Pip diagnosis - Central cord syndrome

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Re: Pip diagnosis - Central cord syndrome

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:thankyou: I'm a little worried how grass will affect him when it starts to grow this Spring. He's doing his walking on short brown dry Bermuda right now. Hope it's a dry year.
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Re: Pip diagnosis - Central cord syndrome

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Just an update on Pip. His gait does not appear noticeably better, but he is noticeably faster. He is still falling frequently, but I would say he is expending less emotional energy in frustration and disheartenment, because he knows he can get back to sternal without extended fruitless effort.

He is still having an issue with steering. I can only conclude that the front legs are primarily responsible for steering. He will make a good run a short distance, then have to course correct at a sharp angle. The sharp angle is tricky and is an opportunity for losing one's balance. This is a problem a rear paralyzed dog does not have.

Basically I think what he is doing to make a slight turn is slowing down a lot, then shifting nearly all weight to his hind feet in order to lift both front feet and plant them in the new direction. In other words, he does not seem to be moving his front feet in the new direction incrementally step by step. It's like, 1) go straight 2) slow down 3) almost stand on your hind legs 4) put your front feet back down again in the new direction, and 5) hopefully continue walking.

His other method is to come to a stop in sternal position when he knows he is going too far in the wrong direction. So he pauses and rests. Then when he is ready to start again, as he is getting to his feet, he can use those strong hind legs to kind of leap himself into the new direction on that first step. (This may make no sense if you do not have a dog like this.)

We are not doing much of the carry exercise now. Since a week ago, or a little longer, I have just been taking him outdoors every few hours and letting him walk/run. I put him by the fence and he goes to the back door. We do this 2 or 3 times. It is still an effort for him, and he gets tired by the third time, but then we go out and do it again a few hours later, repeat. We are still doing Wall Treats morning and evening. He still knuckles a little on both front feet occasionally, doing Wall Treats on carpet, but does well.

He is very heat intolerant, and there isn't much shade in the yard as the trees have not leafed out yet, but it is in the high 70's. Partly it's because he is black, but so is Dolly and she stands the heat better. He still does not drink from a bowl and gets his water mixed in his food. They said his swallowing problem is unrelated to his cervical spinal injury. He will take a few laps if he is extremely hot, but then he does his little heh-heh-heh cough because of something with his swallowing. It makes me even more careful about not letting him overheat, so we do short sessions, and the summer is only going to get hotter. :heat:

I was remembering Cricket, who was considered a spinal walker (which Pip is not). Cricket and Pip really don't have a lot in common, except the amount of ataxia while still managing to walk. Cricket had quite a bit of sway and ataxia in his hindquarters. He walked and ran happily but with very visible effects in his gait. I started thinking if this is as good as Pip will get, it will be harder for him than Cricket, and I felt a little discouraged. I would say his gait is neater than Cricket's was, but with his front legs affected he falls a lot, and a dog with hind leg issues like Cricket could just get back up with little problem. Front legs mean tripping, flopping, a shoulder roll.

If he was 7 when I adopted him (so they said), then he's 8 now, and I don't like to think of him continuing to fall as he ages. But then I look at how he is going faster this week than last week, and I just need to not worry about it. He is happier being able to get himself around any kind of way for now. I might (?) expect him to lose some mobility with age, but I don't know. Right now he does not have a lot of margin that he could afford to lose. But he is still improving, and that is just thinking out loud.
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Re: Pip diagnosis - Central cord syndrome

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Go Pip!!! :clap:

I just love your updates! You are so amazing withing with your baby!
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Re: Pip diagnosis - Central cord syndrome

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Here are two posts where I mentioned Pip does not tolerate heat and cold well. Today I think I found the answer, which I will post down below.
CarolC wrote: Sun Nov 07, 2021 7:54 pm I've been thinking about cold and dogs, too. I'm in South Texas, so all summer I've had the air conditioning on 79-80, and 77 at night. Now we have been getting cold off and on. I have 2 paralyzed dogs right now. [snip] Pip has central cord syndrome from a neck injury and as far as I can tell, he does not thermoregulate well, which can be the case with some spinal injuries. He overheats very easily outdoors :heat: , you have to watch him, and he hates the cold :cold: but does NOT like to go under a blanket, possibly because with his front legs paralyzed he can't get out easily and might worry about breathing, I don't know.
CarolC wrote: Fri Mar 18, 2022 6:21 pm He is very heat intolerant, and there isn't much shade in the yard as the trees have not leafed out yet, but it is in the high 70's. Partly it's because he is black, but so is Dolly and she stands the heat better. [snip] It makes me even more careful about not letting him overheat, so we do short sessions, and the summer is only going to get hotter. :heat:
The following excerpts are from some information about human Central cord syndrome, which is all I have to go on, because there is virtually no information about dogs online that I can find. NOTE that I am extrapolating from humans to dogs, I have not found an article that says this is a known issue with dogs, and I am not a vet or in the medical field, so I could be wrong. Pip's injury is cervical. Colored highlighting is mine.
https://www.ncbi.nlm.nih.gov/books/NBK441932/ wrote: Central Cord Syndrome
Patients often complain of sensory deficits below the level of injury, but this is variable. Pain and temperature sensations are typically affected, but the sensation of light touch can also be impaired. The most common sensory deficits are in a "cape-like" distribution across their upper back and down their posterior upper extremities
https://sciprogress.com/body-temperature-regulation-spinal-cord-injury/ wrote: Body Temperature Regulation Following a Spinal Cord Injury
Another issue that often arises following a spinal cord injury is body temperature regulation. This is particularly true for cervical and high thoracic (T6 or above) injuries. [snip] As part of thermoregulation, one needs to be able to feel when it is getting too cold or too hot. Normally, signals will be sent up and down the spinal cord to the hypothalamus in the brain. [snip] When this connection is severed, individuals may have to take a more direct role regarding body temperature regulation. It often means that they have to be a lot more aware about the potential affects of body temperature. This is particularly true with injuries that occur higher up the spinal cord and where a greater amount of the body is affected.
The following study involved taking the temperatures of veterans with spinal cord injury living in hospitals with the air conditioning setting at 72-74F (22-23C). It showed that some of them were getting hypothermia at normal indoor temps.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2032005/ wrote: A total of 867 measurements of body temperature were evaluated; normal temperature was recorded 298 times (35%), subnormal temperature was recorded 544 times (63%), and hypothermia was recorded 25 times (3%). There were 15 patients with 30 hypothermic episodes; subnormal temperature was found in all 50 patients from 1 to 47 times.
When I got Pip, he had been paralyzed for 3 months. He was so used to being curled up in a tight ball that we had to work and work to get him to relax (see his Petfinder pic below). I thought it was because he was scared and being self-protective. I asked the rescue if she had ever seen him stretched out like a normal dog during the 3 months she had him, and she said she had not. In the back of my mind I did wonder if he could be cold, simply because he's a chihuahua. I now suspect that was part of it. She never took him outside (because he didn't need to go out to do his business), and he doesn't burrow under blankets, so he spent those 3 months lying on top of blankets at indoor temps.

If I take him out and the temp is in the high 70's, but the sun shines directly on his coat, he is soon overheating, even though you would think the surrounding air would keep him cool enough, but it does not. I am considering getting some kind of canopy near the back door, to keep the direct sun off of him.

Being curled up, whether from tension or from being cold, made it impossible for him to learn to sit sternal, which delayed his walking by at least 3 months and he lost recovery time. It's only my guess, but a building block of learning to walk again for a dog with a spinal cord injury in the neck (at least my dog) who does not thermoregulate well, is being kept warm enough. For him, too cold could be what seems a normal indoor temp for us. I've been keeping it at 79-80 indoors and 77 at night. I confess I kept it at 79 this winter, too... :oops:

Pip - Petfinder.jpg
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Re: Pip diagnosis - Central cord syndrome

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Temp problems are certainly true of humans with SCI from most sources, so it makes sense that it'd be true of critters too.
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Re: Pip diagnosis - Central cord syndrome

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I find that part about the "cape-like distribution" (in humans) interesting.
https://www.ncbi.nlm.nih.gov/books/NBK441932/ wrote: Central Cord Syndrome
The most common sensory deficits are in a "cape-like" distribution across their upper back and down their posterior upper extremities
From the beginning, he has had this little spot on his spine around the hip area where he will react if you pet it. I asked the vet to check it back in July when he was getting an exam so he could have a neurology referral, and he said nothing there. Well, there is. There definitely is. He still flinches if I pet it. It's hypersensitive. At first I was afraid it was a second injury, like maybe he injured his neck but also his lower back in the same incident when he became paralyzed last April. Now I wonder if there is a pattern on his back where the upper back has less feeling, the lower back has normal feeling, and that meeting point in between has hypersensitive feeling?

I found out just the other day that he likes having his upper chest petted like a belly rub on the chest. It's the first time I've seen him actually look like he's enjoying something physically. It's unusual for him to be stretched out enough for me to pet him like that, because he does not ever roll over and lie on his back. It happened after I had mopped him up with a washcloth after he wetted his chest and I was checking him with my bare hand to be sure he was dry. So he has normal feeling on his upper chest, and hyper feeling in that area on his back over the hip area. Not sure about the cape area. He knows when I am brushing grass off of him.
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Re: Pip diagnosis - Central cord syndrome

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Excuse the double post, but there are 3 more thoughts on this same subject of temperature regulation. All just thinking out loud, not 100% sure of any of them.

Sitting on a lap
When I was inquiring about adopting Pip, the lady who rescued and fostered him felt it was very important that I should sit with him on my lap for 30 min every night. She had to work full time, so she kept him on blankets in an x-pen (to be sure other dogs did not step on him), but at night she made sure to sit with him on her lap for at least a half an hour while she watched TV. She said he was the sweetest boy (I agree) and this was his favorite thing. At the time I thought, yes, I'm sure it would be. Dogs are social and she's a special lady with a big heart for dogs, and I'm sure lying on her lap for half an hour every night was the highlight of his day. I still think that. But in addition, I think he may have also been looking forward to a warm lap, and being warmer for a little while every evening, since he was curled up in a ball all the time because he doesn't keep himself warm in the normal way. Only guessing.

Hydrotherapy
I have really regretted not being able to get him into hydrotherapy where he could swim or use the underwater treadmill. He has a swallowing problem and I was scared he'd aspirate the water in the pool and cough/choke/develop pneumonia. I had a hard time picturing him lengthening out his torso and straightening his topline enough to swim properly because he tends to curl up, which would make it even harder to keep your head up out of the water. Now I suspect there could have been another problem. They keep the underwater treadmill tank (or the rehab pool) at a specified temperature that experts have found is best suited for a dog exercising in water. I am almost certain it would have been too cold for him. Maybe it's just as well we didn't try it.

Carry exercises
I really noticed the cold this past year, because when I took him out to potty in the cold, I would stand him up, exposing his whole underbelly, and it was obvious he was freezing. He didn't shiver though, but you could tell. A few days ago I was carrying him when it was cold (but not super cold) and I could feel a slight shudder in him briefly. It's the only time I've noticed it. Last summer when we did carry exercises, he never seemed to want to quit from overheating. It may be because he is tucked under my arm in a football carry for the carry exercises, and it keeps a lot of the sun off of him. Also he was not really exerting, he was merely bearing weight in his front feet. Now that he is out in the middle of the yard with his little black fur coat fully exposed to the sun beating down, and he is exerting himself to run with all 4 legs, he gets hotter.
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Re: Pip diagnosis - Central cord syndrome

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I have a nephew who is quadriplegic from a car accident several years ago. He has terrible difficulty regulating his body temperature so it only makes sense that your baby would as well.
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Re: Pip diagnosis - Central cord syndrome

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I'm sorry to hear that. We probably have little idea what people go through with various conditions. The person who first told this board about gabapentin for pins and needles was an amputee. I would think people with real experience with some of these condtions would understand what is going on with our pets much more quickly than we do.
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Re: Pip diagnosis - Central cord syndrome

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Today Pip did 2 things.

He was barking at a cat and he stood up all the way, not just a half crouch. If was a 3-point stand, as his front paws were crossed at the ankles, feet touching, and his hind paws were spaced well apart. Usually he only dares stand up halfway. He held it for a long time, barking all the while.

Then I had put him about 2/3 or 3/4 across the yard toward the back fence, and he was walking toward the back door (he kind of speed walks with some bunny hops). For the first time I could see in his face he was intently focused on steering. I am guessing steering is tricky when you are crossing your paws with every step. If he tries to run, he goes off course in no time. He seemed to be slowing his walk and really ensuring he went in "that direction where I want to go" and didn't wind up "over there", so to speak.
:trophy:
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Re: Pip diagnosis - Central cord syndrome

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coxmaria3 wrote: Fri Apr 01, 2022 4:51 pm I have a nephew who is quadriplegic from a car accident several years ago. He has terrible difficulty regulating his body temperature so it only makes sense that your baby would as well.
Absolutely true, and it's my experience that humans and critters with brain damage don't regulate body temp as well, either. It's probably from different mechanisms for central versus SCI. As I recall, when the spine is damaged the reflexes like opening and closing the blood vessels for temperature control can't operate (or can't operate well). I don't have time to look it up again now.
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Re: Pip diagnosis - Central cord syndrome

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CarolC wrote: Mon Apr 04, 2022 11:50 am Today Pip did 2 things.

He was barking at a cat and he stood up all the way, not just a half crouch. If was a 3-point stand, as his front paws were crossed at the ankles, feet touching, and his hind paws were spaced well apart. Usually he only dares stand up halfway. He held it for a long time, barking all the while.

Then I had put him about 2/3 or 3/4 across the yard toward the back fence, and he was walking toward the back door (he kind of speed walks with some bunny hops). For the first time I could see in his face he was intently focused on steering. I am guessing steering is tricky when you are crossing your paws with every step. If he tries to run, he goes off course in no time. He seemed to be slowing his walk and really ensuring he went in "that direction where I want to go" and didn't wind up "over there", so to speak.
:trophy:
I'd bet that "steering" takes a lot of concentration for the little fella!
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Re: Pip diagnosis - Central cord syndrome

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For whatever it's worth, describing this...

He does not stick his tongue out and pant, ever. When he starts to overheat, he starts barking to tell me, and his bark sounds different. It is short of breath.

His form of panting consists of opening and closing his mouth. He opens his mouth maybe 3/4", closed, open, closed, open, etc.,...but his tongue is in and his mouth is only open slightly. Then he needs to be in out of the sun right away. :fan:

The other thing he does that I've seen a couple of times is he will peel back his lips on the sides of his mouth (but not the front) exposing his gums, only for a second, then he may do it again. It may just be the lower lip, can't remember.

I'm afraid a neurologist would say this has nothing to do with his injury, just as they said the aspirating water when he drinks is unrelated. It may be unique to him, and caused by something else, but that's what he does. I move him to the shade, he cools down a little but he does not stay, he goes back in the sun. After a bit I have to take him in. :heat:

We need some kind of little portable nylon sunshade I can place over him when he goes to his chosen spot. I tried looking online for beach sunshades (I know nothing about them and he only needs a little one) but so far no luck. Something about 36" square would do the trick.
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Re: Pip diagnosis - Central cord syndrome

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4/8 was his one year anniversary.

He did really, really well today. I put him in the back righthand corner of the yard and he walked diagonally about 45 feet without falling, and then did it again. The first time, I thought maybe he was headed to the gate in the left front corner of the yard, but he went about halfway, paused and sniffed something but couldn't hold the stance, and had to keep going, so he went 45 feet and rested near the door.

I took him back to the corner again after a while and he did it again. He headed out diagonally on the same trajectory, found the same spot, stopped, sniffed, and urinated. Mission accomplished (you could see it in his face, "I got that done"), he finished his walk, coming to rest near the door again.

I was watching him and this is the first time I've seen it actually happen, where he urinated while standing but sprayed his chest. I dried him and washed him off with a wet washcloth. It must be confusing for him, why this happens. I'm sure it's because he needs to lengthen his stance, but right now he does well to stand and pee at all, and I'm thrilled he can do that. I don't think he'll be able to lift his hind leg till he can get his front feet spread further apart, and right now he's still scissoring a lot.

He has gone distances before, but never this far without losing his balance or having to stop along the way, so he did G-R-E-A-T.
:wow:
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Pip is back to chasing cats

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This morning I set him down in the back corner of the yard maybe 7' from the fence. A cat walked across the yard next door on the other side of the fence. Pip started barking, so the cat ran under the fence into the alley. Pip ran to the fence without falling (in spite of being excited), sat down in a good erect sit (sitting is tricky when you are paralyzed in your front legs), and maintained his sit while he barked at the cat.

This afternoon I set him down near the side fence and he walked toward the back door without falling, stopped and urinated without getting himself wet, and resumed walking to his favorite spot to settle down.

I'm so glad when things WORK for him!!
:hurray:
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