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)

lumbosacral stenosis - say what?

AP Here:
Tonka and I have been to see a Neurologist, Dr. Harris http://www.vetneurochesapeake.com/index.php?page=dr-jeanene-harris at Veterinary Neurology of the Chesapeake www.vetneurochesapeake.com/ . His left hind leg is still not right and he is walking sideways. While he was there he was also seen by Dr.Burgess http://www.cvssvets.com/surgeons.php as an orthopedic consult.  The presumptive results were-

Assessment and Diagnosis

Neuro Localization - Spinal lumbosacral cord (L4-S3): Tonka's neurologic exam is revealing subtle lower motor neuron deficits in his left pelvic limb. Given these findings in association with pain on tail elevation, the most likely location for the problem is at the lumbosacral junction. Possible causes would include lumbosacral stenosis (Type II disk disease, arthritis of the articular facets, and enlargement of associated ligaments and soft tissues). Other possibilities would include neoplasia (primary or metastatic cancer) or infectious/inflammatory diseases; however these are thought less likely.

The best diagnostic test to determine the exact cause for his defecits would be an MRI /- a spinal tap and electrodiagnostics (EMG, MNCV, etc.).

Tonka's mild neurologic deficits are further complicated by concurrent orthopedic disease. An orthopedic exam revealed discomfort on manipulation of both of his hips (left more than right) and radiographs of his pelvis reveal evidence of hip dysplasia and osteoarthitis of the left hip. Tonka also resisted manipulation of his left stifle (knee) and there is concern that there may be a meniscal tear. There is no evidence of cruciate ligament rupture at this time.

Since Tonka had his heart surgery this year and just had the rhinoscopy a month ago we are opting to try medication for a few weeks to see if there is any improvement. If not then we will have the MRI to rule out the Lumbar Sacral problem. I am hesitant to put him back under anesthesia so quickly after the last one and we are just now getting the prednisone out of his system and he is acting more alert and like his old self. We have known about the hip since 2009 and it has never been an issue until now so I am not sure what to think. We will just have to deal with whatever comes our way like we always do. I know he is tired of being poked and prodded and I don't blame him. If you are curious as to what an MRI for your dog costs these days in the Maryland area try $1750.00 and that does not include any additional items like a dye test or spinal tap.