Wednesday, October 2, 2013

1172. Quadraparesis: A young Pom cannot stand or walk











Oct 1, 2013
The care-giver brought in a 7-month-old Pom, not able to stand at all. The couple had volunteered to care for this dog as her lady owner's apartment was being renovated and this would take some time.

Vet 1 had seen her twice and had given meloxicam, tramadol pain-killers. No medical records were presented at the first consultation with me. As the dog had pain-killers, it was difficult to find the source of pain. Spinal palpation elicited some pain in the T/L area and the dog cried when het left hind was extended for the X-rays.

Oct 2, 2013
This morning, the dog was not able to become upright when laid sideways to the left and to the right. However she could sit on her sternum. The pedal reflexes of 4 limbs were poor, esp. left fore and right hind. Shining a light constricted both pupils.  I palpated from the neck to the tail spinal area. The dog screamed at the spinal area between the neck and the shoulder blade. I had this scene videoed.

What was the problem? Would the dog recover? The caregiver was worried and so was the owner. This was a young dog and she could not walk or stand. When laid sideways to the left and to the right, she could not upright herself.  I videoed this behaviour. This was worrisome as there seemed to be a very serious injury of the brain or upper spinal cord.  I phoned Vet 1 for the medical records. Only pain-killers were given orally and one was injected. No blood test or X-rays were done. As the dog salivated, the care-givers brought the dog to consult me since I had treated their dog with difficulty in breathing successfully curing it within 2 days. It is not every dog that I treat recover within 2 days and this case was probably a mild upper respiratory infection.  Unfortunately, pet owners judge the vet's expertise by the speed of recovery and this is not right.    

After videoing, I gave this dog a subcutaneous injection of saline, glucose and amino acids and anti-inflammatory and antibiotics, expecting no response.

BLOOD TEST & VISIT BY THE OWNER ON OCTOBER 2, 2013
"It is best to take a blood test to check whether there is any infection causing this ataxia," I advised the owner who came in the morning. She agreed to the blood test and was most happy that the Pom was walking on four legs.

Yesterday, Dr Daniel thought that a blood test would add to the cost as I had 4 X-rays taken. "It should be done since the owner wanted to know why the dog had been ill for two weeks." I explained.

SIGNIFICANT BLOOD TEST RESULTS
Total white cell count was 19.1 (6-17). Neutrophils was 88%, Absolute 17.00 indicating a bacterial infection. The dog was put on antibiotics.
Platelets were higher at 720 (200-500).

VET 1'S MEDICAL RECORDS. 
Vet 1 had diagnosed traumatic injury to the back and advised strict rest. But no supporting evidence was deemed necessary in the two visits. Each vet has his or her own point of view and so the diagnosis of trauma was correct and pain-killers of NSAID of 3 types were given. Meloxicam on first visit. Then tramadol and injection of bup under the neck skin.

"But there were 3 adult dogs inside the caregiver's apartment and they jump onto this young Pom during play time and feeding," the owner complained to me when she visited on Oct 2, 2013.  She was quite upset as Vet 1 had already given instructions to let this Pom rest.

"It will be much difficult for me to advise your sister-in-law to restrain their 3 dogs. When your Pom is crated, she will bark furiously, causing noise nuisance to neighbours.
Is there any possibility of you taking back the dog to your apartment and crate her? Then there will be no pouncing upon her by the big "heavy" dogs of your sister-in-law.  The in-laws did phone me a few times asking when the dog will recover as they had got some backlash. "I don't know when she will recover," I said frankly.    

Surprisingly, in the afternoon of Oct 2, 2013, the Pom could walk and pace inside the crate. She would eat some of the A/D canned food.  When the owner came with the brown rice, she was elated as the dog was shrieking to go home. "The dog has not recovered yet," I said. "It is the drugs."




OCT 3, 2013
A bright sunny morning. I videoed the dog. She was reluctant to move. At around 10 am, the owner came and she was prancing and shrieking. In the afternoon, the caregivers came. Too much walking. At 7.22 pm, I checked on her. She was reluctant to stand, with her hind legs underneath her body and between the front legs. However, she could walk on 4 legs but there was incoordination in the back legs.

Expected to go home tomorrow. If confined properly, she should recover.

CONCLUSION
An unusual case of quadraparesis starting with back limb ataxia for 2 weeks earlier. Most likely there is traumatic injury of the neck and back area. There was intense pain in the neck area on Oct 2, 2013 when I palpated the neck to shoulder area of the backbone. This would lead to the quadraparesis (unable to stand on 4 legs tempoarily).

As to the cause of the bacterial infection of the blood, it is hard to locate the source.

 

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