Species: dog
Breed: French Bulldog
Sex: f, neutered
Weight: 10.7 kg
Birth date: 2020-05-08 00:00:00
Primary diagnosis: Left sided extradural compression centred L3/4, extending cranially to L2/3
Situation: post surgery
Time since surgery: > 12 hrs
Recovered from anesthesia: No sedation (0)
Medical history: The dog was presented for the first time in March because of a change in gait, no longer wanted to play like normal and could no longer walk quickly. She was injected with painkillers. After that the problem stabilised until 1 week ago (03.07) when she partially crossed her hind legs while walking and also showed overkneeing. Owner then went back to the private vet last Friday (05.07) -> neurological examination unremarkable but inflammation and pain in the caudal back area according to the private vet. There was also more paresis on the left than on the right. For at home the owner received Meloxicam (SID) and Gabapentin (9 mg/kg TID). At presentation at our clinic on the 07.07 they been giving this for 4 days without any improvement, since yesterday Jalpa has been unable to walk, which is why she actually wanted to start with cortisone (also from the private vet) that day, but the owner's husband gave Irfen (300mg), so they only gave Gabapentin in addition and then came to the emergency. Jalpa is normally a very active dog who is very rough with other dogs but nothing has ever happened, not even with the owner's second dog. A week ago, Jalpa still had diarrhoea, which is why she was also given Protexin (pre- and probioticum) by the private vet. The diarrhoea has improved again and the faeces are now still soft but formed. The same day of presentation a MRI was done, and afterwards the dog went into surgery for a left sided hemilaminectomy and fenestration. MRI report: Left sided extradural compression centred L3/4, extending cranially to L2/3; Multiple thoracic vertebral malformations, including hemivertebrae and mild kyphosis; Lumbosacral intervertebral disc protrusion.
Medication: 08.07: Methadon 0.2 mg/kg IV q4h, Ondansetron 0.3 mg/kg IV TID, Omeprazol 1 mg/kg IV BID, Cisaprid 0.5 mg/kg PO TID, Gabapentin 10 mg/kg PO TID, Fortiflora PO on the food BID. (Carbodote 20 mg PO given 1x on the 07.07 because of Ibuprofen overdose). 09.07: Ondansetron & Omeprazol & Cisaprid & Gabapentin & Fortiflora same as on 08.07, switch from Methadon to Buprenorphine 0.02 mg/kg IV TID. 10.07: Buprenorphine & Ondansetron & Omeprazol & Cisaprid & Gabapentin & Fortiflora same as on 09.07.
Neurologic exam: Neurologic examination on 08.07. Mentation: attentive. Posture: paraparetic, unable to stand. Gait: non-ambulatory paraparesis left lateralised. Postural reactions: Forelimbs unremarkable, hind limbs absent. Cranial nerves: unremarkable. Spinal reflexes: Forelimb unremarkable, hindlimb increased, perianal reflex and panniculus unremarkable. Sensitivity: Painful thoracolumbar. Neuroanatomical localisation: T3-L3. Neurologic examination on 09.07. Mentation: alert. Posture: paraparetic, but able to stand (with knuckling on forelimbs). Gait: ambulatory paraparesis, knuckling when walking, some steps without knuckling (right better than left). Postural and positional reactions: Forelimbs unremarkable, hind limbs absent. Cranial nerves: unremarkable. Spinal reflexes: Forelimb unremarkable, hindlimb increased, perianal reflex and panniculus unremarkable. Sensibility: Painful thoracolumbar.
Pain type: acute, chronic, nociceptive, inflammatory, somatic
Pain origin: back
Pain duration: 24 hours to 7 days
Estimated pain severity: 25