

In the meantime, have a great week everyone!



Cheers,

Laurie