Pip diagnosis - Central cord syndrome

Neurological Disorders Resources. Treatment and care for pets having pain or trouble walking or standing due to spinal injuries or neurological disorders like IVDD, FCE and DM.
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critters
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Re: Pip diagnosis - Central cord syndrome

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:lol: You oughta have a doctorate in Pip science by now!
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Re: Pip diagnosis - Central cord syndrome

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He's doing something else new. He's started curling up tightly on his left side now. For 2 years he didn't lie on his left side. Now he does.
:pardon:
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Re: Pip diagnosis - Central cord syndrome

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Ares only flopped on 1 side, too. :?
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Atlantoaxial instability

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I guess even normal pets tend to prefer one side.

Pip had an appointment with the head vet at our family veterinary hospital. I went in and "spilled" a barely coherent account of everything that's gone on. How he's been paralyzed for 2 years, the DACVIM board certified neurologist said it was probably FCE, ANNPE, or syringomyelia, and that it probably wasn't syringomyelia because he'd been improving.
CarolC wrote: Tue Aug 24, 2021 10:10 pm Pip was examined by a board certified neurologist today. The diagnosis is "Open for non-ambulatory tetraparesis and central cord syndrome". She doesn't think an MRI would change anything. He probably has either FCE, ANNPE, or syringomyelia, and it probably isn't syringomyelia because he's been improving. Her recommendation was to continue PT.
I told him how we did PT till he could walk, then months later he began losing his walking and was diagnosed with laryngeal paralysis. I thought the "lar-par" was affecting his exercise tolerance (he'd do goldfish breathing when he was hot or exercising) so we tried wall exercises indoors, but he began not wanting to do those, even though it was cooler indoors. He looked uncomfortable when I would stand him against the wall.

So I rested him 11 weeks in case he had "done something". Then I made him a trolley. I thought it would be perfect. He could run without needing to balance or bear much weight, and he did! But it seemed to bother him afterward. We'd do four 48-foot runs 2x/day. I reduced it to once a day, then only 2 runs, then we quit when that seemed to bother him, too.

Since ending the trolley in March, he's had no exercise and has been restless and has been getting uncomfortable in the late afternoon/early evening. Elevating his head on the side of his bed, kicking. I found that if I put him in his playpen, he can get himself comfortable by lying in a crocodile position with his chin and neck stretched out flat on the blanket.

I forgot to mention to the vet we also checked him to rule out myasthenia gravis at my request (but this was the same vet who ordered the test for us). I was wondering if he did have syringomyelia like the neurologist mentioned nearly 2 years ago, after all.

I finally said, "The one thing I'm sure of is this isn't FCE, or if it was FCE, he has something else, too." The vet took him from me and then something wonderful happened. The vet FELT his neck pop when I handed him to him. (It's been doing that going clear back to when I would carry him and he was still learning to hold his head up.) I said, "Oh, thank God, finally." Because nobody ever seems to find anything when they examine him. He asked if he'd ever had any x-rays. I said no, and the hospital where he was seen by the neurologist didn't have an MRI.

[NOTE: Looking back at my earliest notes, he had an x-ray at the rescue vet in Dripping Springs April 2021, but I've never seen it. I was told it hadn't found anything. In his adoption papers I have a copy of the invoice from that vet showing vaccines, a dental and one radiograph. Also, the physical therapist said she had found pain when she examined him for his PT evaluation August 17, 2021. I told her the vet had not found any. She said she didn't know what kind of palpations they did, maybe she was doing a different kind, and then she demonstrated by putting her hand under his neck and working her fingers deep into it in an upward direction.]

The x-rays yesterday showed no syringomyelia. They show atlanto-axial instability, which is C1-C2. Also narrowing of the intervertebral spaces at C2-C3 and C3-C4, with possible fusion occuring. He said it was from an old injury. He said the pons had demineralized (I think he meant dens, not sure). Anyway, that explains why even the trolley was bothering him. Because he had to hold up his head while moving, running with his neck stretched forward as dogs do when they run, and that alone was enough.

I am now thinking back over everything. It seems clear exercise was not a good idea. The exercise before he began walking was assisted exercise and probably strengthened his neck. When he began walking solo, he fell a number of times, usually on his side in a shoulder roll, or if he went forward he would land on his windpipe because his front legs didn't support him. At his one-year mark April 2022 he could walk from the back fence to the house. By May 8 it was 100 degrees out and he doesn't tolerate heat. May 13 he was improving his stride in his front legs. In June he was goldfish breathing in the heat and also started yawning. We had the hottest May and June on record.

In July I wrote
CarolC wrote: Wed Jul 06, 2022 9:29 pm He's just not walking as well as he was. I can only guess it's the heat. He falls a lot, and has more trouble getting back up in the thin grass and hard ground. He was getting at least 2 runs per outing, from the back fence to the door, but it's too hot so we're doing one, which is half his usual exercise. To be honest, his first run is never as good because if he needs to go Number Two then it throws him off before he gets very far. The second run in each pair was usually his better one. He's still doing as well as ever on his wall walking, very confident. When he wipes out in the dry grass, he gets dust in his eyes and mouth.
In August 2022 he started having apparent "itching" and kicking furiously at his neck. It went on for a week or 10 days and then quit. I quit exercising him August 9, 2022 because I was afraid he'd done something to his neck through falling when he walked outside. September 12 he was diagnosed with laryngeal paralysis and I started Knox Blox. September 22 we did the myasthenia gravis test (because I couldn't figure out why an FCE dog was losing his walking). October 3 was the first time he had trouble eating his breakfast kibble (problem chasing it in the bowl). October 5 the vet tried 2 weeks of steroids in case it was something steroid responsive.

In January I wrote
CarolC wrote: Thu Jan 12, 2023 4:18 pm today we tried Wall Treats after not doing it since the end of October when he couldn't seem to do it and looked uncomfortable. I got the peanut butter treats out and he about licked my hand off with excitement. I put one down for a 3' walk and he did it with effort but no apparent discomfort. When I put the next one down he got up and did it with visible confidence... I thought 2 was enough after 11 weeks off. We will try it again tomorrow. Life just got better.
That didn't last long. He was still uncomfortable, so we quit again. On February 14, 2023 I made him his "dog run" trolley on the fence. On March 3 he was running the trolley like a champ. But then we had to discontinue it.
CarolC wrote: Fri Mar 10, 2023 7:34 pm We discontinued the trolley several days ago. I'm probably going to end up dismantling it. I don't think he can keep doing it. I think it bothers his neck, even though he loves being able to move normally like he wants to. I tried just letting him do 2 runs and brought him in, but he looked uncomfortable after only 2 runs, so I decided to quit completely. The discomfort (if that's what it is) goes away after a while, and he might actually think it's worth a headache or neck ache to be able to run for a minute, but I don't want to make anything worse.

If you notice the look on his face in the picture, it's more determined than joyful. I think it could be, "I can do this and I'm going to give it my all, look at me go, but it hurts." After his run, an hour or two later he seems mentally happier and confident because he did something he wanted to do (run). I don't want to take that away from him, but I'm thinking we might have to if it's going to bother him.

This is looking more and more like syringomyelia. He is having frequent episodes of kicking toward his head/neck and scooting himself across his bed to get his head elevated up on the edge. He'll do that for an hour, then he's OK. In the morning he's barking and happy, but he starts to look uncomfortable in the late afternoon, early evening. Today he was restless and uncomfortable from about 6-6:30PM, yet we haven't done anything all day except eat, drink, have blox, and potty several times, and I'm careful how I handle him.
And that's pretty much where we are now.

At least there is finally an explanation for all of this. Atlantoaxial instability. It's better than not knowing.

The vet is sending off his x-rays for review.
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Re: Pip diagnosis - Central cord syndrome

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Wonkers are almost always a puzzle, so, personally, I wouldn't consider that the final diagnosis for awhile yet...

Ares was far from normal, and we found out at the end he had developed spinal curvature to the extent they couldn't straighten him out for x-rays. It's always something!!
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Re: Pip diagnosis - Central cord syndrome

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That's really interesting about the curvature. Hunh. :thinking:

Found this.
https://vetster.com/en/conditions/dog/atlantoaxial-instability wrote: Symptoms vary depending on the extent of spinal cord compression. In rare cases, AAI may cause damage to the brainstem, resulting in symptoms like facial paralysis, trouble swallowing and lack of balance/coordination.
Here is the video of him drinking again.

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Re: Pip diagnosis - Central cord syndrome

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I really-really-really-really need to be able to express his bowel, and no matter how I've tried, I get zero. I've done it with 3 other dogs. I was reading about it on christopherreeve.org. Pip has a spastic/reflexive bowel (as opposed to flaccid). They recommend suppositories 15 min before the bowel program and then digital stimulation with lubricant. I ordered some baby pure glycerine suppositories and some KY Jelly. I have tried external stimulation of his anus without lubricant (cotton swab) and it totally does not work, you can do it all day and get nothing. I also tried an ice cube and that has no effect. His anus is tiny. He doesn't go on a schedule so you never know when. It's about every 36 hours, but not always. I put him on his potty towel morning and at bedtime. Often he goes when I am in the other room getting Dolly ready for bed, and about 1 out of 5 times he gets some mess on him because he can't help it if I'm not there to pick up immediately, and he moves to try to get away from it. It will be better for him if we can reduce the need for baths, considering his neck.
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Re: Pip diagnosis - Central cord syndrome

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Maybe get him on a schedule?
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Re: Pip diagnosis - Central cord syndrome

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If I only knew how. His meals are at the same time every day, give or take 30 min. Lately his soy mik is between 8-9am and the blox are about 4:30-6pm, so the blox vary by 90 min. If suppositories work, then we could be on a schedule.
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Re: Pip diagnosis - Central cord syndrome

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True.
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Re: Pip diagnosis - Central cord syndrome

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He has a neurology consult Tuesday with a different neurologist (not the one that misdiagnosed him). I was thinking if he needed to stay in the hospital, what a list of special needs he would have. All legitimate. Can't be in a kennel because he springs himself. Can't drink water. Probably shouldn't be under a heat lamp because he doesn't thermoregulate well. You have to pick him up and set him down in a very specific way. I put his videos on a flash drive and dropped them off for the neurologist today.
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Finally expressed his bowel after having him 22 months

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At long last I finally managed to stimulate Pip to express his bowel. It's not like I haven't tried before. The infant glycerine suppositories came. I put on a glove and coated one with vaseline, and tried...and tried...and tried...and tried...and tried...for no kidding, probably 10 minutes, to get it inserted. He has the tiniest, tightest little locked down anus, bless his heart. I don't know if that is typical with a C1 injury and spasticity. I tried different angles, tried spreading his skin apart, COULD NOT DO IT. It isn't constipation, his stools are soft enough.

Poor Pip, so patient. Finally I gave up, and then I thought, let me try the Q-tip method again. I've tried it before to no effect, but at least I could get it in. I did, and after twirling it for about 30-45 seconds, it worked. Couldn't believe it. Maybe it was all the tap dancing on his rear with the suppository that helped. :blush: :roll: :lol:

Here is a photo of what I COULD NOT get inserted. The coin is a quarter. (Sorry about the flash on the side of the saucer.)

glycerine.JPG
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Re: Pip diagnosis - Central cord syndrome

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Interesting! These furs are always an adventure!! :mrgreen:
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Neurology appointment

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Still don't have all the answers I'm looking for. He is on 0.75 ml gabapentin 2x/day now. If it helps, it will be worth it. Dolly was on 0.5 ml when she got it and she's only 1 lb less than Pip. Gave it to him in some canned food, he ate it. He was hungry. They told me to fast him so he didn't get any breakfast. Long day for him. They said it might sedate him. He is resting in his day bed and it's after 8 pm. They said he was really good. My vet who took the x-rays said he was really good, too.
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