A"spastic" dog

Re: A"spastic" dog

Hannah Wynne Richards — Tue, 25 Oct 2011 09:40:18 GMT

Angiostrongylus doesn't have to look like warfarin-can be just neuro symptoms,somaybe this is the answer

Wynne

Re: A"spastic" dog

plantagenet — Tue, 25 Oct 2011 08:52:25 GMT

I have seen several tremorgenic mycotoxicosis - oddly - but all have been far more tremors and less ataxia than this.

Re: A"spastic" dog

mariette asselbergs — Tue, 25 Oct 2011 06:44:42 GMT

One more update:

We did find Angiostrongylus in the faeces with the Baehrman method, so maybe it was a bleed? But no signs of bleeding anywhere else.

Mariette

Re: A"spastic" dog

David Mills — Sat, 22 Oct 2011 10:27:37 GMT

Yes, then, you have them.

Re: A"spastic" dog

Anonymous — Sat, 22 Oct 2011 08:14:57 GMT

[quote user="David Mills"]My points were fairly simple.[/quote]

I was just trying to separate what I thought were effectively 2 separate points that you were making for ease of discussion, namely:

1) The mechanism of potential benefit of IVFT in the case of a nephrotoxin (i.e. to support renal perfusion rather than dilute/eliminate toxin).

2) The lack of any sound indication for IVFT in this clinical case.

I'm not necessarily disagreeing on either point, just trying to clarify.

Re: A"spastic" dog

David Mills — Sat, 22 Oct 2011 00:39:05 GMT

Nice try.

My points were fairly simple. Still no hx of toxin ingeston in this dog, hx/clin signs/demeanour don't support ivft.

Diluting toxins doesn't make them less harmful if the animal has ingested a harmful dose. I think you labour under false theory if you think 'flushing out' the lily toxins works - they still pass through the kidneys causing damage, just more quickly. The ivft simply maintains perfusion meaning arf is less likely to develop. If does nothing for the toxin load. concentration is irrelevant.

Incidentally, had this dog had known toxin exposure, then if possible renal effects then yes, ivft. But it didn't. So it's overkill.

Re: A"spastic" dog

Anonymous — Fri, 21 Oct 2011 19:56:07 GMT

[quote user="David Mills"]Diluting a substance that is going to cause renal damage won't stop it causing renal damage, or even reduce the amount of renal damage the substance directly causes. Yes, in some cases, ivft can avert oilguric ARF or kidney shut-down by maintaining perfusion but these are secondary effects and you need to catch it early - I've never seen a cat with lily intoxication come back from ARF. In this dog, specifically, producing urine, drinking, no PUPD/vs/dx, no dehydration, no systemic illness, consciously aware, already showing signs, didn't need ivft and it would be closing the door after the horse had bolted, to the financial gain of the practice and with no positive effect on the dog. What I was reacting to was the blanket application of a catch-all concept to something where we don't know the cause and ignore the dog's medical status - and these things are naturally self-justifying: dog gets better with or without 'supportive therapy' but because it might get ivft this obviously helped. So we do it again.[/quote]

I think I follow your points here:

1) In the example I gave of lily intoxication in cat, you would instill IVFT before the onset of clinical signs other than the initial usual vomiting, but only if there was known lily ingestion or PUPD had developed. This would help maintain renal perfusion and avert oliguric ARF, giving the kidneys time to recover from the toxic effects of the lily, but would not reduce the toxicity of the lily either by reducing the concentration (dilution) or time of exposure (more rapid elimination).

2) In this specific clinical case, neither you, nor anyone else, can suggest a probable specific toxin which is demonstrably, or could be reasonably presumed to, benefit from IVFT either to speed recovery by increasing toxin elimination (I don't even know if this happens at all) or by maintaining renal perfusion and preventing renal damage/allowing renal recovery. Therefore you feel the recommendation of IVFT is unecessarily over-the-top in this case.

Do I follow correctly?

Re: A"spastic" dog

David Mills — Fri, 21 Oct 2011 17:21:53 GMT

[quote user="Hannah Wynne Richards"]

David I can understand you being under intense financialpressure in a charity clinic

[/quote]

Ummm...not where I'm coming from. ivft/hosp/monitoring is incredibly cheap in the grand scheme.

[quote user="Hannah Wynne Richards"]

PROVE that IVFT DOESN'T work before you comdemn what is currentlyaccepted best practice

[/quote]

Misrepresentation. I'm talking specifically about this case, where there isn't, historically or at time of presentation, evidence of ongoing fluid losses, or any systemic involvement whatsoever that would warrant ivft as 'supportive treatment'. Medically there is no indication for it. Fine, if people are happier with the precautionary principle, great - but don't use it as a cover to save face, or because one can't think of anything else to do. As Mr Neuhoff says, no EBM either way - but we need to be aware of cause and effect.

Currently accepted best practice by whom, may I ask? There certainly isn't objective evidence to that end, so it cannot possibly be. It all rest on opinions, and just because a lot of people share an opinion doesn't make it right.

Re: A"spastic" dog

David Mills — Fri, 21 Oct 2011 17:21:52 GMT

[quote user="Hannah Wynne Richards"]

David I can understand you being under intense financialpressure in a charity clinic

[/quote]

Ummm...not where I'm coming from. ivft/hosp/monitoring is incredibly cheap in the grand scheme.

[quote user="Hannah Wynne Richards"]

PROVE that IVFT DOESN'T work before you comdemn what is currentlyaccepted best practice

[/quote]

Re: A"spastic" dog

mariette asselbergs — Fri, 21 Oct 2011 13:38:13 GMT

I saw the dog again today, he was almost back to normal, but still a bit high stepping with the back legs. Had had his last diazepam 30 hrs ago. Owner said that the diazepam geve better result than the barbiturate, but difficult to tell if he was already recovering. See today's video

www.youtube.com/watch

I have taken a feaces sample for Angylostrongylus.

Discussed with owner possibility of contact with pour on treatment but they haven't used any.

Also discussed the possibility of recurrency and they said they knew about this sort of thing in "inbred" collies.

So we'll wait and see.

Re: A"spastic" dog

Hannah Wynne Richards — Fri, 21 Oct 2011 10:47:22 GMT

David I can understand you being under intense financialpressure in a charity clinic, and Marriette unable to hospitalise in this instance, as the owners won't allow it,but PROVE that IVFT DOESN'T work before you comdemn what is currentlyaccepted best practice

Wynne

Re: A"spastic" dog

Simon Neuhoff — Fri, 21 Oct 2011 08:55:19 GMT

[quote user="David Mills"]

What I was reacting to was the blanket application of a catch-all concept to something where we don't know the cause and ignore the dog's medical status - and these things are naturally self-justifying: dog gets better with or without 'supportive therapy' but because it might get ivft this obviously helped. So we do it again.

[/quote]

I can agree with this at least - how much of what we do is driven in exactly this way? It worked once - lets do it again. Which is why I am so keen on evidence based medicine.

Re the rest - broadly in agreement but I would suggest there is some advantage in having iv access and close monitoring in a case where you don't know what is going on, whether the dog is going to improve or crash dramatically.

Re: A"spastic" dog

David Mills — Thu, 20 Oct 2011 23:36:14 GMT

[quote user="David Beattie"]

Might be quoting out of context, but I'd dispute that statement strongly (e.g. lily intoxication in cats would be good example where you better get started on your fluids before azotaemia develops in otherwise healthy appearing cat)

I'd also have thought that urinary excretion is a major route for many toxins and that fluid diuresis would help eliminate many toxins (obviously not all).

[/quote]

Diluting a substance that is going to cause renal damage won't stop it causing renal damage, or even reduce the amount of renal damage the substance directly causes. Yes, in some cases, ivft can avert oilguric ARF or kidney shut-down by maintaining perfusion but these are secondary effects and you need to catch it early - I've never seen a cat with lily intoxication come back from ARF. In this dog, specifically, producing urine, drinking, no PUPD/vs/dx, no dehydration, no systemic illness, consciously aware, already showing signs, didn't need ivft and it would be closing the door after the horse had bolted, to the financial gain of the practice and with no positive effect on the dog. What I was reacting to was the blanket application of a catch-all concept to something where we don't know the cause and ignore the dog's medical status - and these things are naturally self-justifying: dog gets better with or without 'supportive therapy' but because it might get ivft this obviously helped. So we do it again.

Re: A"spastic" dog

Elisabeth Knappett — Thu, 20 Oct 2011 23:23:22 GMT

I have seen something very similar in a working collie here - the dog had no known contact with toxins other than running with sheep that had been treated 48 hours earlier with pour-on. Their fleeces were damp (its always raining) and we assumed he had been exposed cutaneously. After a bath with detergent and a quiet warm bed for the night his tremors were much improved, when he was sent home with strict instructions to be kept away from the sheep for a further week. The farmer reported he was back to normal a few days later, and is still doing fine.

Don't know exactly what the product was, but could find out tomorrow....

Re: A"spastic" dog

Mark Lowrie — Thu, 20 Oct 2011 15:08:45 GMT

What an interesting case! I think many of the suggestions so far are certainly possible but I’d like to add another to the mix…

The video (ataxia and cerebellar signs) and the description of tremors make me consider neuromyotonia/myokymia – something that is reported in Border Collies. It is usually paroxysmal with mild and severe episodes but it is not uncommon to see constant muscle twitching that persists during sleep or anaesthesia. Unfortunately the best way to diagnose this is to consider MRI (brain) and electrophysiology. However, if this is not an option I would monitor the dog and see if these episodes become frequent. If they do then I would consider mexilitene to try and reduce the frequency of the episodes. The major concern with this is hyperthermia so if the dog is getting hot during an episode consider active cooling.

This is a very interesting case – thanks for sharing the video and do let us know if more episodes occur or whether this single episode resolves completely, i.e. if it is a toxic problem. I think a number of things could explain this problem, and another that I don't think has been mentioned in the threads so far would be dyskinesia but it is unusual to see such marked cerebellar signs with this.

Re: A"spastic" dog

Anonymous — Thu, 20 Oct 2011 14:33:40 GMT

[quote user="David Mills"]

So in a dog such as this, whose history reads drinking and urinating normally, has appetite but struggling to eat with tremors, and has mobility, you would STILL want it hospitalised on fluids? If something's nephrotoxic, fluids ain't going to stop it being so, especially as the dog is showing signs, and no obvious evidence from history of being in acute RF.

I'm not set against fluids, but I was wondering when 'supportive treatment' would be raised. I agree you need to select your cases/owners but I profoundly disagree with the jumping for hospitlaisation and ivft in this case with this history and signs. I think, unfortunately, it's become a blanket treatment to make us feel like we're doing something when we're stabbing in the dark; in such a situation, can't see it being anything more than a sham.

[/quote]

I take your point on challenging fluid therapy just for the sake of it, but I think in cases of unknown toxic exposures is acceptable practice and may be beneficial.

[quote user="David Mills"] If something's nephrotoxic, fluids ain't going to stop it being so[/quote]

I'd also have thought that urinary excretion is a major route for many toxins and that fluid diuresis would help eliminate many toxins (obviously not all).

Re: A"spastic" dog

Andrew Kent — Thu, 20 Oct 2011 10:00:32 GMT

I agree that there is much we do not know about this case that would aid decision making about management - ideally we would check blood pressure, electrolytes, biochem etc etc and be guided by the results of these.

However, in the absence of this information initiating fluid therapy to maintain renal perfusion and minimize secondary renal damage if present (for example if renotoxic or causing rhabdomyolysis etc) is certainly not wrong and may in my view have some benefits. Hospitalising the dog also allows closer monitoring for any changes and maintainance of an IV line to give meds if needed.

As a previous post suggested it is also often less distressing for the owner for the dog to be hospitalised so they do not have to deal with the dog being like that at home.

Re: A"spastic" dog

Anonymous — Wed, 19 Oct 2011 22:03:37 GMT

various farm drug toxins sound more likely etc., but I'd include cannabis on my list of possible intoxications in a dog like this with no possible history of poisoning - some clients don't like to confess to feeding the dog a special brownie...

Re: A"spastic" dog

David Mills — Wed, 19 Oct 2011 21:38:09 GMT

Re: A"spastic" dog

Andrew Kent — Wed, 19 Oct 2011 19:11:20 GMT

Supportive treatment = nutritional support, support of urination if necessary, sedation if needed, maintaining mobility, regular turning if needed etc etc. to be honest my nurses are so great that it is most of the things that are done without me even thinking about them. And IVFT is on the whole a good idea because some toxins are nephrotoxic and in the absence of knowing what toxin it is prudent to cover for this eventuality. Lipid therapy would be useful if avermectin. Andy

Re: A"spastic" dog

Amanda Nicholls — Wed, 19 Oct 2011 18:06:21 GMT

[quote user="David Mills"]

I've never actually been convinced by this blanket 'supportive treatment' argument when we can't treat the cause, and that we dive straight for iv fluids. If the dog is eating, drinking, and behaving normally apart from the neurological signs then what's the point of iv fluids? In fact they can just make things worse. And hospitalising a dog with neuro, possibly hyperaesthetic signs, adds to stress. What sort of 'supportive treatment' might you suggest? I think we do it just to make ourselves feel less useless in the face of something like this - this dog isn't going to get better because of iv fluids or 'supportive treatment' - but I think we do sham the clients somewhat with this approach.

[/quote]

Although I agree with your reasons for not hospitalising this dog, I disagree that to hospitalise for supportive treatment would be to sham the clients in all cases. The owners of this dog are farmers and are likely to be practical and sensible and very capable of providing care at home, the dog being a farm dog would very likely be stressed in a hospital environment. However, your average pet owner would be very upset to see their pet behaving this way and would almost certainly want it hospitalised and be grateful to have the vet do whatever they could. I can't imagine the number of telephone calls I would receive if I asked a client of mine to look after this dog at home or they would go somewhere else!

Re: A"spastic" dog

mariette asselbergs — Wed, 19 Oct 2011 16:32:22 GMT

"And I'd forgotten that youtube now allows you to post a video as 'unlisted' which means only people/websites with the link can see it. That might be useful for other members who want to show a case, but want to restrict who can see it. "

Yes Arlo, I saw that and applied it to this video because I did not want it to end up in the "look at my funny dog" category.

Thanks (do you think I can list it as CPD ?)

Mariette

Re: A"spastic" dog

mariette asselbergs — Wed, 19 Oct 2011 16:23:15 GMT

Thanks very much for all the suggestions and experience shared!

This farmer breeds pedigree Suffolk sheep, has very good beef cattle winning shows, and has a number of horses in competitions as well, and they are very into their animals (on the video you might notice that they gave this dog one of the kids' duvets to lie on!!). I don't think they had been using strychnine illegally, I discussed it and I think in the interest of the dog they would have told me if that had been going on. I do think that there is a fair chance of contact with some ivermectine somewheremaybe.

But the update today, by phone, is that the dog is improving, is drinking and eating normally, has no more problems with his front legs but is still high stepping with his back legs. When we wanted to switch him to diazepam the owners said they had a stack of 10 mg tablets for themselves!! (This IS still a James Herriott practice.....). I'll take a sample for Angylostrongylus and we'll add panacur and vitamin B to his treatment, just to be safe, and are hoping for the best.

And it just occurred to me today that I have seen these sort of symptoms once in my own dog due to still another different cause: I was making biodiesel and had left the lid off a bucket of freshly mixed chipfat and methanol. Next thing I notice is our English bull terrier in tremors and all over the place. I have never Googled anything so quickly! They advised alcohol as strong and as quick as possible and I sadly sacrificed two big glasses of whisky which she happily swallowed in the midst of tremors. It worked and she snored through the night.......

(But this farmer is not making biodiesel).

Thanks again for all reactions! This forum is a gem really!

Mariette

Re: A"spastic" dog

David Mills — Wed, 19 Oct 2011 13:47:42 GMT

[quote user="Andrew Kent"]One other thought. As you mention vitamin B there is a congenital hypocobalaminaemia recognised especially in collies. Diagnosis is by finding MMA in urine (need to freeze sample and send to USA). Neuro signs have been recognised as a clinical sign of this. Treatment is regular life long Vit b injections.

[/quote]

Age of onset this late if its congential?

Re: A"spastic" dog

David Mills — Wed, 19 Oct 2011 13:46:59 GMT

In terms of localisation it has to be cerebellar with hypermetria and loss of fine control. There looks to be some hyperaesthesia too, although it is a collie. Speed on onset/age of dog points to to ingestion or infectious. Would definitely treat with panacur/advocate as a lungworm cover.

[quote user="Andrew Kent"]

If toxic then ideally needs to be hospitalised on intravenous fluids and for supportive treatment.

[/quote]