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Author Topic : Please read - input needed - trying to find answers!
 Dalkeith
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7/25/2015 6:04:01 AM reply with quote send message to Dalkeith Object to Post   

Looking to speak to anyone who has experienced something similar to what I’m about to describe:

I have an 8 month old male neutered Rhodesian Ridgeback who I’ve owned from 9 weeks of age.

By the time he was 12 weeks old it was apparent that he had poor hip conformation – which led to him requiring a surgery called Juvenile Pelvic Symphysiodesis (JPS) which effectively cauterizes one of the growth plates in the pelvis to help the pelvis grow differently and cover the femoral heads more as he grows so that his hips aren’t as bad.

This procedure was done at 14 weeks of age and he has recovered fully from this and recent xrays have shown that the operation was a huge success and his hips have really improved which is fantastic!

A few weeks ago (started on the 15th July) he started to show some unusual signs though. Each day he is becoming progressively worse and so far 3 different vets have assessed him and we don’t have a definitive diagnosis yet. He is booked in to see a specialist on Tuesday 28th.

Signs in order of progression (Time frame = 10 days):
- Yelping/screaming in pain at random times (for 2 days only)
- Weakness in the hindlegs
- Reduced range of movement in both hindlegs/hips
- Tense muscles in hindlegs
- Altered gait
- Hip swaying when walking
- Hind legs slipping on tile floors
- ‘bunny hopping’ when running
- Laying down, resting more often
- Tripping over
- Falling over
- Heightened response to reflexes
- Running with a ‘drunk’ gait in the hind legs
- Complete loss of function in hindlegs at random times (only lasting for 2-3 seconds)
- Wide-based stance in the hindlegs
- Occasional scuffing of nails


He initially started yelping on the 15th and 16th July at random times – and for no apparent reason – like he would be standing still or sitting down or asleep and would start screaming in pain. He started pain relief and anti-inflammatories on the 17th July. Since then he hasn’t yelped or screamed.

When he goes to run he gets a few strides in that are normal and then his hind legs start to swing wildly as if they have a mind of their own and then he falls over.

His demeanour is still about 90% the same. Still eating, drinking and toileting normally, still happy and playful etc. But he has started sitting on his bed more often – which for an 8 month old is unusual.

He did have a severe bout of diarrhoea about 1-2 weeks before this whole episode started – and I have no idea if that is somehow related or not. He now finds it hard to maintain a squatting-type position when toileting.

He has had a full general anaesthetic and xrays of his hips, pelvis and cervical spine (neck). All the xrays came up relatively clear.

Some of the differential diagnosis’ that the vets have come up with so far include:
- Wobbler’s syndrome
- Neurological issue
- Pinched nerve
- Neospora infection (protozoa)

The 3 vets that have examined him so far are stumped. When they examine him he doesn’t show any real signs of pain or distress when they test all his muscles in his neck, spine, legs etc.

So ... I was wondering if anyone has ever seen something like this before?

(I live in Australia by the way.)

Everyone in his pedigree have all been hip scored etc and apparently none of them have hip issues despite my boy being born with ‘mild’ hip dysplasia (hence the need for the JPS surgery). I have spoken to both the breeders of his dam and sire and there were 2 dogs in his pedigree on his Sire’s side that produced a pup with Wobblers Syndrome back in 2008.

The dog who sired the pup with Wobblers back in 2008 was a top sire at the time and had 14 or 15 litters in his lifetime (and after as they had stored sperm) and produced just over 100 pups. There was only 1 dog on record to be diagnosed with Wobblers in those 100 pups. Both the sire of that pup and the dam appear in my boys pedigree. I have no idea if Wobblers is a hereditary disease or not ...

I’m hoping to get answers when I see the specialist on Tuesday – because I am stressed out of my brains and it’s absolutely heartbreaking watching my 8 month old not be able to be a normal puppy sad :(



And a picture of my beautiful boy, Emmett:


 Perdix
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7/25/2015 11:15:36 AM reply with quote send message to Perdix Object to Post

Have they considered particularly early onset Degenerative myleopathy?
 PPvallhunds
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7/25/2015 1:21:52 PM reply with quote send message to PPvallhunds Object to Post

this post has been edited 1 time(s)

id be wondering about DM to due to his breed and the weakness in his back legs getting worse.

One sign to look for with that apperantly is the claws on the back feet, if the inside ones are more worn then the outside ones its ment to be a warning sign from what ive read.

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Last edited by PPvallhunds on 7/25/2015 1:23:08 PM
 DoogieG6521
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7/25/2015 6:23:37 PM reply with quote send message to DoogieG6521 Object to Post

www.uskbtc.com/about-kerries/health-genetics/progressive-neuronal-abiotrophy/

This sounds a lot like PNA that can be seen in Kerries. Sorry your. Little guy is not well sad :(
 Quileute Legends
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7/25/2015 7:22:57 PM reply with quote send message to Quileute Legends Object to Post

Thanks very much for your input happy :)

DM is certainly one of the possibilities. (I forgot to add that to the list).

It seems that all of the possible diseases just don't seem to match up completely ... or perhaps he will start developing more of those symptoms in time ... who knows sad :(

Rij (Dalkeith)

(Posting from my other kennel)
 gaylanstudio
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7/25/2015 9:35:19 PM reply with quote send message to gaylanstudio Object to Post

No suggestions but it's heartbreaking - such a handsome bright-eyed boy. Hope this has a good outcome.
 Ariege
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7/25/2015 10:26:15 PM reply with quote send message to Ariege Object to Post

Thanks GaylanStudio happy :)

It is heartbreaking to watch sad :( The good thing I suppose though is that he is still pretty much 90% his normal self. He has been a bit more sooky/seeking cuddles than normal, and does spend more time sitting on his bed - but other than that he is still trying to race around the backyard with his brother and still does all the normal puppy things like chewing his favourite things, playing with other dogs, snuggling with me etc happy :)

Its just horrific to watch him trying to run sad :( I think thats the worst part of it sad :( He still wrestles with his brother, but sometimes he will fall awkwardly and cry and that just makes me cry sad :( His brother doesn't understand whats going on and hasn't changed the way he plays with Emmett - it can be so hard to explain to a dog that he suddenly needs to be gentle with him little brother ... sometimes they just don't understand.

Rij of Dalkeith
(posting from my other kennel)
 Ariege
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7/25/2015 10:31:42 PM reply with quote send message to Ariege Object to Post

this post has been edited 1 time(s)

Some photos of Emmett growing up with his older brother Tonks:





















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Last edited by Ariege on 7/25/2015 10:33:33 PM
 Oakwood Creek
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7/28/2015 6:54:03 AM reply with quote send message to Oakwood Creek Object to Post

So sorry to hear about your problems with Emmett, so sad in such a young dog too. I can't offer any input I'm afraid, never had problems like it in RL. I just hope the vets can figure it out and do something to make his life more comfortable.
 Treestand Kennel
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7/28/2015 10:22:20 AM reply with quote send message to Treestand Kennel Object to Post

I am so sorry to read this! sad :(

My first Great Dane had DM. His hind end was never very muscular from the time we rescued him at 5 months, and when he got older what little muscle he did have deteriorated even more. It was heartbreaking to watch him be 100% present in mind, but watch his body fail him. He still wanted to go for walks, so my dad walked him for as long as his body was able. We put boots on his hind legs because his hind feet would drag (the walks stopped when the dragging increased) It was always the inner two that were ground down.

He never yelped or screamed in pain, but in his entire life he never cried when he got hurt. My parents bought a wheelchair to try and help him cope with the steady loss of his hind legs, but it stressed him out too much so they decided not to push the issue.

He was on pain meds, glucosamine, chondroitin, MSM, and fish oil. But when his quality of life began to deteriorate, we chose to put him to sleep (he was 11 and a half and got pneumonia once a month and his body was beginning to fail beyond his hind end).

Lola, our other Dane, would play to his desire and then would stop (surprising, considering she was 5 years younger than him) and then when he really started to go down hill, she completely adjusted her ways and would just lay by him and give him anything he needed or felt he needed, extra space, her food, pets from people.

I hope the specialist can shed some positive light on Emmett!

I am thinking of you and the boys!
 Dalkeith
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7/31/2015 5:58:36 AM reply with quote send message to Dalkeith Object to Post

Update:

Saw the specialist on the 28th July. He agrees that it is definitely a neurological issue and feels that it is almost definitely Wobblers Syndrome sad :(


Emmett needs to have a CT scan and myelogram to confirm the diagnosis and assess the severity. The scan results will let us know if he is a candidate for surgery and if so - what particular technique of surgical decompression will work to allow his spinal cord to stop being pinched.

The myelogram has a lot of risks ... as does the surgery ... but if I don't go ahead with the tests and surgery then he will only survive for a few more months on medical therapy (steroids and pain relief) ... sad :(

The myelogram has a 1 in 1000 risk of the patient suffering an allergic reaction to the contrast medium which can cause them to die sad :( There is also a risk of seizures and paralysis ... I'm absolutely freaking out! sad :(

They can do an MRI scan - but it doesn't give the right level/amount/type of detail that they need in order to see the spinal cord and all the bone structures surrounding the cord etc. The CT and myelogram will give them a much clearer image and will give them ALL the information they need. As scary as the risks sound - the specialist says this is what he needs.

If I choose to not go ahead with any tests or surgery then the only option is to manage him on steroids and pain relief medication but it will come to the point where the lesions become permanent and he will lose function in his legs completely and will get to the point where euthanasia on humane grounds will be the only option.

I am not the sort of person who keeps their pets alive if they have no quality of life - so I'm opting to give him the best chance of survival by undergoing the testing.

So realistically my only option is surgery. At the end of the day there is a risk that he may have too many bony deformities causing lesions on his spinal cord that may mean that surgery isnt an option and then I will have no choice but to euthanaize when he gets to the point where he can't function or enjoy life.

Naturally I'm absolutely gutted sad :( sad :( sad :(

The specialist has been fantastic so far and has told me that he will be 100% upfront with me and will 'tell me how it is' straight away if he feels that surgery will work or not work etc - so at least I feel comfortable that he won't just push for surgery etc. Because I don't want to put Emmie through such a traumatic experience if he has no chance of a realistic 'recovery'.

The tests and surgery will cost me about $4500.00 which will be worth every cent if it means he can go back to being a normal functioning puppy again and have a chance at a normal lifespan.

I'm at that point where I feel like my brain can't take in any more information and my heart can't take on any more bad news. I haven't broken down yet but I know that handing his leash over to the specialist when he goes in for testing will have me in a puddle of tears. Even though I'm a vet nurse and surrounded by this sort of stuff on a daily basis it doesn't make it any easier when it's your own pet. If anything I think it makes it worse sad :(

I'm praying that the CT and myelogram results come back with a good result so we can 'fix' him as best as we can happy :)

At this point in time we don't know the severity of the disease and therefore we don't know what the future holds for Emmie - so everything is hanging on the results of the CT scan and myelogram.

I will keep you all updated when I have the results of the scans.

Please keep Emmie in your thoughts happy :) xxx
 Magyar Kutya
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7/31/2015 11:11:39 AM reply with quote send message to Magyar Kutya Object to Post

You and Emmett will be in my prayers xx
 PPvallhunds
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7/31/2015 1:11:52 PM reply with quote send message to PPvallhunds Object to Post

Poor little guy, but at least you have a diagnosis and hopefully the ct will say he can be helped. But if not at least you will know you did everything possible for him, some wouldn't have.

We will keep our fingers and paws crossed for him.
 gaylanstudio
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7/31/2015 2:06:56 PM reply with quote send message to gaylanstudio Object to Post

My thoughts are with you and Emmett.

I remember being in a similar situation - twice - with Tyler. The first time it was autoimmume, the bill $5000. Turned out to be more than that adding in the periodic blood tests watching for recurrence (didn't have any). The next time gastric tortion - $3000 with a preexisting heart condition at 15 years, they didn't think his chances were great, but it was a case of buying him a few more months at risk of him dying on the table. He got through that well and had a pretty good summer.

No regrets for the money spent. He was worth every penny. Still miss him although Baxter is a joy and I'd do the same for him.
 Yippee Yahoo Kennels
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7/31/2015 4:29:32 PM reply with quote send message to Yippee Yahoo Kennels Object to Post

So sorry to hear this is the turn out. You and Emmett will be in our thoughts.
 kiroja
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7/31/2015 6:36:27 PM reply with quote send message to kiroja Object to Post

Best wishes for a good outcome for your baby! I can't imagine how tough it is to be dealing with that but don't worry, your decisions will be doing right by your kiddo.
 Dutch Creek Kennels
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7/31/2015 10:30:04 PM reply with quote send message to Dutch Creek Kennels Object to Post

I am so sorry to hear about your boy. He is in my prayers. sad :(
 Treestand Kennel
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8/3/2015 4:06:21 PM reply with quote send message to Treestand Kennel Object to Post

I am happy you have a doctor who will give you straight answers, not just push surgery. Fingers crossed the tests give desirable results!

You, Emmett, and Tonks are in my thoughts!
 Spyte
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8/6/2015 11:39:04 AM reply with quote send message to Spyte Object to Post

You are all in my thoughts and prayers. I can only imagine the slew of emotions that you are experiencing right now. If there is anything I can do please let me know.
 Guiding Senjis
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8/7/2015 1:23:27 AM reply with quote send message to Guiding Senjis Object to Post

Praying that the tests will show a way to help your pup and that you have a surgeon that will be straight with you on the possibilities.
People can also have reactions to the contrast, but rarely have issues.
Hang in there and know you have a lot of support here.
 Dalkeith
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8/7/2015 7:37:52 AM reply with quote send message to Dalkeith Object to Post

Sorry for the delay in getting back to everyone- yesterday was a big day full of stress and emotions and to top it all off I’m coming down with a cold/flu so I’ve just been exhausted.


Firstly – the best news is that Emmie came through the tests and scans 100% fine in terms of he didn’t have any reactions to the anaesthesia or the contrast medium (‘dye’) that they used. (As there was a 1 in 1000 chance that he could have had a severe reaction to the contrast medium and died – one of the most serious risks of the myelogram study).


I was very hesitant to put him through such a risky procedure but the specialist explained that there are 2 main types of imaging used to view the spine – CT and MRI – and that the MRI wouldn’t give them the detail they needed. (As MRIs are more focused on soft tissue structures, and the CT is more focused on the spinal cord and bony structures.). The myelogram study is a ‘dye’ of sorts that is injected into the spine and basically soaks into the surrounding areas and ‘lights up’ to show the passage way through the spinal cord and gives the most informative and accurate view of the spine.


Emmie is now sporting a rather embarrassing new hair cut on the back of his head which realistically is the least of his problems – but is definitely a conversation starter! As a result of the scans and anaesthetic his clinical signs (symptoms) will be worse for 24-72 hours.


Emmie was admitted to the specialists at 8am yesterday and stayed there until 6:30pm. I spoke with the specialist in the morning (prior to the procedure being done) and he was still convinced that Emmie had congenital/developmental Wobblers syndrome and that the scans would allow us to 100% confirm the diagnosis and assess the severity of the disease.


I spoke with the specialist at 1pm and he had some rather shocking news. The initial CT and myelogram images had come through and there had been a completely unexpected discovery. He was now telling me it was NOT Wobblers and that he would talk to me later at the discharge and give me more information then ... Naturally I was freaking out – as once again we were being put in the ‘no idea what your dog is suffering from’ boat!


When I went in at 6:30pm to pick Emmie up the specialist showed me through to the imaging room to show me the scans on the computer. He explained that with Wobblers you can normally see 1 of 2 things: a) disk-associated compression - which he had never suspected as it is more of an age related thing. Or b) osseous or bony malformation causing spinal cord compression – which was what he was expecting to see.


He showed me the images and it was very clear straight away that he has NEITHER of those issues. (Weirdly enough they had a Doberman in at the same time as Emmie who actually has Wobblers and the specialist was able to show me both the Doberman’s and Emmie’s scans side by side to show me the difference).


He then showed me the myelogram study scan and pointed out that this is where the abnormality was. With a myelogram they inject the ‘dye’ into the spine and it is meant to flow along the spine and be soaked into the surrounding tissues over a few hours. But with Emmie the ‘dye’ got to a certain point in the spinal cord itself and seemed to be occluded or blocked off by something. So they ended up repeating all the images again a few hours later and we seem to have some sort of a diagnosis – although more testing is needed.


The specialist seems to think that Emmett has whats called a ‘subarachnoid cyst’ within his spinal cord itself. At this stage he isn’t sure what has caused the cyst – as apparently it can be very hard to determine the cause – but the possibilities can include:

- Trauma

- Congenital malformation

- Parasitic infection

- Unknown cause.


The specialist thinks that trauma is HIGHLY unlikely to be the cause – and he is leaning more towards congenital malformation OR a parasitical infection. There are several parasites including lungworm and a protozoa known as ‘neospora’ that can invade the spinal cord. Lungworm is generally transmitted by dogs eating snails and slugs (as they host the worm’s larval stage). Neospora is generally transmitted by dogs eating cat faeces from cats who have picked up the protozoal infection.


So this was a totally unexpected finding and we’re all quite shocked!


Apparently subarachnoid cysts are common in Pugs and other smaller dogs but their cysts are generally found in the thoraco-lumbar spine (the spine near the chest and mid-back) whereas a number of cases of subarachnoid cysts have been reported in young (<18months) large breed dogs and these cysts generally occur in the caudal or cranial cervical region of the spine (in the spine associated with the neck from the base of the skull to the top of the shoulders).


Emmie’s cyst is located around the C4-C5 part of his neck (sort of just before his shoulders start). (Spinal Arachnoid Diverticula is the proper name for subarachnoid cysts).



So where do we go from here?


I haven’t had much time to research and absorb information yet but from what I understand my options with Emmett aren’t particularly great. From what I’ve read online some cases have been attempted to be managed without surgery using medication alone – and these have not gone well. These cases (medical management) seem to only keep the patient comfortable until they are euthanaized due to the severity of their condition. The other option is surgery.










The specialist seems to feel that surgery is the only option. With the surgery they will cut down into his spine, lift off the bony structures protecting the spinal cord and will attempt to either remove the fluid from the cyst, or remove the entire cyst itself. The risks are very high. From what I understand (and I haven’t had a chance to sit down with the specialist and really go through all the details as we are waiting for the CSF analysis to come back before we do this) – the surgery is risky because of the fact that the cyst is located within the spinal cord itself. This means that there is a 35-40% chance of paralysis. (But on the other hand also a 60-65% chance of successful treatment!).


I don’t fully understand any of it at the moment – but from my morning of reading journal articles on the internet there seems to be a mention of some of these subarachnoid cysts recurring! (Coming back again at a later stage).


I hope to God that Emmett doesn’t have a recurring type.


As you can see – this finding was totally unexpected – even to the specialist – and now everything is even more unclear and frightening.


These subarachnoid cysts seem to display the same clinical signs (symptoms) as Wobblers disease – which is where the confusion has come from.


The interesting thing though is that Emmett had ALL but ONE sign of Wobblers – he didn’t have a painful neck. (This was baffling me as a painful neck seems to be the most common sign of Wobblers and I wondered why he didn’t have that symptom). From my reading today it seems that this non-painful neck seems to be a clinical sign of subarachnoid cysts. So at least that little mystery has been solved.


Emmett’s clinical signs (symptoms) are all associated with spinal cord compression – which occurs in Wobblers and a number of other diseases including this subarachnoid cyst disease.


(Spinal Arachnoid Diverticula is the proper name for subarachnoid cysts).



Note: At this stage the specialist feels that surgical decompression of the spinal cord using ‘dorsal laminectomy’ or ‘hemilaminectomy’ in association with drainage or partial/full excision of the cyst with potential ‘dural marsupialisation’ will be the type of surgical approach that Emmie will need. (this approach is mentioned in the articles).



Here is a short history from the specialist:

PRESENTING COMPLAINT: Unusual gait
HISTORY: Progressive changes to his gait. He has had sporadic bouts of pain.
CLINICAL FINDINGS: Marked ataxia to all limbs however the hind legs are more

affected than the front legs. Clinical examination is consistent with a

cervical lesion. There are no central signs.
DIAGNOSTIC TESTS: Clinical examination, CSF tap (results pending) and CT myelogram
DIAGNOSIS: There is a lesion in the parenchyma of the spinal cord at C4-C5. It is an intramedullary lesion. Differential diagnosis would include: a sub arachnoid cyst, parasitic granuloma, central canal cyst, syrinx.
SURGERY: None at this stage. Await CSF results – then reassess from there.
PLAN: Await results. If CSF is normal consider dorsal laminectomy and

durotomy to investigate the cause further and marsupialise the cyst

further.
PROGNOSIS: Open.




I just hope that we can fix Emmie and restore him to normal function.


At the end of the day I am happy to do whatever it takes to fix Emmie – but I won’t put him through spinal surgery if the specialist doesn’t think it will cure him.


---

The above was an excerpt of what I sent to his breeders this morning, then the text below this is what I sent to them once I received the CSF results this afternoon:


Further to my email earlier this morning I have now spoken to the specialist with the results of the CSF analysis. It has come back 100% normal/clear.


Which in effect isn’t really good news either. All it means is that the cause of this ‘cyst’ has been ruled out as being a parasitic-related thing.


Which now means the only options are:

1) MRI

2) MRI and explorative surgery

3) Explorative surgery without the MRI

4) Medical management followed by eventual euthanasia

5) Euthanasia.


At this stage I don’t feel that he is painful – which means that I do not wish to euthanize at this stage of the disease. However it may still be the only humane option further on down the track if he continues to deteriorate.



The MRI is more focused on soft tissue detail and so it may be useful to help give us another ‘view’ of the spinal cord and the offending cyst. This MRI will cost me roughly $1400-1800. It would be another anaesthetic, and he would be taken to a human hospital as the specialist don’t own their own MRI scanner.


The biggest issue with the MRI is that it ‘may’ give us more clues to what the cyst is, but it may also give us no further information. We may choose to go ahead with an ‘explorative’ laminectomy surgery after the MRI.


The ‘explorative’ laminectomy effectively involves the specialist surgeons cutting through the muscle down to the spine and ‘lifting off’ the bone structures that are covering the spinal cord so they can visualise the cyst. At that stage they can then assess whether or not removing the cyst will be curative or not.


They may decide to remove it or they may decide that it is not operable.


At this stage we have absolutely no idea what will happen if we leave the cyst in or if we take it out. I have no idea how long Emmett may live if we do nothing other than medical management (using medications to keep him comfortable). I also do not know how long he will live if we do the surgery and choose to remove the cyst – as nobody has the answers at this stage.


The cause of the cyst is so unknown – it could be a congenital malformation or even potentially neoplasia (tumour). There is no way of really knowing what it is until we do the surgery.


I am now at a complete loss for what to do. I don’t have any useful answers and I don’t have a prognosis. I just have a list of the things we’ve ruled out.

I really don’t know what to do. If I choose to do the surgery I need to do it sooner rather than later as each day that goes by could be potentially causing more permanent scar tissue to his spinal cord.


He deteriorated quite rapidly over the first 15 days from the first day that he started showing signs but since starting on the Prednisolone he seems to have slowed down in his progression - which could be a good sign - its really hard to tell though.


If anyone has any advice I’m open to hearing opinions on what I should do.




Links of interest:



This article here is the best that I have found so far that explains a lot:

www.vetbook.org/wiki/dog/index.php/Arachnoid_cyst



The above listed article is full of a lot of medical terms and is a little confusing at first to read but if you have the time and patience please read it as it is very informative. (Note - the study talks about both human and dog cases).

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