Need Suggestions - Mysterious Pain

[RemusinCA]

Hello, posting the recent history of our boy Remus's struggle with pain over the past 2 months as right now we are really scratching our heads. All ideas and opinions are appreciated as we are currently taking shots in the dark. Trying to put down as many details here as possible in case something sparks an idea with someone. 

About 2 months ago, we had a fairly normal weekend- Remus went to see some greyhound pals and they ran around a bit in the morning - nothing terribly exhausting, but it was slightly warm out. The next day, we did a 1 hour walk with Remus. This level of activity is fairly normal for him on a weekend, but could have been slightly exertive. 

The next day, we noticed that when Remus was lying down on his side completely for a while (1-2 hours), when he would begin the motion to get up by lifting his head, he would yelp. We originally thought that maybe he had pulled a muscle, so we decided to take it easy with him that week and see how he did. 1 week later he was no better, brought him to our greyhound savvy vet who put him on Rimadyl and Methacarbomol and rest for a week. We did this, and limited his walk times and running up/down the stairs. During this time, we did see improvement - he wanted to play and run around in the house but we prevented him from doing so. He was still yelping/whining when moving his neck while on these medications, but the pain didn't seem extreme. We started to taper down the Rimadyl but we noticed almost immediately that he reverted back to his previous state. We took him back to the vet, where we did xrays on his neck and shoulders. The x-rays came back entirely normal. No signs of cancer, no arthritis, but she advised that problems with discs may not show up on the xrays. Vet recommended that we see a neurologist and that an MRI would likely be needed. Meanwhile, we added Gabapentin with the Rimadyl. 

We scheduled a neurologist appointment, which at the time was over a month out, however we were put on the waitlist for cancellations. In the meantime, we wanted to pursue holistic strategies in an effort to make Remus more comfortable. We started acupuncture and the holistic vet advised adding amantadine to his pain meds. She also wanted us to start Western herbs called Pain Plus and Chinese herbs called Body Sore. Remus did great during this acupuncture appointments, seems to take the treatment very well and this seemed to give him a small amount of relief for the next 12 hours, but since then we have only been able to get him 2 sessions. 

While we waited for the neuro we decided to get a second opinion and took him to another greyhound savvy vet. This vet recommended an injectable steroid, triamcinolone. We weren't ready to do an injection that day, as there are negative interactions with the Rimadyl so instead he sent us home with the oral version. We spoke to our primary vet afterwards, who agreed that since the Gabapentin, Amantadine, and Rimadyl didn't seem to be doing the job it was likely time to try a steroid. This appointment was last Monday and we had planned to give the oral Triamcinolone later that week.

Later that day, we got a call from the neurologist that they had a cancellation for the next day, so we jumped on it. On Tuesday, he went to the neuro for an exam. Remus performed well on the neuro exam but the neuro did recommend an MRI to look for a multitude of things. After thorough pre-work (blood work, urine analysis, chest xrays and echocardiogram) to prep for the anesthesia, Remus had his MRI the next day. Remus was a trooper and came home late that afternoon doing fine post-anesthesia. This was actually the first night in many weeks that we all slept soundly as the effects of the anesthesia helped him with the pain (he normally wakes us up 2-6 times per night screaming in pain). The good news and bad news from the MRI was that they found absolutely nothing. No bulging/herniated discs, no signs of IVDD, no LS, no tumors, no cancer. Nothing that would be indicative of neck pain. We also had them take a spinal fluid sample to check for infections and microscopic cancers, which also came back normal and healthy. 

At this point, the neuro recommended we try steroid treatment, he prescribed prednisone. In addition, we are testing for fungal infections, tick-borne diseases, rock mtn spotted fever. We've received the majority of these tests back, all of which are negative. Post-MRI, Remus's pain has worsened as the Rimadyl has left his system. Last Friday, (5 days off Rimadyl) we decided to try the triamcinolone. Remus was on this for 2 days - we saw no improvement. The vet said that if the triamcinolone does work, we should see improvement within 48 hours, we saw none so decided to stop as we know that steroids are not without consequence and at this point we still have no idea what we are treating so they could do more harm than good. Remus is still receiving Gabapentin (although we now aren't sure if this is doing anything), Amantadine, Pain Plus, and Body Sore. He still screams when getting up out of bed, but now we notice he sometimes screams when he puts his head downwards to lie down. He avoids the motion of shaking his head, although we can tell he wants to. In general he is lethargic, doesn't play, and stiff in the front. We notice that if we massage his neck and shoulder muscles before he gets up from bed that seems to greatly reduce his yelping/screaming. He has very little appetite, but I can get him to eat by mixing in boiled chicken and freeze dried lamb patties into his normal kibble food. We may try the prednisone this week. 

I am exhausted, worried and stressed. I am sleep-deprived so probably forgetting something here. What would you do? Ideas or suggestions. Thank you to all those who post here, this forum has been a great resource. 

 

[Houndtime]

I'm sorry that I have no suggestions or a good opinion.  I am sad that your boy is feeling so poorly and in pain.  I have a boy who is limping for almost a year and we can find really nothing that is causing it, though he does do better on an anti-inflammatory.  I wish you luck and please keep us informed when you find the cause.

[spottydog]

No advice…but sending best wishes for a positive resolution.

[okslater]

Hi RemusinCA, I have no advice but this sounds exactly the same thing that is going on with one of my greyhounds, Lemming. We have been waiting for an MRI and neurology appointment for a month now, it's booked in for 7th July. She is on gabapentin but I'm not sure it's doing much. We are also struggling due to broken sleep and 24/7 monitoring of her to stop her shaking her head and erupting in screams of pain (whilst also both trying to work from home full time). We can get her out for two very short walks a day but more than that and it sets her off.

I will report back on her neurological tests and mri results. How old is Remus? Lemming is 7, and never raced, and has always been really fit and agile. The only difference with your hounds symptoms to mine, is Lemming still has a massive appetite and she still manages to get down two flights of stairs in about 5 seconds if she hears the fridge door open. Which can't be doing her much good, so we've put the baby gates back up. 

[greysmom]

All of those symptoms sound like a neck injury to me - soft tissue injuries won't show on xray or MRI, and can seem to be really mysterious.  And neck injuries can take a long time to heal, sometimes many weeks or months.  If he's doing better on an nsaid I would put him back on one, and really restrict his activities for an extended period.  I would also talk with my vet about adding in an actual pain medication like codeine sulfate.  Avoid most other opioid meds like Tramadol and fentanyl as they are not tolerated by greyhounds well.

The other modality you might consider is canine chiropractic.  The issue could be up nearer his skull where it connects to his spine and a chiro adjustment might help.

Did the MRI include the shoulder areas of both sides?  This is my other thought.  Sometimes, though very rarely, greyhounds can develop a calcification of a shoulder tendon that can cause a severe pain response.  You might try searching on the forum for threads on this as we've had several, and their info might help you.

Good luck!

[RemusinCA]

@okslater Remus will be 7 in one month, so about the same age as your Lemming. Remus was an ex-racer in Florida, tore his right achilles on the racetrack at the age of 4, which was surgically repaired. He also has "larval leak" hookworm, which could be contributing to his lack of appetite as we are in the middle of "prison protocol" (drontal plus). Don't let our scenario skew your thinking. If I had to do it again, I would definitely pursue the MRI and do the exhaustive testing with the neuro. I would also look into acupuncture if available and affordable in your area - seems to be one of the few things that provides relief. 

@greysmom Thanks for all your posts on this forum! We started him on prednisone this morning, will try that for a week and if no change we may switch him back to Rimadyl. I am asking for a refill on the methocarbamol, since we are now assuming this is soft tissue/muscle related. The neurologist did take a look at his brain and both shoulders - nothing abnormal. I will ask about the codeine sulfate and calcification on the shoulder tendon. Thank you!

I am speaking to our regular vet this afternoon and the neuro again later this week. Will provide any updates.  

[okslater]

Oh yeah we're absolutely not going to bail on the tests, we're counting down the hours! We can't live like this. It's heart-breaking seeing her in so much pain. I will definitely explore alternative therapies if there's no obvious cause but my guess at the moment is a ruptured disc or something as she collided with our glass back door about 3 months ago. 

Hopefully the prednisone works and I will be watching for further updates.