SRMA?

RE: SRMA?

Anthony Dennison — Thu, 25 Apr 2019 17:51:20 GMT

So, update on this case:

Slowly improved over the following 24 hours until able to walk with stiff limbs and some ataxia. Gone home on 2mg/kg/day prednisolone and managed as an outpatient.

[quote user="Virginia Campbell"]lungworm can cause weird localised bleeds in weird places with weird clinical signs.[/quote]

This was a differential, but we just don't see lungworm where we are. We've looked for it a lot, and never found it. Plus the dog had been showing signs of SRMA for a few days prior to presentation with me.

I'm on 2nd on call again this weekend (and was on Tuesday). Praying for a more sedate time!

RE: SRMA?

Virginia Campbell — Mon, 22 Apr 2019 04:56:36 GMT

Robaxin (methocarbamol) tablets are not overly expensive and quite a nice safe muscle relaxant for spasm-y sore muscles and you can mix and match with other drugs quite easily. Could be worth ringing around some local practices to see if anyone has any on the shelf.

As for cause, bleed due to arteritis seems to make sense. Other random thoughts...if you had a fibrocartilagenous embolism high up in the cervical spinal cord, could this have temporarily tiddled about with the intracranial pressure? I don't think this site, or the several days sore neck lead into it would be typical though.

Also bear in mind the answer to every other "what's your diagnosis?" riddle in internal med CPD lectures for the past 10 years...lungworm can cause weird localised bleeds in weird places with weird clinical signs. Panacur is cheap :-)

RE: SRMA?

Liz Barton — Mon, 22 Apr 2019 00:38:49 GMT

[quote user="Anthony Dennison"]Oh, and I'm still at work. I've now been here for 32 of the last 38 hours.[/quote] Blimey! Hope you have a chance to relax soon...

With tetanus any stimulation makes the clinical signs worse, so we had minimal sound and light (even put cotton wool in the ears as a dampener). You say she's having supportive care, so I'm guessing IVFT you're either draining the bladder or have an IDUC if she can't consciously urinate. Turning every 2-4 hours (but as she's now in sternal this may no longer be necessary). I'd add in gastroprotectants if the dog is having high dose steroids and not eating yet.

It doesn't sound like tetanus, but obviously acute CNS to come in seizuring like that. I've never seen an SRMA present with seizures, so am interested to know if others have.

Great job getting it this far in your crazy week!

RE: SRMA?

Anthony Dennison — Sun, 21 Apr 2019 22:42:03 GMT

[quote user="Andreia Dias"]The only other thing I can think of would be some muscle relaxant? Would you have something other than diazepam available?[/quote]

We have midazolam, but anything more significant and we may have to consider ventilation which we're not set up for and the owners can't afford.

She's gone from only being able to lie in left lateral recumbency this morning to sitting up in sternal by herself and wagging her tail. So chuffed considering how crap she was last night!

Oh, and I'm still at work. I've now been here for 32 of the last 38 hours.

RE: SRMA?

Andreia Dias — Sun, 21 Apr 2019 21:28:43 GMT

I would also consider toxicity, though would think that would have been improving over time... Is the dog on fluids? I think we used a combo of metronidazole/penicillin (ampicillin?) on the last tetanus case we had (but not my case).

The only other thing I can think of would be some muscle relaxant? Would you have something other than diazepam available?

Can't really advise more than that, sounds like you are doing a nice job with it. Let us know how it turns out!

RE: SRMA?

Anthony Dennison — Sun, 21 Apr 2019 10:57:55 GMT

[quote user="Matt Hilary"]Any role for diazepam for muscle relaxation?[/quote]

Yeah, I used it last night but it was very short lived. Think it's a pain response rather than extensor rigidity so trying with some methadone and if that doesn't help I'll add it back in.

RE: SRMA?

Matt Hilary — Sun, 21 Apr 2019 10:54:42 GMT

Sounds like you've done a great job. Any role for diazepam for muscle relaxation?

RE: SRMA?

Anthony Dennison — Sun, 21 Apr 2019 10:02:56 GMT

[quote user="Joyce Whitehead"]Reading it, tetanus would be my other thought.[/quote]

Yeah, which is why I've added in metronidazole. Doesn't look like a classic tetanus though, no 'sardonic smile' or whatever that presentation is called.

Spoke to Liverpool over the phone, they think SRMA but may have also had an intracranial bleed due to the arteritis. Just going to control the pain and throw steroids at it, see what happens. Owners can't afford referral unfortunately.

RE: SRMA?

Joyce Whitehead — Sun, 21 Apr 2019 09:27:07 GMT

Reading it, tetanus would be my other thought. The SRMA dogs I’ve seen have been pyrexic but maybe this one is further down the road and so has lower temperature. I haven’t seen a tetanus for years but have got a couple through with nursing and relaxants. We used to use Largactil but I think that’s long gone, and I think anything promazine mightn’t be good if she has maybe seizured. I’ve also used diazepam for the tenseness. But of course SRMA is also a possibility. Well done on getting it so far, especially with all the rest of the stuff you’ve had. Keep tomorrow morning in mind....