Hello Everyone,
I met an older (8yr)67 lb. Neutered male Airedale that came to our clinic with progressive ataxia. He was in a rollover accident where he was ejected from the vehicle back in Dec. 2018. No broken bones or open wounds miraculously. He appeared to recover from that accident without incident. Fast forward to 5 months ago, per owner he has become increasingly ataxic in the rear limbs.I am wondering if this dog could have taken a bad spill and slipped splaying the rear limbs out and was struggling to get back up before all this started. The time this all started was during the cold, icey season in their area. Though the owner does not remember anything like that happening they also weren't with him 24/7.
Blood work showed NSF. Though this breed is not overly represented, symptomatically it was felt a rule out of DM was warranted,so they did send out a DM test which we haven't gotten results back on yet. There was an MRI done which showed a inflammatory process in both hips and a possible fluid filled area in the Left rear limb. They did ultrasound and biopsy that area and found it to be a benign growth (lipoma). No other significant findings. There was no definitive diagnosis made. So now we start to rehab him. Treating him like a disc patient right now.
He is weaker on the right with delayed proprioception and Hyperalgesic on that limb. When he walks with support of help up harness his swings his right rear limb in an exaggerated fashion almost every step. I did try some hobbles on the rears and it seemed to help a bit but when walking, he also crosses over in the rear limbs, which tangles the hobbles up.
Since he came to us he has been put on Prednisone to treat the inflammation and Gabapentin for pain.. We have been lasering, doing massage, neck and tail traction, UWTM exercises of weight shifts and 3 leg stands, (tried to do some assisted walks but he is not able to do that yet). Joint mobs, cookie bends to the shoulder with support, dynamic stabilization exercises, Range of motion exercises. I get him up to stand for about 3 minutes so far. I have not done balance exercises out of the water yet.
I do see little improvement in his strength but wondering if I could be doing more for him. He does not act painful in any one particular area except the thoracic region. I feel that may be due to overuse in that area to try to stabilize his rear end??
Thoughts and ideas would really be appreciated. Love this forum and all the excellent incites. We are so lucky to have this.
Laura
Ataxic Older dog
Re: Ataxic Older dog
Hi Laura!
Tough case, especially without any sort of presumptive diagnosis!
So, I'm going to back up and think about differential diagnoses given the info you've provided... because that's what should guide your treatment planning.
In no particular order:
1. DM (waiting on test... but your description of gait doesn't quite add up)
2. Lumbosacral stenosis (okay, I'd actually put this as my first thought)
3. Cancer of some kind (because you can always throw that in to the differentials, as per what we see our local neurologist do with his lists)
4. Caudal cervical stenosis, degeneration...
Okay, I'm actually going to lean towards lumbrosacral stenosis still and I think that is how I would begin to treat it.
As such, with neuro dogs, I always think of therapy having two pillars as to what to do / where to focus. 1) Root of the problem (target therapist to L-S) and 2) Function.
In the first category: Laser, Tail pull tractions, acupuncture, shockwave, PEMF, Mobilizations
In the second category: UWTM, functional exercises, maybe a cart (standing cart or homemade quad cart... see video training 202 for a homemade cart. I just sent another dog home with one of ours on Friday as a way to provide normal upright stimulus and provide a way for the dog to walk.)
And you might end up fitting the dog with a permanent wheelchair. Which doesn't mean you failed. (I think we have to remind ourselves of that.) It can be the best option for quality of life. Plant a seed now, so that it has time to grow if the dog doesn't show signs of improving.
I hope this helps!
Cheers,
Laurie
Tough case, especially without any sort of presumptive diagnosis!
So, I'm going to back up and think about differential diagnoses given the info you've provided... because that's what should guide your treatment planning.
In no particular order:
1. DM (waiting on test... but your description of gait doesn't quite add up)
2. Lumbosacral stenosis (okay, I'd actually put this as my first thought)
3. Cancer of some kind (because you can always throw that in to the differentials, as per what we see our local neurologist do with his lists)
4. Caudal cervical stenosis, degeneration...
Okay, I'm actually going to lean towards lumbrosacral stenosis still and I think that is how I would begin to treat it.
As such, with neuro dogs, I always think of therapy having two pillars as to what to do / where to focus. 1) Root of the problem (target therapist to L-S) and 2) Function.
In the first category: Laser, Tail pull tractions, acupuncture, shockwave, PEMF, Mobilizations
In the second category: UWTM, functional exercises, maybe a cart (standing cart or homemade quad cart... see video training 202 for a homemade cart. I just sent another dog home with one of ours on Friday as a way to provide normal upright stimulus and provide a way for the dog to walk.)
And you might end up fitting the dog with a permanent wheelchair. Which doesn't mean you failed. (I think we have to remind ourselves of that.) It can be the best option for quality of life. Plant a seed now, so that it has time to grow if the dog doesn't show signs of improving.
I hope this helps!
Cheers,
Laurie
LAURIE EDGE-HUGHES
Re: Ataxic Older dog
hi Laurie,
I am sorry to be so long responding back. Thank you so much for your response. This case had me stumped, Didn't know how much was related to possible old injures from the roll over accident that had progressed to existing problems. The test did come back and I am sorry but forget the specific wording, but to me I interpreted it as saying there was a presumptive diagnosis of DM but it didn't say conclusive. Once the Vet told owners results they wanted to just come and get him and not do any rehab. I was saddened because I really wanted to help this guy if we could. I have called since they were home to ask how he is doing but have not had a return call from them yet. When they left I did give them a hand out of some suggested exercises for them to work with him and also advised that they could look into a PEMF pad from Assisi and check in their area for a acupuncturist or physical therapist to work for them near their home. I will let you know when I do how he is fairing.
Thanks Again,
Laura
I am sorry to be so long responding back. Thank you so much for your response. This case had me stumped, Didn't know how much was related to possible old injures from the roll over accident that had progressed to existing problems. The test did come back and I am sorry but forget the specific wording, but to me I interpreted it as saying there was a presumptive diagnosis of DM but it didn't say conclusive. Once the Vet told owners results they wanted to just come and get him and not do any rehab. I was saddened because I really wanted to help this guy if we could. I have called since they were home to ask how he is doing but have not had a return call from them yet. When they left I did give them a hand out of some suggested exercises for them to work with him and also advised that they could look into a PEMF pad from Assisi and check in their area for a acupuncturist or physical therapist to work for them near their home. I will let you know when I do how he is fairing.
Thanks Again,
Laura