Species: dog
Breed: Boxer
Sex: m, neutered
Weight: 32.8 kg
Birth date: 2020-05-25 00:00:00
Primary diagnosis: Acute lymphocytic leukemia, paraneoplastic polyarthritis
Situation: emergency initial
Medical history: The dog was presented to our clinic on 11.11.2024. Last Sunday (03.11) the symptoms started. The dog slipped on the stairs with his hind limbs, he no longer wanted to jump on the bed / couch, but he could still walk. When they took him for a walk, he walked behind them and looked weird. On Tuesday 05.11 they went to the private vet, who said a nerve could be pinched. They then started with restraint and therapy with Gabapentin TID and Metacam SID. He was better at first, he was walking normally again. However, with the medication he was calmer than usual and his behaviour was changed. On Saturday 09.11 he slipped and lost urine. Normally he is an athletic dog, but in the last week they have had to really motivate him to walk, and since the evening before presentation / the day of presentation he did not walk at all. The day of presentation he suddenly lay down, screaming and rolling in pain and then lay apathetically in his lost urine. In this situation the owners tried to help the dog, but he bit them. The day of presentation they tried to reduce the Gaba from TID to BID. He got gaba & metacam the last time the day of presentation at 08. At first he was urinating normally, but now he can no longer lift his paw. He can still defecate but he doesn't stand still, he keeps on walking. It has happened 2-3 times in his life that the dog has shown like Parkinson's in the head, the last time on Sunday when the symptoms started, but the trembling disappears immediately when they call the dog and give treats. They went to the private vet, that gave Buprenorphin and referred the case as a disk extrusion suspect. At our clinic the dog had an awful pain crisis when we tried to make him walk. The owners decided to euthanize the dog.
Medication: Before presentation (given last time on the morning of presentation 11.11 at 08): Meloxicam PO SID, Gabapentin PO TID (day before presentation only BID). At the private vet (unclear exactly when): Buprenorphin 0.01 mg/kg SC/IM. Before observation 2: Methadon 0.3 mg/kg IM, Ondansetron 0.3 mg/kg IV, Omeprazol 1 mg/kg IV, Fentanyl CRI 0.0025 mg/kg/h.
Orthopedic exam: Gait: Lameness 5/5 on both hind limbs, walks as if he is walking on eggs and is extremely painful when he puts weight on the hind limbs(avoids putting on weight). Palpation: Both tarsal joints and both stifle joints moderately filled, severly dolent and very warm; Carpal joints and elbow joints slightly filled and less dolent.
Neurologic exam: Mentation: severely stressed and painful. Posture: initial lateral position. Gait: anamnestic paraplegic, here highly painful, does not want to walk, good motor function on all 4 limbs; Outside: rather severe lameness in both hind limbs, no clear paresis visible; On limb palpation of the left knee, severe dolence, no longer palpable, ‘lateral position’ again; Neurological examination cancelled => first analgesia and orthopaedic examination. Postural reactions: not performed. Cranial nerves: carried out. Spinal reflexes: carried out. Sensitivity: see gait. Neuroanatomical localisation: rather not neurological.
Pain type: acute, inflammatory, orthopedic, somatic
Pain origin: hind legs
Pain duration: More than 7 days
Estimated pain severity: 88