extensor rigidity and dysphasia in a dog diagnosed with cervical disc disease.

[JuliPotter]

Dear Laurie,
I have been working with a patient diagnosed with cervical IVDD in July, and though he has improved, some symptoms are persistent; I am wondering if there might be something else going on.

Winston is a 13-year-old MN Chihuahua who was seen in July by veterinary neurologist Dr Young at BVNS due to recent knuckling during walk. Based on Dr Young’s physical exam findings of altered tone, altered reflexes, (both in the thoracic limbs) and altered gait, a cervical spine lesion was suspected. The results of an MRI indicate that Winston has disc disease at C4-5 and C6-7. Decompressive surgery was recommended to manage the multi-level cervical disc disease but the owner chose conservative therapy (pain meds, laser tx, manual therapy, acupuncture, TherX).
Winston has definitely improved since July, but there are several persistent symptoms that I would like to explore, and I would love your input (Thank you!).
Winston does seem more comfortable in general, and his CPs are now normal, but his front legs remain very stiff/extensor rigidity. I can not extend the shoulder, there is limited shoulder flexion, and limited elbow flexion, bilaterally, and the muscles around his neck are still very tight/tense as well. There is atrophy of the supraspinatus muscle bilaterally, but the infraspinatus muscle seems hypertrophied and is quite tense, and over the pelvis, the deep gluteal muscle also seems hypertrophied and tense. I feel there is quite a bit of stiffness/decreased mobility along Winston's thoracic and lumbar spine as well.

Videos of Winston walking: https://photos.app.goo.gl/cQsEcpx81rZQn5aH9

My other concern is that Winston continues to have difficulty swallowing; we noticed this when Winston was first diagnosed with cervical disc disease. I emailed you a video of Winston swallowing, along with videos of Winston walking, in case you can't open the link above.
Winston also has muscle atrophy over his skull, particularly of the temporalis muscle, and I noticed atrophy of the masseter muscle as well. He avoids rostral glides of the TMJ, and I have noticed that C1 is rotated.

Thank you so much, Laurie!
Sincerely,
Juli

[lehughes]

Hey Juli,

My apologies for not getting to this until now. (October has been chaos!)

So, this little Winston... Oh my!!!

I was going to say, look higher (i.e. C1), but he doesn't quite look like the other atlanto-occipital instability dogs I've seen. That being said, he does sort of look like the post op C5 region dogs I've seen. However, the swallowing COULD be attributable to something higher - and as such a bit of laser on/around C1 and/or some gentle mobs on C1 might be in order.

So, I'm going to say that the gait is 'somewhat' typical for a C4-5 lesion.
I would continue with your current treatments - laser, mobs, traction, acup, etc. I would add in some Neuro Rehab treatments to work on breaking the spasm. I.e. In standing, flex a paw and stimulate a flexor withdrawal in order to gain flexion of one limb. Repeat a few times on one side and then the other. (I'm thinking front legs in particular, but you can try on the back legs as well - but I assume they are less rigid.
I think you need to get that going before you can have success with cavalettis or other ther ex.
You can also try using the e-stim under the foot pad. I have a video... just trying to remember what it's called in order to tell you which one to watch!!!
Found it! Video Training 27 - Ways to Play with E-Stim

Best of luck... that's what I've got for you off the top of my head!

Cheers,

Laurie

[JuliPotter]

Laurie, thank you so much! I will see Winston again next week!
yes, the back limbs are less rigid, but this little guy seems tense all over. Last week his mom told me that he is still knuckling on the front, and with the chronicity of the disc and spinal cord lesions, I suppose this is not unexpected, but I wonder if some of the knuckling is also related to the fact that his thoracic limbs have such limited range of motion. I have tried to emphasize how important it is to work on decreasing the spasm in the front legs, but....having your recommendations, I have told Rhonda how amazing you are, will help to emphasize this! Thank you!

All my best,
Juli

[lehughes]

<3

[JuliPotter]

Dear Laurie,
I have an update on Winston ....in the fall, I contacted Jenny Moe with Doggon Wheels to ask if she thought Winston might benefit from a cart. She recommended a quad cart but after watching the videos of Winston, she said that she suspected that Winston might have Cushing's myopathy. It has been a year since Winston's diagnosis of cervical disc disease and he has not improved, actually, the rigidity has worsened, and Rhonda, his mom, has also noticed hairloss on Winston's tail, thinning of the skin, and he has been panting quite a bit more than expected. I commented on recent blood work, suggesting that Rhonda do further diagnostics to determine why the GGT was so high. An abdominal US was performed and the ultrasonographer reported enlarged adrenal glands. Winston's first test for Cushing's (a low dose dex suppression test) was normal but Rhonda was encouraged to submit blood work to University of Tennessee for an adrenal profile, and the results were positive, the post ACTH cortisol value was quite high, and 7/12 values on the profile were elevated, indicating "adrenal hyperfunction". So it appears as if Winston may truly have Cushing's myopathy or myotonia. Rhonda recently started Winston on medication for Cushing's (melatonin, lignans, and Mitotane) based on the results of the adrenal profile and recommendations from the University of Tennessee.

During my visits, which have only been every 4-6 weeks, my goal has been to try to decrease the stiffness/spasm though massage, myofascial release, joint mobilizations, neuro treatments, and therapeutic exercise; Rhonda has been doing laser consistently as well, and there has been no change, and at my last visit on July 3, Winston was more reactive to my attempts at manual therapy. I did another search on Cushing's myopathy in dogs and I did find a paper that was published in JAVMA on Jan 1, 2024. The paper states that acupuncture and rehab have been of little to no help in dogs with Cushing's myopathy or myotonia! I also read that the tongue and muscles of mastication can be affected leading to difficulties in chewing and swallowing.

Here is the link for that paper-
https://avmajournals.avma.org/view/jour ... 7.0424.xml

Laurie, I am worried that I might do more harm than good for Winston, plus, I have seen no changes after manual therapy and therapeutic exercises. I do believe that a quad cart would be beneficial for Winston for it would allow him the freedom to move on his own but his mom has been reluctant to do this. I appreciate any suggestions or input you might have.

here is the link for a recent picture and short video of Winston (July 4, 2024)- https://photos.app.goo.gl/NHwZJ5jfjzFeBAqy9

Thank you so much,
Juli