Possible Geriatric Wobblers

[JuliPotter]

I would like your opinion on a patient that I am currently seeing.
Beau is a 14 year old MN Basset Hound mix owned by Burk and Linda Hershey. Beau seems to be having quite a bit of trouble with his back legs; he is off balance and very slow moving. As well, though Beau is eating, it can take him hours to finish his dinner and he needs a lot of encouragement. Beau only eats in the evening. Beau did have senior blood work (CBC, Chem, T4, UA, 4DX Snap test) done on June 1, 2018 and the results were within normal limits.
Beau is currently taking joint supplements, Dasuquin and Eicosaderm as well as a multi-vitamin- Cell Advance by Vetriscience and 3 medications for his eye.
Beau is quiet this evening though he will take treats. While walking around he moves slowly, he walks with his head down, his front legs cross over slightly while walking and he is ataxic in the rear; he seems stiff with a shortened stride in all 4 limbs. He is limping on the right forelimb, he seems weaker on the right rear leg and he stumbles occasionally, he tires easily.
Posture - Lordosis is present in the thoracic spine, his thoracic spine is quite long and his back legs are longer than his front legs; he continues to have a narrow base stance in the rear, he tucks his pelvic limbs underneath him while standing.
There is muscle atrophy of the temporalis muscles.
Beau does appear to be painful with a side glide of C6, C7, bilaterally, possibly worse on the left for he did whine. Resists lateral flexion of his neck both right and left and he tenses when I attempt to palpate C7. He avoids passive movements (rostral glides) of the TMJ bilaterally. He seems painful with palpation of the first rib on the right.
Thoracic limbs – angular limb deformity present, triceps and biceps are very tight, triceps feel atrophied, both elbows are thickened, decreased extension of the elbows, decreased shoulder extension. Teres major and Latissimus dorsi muscles are tight/tense. In general, Beau resists palpation of his forelimbs and he does not want to lay on his side.
Thoracic spine Paraspinals feel atrophied with low tone. Occasional flinching with DV pressure at the angle of the ribs (6,7,8) on the left. No reactivity noted with rib shearing.
Lumber spine –paraspinals feel atrophied. At the Lumbo-sacral region, Beau was reactive (restless/moved away) with DV pressure on the right side of the spinous process of L7.
Pelvis –No abnormalities noted upon evaluation of the pelvis.
Pelvic limbs – moderate muscle atrophy present, sartorius and quadriceps are tight and hamstrings are flaccid on both the right and left. Noted trigger point/thickening of the left Sartorius muscle closest to the insertion. He does seem uncomfortable, tries to move away, with palpation of the left patella/patellar tendon and I can luxate the right patella slightly. Decreased CP on the right. Beau shows little resistance when I pull back gently on the right pelvic limb.
I am wondering if most of the weakness I am seeing in Beau's pelvic limbs is related to possible Geriatric Wobblers (caudal cervical disease) or could there be a secondary issue. I was thinking maybe he had LS disease as well because he is so weak in the rear, especially on the right; he seems to have little to no strength in his right hip flexors (he does not resist me at al when I pull back on this leg) but he does not seem overally painful with manipulations at LS; he has good anal tone.
Could this be secondary to the C-spine as well? He definitely has OA in both elbows! I believe that he may have some underlying GI disease as well and I have talked to his rDVM about this. Thank you so much for your help!!
Juli
Juli Potter, DVM, CCRT

[lehughes]

Hi Juli,

Great work up!

So I think you're likely on the right path with this dog. It could be both a caudal cervical issue with a dash of lumbosacral disc disease. But yes, the clinic picture sounds very much like a geriatric wobblers.

I find they do well with traction, mobilizations, laser, perhaps some acupuncture and/or PEMF if available. Then I'd also add in some tail pulls and a bit of L6,7-S1 mobilizations for good measure. But focus more on the neck. When mobilizing the neck, go with mobilizations that don't hurt. Start up at C5 (you'll still affect C6 and C7). Start with grade 2's and then progress to 3's.

I LOVE geriatric wobbler's! Just start treating... I'm sure you'll make a difference!

Best of luck!

Laurie

[JuliPotter]

Thank you, Laurie, I have been working with this pup for a while now and his symptoms seem to vary .....it helps so much to have your insight! You are the best!!