Consumer Guide to Pet Insurance

History: Acute onset of whole body tremors.  The tremors are only noticed with activity and stop with rest or sleep.

Case Video:

Neurological exam:

Mental status: BAR
Gait/posture: Whole body small amplitude/high frequency tremors; intermittent hypermetria FLs; wide based hind limb gait; mild ataxia x 4
Cranial nerves: WNL
Postural reactions: Normal CP/hopping x 4
Spinal reflexes: WNL x 4
Spinal pain: None
Muscle tone: Normal x 4
Muscle atrophy: None
Pain sensation: Normal x 4
Cutaneous trunci: Normal bilaterally

What is your neurolocalization?  What are the top differential diagnoses? (SCROLL DOWN TO SEE ANSWERS)

Neurolocalization = Diffuse brain

Differential diagnoses

• Steroid-responsive Tremor Syndrome (“Little White Shaker”)
• Tremorgenic toxins
  • Moldy food containing mycotoxins (Penitrem A & roquefortine)
  • Organophosphates
  • Pyrethrins
  • Metaldehyde (snail & slug poison)
  • Lead
  • Bromethalin
  • 5-fluorouracil (chemotherapy agent)
  • Macadamia nut ingestion
  • Theobromine (chocolate)
  • Strychnine
  • Rare congenital/enzyme disorders

Diagnostics
Pre-anesthetic CBC/biochemical profile and U/A were unremarkable.   Since there was no history of toxin ingestion, an MRI and spinal tap were performed.   The MRI was within normal limits.  CSF analysis showed a mildly increased WBC count (12 cells/μL; normal < 5), but a normal protein level.  Differential cytology demonstrated a lymphocytic pleocytosis.  Infectious disease tests were all negative.

Diagnosis
Steroid-responsive Tremor Syndrome

Treatment
The patient was started on prednisone (1 mg/kg PO BID x 2 weeks) and diazepam (0.5mg/kg PO TID x 1 week).   The tremors resolved within a few days and she was normal at recheck exam 2 weeks later.  The prednisone was tapered slowly and we were able to completely stop the prednisone at 8 months.

Prognosis
The prognosis for SRTS is very good to excellent if treated early & aggressively.  Recurrence is uncommon  for SRTS, but can occur in dogs with toxicity if exposed to the same toxin again.

This could be a cute coffee table book to give as a gift to a dog-owning, house-dwelling friend, or even to buy for your own coffee table to answer the question of why there is dog hair on the furniture … what?! how’d that get there?!

The 5th Annual ACVO®/Merial® National Service Dog Eye Exam Event brings together veterinary ophthalmologists and thousands of service dogs for free eye exams.

 Registration begins April 1^st-30^th  for the May 2012 event.

During the month of May 2012, the American College of Veterinary Ophthalmologists (ACVO) is launching the 5th annual ACVO/Merial National Service Dog Eye Exam Event to help serve these dogs who dedicate their lives to serving the public. More than 180 board certified veterinary ophthalmologists throughout the U.S., as well as Canada and Puerto Rico, traditionally elect to provide free sight-saving eye exams to thousands of service dogs. Registration for service dog owners and handlers begins April 1, 2011. During the complete ocular exam, the veterinary specialists will look for problems including: redness, squinting, cloudy corneas, retinal disease, early cataracts and other serious abnormalities. Early detection and treatment are vital to these working dogs. Last year, more than 3,200 active service dogs received free eye exams throughout the month of May.

A sampling of groups served since the ACVO/Merial National Service Dog Eye Exam Event launched in 2008 include: Transportation Security Agency (TSA), military working dogs, local fire, rescue, and police agencies, and also individual service dog owners and handlers who rely on these amazing animals daily.

 DOES YOUR SERVICE DOG QUALIFY? 

To qualify, animals must be “active working animals” that were certified by a formal training program or organization or are currently enrolled in a formal training program. Guide dogs, handicapped assistance dogs, detection dogs, police dogs, search and rescue dogs and formally trained and certified therapy dogs (through the Delta Society or similar) qualify. The certifying organization could be national, regional or local in nature. Essentially the dogs need to have some sort of certification and/or training paperwork to qualify for this particular program. Other service animals are welcome to participate (i.e. horses, cats, etc.), as long as they meet the stated qualifications. Additional registration details can be found at www.acvoeyeexam.org

THE FOLLOWING STEPS MUST BE COMPLETED TO PARTICIPATE:

Step 1: In order to receive the free eye examination you must FIRST register online for this event at www.acvoeyeexam.org A confirmation and registration number will be sent to your e-mail address after registration. You will need to provide the registration number when scheduling your appointment with the ophthalmologist. If you do not register, you cannot participate in the event. 

 Step 2: Once you have registered, the web site will push you through to a page that will allow you to search by state to locate a clinic near you. (Clinics may not be available in every state.)

 Step 3: After locating the clinic you would like to visit, call their office directly, identify yourself as participating in the ACVO Service Dog event and make an appointment providing the registration number you attained. The dates and times that this program is offered may vary from clinic to clinic throughout the month of May. We suggest you register early in April to ensure a better chance of securing an appointment at your preferred clinic. Those who wait to register may find it difficult to find a clinic with open slots. 

 Step 4: Visit the ophthalmologist at the appointed time. Please call ahead if you will be late or have to cancel your appointment.  During the examination an eye health screening will be conducted on each animal. The complimentary eye exam through your veterinary ophthalmologist is of a screening nature. Should more services be needed or desired, you may discuss your options with the specialist. It is expected that the majority of animals will be healthy and will not be in need of additional services. But should such a need arise, your veterinary ophthalmologist is the expert that can discuss the condition, present options and best treat your animal.

 Step 5: After your Service Dog’s eye examination is complete, your veterinary ophthalmologist will provide you with a copy of your examination form and information. Please take this back to your primary care veterinarian to complete your medical records upon your next appointment. Your veterinarian is an integral part of the team needed to keep your Service Dog health.

 Data collected on each animal will remain private and be utilized for research purposes only.

 Remember, you MUST pre-register @ www.acvoeyeexam.org prior to making your appointment with the veterinary ophthalmologist. Registration for the 2012 event runs April 1^st-30^th with appointments booked throughout the month of May.

 Further questions/information can also be attained via our website at www.ivghospitals.com or by calling and speaking with a member of the Port City Ophthalmology Team at (603)433-0056.

Thanks again Angie’s List Members!

Canine mobility carts can be used by any pet (even cats and farm animals!) that has significant weakness requiring assistance to ambulate.  This is most often due to a neurological condition, but, in some cases, dogs with severe osteoarthritis (e.g., hip arthritis) may benefit from a cart to help alleviate pain and improve quality of life.  Some companies even make carts for patients that have only front leg weakness or “quad carts” for patients with weakness in all 4 legs.

Not sure that your pet would benefit from a canine cart?  Take a look at the video of Angus and Bailey.

Angus was brought in to the Neurology Department in August 2005 after a sudden onset of hind limb paralysis.  MRI showed that he had a severe disk herniation (“slipped disk”).  He only had a 50/50 chance of walking again because he lacked pain recognition when his toes were pinched (paralyzed dogs that DO retain pain recognition have a 95% chance of walking again).  The owners pursued surgery to give him the best shot at walking again.  Unfortunately, Angus is one of the 50% that didn’t regain the ability to walk.  However, he has been enjoying life ever since in his canine “wheelchair.”  Angus runs & plays in his cart and we have a hard time keeping up with him when he boards at our hospital.  Angus is quite the lover as well…he has many “girlfriends” in the veterinary technicians and doctors at MVRH.

Bailey was a fantastic dog owned by one of our client care representatives.  He was a sweet and gentle German Shorthaired Pointer that was diagnosed with Degenerative Myelopathy, a disease that causes a non-painful, chronic, slowly progressive hind limb weakness that eventually progresses to paralysis and front leg weakness.  His owner put him in a cart 9 months after he was diagnosed.  He did very well in his cart until 2 years after his diagnosis, well beyond how many dogs with his condition do, until the disease finally started to affect his front legs and he was humanely euthanized.   While 2 years doesn’t sound like a long time for us, it is an extremely long time for a large breed dog.  He had a great quality of life during that time and his owner treasured every minute that she had with him.   As you can see in the video, his owner had to trot at times to keep up with him!

Canine carts can also be used during rehabilitation to help patients relearn to walk.

Mel is a Doberman pinscher that was brought in to MVRH following a sudden onset of inability to walk on all 4 legs.  MRI revealed a herniated disk in his neck and he was taken to surgery to remove the ruptured disk material and decompress the spinal cord.  He then started intensive physical therapy in our PT department and at home.  Mel’s humans are extremely dedicated owners. When he didn’t regain the ability to walk quickly, they purchased a “quad cart” to help with his mobility, but also as an aid to physical therapy.  As you can see from the video and pictures, he loved being in his cart.  Eventually, he relearned to walk and no longer needs his cart!

Mel in his quad cart and walking through the snow after relearning to stand & walk

There are many companies that produce canine mobility carts.  Here at MVRH, we prefer Eddie’s Wheels for Pets.  They are a local company located in western Massachusetts.  Their carts are custom made to the size of the pet, durable, and have large wheels that are less likely to get stuck while walking outdoors.  The owners are incredibly nice and their customer service is excellent.

Meningioma is the most common brain tumor (60%) in cats.   Clinical signs depend on lesion location, but common signs include seizures, circling, behavior change, as well as non-specific signs of lethargy and decreased appetite.  MRI is usually diagnostic, although surgical biopsy is required to definitively diagnose a meningioma.  The MRI image above shows a typical meningioma.  As was the case for this patient, meningiomas are often located superficially over the cerebral hemispheres and can be readily accessed.  Surgical excision is the treatment of choice.  Unlike dogs, meningiomas in cats usually do not invade into brain tissue and are easily removed in their entirety (like a peanut coming out of a shell).  Most cats do very well following surgery. It’s not uncommon for a patient to survive many years before a new meningioma arises or the patient develops an unrelated disease (e.g., chronic kidney disease). The average survival time is 2 years, but complete surgical excision can be curative.

The ability to use advanced diagnostic techniques such as ultrasound, endoscopy, CT scans and MRI are readily available.

Intensive treatment options are available for the unexpected accidents such as ingestion of toxic materials or foreign bodies, vehicular accidents, and bite wounds.

Diseases can be attacked by more specific medications and our pets are living longer and more comfortable lives.

Unfortunately, with advanced care also comes an increase in costs.   Read more: