Thursday, December 8, 2011

It may be all in his head!

AP here with an update:

I took Tonka to see Dr. Jay McDonnell to see if he might be able to shed some light on what has happened with my boy. He went over the MRI with me and he did not see anything different than what Dr. Harris had seen.

The MRI is a device that uses strong magnets that spin around the patient, and picks up the magnetic signals emanating from the cells as they demagnetize. This gives a picture of the inside of the body without having to use surgery and is more precise than X-rays.

In a dog there are 36 pairs of spinal nerves of the 36 spinal segments which are categorized into the 5 spinal cord segments labeled cervical thoracic, lumbar, sacral and caudal

8 cervical; 13 thoracic; 7 lumbar; 3 sacral; & 5 caudal = 36 total

His lumbar and lumbosacral areas of his spine look great so there is nothing to suggest that his problem is due to a disk problem or stenosis which is a narrowing of a spinal area that would put pressure on the spinal cord or nerves.

He does have some intramedullary (within the spinal cord) hyperintensity within the thoracic part of his spinal cord. A hyperintense signal is a "bright spot" on an MRI. In order to eliminate fluid being the cause such as cerebrospinal fluid they use FLAIR "Fluid attenuated inversion recovery" which is a pulse sequence that essentially removes fluids from the picture. This allows any lesions to be visible. It is not known what has caused his bright spots and in order to get a fuller picture of what has happened we would have to MRI his cervical area and his brain. The plan at this time is to do that in January. The brain and spinal cord are surrounded by cerebrospinal fluid (CSF) and this fluid nourishes the nervous system and protects the brain and spinal cord so it directly reflects what is going on inside the nervous system. Dr. Harris checked for CSF problems at the time of his MRI with a spinal tap and it came back normal. It could be that there is too much CSF and perhaps a narrowing that is inhibiting the normal flow and creating elevated intracranial pressure so he is now on Prilosec. Prilosec which is omeprazole relieves heartburn in people but in dogs it reduces the production of cerebrospinal fluid.

We have seen some improvement with the foot drag which is now a lift and stutter until he gets tired and then it is back to a drag. The incontinence seems to come and go – some good days, some bad so we are just going to create as normal an environment and routine as we can. The advice was to “do the things that he likes and that seem to work and avoid the things that make him worse” and we can certainly do that. We will continue with the acupuncture and anything else that helps him physically. Twice a week I will take him to the park and let him “see” his dog friends and once a week we will go visit his human friends and that should keep him emotionally happy.

I cannot say enough great things about Dr. McDonnell and Dr. Harris. I never felt rushed or pressured into any procedure. They both took the time to go over the MRI results with me and the support staffs were and are always extremely professional and helpful. You can tell when people really care and understand what you and your pet are going through and this group does. I hope you and your pet never need a neurologist but if you do Tonka and I would recommend you check in with Veterinary Neurology of the Chesapeake and Dr. Jay McDonnell, DVM, MS, Diplomate ACVIM (Neurology) and Dr. Jeanene Harris, DVM, MS, Diplomate ACVIM (Neurology)


Bertha and her Merry men said...

WOW, that's a lot of information but it sounds like things are being ruled out. Hug the big Guy yet again from all of us.

Anonymous said...

humm... hope it's not Canine degenerative myelopathy?

Degenerative myelopathy begins with the spinal cord in the thoracic (chest) region. Symptoms initially affects the back legs, dragging of one or both paws, and as it progress causes incontinence...

Tonka said...

Hi Anonymous. My neurologic exam was not consistent with a thoracic myelopathy. My breed, age, sudden onset and MRI and CSF tap do not fit. Nothing really fits any difinitive problem but anything is also possible with me! My incontinence is only after I have been laying down for awhile and I get up and stretch or if I walk down a hill. I do not go in my sleep and can make it through the night. The bright spots can be any number of things such as a congenital abnormality, a 'pre‐syrinx' (a precursor to syringohydromyelia), myelitis
(infectious or inflammatory), gliosis (scarring of the spinal cord) or neoplasia. I have been progressing with acupuncture and therapy in the right direction with lifting my foot instead of getting worse. Thanks for writing.