Thursday, June 1, 2017

3081. Slipped disc in a 9-year-old, female intact Miniature Schnauzer

Jun 1, 2017

Miniature Schnauzer became paralysed on hind legs yesterday. Vet 1 did X-rays (below) and showed "slipped disc". Prescribed meloxicam for 4 days.

Owner was a vet nurse and consulted me for second opinion. I did the spinal palpation (pain from between shoulder blade area to middle of back) , placing and pedal reflexes and pinched the toes.

Prognosis is not so good as there is no reaction to the pinching of toes of the back legs and needle pricking of skin behind the groin to the paws of back area. Poor reflex seen on left front paw. .






X-RAYS
IVDD at lumber 4 and 5.
Spurs seen in these 2 vertebrae.


BLOOD TEST
June 2, 2017.
1. No bacterial infection as total white cell count and neutrophils ae within normal range.
2, No anaemia. Platelet count  1852 (200-500) is very high with platelet clumping noted and large platelets seen.
Large platelets are abnormal and the cause may be genetic, traumatic or auto-immune disease such as immune thrombocytopenic purpura (in this case, platelet count is low and not high as in this case).

3. Glucose 2.5 (3.9-6) is low. May be due to stress and painful slipped disc.
4. Kidney and bone/joint function normal
5. Liver has elevated AST but normal ALT. May be due to stress and pain.

Blood test to be done 4 weeks later.

DIFFERENTIAL DIAGNOSIS
Fracture, dislocation in the spinal area, neoplasia, bony spurs, herniated disc (slipped disc).

DIAGNOSIS
IVDD L4-L5 causing paraplegia

TREATMENT
1. Surgery and MRI. In USA, MRI $2,500.Surgery US $5.000-7,500. Surgery to be done within first few days as early as possible. It is doubtful there are experienced vet surgeons in Singapore with sufficient number of cases to refer to.

2. Conservative treatment in this case
2.1 Cage rest 3 months and pain medication.
2.2 Therapy - sling to walk on front legs and try standing on hind legs. Owner will purchase online a wheelchair from China, arriving on Jun 13, 2017.
2.3  Carry to grass as dog will not eliminate indoors. Dog pees and poops on Jun 3, 2017.
2.4  Clean back area after urination and defeacation.
2.5  Turn him on sides every 4 hours to prevent bed sores. Sternal recumbency (rest on chest area instead of lying sideway) means recovering well.
2.6. Painkillers when needed esp. first week.
2.7. Lactulose to loosen stools and prevent constipation.
2.8. Good quality food with high fibres and neurobion.  

CONCLUSION
IVDD
It is possible that the dog had fallen down from the steps as the painful area is extensive, from behind the shoulder blades to mid-lumbar area. The bony spurs may or may not cause IVDD.








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