What is your diagnosis?

Presentation

Abigail is an approximately 50 pound, female, spayed, adult, mixed breed dog who presented to Animal Kind for acute signs of pain. She had begun crying out and trembling that morning. Her person reported no history of injury. She was being given a low dose of the corticosteroid, prednisone every other day to control the symptoms of her chronic allergic skin disease.

On physical exam, Abigail seemed painful when moving from a sitting or prone position to standing and resented handling of her right hind leg. However, she was extremely tense and nervous during the examination and the veterinarian was unable to confidently localize the source of her discomfort.

Despite our good intentions, situations like this one with Abigail arise frequently. Veterinarians understand that animals in distress are often very nervous especially in unfamiliar surroundings with unfamiliar people. We do our best under these circumstances to use patience, experience, and the sometimes tests to further investigate. What would you do in this situation?

Diagnostic Tests

Based on her signs and examination findings, the veterinarian recommended radiographs (x-rays) of Abigail’s back and hips. The images are included below.  (Click on each x-ray to see the full image.)




What abnomalities do you see?

Interpretation

Based on these images, Abigail was diagnosed with intervertebral disc disease and hip dysplasia. The radiographic signs of her intervertebral disc disease were a collapse or narrowing of the space between the 12th and 13th thoracic vertebrae and the presence of bone spurs known as discospondylosis on the ventral or bottom aspects of several vertebrae.

The diagnosis of hip dysplasia was made by recognizing a decreased depth of the acetabulum which is the socket of each of Abigail’s hip joints. In addition to this, there was significant bone spur or osteophyte formation in both hips.

Conclusion

Both conditions identified on Abigail’s radiographs are potentially painful. We began treatment with a pain control drug called tramadol and recommended strict activity restriction. Abigail continued to have signs of pain. Because the sharp, intermittent nature of her pain was most suggestive of intervertebral disc disease, we recommended increasing the dose of her prednisone.  Anti-inflammatory corticosteroids such as prednisone are often helpful in relieving the pain associated with spinal diseases.  Abigail’s signs rapidly improved.

In the long-term, weight control and possibly other arthritis control medications directed against the degenerative changes seen in her hips were indicated. Abigail, like many older patients, has more than one concurrent disease and making her happy and comfortable involves managing more than one problem.