Weakness In Back, Continued

[christinepi]

I posted this a few days ago:

 

http://forum.greytalk.com/index.php/topic/320550-weakness-in-back-or-whats-going-on/

 

Based on what was suggested, I sent an email to a specialist who has seen Tracker before on other issues. I wanted to know whether she could perform the palpitation and injection as mentioned in Dr Stack's article (link above), because if she didn't, I would end up shopping around adding to T's and my stress trying to find another doc; if I knew she didn't I could move one and try to find another vet who did. She wrote me back:

 

 

If Tracker has changes that you feel are consistent with lumbosacral stenosis, he should be seen by a neurologist. I would prefer he be seen by our neurology service either in Redwood City or in Campbell rather than myself so that he can get the best neurologic assessment possible. To diagnose something like lumbosacral stenosis, it is much more involved than just simple palpation; a full neurologic exam is best. I would agree with Dr. Stack that Greyhounds are different than many other breeds of dogs; however, I would prefer that you see someone who specializes in neurologic issues of the spine so that you don’t have to end up with two appointments. At the appointment you can then discuss options for Tracker based on the neurologist’s findings. Dr. Stack’s article is interesting; however, it’s best to start with Tracker having an evaluation and then discuss his signs and your options based on findings.

Would members agree? I'm not opposed to anything she is saying at this point, it's just that according to Dr Stack the best way to diagnose this IS with palpitation and I really don't want to subject Tracker to a ton of x-rays etc if I can help it. I also have not taken him to our vet here in town, who knows nothing about Greyhounds--I like her a lot, but she's a generalist and can't be expected to have the knowledge of a specialist plus we have next to no Greyhounds in town. She would probably just x-ray him or send me to a specialist anyway (who would then take x-rays etc). I feel kind of stuck right now. Tracker hasn't had any more incidents since I posted, his tail wags happily, but I know these guys are stoic and I don't want him to be in any pain if there's any chance. I'd also gladly take him to the suggested neurologist, if forum members would feel it makes sense. It just makes me leery that she doesn't trust the palpitation method.

[XTRAWLD]

Kasey had LS, I went to two vets, one of which was a grey specialist. He would have been happy to do the injection because he understood the breed, etc. but wanted it backed up with an MRI. (The nerve can be compressed in two directions and an MRI is the only definitive way to know for sure). A lot of vets won't do the injection period. From what I understand, the dog also needs to be sedated so they don't move because it is a risky injection site. The injection only works for a period of time, and then you have to do it again, and again. It's not a one time cure.

 

Get him on gabapentin. It's a safe drug that has a wide range and you'll see the benefits immediately.

[krissy]

My experience is that LS is a diagnosis of exclusion in most cases. There is not a single definitive way to diagnose it. Clinical signs and palpation are not diagnostic, however imaging can have its limitations and grey areas as well unfortunately. Diagnosing LS is generally a matter of having an appropriate breed, clinical signs that fit, and ruling out other problems that can cause the same symptoms that have more definitive diagnosis. Is it a good bet in an older greyhound that it's probably LS? Yes, but they are not immune to other neurologic conditions that can present in the same way.

[XTRAWLD]

My experience is that LS is a diagnosis of exclusion in most cases. There is not a single definitive way to diagnose it. Clinical signs and palpation are not diagnostic, however imaging can have its limitations and grey areas as well unfortunately. Diagnosing LS is generally a matter of having an appropriate breed, clinical signs that fit, and ruling out other problems that can cause the same symptoms that have more definitive diagnosis. Is it a good bet in an older greyhound that it's probably LS? Yes, but they are not immune to other neurologic conditions that can present in the same way.

Well said. Right from the vet's mouth. My vet also tested around the anus with the end of a pen to see what the reaction would be. Apparently the reflex would be compromised if LS was present. Does that make sense? (In Kasey's case he had no reaction on one side, and a small reaction on the other).

[christinepi]

Would it make sense for me to go straight to a neurologist, even if, say, it's something else, like arthritis or non-neurological thing, causing this? I can't figure out what doc to see.

[dmswartzfager]

Would it make sense for me to go straight to a neurologist, even if, say, it's something else, like arthritis or non-neurological thing, causing this? I can't figure out what doc to see.

 

Yes. I am an RVT with a veterinary neurology service. Our doctors tell our clients that there are two purposes to the neurologic exam - 1. Is the problem neurologic? and 2. If it is a neurologic problem, where is the problem in the nervous system? (the "localization" of the issue). By seeing a neurologist, you can rule in or rule out neurologic issues, and if it's not neurologic, they can usually very clearly tell you where the problem is and be able to guide your next steps.

[christinepi]

 

Yes. I am an RVT with a veterinary neurology service. Our doctors tell our clients that there are two purposes to the neurologic exam - 1. Is the problem neurologic? and 2. If it is a neurologic problem, where is the problem in the nervous system? (the "localization" of the issue). By seeing a neurologist, you can rule in or rule out neurologic issues, and if it's not neurologic, they can usually very clearly tell you where the problem is and be able to guide your next steps.

 

Laid out like that it makes total sense and it really helped me make my decision (to see the neurologist). Thanks!