Kevin had been feeling just fine in his old age, until yesterday morning when he was unable or unwilling to stand and walk in his hind end. Kevin's mom took him to her vet, where an abdominal mass was diagnosed. With bloodwork, chest radiographs, and abdominal radiographs in hand, and with the assumption that pain from Kevin's abdominal mass was the cause of him being "down in the hind," Kevin's mom brought him to the VTH for further work up and monitoring.
At presentation, Kevin really was pretty down in the hind. A big guy at over 100 pounds, we had to hoist him out of his owner's van and onto a gurney to take him to the treatment area.
Once we began to evaluate Kevin further, though, it became clear that more was going on than just an abdominal mass. With the support of a belly sling and about 4 people hoisting, we got Kevin to his feet for a neurologic and orthopedic assessment.
What we found was that Kevin was actually willing to try to walk with his right hindlimb, but his left hindlimb appeared to be almost totally useless. A test of conscious proprioception (whether the brain and body can feel where the limbs are in space) revealed zero proprioception in the left hindlimb and minimal proprioception in the right hind. We laid Kevin down on his side for additional assessment. His forelimbs were almost totally normal -- he could walk on them and move them normally, with normal muscle tone and reflexes.
Kevin's hindlimbs, however, were another story. Both limbs were neurologically impaired, with the left more severely affected than the right. Muscle tone was extremely decreased in both limbs, meaning Kevin's muscles offered almost no resistance to manipulation of his limb. His thigh musculature was moderately atrophied on both sides. When we extended either hindlimb and pinched a toe, Kevin could feel the obnoxious sensation but could offer only the weakest of attempts to physically withdraw the limb away from the pinch. Finally, Kevin's patellar reflexes ("knee jerk" reflexes) were very decreased.
All of these findings pointed to neurologic disease within Kevin's lumbosacral spinal cord, with worse disease on the left than the right. Additionally, we could feel a grapefruit-sized mass in Kevin's belly, but he gave us no sign of any pain when we palpated around this mass or elsewhere in his abdomen. In other words, we could find no reason in Kevin's belly for him to be painful enough not to walk.
When we went to discuss these findings with Kevin's owner, however, it became clear that she was convinced that he was orthopedically and neurologically sound. She assured us that his abdomen was painful and that was why he was down.
Fortunately, Kevin's mom seems like a great lady, and she readily agreed to hospitalize him overnight for IV fluids, monitoring, and supportive care, with abdominal ultrasound and thoracic rads in the morning. We also put in a request for a neurology consultation to be done today for Kevin, in the hopes that they can further pinpoint his neurologic disease and determine if it might be related to his abdominal mass. I'm hopeful that with a little more time to process the information, Kevin's owner will come to realize that he has potentially multiple issues.
In other news, poor Wes from Wednesday night was sent on his way to doggie heaven yesterday afternoon. Given that his owners didn't really want to pursue any treatment once they'd gotten the diagnosis of either lymphoma with an acute leukemic crisis, or acute lymphoblastic leukemia, it was probably for the best. It's just nice when you can get them feeling better for a few days before you let them go...
No comments:
Post a Comment