"GUS", Male French Mastiff, DOB 05/2006 Case Study
After being hit by a car on October 24th, 2007, Gus was taken to the Capital District Animal Emergency Clinic where he was treated for shock and found to have complete paralysis of the hind end (including tail, urinary and defecation abilities) due to spinal cord compression caused by a herniated disc. Gus’ family was told that his best chance for survival was emergency neurosurgery, and that even with surgery his prognosis was guarded.
Hopeful, his family transferred him to VCA South Shore Animal Hospital on October 25th, 2007. At the time of surgery, he could not feel or use his back legs at all. Dr. Stephanie Kube, a board certified neurologist, performed the surgery. Gus was diagnosed with a herniated lumbar intervertebral disc and a fractured process of the 7th lumbar vertebrae. His tail was amputated and the herniation responsible for the spinal cord compression was relieved. He stayed in their Intensive Care Unit for 3 weeks. During that time he had an indwelling catheter, and needed to be evacuated regularly due to his loss of bladder and bowel control. He also suffered from severe neurological spinal-like pain over his lower back. This was treated with medication, and slowly feeling came back in his toes.
Gus was transferred to Shaker Veterinary Hospital on November 19th, 2007 for further rehabilitation. He still needed to be catheterized three times daily to empty his bladder. He was on pain medication for the spinal pain and anti-anxiety medication to help relieve some of his apprehension about his situation and new surroundings. He would cry in pain every time anyone touched him.
Gus was started on daily rehabilitation treatment including range of motion exercises, stretching and massage, the TENS unit (electrodes used to relieve spinal and muscular pain), and Neuromuscular Stimulation was used for muscle contraction. His muscles had atrophied during his convalescence and he needed to contract and rebuild his strength (he had lost nearly 30 pounds of muscle mass).
Over the last 2 months, Gus has regained sensation in his hind legs, starting first with his toes and then slowly up each leg. He can now feel both legs entirely. With the aid of medication, he went from catheterization 3 times a day, to manual expression of his bladder. He has progressed from severe diarrhea and defecating without warning to unpredictable but typically firm stools. His urination and defecation abilities have been slow in returning and have only been somewhat normal for the last 10-14 days. He has been weaned off of his anti-anxiety drugs but is still being medicated for pain.
He has recovered the ability to use his back legs, and can now pick himself up on his own and support most of his weight. Using a sling to help him with balance, we have gradually increased his exercise regimen from 5 minutes on the treadmill to 15 minutes. He does not walk normally, and though he may never walk completely normal again, he is expected to continue to improve. Due to his intensive nursing care and partial paralysis, Gus has not been able to go home to date, although his family has been able to visit him here. Our hope is that Gus will join his family at home soon. Gus, once a painful, paralyzed, borderline depressed dog, has developed into a happy outgoing dog.
Fibrocartilaginous Embolism (FCE) Case Study
Fibrocartilaginous Embolism (FCE) is a condition often characterized by acute lameness or knuckling over without apparent tenderness. Lameness can be a symptom of numerous conditions and proper diagnosis of FCE or any other condition requires a doctor's exam and or diagnostic tests (ex. x-ray, bloodwork).
Typically with FCE, the symptoms appear suddenly, often while engaged in active play such as fetch or frisbee. The dog may land from a jump incorrectly and become unable to use one or both legs normally. Handling the lame leg will not reveal any soreness or discomfort to the pet.
What is FCE?
FCE results when material from the nucleus pulposus (the gel-like material which acts as a force-absorbing cushion between two vertebrae) leaks into the arterial system and causes an embolism or plug in a blood vessel in the spinal cord. The condition is not degenerative, and therefore does not worsen. FCE is not painful for the pet, but some permanent nerve damage is likely. Roughly half of all patients diagnosed with FCE will recover sufficient use of their limbs.
Who is likely to suffer from FCE?
The most typical victims of FCE are large breed adult dogs, although all dogs are susceptible. It most often occurs during hard play or as a result of a accident or injury (ex. a hard fall or a hit by car).
Diagnosis
X-rays rule out other possible causes for the lameness and/or neurological symptoms such as fractures, inflammatory disease, cancer, or a slipped disc. Cerebral Spinal Fluid (CSF) taps usually show no red blood cells, normal white blood cells and elevated amounts of protein. This is consistent with vascular lesions of the spinal cord.
 |
 |
|
| Axial T2 MRI Image – The cross sectional view through the area of hyoerintense signal shows the area of nerve injury within the cord. There are normal CSF columns around the cord and minimum cord enlargement. If a myelogram was done, it would probably not show the this damage. | Axial post contrast T1 MRI Image – This is the same cross sectional view as the axial T2 view. If the area of hyperintensity were inflammatory in origin, contrast would leak out of dilated vessels and cause the area to have hyperintense (white) signal. The reason it is not present is because there is a loss of blood flow to the area preventing contrast from reaching it, consistent with a fibrocartilaginous embolus. |
 |
||
| Sagittal T2 MRI Image – The oval area of hyperintense (white)signal within the cord represents an area of infarction. The nerve cells are injured due to lack of oxygen and have more unbound intracellular and extracellular water resulting in increased T2 signal. |
Treatment
Treatment is usually nonspecific supportive measures and nursing care. Corticosteroids may be used, but their effect on the outcome has not been documented. Physical rehabilitation may be beneficial for patients with FCE, and is one of the services offered by specially trained technicians at Shaker Veterinary Hospital, P.C. Techniques vary depending on the location of the FCE and the degree of damage to the spinal cord. Passive range of motion exercises can be used in joints and muscles at risk of developing contracture. Deep water hydrotherapy is used to stimulate muscle activity and to promote muscle/nerve re-education. Massage is used to maintain circulation. And finally, ambulation exercises such as using an exercise ball are used for strengthening.
Hydrotherapy Case Study
The dog pictured here was presented to the doctors at Shaker Veterinary Hospital for lameness and curled toes on his right rear leg. This dog was dragging the leg behind him. A CT-scan was not diagnostic. This pet was treated with rehabilitation therapy. Using both special exercises on the exercise ball, and sessions in the hydrotherapy tank, the dog has greatly improved use of the effected limb.
 |
 |
|
Initial position of leg |
Use of exercise ball to strengthen |
|
 |
 |
|
Image showing toe curling |
The buoyancy of hydrotherapy enables |
Return to the Shaker Veterinary Hospital Homepage