Page 10 - Clinical Connections - Summer 2024
P. 10

RVC RESEARCH    STUDY    VETERINARY SERVICES       RVC.AC.UK
         Neurology

        THE THERAPEUTIC JOURNEY OF A DOG
        CALLED WORM


        Holly Smith, Head Neurology and Rehabilitation RVN and owner of Worm

                orm,  a  five-year-old  miniature   and pain scores carried out to ensure he was   slides  on  a  textured  surface  or  wobble
                dachshund, came to RVC Small   comfortable.  He  regained  the  movement   cushion.  Worm  was  a  good  boy  for  his
        W Animal  Referrals  last  August   in  his  back  legs  the  same  evening  as  his   physiotherapy and enjoyed the attention!
        following an acute onset of back pain and   surgery and was able to wag his tail! Worm   In hydrotherapy he used the underwater
        difficulty walking.                 recovered well postoperatively.     treadmill to improve his walking. This helps
          At that point Worm was bright, alert and                              with strengthening, by walking against the
        responsive.  Physical  examination  was                                 resistance of the water. With someone in the
        within  normal  limits.  However  neurological                          treadmill every session, they could also help
        examination  revealed  mild  ambulatory                                 make sure he was placing his feet properly,
        paraparesis,  proprioceptive  ataxia  in  the                           practising  and  improving  proprioception.
        pelvic limbs and thoracolumbar kyphosis.                                This was not Worm’s favourite thing to do
          Postural reactions were reduced in both                               and some bribery with treats was needed!
        pelvic limbs. Spinal reflexes were intact in all                         Worm  has  made  a  full  recovery  from
        four limbs. The thoracic limbs were normal.                             his  intervertebral  disc  extrusion  and
        Cranial  nerves  assessment  was  normal.                               hemilaminectomy  surgery.  This  doesn’t
        However,  spinal  hyperaesthesia  was   MRI  image  showing  a  normal  disk  (above)   mean  it  might  not  happen  again  and
                                             and disk extrustion (below)
        detected on palpation of the thoracolumbar                              therefore he is kept a close eye on and isn’t
        region. These findings are consistent with a                            allowed to climb stairs or jump. There are a
        T3-L3 myelopathy.                                                       lot more ramps in his house now!
          Given the mild nature of the clinical signs,
        conservative  treatment  was  elected  in  the
        first instance. Worm was started on medical
        treatment for pain and a period of strict cage
        rest,  which  meant  he  was  confined  to  his
        crate and only taken to the garden on a lead.
          After a period of four to six weeks, Worm
        was  comfortable,  and  his  neurological   Worm had to have strict cage rest again
        examination  was  normal. At  that  point  he   for at least four weeks after his surgery. It
        could  gradually  increase  his  exercise  and   was important that he didn’t try to run, jump
        stop his medication. Worm had recovered   up or climb stairs, which could cause him
        well  from  this  episode  of  back  pain  and   pain  and  possible  deterioration.  He  was
        myelopathy.                         back to going to the garden on a lead for a
          A few weeks later it was noticed that Worm   change of scene and the toilet, three to four
        was  “wobbly”  on  his  pelvic  limbs  again,   times a day for five to ten minutes only.
        seemed uncomfortable and not himself.
                                            Physio, hydro and K-laser treatment
        Admission as an inpatient           During  his  recovery  Worm  had  laser,
        Worm  returned  to  the  RVC  in  October,   physiotherapy  and  hydrotherapy.  The
        when  he  was  assessed  by  the  Neurology   exercises  improve  strength  and  balance
        and  Neurosurgery  Service  again.  He   while  maintaining  a  positive  muscle   Worm  on  the  underwater  treadmill  (above)
                                                                                 and wearing their 'doggles' (below)
        was  paraplegic,  with  intact  nociception   memory,  so  the  body  doesn’t  remember
        (paralysed back legs, could still feel them).   abnormal as normal, instead of returning to
        He was an inpatient for four days.  normal function.
          MRI   of   the   thoracolumbar   spine   Laser was used on his back to help the
        identified  an  intervertebral  disc  extrusion   wound heal and give extra pain relief. These
        at  T12-T13  intervertebral  disc  space,   are short sessions and comfortable for him.
        which  was  pressing  on  the  spinal  cord. A   He  had  to  wear  “doggle”  eye  protection
        hemilaminectomy was performed.      during the sessions.
          Pain   was   managed   pre   and    Physiotherapy   exercises   include
        postoperatively  with  opioids  (methadone),   massage,  passive  range  of  motion  on
        along with a non-steroidal anti-inflammatory   his  back  legs.  We  then  incorporated
        drug and a nerve pain medication.   active/assisted  exercises,  which  involved
          Initially  Worm’s  bladder  was  checked   supported  standing,  rhythmic  stabilisation
        regularly to see if he could urinate by himself,   (wobbling)  on  a  wobble  cushion  and  foot     For small animal referrals, please call:
                                                                                     01707 666399
                                                                                       Email:
                                                                                     qmhreception@rvc.ac.uk
        10   Summer 2024
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