Yep – a thorough patient history is an extremely important first step in any case – what questions would you ask Lily's owner? Yes owners description of the problem is critical including the ONSET and PROGRESSION.
Also think HOW would you ask your questions? Lily's owner is a smart lady, but doesn't have a medical background.
So the owner informs you that Lily was fine until ~4 weeks ago, then quieter than usual, off food and stiff back legs for the last week. Other aspects of her general health have seemed fine, no travel history out of UK.
Don't forget to ask general health history questions –> prior health, medications, diet, travel history etc.
Lily's owner says she no longer wants to jump up, climb stairs or jump into the car.
Great idea Harriett, anything you should do before?
So Lily's physical exam findings:
Make a note of anything significant that you want to add to your problem list.
It is useful to do orthopaedic exams at the same time as neuro exam since gait analysis, laying in recumbency common to both.
Neurological exam as follows:
What are the aims of our Neuro Exam? What questions are we asking?
For those of you who haven't heard of the 6 finger rule don't panic. Its just a method of teaching used at RVC to organise our clinica presentation in order to come up with a refined list of differentials.
Here is a link that one of the students sent on the night to help you understand 🙂
6 Finger rule: 1. Signalment, 2. Onset (acute/chronic), 3. Progression, 4. Symmetry, 5. Pain (yes/no), 6. Neurolocalisation.
So considering her neuro exam findings and our other findings before that, what do you want to include on your problem list?
So what are your DDx for these problems?
Good, although do you think neoplasia and IVDD would fit with pyrexia, and neoplasia with the degree of pain?
MUA is unlikely in this cases as it usually causes marked CNS signs (mostly brain, sometimes SC), less overt pain and not typically pyrexia.
Is this the typical age for SRMA (steroid-responsive meningitis-arteritis)? Usually <1 years old. So unlikely in Lilly's case!
Prior to xray taking we must ensure to:
– provide adequate analgesia
– Informed consent from owner
– +/- Haematology and Biochemistyr.
So what abnormalities do you see? Which are clinically relevant?
Here is the same radiograph with the lesions highlighted.
So revised DDx?
Well done guys! What casues discospondylitis? What other tests could you do now?
Great call @jdc0907, always a good idea to culture the urine as a concurrent UTI is a common source of haematogenous spread!
Foreign bodies can also be a source. Good shout
Good work! Broad spectrum is a good choice until the culture results are back. NSAIDs are indeed indicated for analgesia. A defined length of course is difficult. We usually treat until radiographic resolution. This can take a long time….
Guys, you have done brilliantly but we need to wrap it up now.
Remember: Discospondylitits is reasonably common in dogs and many cases can be diagnosed and treated in general practice.