Tuesday, January 22, 2013

Elbow Problem Or Root Signature?

As soon as Jasmine recovered from her disc injury(?), without any break to speak of, we were dealing with sudden severe front left leg lameness. The day it happened, she didn't want to put any weight on that leg at all. Her neck, and the rest of her, seemed fine.


Was it a repeat of the situation from last May?

It certainly looked like it. Back then it was diagnosed and treated as arthritis flare-up. All the indicators looked the same. But in the light of the disc injury(?) in December, different questions arose. Could the neck be involved with this also, even though it seemed fine?

Could it have been a root signature? Or a combination of things? That was the question.
Most root signatures are due to nerve root compression and ischemia. This can be due to disc herniation, tumor, anything that produces pressure in the ventrolateral vertebral canal or intervertebral foramen where the nerves from the spinal cord exit to innervate the body. It may not cause any pain at all in the neck and especially if the nerve entrapment is in the upper thoracic T1-T2. 
However it does cause severe pain to the limb that it is innervating. 

In humans it can feel like a pins and needles type pain. The pain is most severe on compression of the limb (standing on it or pushing with it) and/or from pulling on the limb. Moving the limb causes little to no pain at all.

First one to bring it up was Dr. Beatty. With no apparent trauma event, the fact it came and went quickly and then returned, and Jasmine was concerned about her foot (before the event, not after), to him that screamed neurologic to him.

It would be a typical root signature lameness involving the cervical vertebrae and disks.
I also mentioned root signature because if Jasmine has arthritis in that elbow it is a chronic pain not a severe acute pain. The nervous system is accustomed to the chronic pain from arthritis and without additional trauma there would be no reason to all of a sudden be non-weight bearing or even severely lame. It just doesn't happen that way. If you had said she has been becoming stiffer and stiffer the last couple of weeks and then woke up in the morning not able to use the leg then I would be more of a believer in the arthritis in the elbow causing the lameness.
Back May I too thought it was strange that a chronic disease, such as arthritis, could have such an acute onset of pain.

Of course, that doesn't mean that it COULD NOT happen, because it can.

So it happened, that, on the same day, Jasmine's primary vet started thinking the same - could nerve root pain be the trigger for the events?

If the problem was outside the elbow, though, the whole brace idea would be moot.

Meanwhile, Jasmine's leg looked pretty good. Which theory would that support? I've been a nervous wreck, just waiting for another disaster to rear its ugly head.


On Friday she had an appointment with her primary vet.

He poked and prodded Jasmine, observed her gait.
Her left elbow was reluctant to flex.
Muscles all over the body were sensitive, just short of in spasm.
Nerve function to back left leg was still mildly impaired.
Other joints were stable.
Neck appeared happy.
Conclusion?

The elbow indeed seemed unhappy, which could mean the event was a problem in the elbow, but the root signature could not have been ruled out.

We could, of course do an MRI, but the level of risk doesn't seemed to warrant the potential benefit at this time.

The risk factors of doing the MRI would be
a) anesthesia
b) contrast material(?)
c) further neck manipulation ...? (might be possible that what looked like severe joint pain after Jasmine's last stem cell injections could have been result of neck position for procedure if we calculated the neck issues into the equation ...?)
We're not doing the MRI at this time for sure.

Jasmine's primary vet says the only time it would make sense to do the MRI would be if we wanted to pursue surgery. However, it appears that with surgery, there is only about 5% chance of any improvement of the situation before the surgery. By the time done with scar tissue and the spurs wanting to regrow might be lucky to end up where started. So that just wouldn't make any sense.

I talked to Veterinary Thermal Imaging, wondering whether this, NON-INVASIVE diagnostic would be of any benefit for Jasmine.

I was told that thermal imaging can help to pinpoint disk issues, but cannot determine if the disc has extruded and then popped back into place, or whether it has more permanently prolapsed.

It might be worth using. One problem is that the thickness of Jasmine's rough might make it difficult to pinpoint with structures are affected, as it can be quite insulating. It will also not differentiate between muscular spasm and facet joint or disc pathology. If there is a potential elbow pathology, then the neck can spasm as the dog adopts a compensatory stance.

Either way, before we'd try this we have to see whether anybody within reasonable distance has one of these things.

Jasmine's chiropractor was considering getting one, but it did not happen at the end.

Meanwhile, we decided that IV stem cells might be helpful in either scenario.

Because Jasmine was on the steroids recently, though, we cannot do this any earlier than 45 days of Jasmine being off the steroids. Among other things, the steroids apparently suppress the signaling and the stem cells wouldn't know where to go.

We did find, and order, a dog stretcher that makes sense to us.

So at least, when it gets here, we'll have a contingency. We will continue with the acupuncture and physio. We do have emergency prednisone and Tramadol. I will see if we might be able to get Jasmine more frequent laser treatments.

That's about all we can do right now.

Taking it one day at the time.

***

Related articles:
A Time Bomb Ought To Go Off At Some Point, I Guess: Jasmine's Neck 
Jasmine's Disc Injury(?) Day Two 
Jasmine's Disc Injury(?) Day Three 
Jasmine's Disc Injury: Mom, Why Can't I Go For A Walk?
Jasmine's Disc Injury: The Parole Hearing  
Jasmine's Disc Injury: Spanking New Ramp 
Back To Where We Were Last May?

OK, I Am A Sucker: We're Going Through With The SLIT 
Jasmine's Episodes: Back To The Allergies Dilemma 
This Is What Jasmine's Episode Looks Like
Gotta Try Everything Once (Or Twice): On The Quest To Figure Out Jasmine's Episodes 
Thundershirt vs. Jasmine's Episodes
Jasmine's Mysterious Swelling And Another Experience With VetLiveThe Diagnosis Is In: Jasmine Has An Interdigital Cyst
Jasmine's Mysterious Swelling And Interdigital Cyst Update  
Is Crawling Under Things Some Kind Of Secret Physical Therapy?  
Is There No Place Safe? Jasmine's Acupuncture Session
Senior Sensory Systems Function: Zero Defects  
It Looks Like A Keeper: Jasmine's New Integrative Vet 
Jasmine's Acute Lameness
Jasmine Doesn't Like "Doing Time"
Our Of Jail Free Pass
When It's Looks Too Good To Be True … The Lameness Returns
The Day Of The Treatment
First Time For Everything: A Healing Crisis(?)  
From Zero To Sixty In Four Days: Stem Cells At Work
The Calm After The Storm 
If It Was Easy, It Wouldn't Be Jasmine
Practicing What I Preach: Jasmine's Semi Annual Wellness Exam  
No Skimping On Oral Care 
Our Own Emergency Vet Horror (Part I)
Our Own Emergency Vet Horror (Part II) 
Meet Jasmine
I'm Still Standing! (Happy Birthday, Jasmine)
How Dogs Think (Well, Jasmine Anyway)
How The Oddysey Started: Jasmine's ACL Injury
Jasmine is Vet-Stem's poster child!
Rant About Quality Of Life Versus Quantity, And Differential Diagnoses
Jasmine Is Headed For Her Next Stem Cell Treatment
Jasmine's Stem Cells Are In
Arthritis? What Arthritis? 
Guess Who Is An Ever-Ready Bunny And Really Liking The Bit Of Snow We Got? 
Don't Knock It Until You Tried It: Animal Chiropractic 
Jasmine's Fur Analysis
Back At Chiropractic Care

4 comments

  1. Jana this is such a difficult problem and you're facing such hard decisions...My prayers are with you and Jasmine

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    Replies
    1. Thank you, Gizmo, hopefully it'll all work out for her.

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  2. I have been thinking abut this since last night. I wouldn't do the MRI at this time either. Thermal imaging sounds interesting!
    How often do you take Jasmine for laser treatments? I just contacted a vet about this yesterday. I'm excited to get Sherman started!

    ReplyDelete
    Replies
    1. Jen, thank you for thinking about Jasmine! (((hugs))) Yeah, thermal imaging IS very interesting and truly non-invasive. Still trying to figure out whether it'll show enough in this case.

      Jasmine gets laser every three weeks and acupuncture every three weeks, at different times.

      It would make sense to do it more often right now but have to find a way of doing it locally, as the travel to her chiropractor that often would be prohibitive.

      Laser treatment is great stuff.

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