Visiting Vet: Belvedere is back on his feet
“I think my dog is paralyzed,” the owner said when he called on emergency one afternoon. “He’s fourteen, a Labrador. Something’s really wrong.” I get a million of these calls. Elderly large breed dogs who “just can’t get up,” and owners who think their pups are paralyzed. In fact, most of these dogs simply have a combination of age-related arthritis and loss of muscular strength. They snooze on linoleum or hardwood floors for a few hours, then when it’s time to get up . . . well, they can’t. The floor is too slippery. They can’t get a good grip. Their legs splay out. Their joints are stiff or their backs hurt. Some get agitated and whine and pant and swim around on the floor. Others just give up and flop back down. (Kinda like me at yoga class.)
“Try sliding a rubber-backed bath mat underneath him,” I advised. “Then help him up. Position his feet squarely underneath him. Support his weight using a bath towel under his belly like a sling until he gets his bearings.” Often once these old dogs are helped up and move around a bit, everything loosens up and they’re good to go. (Kinda like me when I first get out of bed in the morning.) Make a routine appointment with your veterinarian if this happens frequently to discuss medications to improve mobility and reduce pain and stiffness . . . but it’s not an emergency.
The elderly dog in question was named Belvedere. His owner was also a senior citizen. He agreed to try my suggestions. Twenty minutes later he called back. No go. Literally. Belvedere couldn’t walk. After getting help from a neighbor to transport Belly here, they headed to my office. I went out to his car with my assistant, Fawn. “Let’s get him out and stand him up in the driveway,” I said, fully expecting Belvedere to be another typical old arthritic dog who did fine once he got moving. But it was immediately obvious this was a bigger issue. Although he could stand with assistance, his hind legs could barely hold him. When he tried to walk, his hind feet knuckled under and his hind legs crossed over each other every which way.
Proprioception is defined as the body’s ability to sense its location, movements, and actions. Belvedere had markedly reduced proprioception in his hind legs. His brain couldn’t tell where his back feet were. Loss of proprioception usually indicates a lesion affecting the spinal cord in the back, disrupting transmission of information from legs to brain. His owner had essentially been right saying Belvedere was “paralyzed,” although the correct technical term in this case is paraparesis — a partial ( as opposed to complete) inability to move his hind legs. We carried him inside to the exam table, where I palpated his back, one vertebra at a time. Nothing seemed painful. I pinched his hind toes, hard. He looked at me, clearly annoyed, and pulled his foot away. This meant he had “deep pain.” His hind legs still had some feeling and motor control. Just not enough to walk.
My differential diagnosis list started with Intervertebral Disc Disease (IVDD), a condition in which one or more of the cartilage disks located between the vertebrae push out of place, putting pressure on the spinal cord. Signs and severity vary depending on the location and degree of the disk protrusion. Another possible diagnosis was Fibrocartilaginous Embolism (FCE). In FCE, a bit of disk material gets into an artery supplying the spine and compromises blood flow, and thus function, resulting in paraparesis. Although Labradors are predisposed to FCE, it tends to occur in young-to-middle-aged large dogs, rather than seniors like Belvedere. Spinal cord tumor also had to be on our differential.
Treatment and prognosis for these diseases are very different. IVDD may improve with rest, anti-inflammatories, and pain medications, but can also get progressively worse. Severe cases require emergency surgery to relieve the pressure on the spinal cord or risk irreversible paralysis. FCE has a better prognosis. What you see on the initial presentation is generally the worst things will be. Over half of FCE dogs gradually regain normal function over a few days to a few weeks with just supportive nursing care at home. Spinal cord tumors? Usually bad news, but palliative care can sometimes extend a dog’s time. How can we tell which problem Belvedere has? We probably can’t. At least not here on-Island. Although radiographs may be helpful, most of these lesions require advanced imaging, such as MRI for diagnosis. That means referral off Island to a neurologist.
In Belvedere’s case, we had an additional challenge. He was a hefty boy, and his owner, a senior living alone, was going to find it hard to manage nursing care if Belly needed to be carried in and out or physically supported to walk. After discussing options, we decided to try an old school treatment — corticosteroids. Although the use of steroids in spinal cord disease is controversial and often frowned upon in human medicine, many veterinarians still use it and anecdotally have good results. I gave a corticosteroid injection and sent Belvedere home with additional oral steroids. We agreed that, at 14 years old, if the big fellow wasn’t able to walk on his own within a day or so, we wouldn’t prolong his suffering and would let him go humanely.
The following morning when Belvedere’s dad called, I was expecting to schedule a euthanasia. But no. “He’s not a hundred percent,” his owner reported,” but he’s getting up and walking well on his own!” Maybe it was FCE and this was a spontaneous recovery. Maybe it was IVDD and the corticosteroid injection reduced the spinal cord swelling quickly and sufficiently to improve function. Maybe it wouldn’t last. But for today, Belvedere is back on his feet, and I got to start my morning with good news and a smile . . . (and a reminder that I should do a little yoga to take care of my own achy old back.)