I have a new patient coming in Saturday and I was hoping for some advice!
She is ~10months FS Springer Spaniel. Her presenting complaint is that she has been experiencing intermittent lameness/ataxia since May 2020. Initially neck pain then hind limb ataxia later in May. R patella sI loose (not sure if the RDVM is referring to the SI joint) and then in September she presented for foreleg pain. She was also seen by the OVC in July 2020 and was found to have pelvic limb weakness weakness/lumbar pain.
We only have a laser at the clinic (U/S and e-stim coming soon!) We do have a pool and an UWTM. Has anyone encountered something similar? What did you do? If not any pointers on ideas for exercises or where to start with this pup?
Thank you!!
Puppy with Ataxia
Re: Puppy with Ataxia
Hey!
I see that I am answering after Saturday. So maybe you'll have more information to update us.
1. I would imaging that the rDVM saying " R. patella sl loose" means that the right patella is slightly loose. So grade 1 perhaps.
2. Since there was once neck pain, and you now also have ataxia, hind end weakness, and an incidence of foreleg pain. I'd weigh neck lesion heavily into the mix of differentials.
3. You question needs to be, "what is the likely diagnosis?" or "what are the differential diagnoses?" as compared to what to do. Because what to do comes after 'what do you think it is and where should I target treatments?'
So, I would look at neck first.
Mobilize the neck. Laser the neck. Traction the neck
Yes, check the back... but with this history, I think neck makes the most sense.
Then with part of your therapy directed at the root of the problem (i.e. the neck), the other portion of your therapy can be directed at strengthening and coordination. For this, your UWT likely makes the most sense, with some land exercises (cavalletti's, weaving, backing up, etc) thrown in to work on coordination and body awareness.
That's how I would approach this case anyways.
So, what did you find on Saturday?
Laurie
I see that I am answering after Saturday. So maybe you'll have more information to update us.
1. I would imaging that the rDVM saying " R. patella sl loose" means that the right patella is slightly loose. So grade 1 perhaps.
2. Since there was once neck pain, and you now also have ataxia, hind end weakness, and an incidence of foreleg pain. I'd weigh neck lesion heavily into the mix of differentials.
3. You question needs to be, "what is the likely diagnosis?" or "what are the differential diagnoses?" as compared to what to do. Because what to do comes after 'what do you think it is and where should I target treatments?'
So, I would look at neck first.
Mobilize the neck. Laser the neck. Traction the neck
Yes, check the back... but with this history, I think neck makes the most sense.
Then with part of your therapy directed at the root of the problem (i.e. the neck), the other portion of your therapy can be directed at strengthening and coordination. For this, your UWT likely makes the most sense, with some land exercises (cavalletti's, weaving, backing up, etc) thrown in to work on coordination and body awareness.
That's how I would approach this case anyways.
So, what did you find on Saturday?
Laurie
LAURIE EDGE-HUGHES
Re: Puppy with Ataxia
No worries, I still appreciate the reply!
What I found out on Saturday is that the neck pain that she was experiencing was from a vaccine reaction and was a 1 off occurrence. I found no pain on palpation and the ROM was good. She was extremely wiggly and nervous (pandemic puppy-not fully socialized but thankfully not aggressive/bitey). Found spasms over T4-7 and around L4-7. She did not like me being anywhere near her hind end and kept trying to run away. I also found that she had pain with a tail jack. ROM in forelimbs seemed quite normal, she was a little tense but I think that was her anxiety more than anything. Hindlimbs flexion was good bilaterally and very resistant on extension, but throughout the assessment she would step up on the stairs and stretch on her own. Pain on palpation of both ilio's. While at the OVC they tested for the Ortilani sign and her LH>RH, but they mentioned that this could be normal given her age. Rads were also done there and everything looked good.
In the meantime the owner's have declined MRI/joint taps. Overall gait looked quite normal 1/5, she did have a slight inward rotation of her RH. Stance: LF:24 RF:24 LR:29 RR:23
I was speaking with a co-worker of mine and her old dog had lupus and at ~7months started showing signs of lameness especially in the hind end. He was only diagnosed when he was about 2- when he finally got his joints tapped. It sounds like it could potentially be lupus- but there has been no fever/swollen lymph nodes or any of the other clinical signs.
Thanks again for the help!
Ema
What I found out on Saturday is that the neck pain that she was experiencing was from a vaccine reaction and was a 1 off occurrence. I found no pain on palpation and the ROM was good. She was extremely wiggly and nervous (pandemic puppy-not fully socialized but thankfully not aggressive/bitey). Found spasms over T4-7 and around L4-7. She did not like me being anywhere near her hind end and kept trying to run away. I also found that she had pain with a tail jack. ROM in forelimbs seemed quite normal, she was a little tense but I think that was her anxiety more than anything. Hindlimbs flexion was good bilaterally and very resistant on extension, but throughout the assessment she would step up on the stairs and stretch on her own. Pain on palpation of both ilio's. While at the OVC they tested for the Ortilani sign and her LH>RH, but they mentioned that this could be normal given her age. Rads were also done there and everything looked good.
In the meantime the owner's have declined MRI/joint taps. Overall gait looked quite normal 1/5, she did have a slight inward rotation of her RH. Stance: LF:24 RF:24 LR:29 RR:23
I was speaking with a co-worker of mine and her old dog had lupus and at ~7months started showing signs of lameness especially in the hind end. He was only diagnosed when he was about 2- when he finally got his joints tapped. It sounds like it could potentially be lupus- but there has been no fever/swollen lymph nodes or any of the other clinical signs.
Thanks again for the help!
Ema
Re: Puppy with Ataxia
Well, I'd try treating for the L/S issues then...
Swap out 'neck' as the primary to L/S as the primary.
I would approach it as a 'treat as a way to rule in or rule out pathology.'
If L/S directed treatment makes everything better... then you are on track.
If not, theN you can go down the road of Lupus or something of the like.
"i.e. It's more likely a horse than a zebra."
Thank you for the update!
Laurie
Swap out 'neck' as the primary to L/S as the primary.
I would approach it as a 'treat as a way to rule in or rule out pathology.'
If L/S directed treatment makes everything better... then you are on track.
If not, theN you can go down the road of Lupus or something of the like.
"i.e. It's more likely a horse than a zebra."
Thank you for the update!
Laurie
LAURIE EDGE-HUGHES