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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 26192
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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My 8 year old male, neutered GSD suddenly became weak in his

Customer Question

My 8 year old male, neutered GSD suddenly became weak in his back legs day before yesterday. No noted history of incident or injury. Hard to tell if he's in pain, no yelping or whining on moving or manipulation, but his eyes flicker and he's panting a bit. Had him to the vet yesterday and I think I may have confused the issue by telling him that I'd had Keme to see one of his colleagues the week before due to a lump on his anus which I was told was a non-malignant tumour. She said its common to develop more. And I also told him that he was straining and couldn't seem to move his bowels. On reflection, this may have been more due to the fact that he's finding it hard to maintain a squat. I guess I was worried another lump had developed and was causing an obstruction. The first vet hadn't done a rectal exam. He did a rectal exam this time and couldn't feel any obstruction, but couldn't palpate the prostate, but no issues with voiding urine (my last GSD died from prostate cancer). Keme has a history of loose bowels once or twice a week, which he's always had, never any blood but can be mucousy occasionally. Anyway, we came away with some Flagyl for potential colitis, which he has been getting, but he moved his bowels this morning ok, with some perseverance and balancing. Normal stool. I'm very concerned it's neurological. He does have ticklish feet, which I suppose is a good sign, and the vet did examine his spine, there was no tenderness noted and good range of motion in hips and legs. I am on a very limited income and would hate to be paying out money for a misdiagnosis (I appreciate tests do have to be done in order to diagnose) ... But he's my boy and I'd spend my last penny on him, I just don't want to run out of money before we find out what's wrong. Can you suggest how I should proceed? Thank you.
Submitted: 1 year ago.
Category: Dog
Customer: replied 1 year ago.
Also, I was wondering if he can have dihydrocodeine for the pain, he's 45kg.
Customer: replied 1 year ago.
Oh, and I got some Xanax for him last week also, as he has extreme fear of the bucket lorry and ice cream vans, would that be any help? I was planning to give it to him mid afternoon as the ice cream van will be around at teatime. Thank you.
Expert:  Dr. Michael Salkin replied 1 year ago.
I'm sorry that your question wasn't answered in a timely manner. His "eyes flickering" - if you're describing nystagmus (his eyes flicking horizontally back and forth) - is the clue for vestibular (balance) disorders. Please confirm that nystagmus has been or continues to be seen. Vestibular disorders will also cause ataxia ("drunken sailor") - his "weak in his back legs".
Customer: replied 1 year ago.
Sorry, I should have been more specific, it's not his eyes flickering but his eyelids, like he's kind of cringing.
Expert:  Dr. Michael Salkin replied 1 year ago.
Ah! Thank you. You're concerned that Keme is experiencing symptoms of myelopathy - spinal cord disorder. Paresis (weakness) in the hind legs is a symptom of myelopathies as is reluctance to jump up or down or navigate steps, trembling/shaking (pain responses), vocalizing when approached or lifted, a change in posture - a "hunch" in the back or holding the neck stiffly and head lower to the ground, and a change in behavior - a normally social dog becoming reclusive or, conversely, a normally aloof dog becoming "clingy". Keme appears minorly affected, however. The symptoms I mentioned are consistent with a painful myelopathy such as degenerative disk disease (a "slipped disk"). Nonpainful myelopathies include degenerative myelopathy seen most commonly in the German Shepherd - a slowly progressive myelopathy, however, similar to Lou Gehrig's disease in people; and fibrocartilagenous enfarct (FCE) - an interruption to the vascular supply of the spinal cord. Pragmatically speaking and in light of your financial constraints, I would consider seeing how a nonsteroidal antiinflammatory drug (NSAID) such as carprofen or meloxicam affects Keme. He doesn't appear to be painful and so the use of dihydrocodeine may not be indicated at this time. A simple disk is expected to quiet down within 3 weeks and you will have avoided stressing Keme with the anesthesia necessary for good spinal films and saved the expense of having those films taken as well. X-rays aren't essential but should be considered when surgical intervention is planned. Please discuss this option with Keme's vet. Xanax can be valuable as a skeletal muscle relaxant. Painful muscle spasms are common in conjunction with a disk. The Xanax isn't contraindicated but might confound our evaluation of his response to an NSAID. Please respond with further questions or concerns if you wish.
Customer: replied 1 year ago.
Thank you for your reply. as I mentioned I was leaning toward it being something neurological, but he had a thorough checking over of his spine and didn't object at all ... but he is behaving as you suggested, very flat affect. Could it be something in his brain ... I guess I'm thinking tumour. He is very reluctant, I've realised, to lower his head. He LOVES cheese, gets few sprinkles of shredded cheese when I have it out, but he wouldn't lower his head to take it from his bowl. He did, however, relish it when I popped it in his mouth. Then I thought maybe it was a cervical injury, but again, no objection when I throughly checked his neck. Anyway, Thank you for your reply. as I mentioned I was leaning toward it being something neurological, but he had a thorough checking over of his spine and didn't object at all ... but he is behaving as you suggested, very flat affect. Could it be something in his brain ... I guess I'm thinking tumour. He is very reluctant, I've realised, to lower his head. He LOVES cheese, gets few sprinkles of shredded cheese when I have it out, but he wouldn't lower his head to take it from his bowl. He did, however, relish it when I popped it in his mouth. Then I thought maybe it was a cervical injury, but again, no objection when I throughly checked his neck. Anyway, I'll see about the NSAIDs and time, I guess, will tell. In the meantime is there anything I should look out for that may indicate something more serious? I'm guessing any other neurological symptoms such as nystagmus, tremors, etc?
Customer: replied 1 year ago.
Sorry, accidentally copied and pasted, ha
Expert:  Dr. Michael Salkin replied 1 year ago.
Encephalopathy is always a consideration; in fact, an encephalomyelitis can mimic the signs of a cervical (neck) myelopathy such as reluctance to lower his head to eat or drink. Encephalopathy becomes a more important differential diagnosis when a mentation (mental status) change is also seen.
Yes, it would be worrisome to see a mentation change, tremors, seizures, rapidly progressive paresis (weakness) or the advent of paralysis. Nystagmus, head tilt, and ataxia are pathognomonic (specifically indicative) of vestibular (balance) disorders...which I don't expect in Keme.
Please continue our conversation if you wish.
Customer: replied 1 year ago.
I called my vet and got tramadol for him. She wanted to avoid NSAIDs in case he also has some colitis. I'll keep an eye on him and see how he goes. Thanks for your advice.
Expert:  Dr. Michael Salkin replied 1 year ago.
I understand. Thank you for the update. I can't set a follow-up in this venue and so would appreciate your returning to our conversation with an update - even after rating - at a time of your choosing.
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 26192
Experience: University of California at Davis graduate veterinarian with 44 years of experience.
Dr. Michael Salkin and other Dog Specialists are ready to help you
Customer: replied 1 year ago.
That's great, I'll let you know how he gets on ... he's naturally been lying down most of the day simply because he couldn't stand for any length of time but always looked tense and kept his head up ... By the way, he'd been reluctant to eat his dinner so I put the bowl on top of a plant pot and you'd have thought he'd not been fed for a week, so I'm hoping, if hoping is the right word, that it's his neck and time will help it heal ... I think I'll look for an animal chiropractor. Here's a photo of him after the tramadol ... Seems to have done the trick:) thanks again for your help and advice. I think a lot of the time we know what the right thing to do is, but reassurance is always necessary where our pets are involved since they can't tell us what's wrong. Have a great weekend!Kind regards
Viv Miller
Customer: replied 1 year ago.
Hi just to let you know that Keme is a lot better today, still a bit shaky in the rear, but no collapsing, so hopefully whatever it is, it's not a major problem. I took him for a gentle walk but he jumped out of the car before I got hold of his harness, and let out a yelp as he hit the ground, but thankfully it didn't seem to trouble him after that. Kind of reinforces my suspicion that it's his neck and I'll definitely get him x-rayed to see if it's degenerative, since there doesn't appear to have been a causal incident ... when I next get paid, unless he deteriorates again before then, I which case I'll be selling my inherited Moorcroft China!Thanks again and if any major occurs or when I get to the bottom of it, I'll let you know.Kind regards
Viv Miller
Expert:  Dr. Michael Salkin replied 1 year ago.
That's good to hear. Thank you for the update, Viv. Handsome Keme is now in my customer photo folder! Thank you for your kind accept. I appreciate it. You may receive an inappropriate follow up sent by the site ostensibly sent by me. It wasn't and I apologize in advance should you receive it.
Customer: replied 1 year ago.
Ha! He's famous! Thanks again:)
Expert:  Dr. Michael Salkin replied 1 year ago.
It's my pleasure.
Customer: replied 1 year ago.
Hi Dr Salkin, just to let you know I had Keme back to the vet today as he was almost completely off his feet last night. This time he did exhibit tenderness over his lumbar region as well as some poor reflexes in his his back legs. Actually it was a LOT of tenderness, he immediately went to his knees. She figures spondylitis with neuropathy which may or may not be associated. She added gabapentin to his Tramadol and we'll try that for a couple of weeks. If it helps him, he'll be on that ad infinitum. Poor fella, he's such an outrageously strong and active dog, I'm feeling so bad for him but I guess the main thing is that he's pain-free and I know dogs don't feel sorry for themselves as we do:)
Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for the update, Viv. Sorry for the delay. I was on a plane all day.
Customer: replied 1 year ago.
It's been a horrible week, Dr Salkin. I had to take Keme back to the vet as an emergency on Thursday as he was hunched over in pain at the back door when I got home and wouldn't or couldn't even come to me. He hadn't eaten fir 24 hours either, despite my getting a raised feeding station for him. This vet (another different vet at the same practice) diagnosed degenerative arthritis in his lumbar and cervical spine, also in his left hip and CDRM as his neurological responses have deteriorated significantly. Now, when he's going downstairs his back legs are completely collapsing, likewise when he turns. I'm just so shocked at how quickly he is deteriorating. A couple of friends suggested I looked into Lyme's disease. It's not common here in Fife, Scotland, but I brought the dogs home with me from Canada a year ago. I don't know how long symptoms can take to develop. I did find a local newspaper article quoting a vet saying it was becoming more common in the area. I never have found a tick on him. I did call my vet to query whether we should test for Lyme's but was met with derision by the veterinary nurse and told I shouldn't believe everything I read online, but if I wanted to waste my money, they would certainly send off a blood test for me (it's about $200). I'm in a quandary, of course I realise that CDRM is by far the most likely cause of his weakness. And I do also know that sudden onset pain can be puzzling but that dogs are very good at hiding pain till they can't hide it any more, but this has all happened in two weeks. He's always been a very active, strong dog, NEVER yelped or cringed when jumping in and out the car or going upstairs, and has gone from being a bit wobbly on his back legs to es
Customer: replied 1 year ago.
(Sorry hit the send button before I was done) to completely collapsing on a regular basis and dragging his legs. I guess I'm just feeling that to suddenly demonstrate three different sites of arthritis PLUS the neurological condition progressing so quickly is so very quick and confounding. Of course I want to rule out Lyme's but I can afford to waste so much money as all the meds he is on are very expensive. He's now on 300mg gabapentin and 150mg tramadol THREE times a day, plus mateacam, which he started on Thursday and mercifully has finally controlled his pain ... he's eating and mostly happy, but his mobility is deteriorating so quickly. I'd be grateful for your input, and sorry to trouble you again.Kindest regards
Viv
Customer: replied 1 year ago.
Metacam, of course ... bloody autocorrect!
Expert:  Dr. Michael Salkin replied 1 year ago.
I understand how upsetting this is for you. While Lyme is a consideration there are much more likely causes of Keme's presentation as you've recognized. The most common symptoms of Lyme where I've worked is an initial fever followed by lameness caused by an infectious arthritis often evidenced in just one joint of an extremity. Renal involvement is the most common (and life-threatening) sequela. Initial signs develop over a month or so. Chronic Lyme can involve all the tissue of the body and eventually wind up in the central nervous system causing seizures. You're rapidly reaching the point of having to make a difficult decision. The combination of a nonsteroidal antiinflammatory drug (meloxicam), a narcotic analgesic (tramadol), and the helper analgesic drug (gabapentin), is as much as I can expect your administering.
Customer: replied 1 year ago.
Thank you, ***** ***** He's actually progressed, even since I wrote earlier, to being right off his back legs and dragging himself around, although he did manage to briefly get up but almost immediately sat down. This is so heartbreaking. I always thought it would be Mena I'd have trouble with. She was very badly bred, I got her at 6 months old and later found out she has dreadful congenital hips and elbows, and has also suffered bilateral partial crucial ligament tears, but she's a wee trooper and is doing really well now at 5 years old:) My poor boy, though. Now that his pain is under control, he just can't understand what's going on. Heartbreakingūüė• Thank you once again.
Expert:  Dr. Michael Salkin replied 1 year ago.
You're welcome, Viv. Keep me posted, please. No need to reply at this time.
Customer: replied 1 year ago.
Better times in Prince Edward Island:)
Expert:  Dr. Michael Salkin replied 1 year ago.
Keme and Mena are now in my customer photo folder!
Customer: replied 1 year ago.
Dear Dr Salkin, I'm so very sad to have to let you know that Keme was euthanised on Sunday. He deteriorated to the point that he couldn't walk by Friday. They finally did x-rays and noted several vertebrae showed signs of spondylosis and that two vertebrae appeared to have no disc between them, most likely a ruptured disc she said. My options were stark, continue investigating with MRI and possible surgery, with a potential cost of over $10,000, and no guarantee of any increase in mobility, crate rest for a month, which may or may not lead to improvement, or euthanasia. The surgery was out, not really because I simply can't raise that amount of money, but because I'd not have put him through that without greater odds. The vet had spoken to a specialist who gave him only 50% chance of ANY improvement in mobility with surgery. The crate rest was a problem as I work full time and he's (was) a big lad, 100lbs, but I really wanted to give it a try, and had begun to enlist physical help from many wonderful friends, however I discovered that said specialist only gave that a 10% chance of that having any success. So, I asked them to keep him in over the weekend to look after him whilst I was working (I don't get paid if I don't work), and I'd make the decision after that. He was well enough within himself, eating and drinking and pain under control. I saw him on the Saturday evening after I finished a particularly hellish day at work. He was much the same and not as upset as I expected him to be at being left there. I was to call the next morning. I did so and was told by the nurse that he was much the same, but had a temperature and that he no longer had pain sensation or reflexes in his back legs. The vet would call me after her consultations, which she did and reiterated what I'd been told earlier. I realised his days were starkly numbered, he was having to be catheterised. I told the vet that, if possible, and with her blessing, I'd like to bring him home to be euthanised the following day. I could provide nursing care for him, and I felt it would be better for him, me and Mena if he was in the bosom of his family to die peacefully at home. She thought this was 'lovely', and we made plans to bring him home. All the way through this discussion, I kept seeking reassurance that this was the right thing, a good thing, for Keme and she supported me fully. Imagine, then, my shock when we went to pick him up, only to find him lying flat out, rigid, panting and whining in his cage. I asked how long he'd been like this and was vaguely told since that morning! Naturally I was horrified, and even more so after they asked me if I wanted him moved a bit so I could be close to him. I expected them to gently slide him out a bit on his bed, but they waded into the cage and bodily lifted him out, screaming and snapping, it was horrendous! I begged them to put him down, they did and he bit me. The poor, poor boy was beyond reason. I begged them to put him out of his misery, which thankfully they did. I was too shocked and stunned to follow this up immediately, but the next day I went into another branch of the practice which is nearby (a small branch that just does vaccines and minor consultations) to see if they could tell me from his computer record what had happened. There were no answers there; the last entry before his euthanasia was his morning exam, with no record of him being in that state. I truly believe he'd been left there alone all day and that they had no idea he'd deteriorated so badly. That, or else, they just didn't care that he was obviously suffering. I've written to the practice manager for answers, and await his response, but there's nothing that will erase the memory of his last hours from my heart. If I'd known he'd deteriorated I'd have rushed there immediately to have them put him out of his misery. It's been a nightmare and I've really no idea what caused this sudden deterioration of his back leg weakness or what led to my finding him in such a poor state. I can't understand why they wouldn't have let me know. I only ever wanted him to get better, and since that wasn't going to happen, for him to have a peaceful death, poor boy. Anyway, it's over now and I get his ashes back tomorrow. Mena is now insured:( Sorry to have to deliver such sad and horrific news.Kind regards
Viv Miller
Expert:  Dr. Michael Salkin replied 1 year ago.

My condolences for your loss of Keme, Viv, and I regret that his last hours were so bad. He was lucky to have you.

 

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