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CASE STUDY INFLAMMATORY BOWEL DISEASE (IBD) Cauda Equina Syndrome (also known as Spinal Stenosis, Lumbosacral Stenosis, CES) UAGCH, AWSA, WSCC, UKC GRCH(2), RBSCWO, FORB CH CRYSTAL'S LADY IN RED "KYRA" CGC(2), TDI, TT, HIC/s/c/d, DSA, NA, CPEL1, RA2, ASCA/RB CD, FDCH, HT, PT, HCT, JHD, WETT, PDX, 0-VCCX, OFA H&E, CARDIAC, THYROID, CERF, vWF 65%, UKC-DNA-P, GSD HEALTH MERIT AWARD EXCELLENT- -White Shepherd DOB: 9-20-95 DOD: 6-26-05 Owner: Judy Huston Breeder: Pam and Larry Koons Website:
ANGUS VON TASZ, CDX TT HC CGC OFA H&E (Excellent) Date of Birth: October 28, 1992 -DOD May 8, 1999 (Bloat) Owner Jean Reeves Breeder Diana Updike AWSA UKC WGSDCI WSCC CH U-CD , CDX TT HC CGC OFA H&E (Excellent) October 28, 1992 - May 8, 1999 (Bloat)Owner Jean Reeves Breeder Diana Updike AWSA UKC WGSDCI WSCC CH U-CD , CDX TT HC CGC OFA H&E (Excellent) October 28, 1992 - May 8, 1999 (Bloat)Owner Jean Reeves Breeder Diana Updike   AWSA UKC WGSDCI WSCC CH U-CD , CDX TT HC CGC OFA H&E (Excellent) October 28, 1992 - May 8, 1999 (Bloat)Owner Jean Reeves Breeder Diana Updike   Dam: WGSDCI CH Hoofprint Emerald “Ashlee” CGC, TDI, TT, CD, FDCH, OFA(H&E) Date of Birth: February 27, 1991 –DOD  March 14, 1998 (Inoperable tumor on spine) Owner Pam & Larry Koons Breeder Joanne Chanyi WGSDCI CH Hoofprint Emerald “Ashlee” CGC, TDI, TT, CD, FDCH, OFA(H&E)  February 27, 1991 –  March 14, 1998 (Inoperable tumor on spine)Owner Pam & Larry Koons Breeder Joanne Chanyi The two diseases are covered in this same case history because 1) they were both diagnosed the same week, and 2) the symptoms of the IBD critically delayed the diagnosis of the CES. Kyra’s history leading up to the diagnosis of IBD: Kyra’s history will include “possible” relevant information beginning when she was a puppy. Keep in mind that at no time up to the diagnosis did I believe that Kyra had any significant problems with diarrhea. Since she was so healthy until she turned 6, I can remember saying that “if” Kyra had an Achilles heel; it was diarrhea simply because if she showed any symptoms of anything, it was occasional soft stools or diarrhea. I, like so many shepherd owners, was told that a lot of our dogs had this and basically, not to worry about it. Since it happened relatively few times over the course of her life, I wasn’t concerned. Becky Joyce and I used to have similar problems -- often at the same time, with Kyra and her littermate, Star. While they were still quite young, we changed their food not only because we were so into the healthy alternatives, but because we needed to find a food that did not result in soft stools. Star, unlike Kyra, seemed to move away from manifesting symptoms of diarrhea or soft stools to having her problems show up as allergies. Kyra, too, has allergies, but nothing she was ever treated for or that gave her obvious problems. Remember, however, that there is a school of thought that says IBD is an allergy and this is why she is on a hypoallergenic diet. November, 1995 Changed food from Eukanuba Puppy to Wysong February 28, 1996 Diarrhea 24 hour fast, Metronidazole & Centrine November 29, 1996 Diarrhea/Giardia Treatment Metronidazole January 14, 1996 Changed food to Global – Best Breed German Dog diet April 18, 1997 Changed food to BARF – Bones and Raw Food August 19, 1997 Fecal test/Giardia Moderate April 7, 1998 Fecal test/Giardia Mild November 1998 Changed food to Wendy Volhard’s Natural Raw Diet September 2001 Anal Gland Infection Antibiotics November 2001 Straining to defecate Impacted stool Dec. – Jan. 2002 Alternated between constipation and diarrhea with considerable straining, but the bloody mucus was the final straw. Vets tried her on a variety of medications none of which helped. They tried Bethanehol, Sulfasalazine, and more. She was vomiting and had blood in her stools. January, 2002 Bloodwork, urinalysis, x-ray, ultrasound showed she had a very enlarged bladder – they called it Bladder Atony. She had lost her ability to urinate more than tiny amounts and her bladder got larger and larger. She was put on Phenoxybenzamine (Dibenyline) 3X day. January 18, 2002 Bowel Biopsy January 23, 2002 Confirmed diagnosis from Colorado State of Severe Eosinophilic ulcerative colitis/proctitis.   Kyra’s history leading up to the diagnosis of CES: Keep in mind that I’m mentioning the incidents that occurred in Kyra’s life simply because they may have been signs of weakness and in some way related to the spinal stenosis. Anyone that knows Kyra personally knows that she is a highly energetic, non-stop, throw herself around, charging kind of dog so I’m somewhat surprised she didn’t have more injuries. But, you guys will be the ultimate judge of symptoms as you keep your own dog’s history. Maybe these are relevant – maybe not, but this is part of the whole tracking process. By tracking, we can learn! September 26, 1997 Lifting back left leg Possible sprain – kept her quiet 10 days April 22, 2000 Swollen painful left hind dewclaw – MSU thought it might be a soft-tissue injury, while my holistic vet thought it was the result of a wasp sting. Either way, they said “rest her.” August, 2000 Door slammed on her tail – yelped October, 2000 Herding judge and handler commented about her broken tail November, 2000 Chiropractor confirmed break and said it wouldn’t regenerate March, 2001 Slammed into a log in our log home, extreme pain, had: 3 neurological exams – found nothing wrong – except tail 2 x-rays – found a touch of Spondylosis Bloodwork normal Urinalysis normal Acupuncture Chiropractic treatment Occasionally, over the years, she would ask for help to get in the Expedition (big vehicle), the Explorer, or on the bed after a full day of activities. She never limped or cried out from pain or showed any other indication of a problem. I, and those people who knew my relationship with Kyra, figured it was just one more way I babied her. She would sometimes put her front legs on the vehicle and look over her shoulder at me as if to say, “I’ll take a boost please.” She would sometimes do the same thing to get on the bed, but five minutes after I “helped” her up, she would get down and then get up again by herself, so I never knew if there was a real problem or not. With her diagnosis of spinal stenosis, it looks like there could have been discomfort. Now, the symptoms begin to blur into the same signs and symptoms I gave above for the IBD. I’m sure she was straining because she had IBD, but I’m also sure she was straining because of the nerve damage that had already occurred and was gradually taking away her ability to urinate or defecate on her own. Also, sometime during the year 2002, Kyra began to urinate more often and smaller amounts. NOW, we know that this is a manifestation of the nerve damage that was taking away her ability to urinate at all on her own. Then, no matter how often I asked vets and breeders and friends about whether females marked territory like males do, or said that I wanted her to have “another” urinalysis, no vet picked up her bladder problem until January 2002 when an x-ray showed the large bladder and she was given the diagnosis of Bladder Atony. The pressure on the disc was the problem. January 21, 2002 Neurological exam at Oakland Veterinary Referral Services Remarks taken from Kyra’s records at OVRS: Bleeding from rectum (fresh blood), there is a flaccid anus and there is no rectal tone on rectal examination; there is flaccid tail paralysis, the urinary bladder palpates large, and there is moderate to high resistance to bladder expression.
NEUROLOGICAL EXAMINATION § Mentation: alert and responsive § Cranial nerves: normal § Gait: normal coordinated gait, no weakness or ataxia noted § Postural reactions: normal conscious proprioception & hopping responses § Spinal reflexes: normal femoral and sciatic reflexes, no vulva-anal reflex § Pain perception: no spinal hyperesthesia, there is decreased pain perception to tail, Perianal sensation is intact § Rectal examination: flaccid anus and rectum, fecal impaction § Lesion localization: pelvic and Cd nerve/nerve root lesion (cauda equina) vs. lesion affecting sacral and Cd cord segments § Main differential diagnoses: chronic intervertebral disc disease L7-S1, spinal canal stenosis (L7-S1, neoplasia
DIAGNOSTIC TESTS § Abdominal ultrasound showed mild generalized bowel thickening compatible with possible inflammatory bowel disease or bacterial overgrowth § CT of lumbo-sacral spine; findings were compatible with Type II disc disease (there is soft tissue opacity in the spinal canal over L7-S1 instead of dural sac, nerve roots and epidural fat). Treatment on January 23, 2002: Nerve route decompression, Dorsal laminectomy L7-S1 confirmed disc protrusion. A discetomy and nucleotomy of the L7-S1 disc were performed.
BOTTOM LINE: The primary indicator for Kyra of Cauda Equina Syndrome (spinal stenosis) was her decreased tail movement. Three weeks before her surgery she competed in agility and completed requirements for four titles. She jumped and moved beautifully. I was very pleased with her level of performance. In other words, unlike some other dogs with this condition, she was not affected in any obvious way with pain, or anything that affected activity or performance level. We can only look back over her history and wonder if each of the individual symptoms and incidents throughout her life was in some way connected to the spinal stenosis. There should NEVER be another White Shepherd owner on this list or related to anyone’s dog on this list to go undiagnosed as long as it took for Kyra. We have had dogs with both Cauda Equina Syndrome (Spinal Stenosis, etc.), and Degenerative Myleopathy (some earlier cases of spinal stenosis may have been mistaken for DM). Anyone with any dog with any of the symptoms Kyra expressed or that other dogs with this condition exhibited, needs to ask their breeders or their breeders’ breeder, if there was ever a diagnosis in their line. They also need to know that, contrary to feedback I got from my chiropractor and a couple of vets, dogs do not break and lose the use of their tail. Dogs may break their tail, but breaks heal. And, in Kyra’s case, her two overt symptoms – in retrospect, were the frequent urination and the paralyzed tail. Now I would know enough to say: all the tests performed so far were not enough, she needs to have a CT scan, she needs to have an ultrasound and x-ray, and I need to do some diet trials. Maybe, as a result of my experience with Kyra, you can help your dog sooner than I could help mine. Here is a place where I have much regret. I was so convinced that the raw diet was the only healthy way to go. I was put off by the commercial dog food industry and by the very idea of feeding a dog dry kibble versus fresh meat and vegetables that I could not hear anyone who told me otherwise. I listened to the raw food experts and the alternative specialists and felt that if I gave my dogs that dry processed food I would be condemning them to poor health. Please keep in mind that this happens to be my personal opinion about processed food and I’m sure it stems from earlier in my life when I was interested enough in nutrition to earn a degree in it. I still believe that processed food whether for our dogs or for ourselves is not the healthiest way to go, but I also understand that if a dog’s system cannot take the food being offered in the raw diet, then it is ridiculous to continue to feed them that way. In the case of a dog like Kyra with a predisposition to IBD, did the raw diet exacerbate her problems? Would she have been diagnosed severe if she had not had bones and raw food when her system couldn’t handle it? I don’t know. So, after years of feeding my dogs raw, Kyra is now on a Hypoallergenic diet -- Hill’s Ultra ZD. My other three dogs are on the commercial Wellness Fish and Sweet Potato diet by Old Mother Hubbard. I still give the other three marrow bones to help keep their teeth clean and then let Kyra have the bone to chew after all the fat is out of it, and I still sneak Zeus, the Malamute, turkey necks or chicken wings as a treat once in a while. Just like there are humans who believe the only way to eat a healthy diet is for it to be natural, fresh, and organic, there are people who feel the only way to feed their dogs is the same way. Obviously, there is a huge range to pick from and more than one method that can work for us and for our dogs. Dog food companies have become very aware of the consumers desire for better food for their dogs and they are responding. There are more alternatives out there than ever before. Kyra’s treatment plan since the diagnosis and surgery. The first few months were spent trying to keep her elimination going. She could not urinate on her own and so I had to manually express her bladder many times each day. This was truly the hardest thing I had to do physically since it took a great deal of strength and the aches and pains I experienced almost stopped me a number of times. She needed exercise in order to get her bladder going so although the winter of 2002 was a very cold one, we spent a lot of time outside. This was a time to reach out to friends because I found myself up against a wall when I was told Kyra could not be catherized any more and I could not express her, nor could my vets. Debbie Martin came over from Canada accompanied by Joanne Chanyi and Lynda Proulx to help me learn how to manage Kyra. By the end of the day, as I watched my friends drive off, I was relieved that we had expressed her twice and I was ready to handle it on my own. It was never easy, but anything can be handled one day at a time and the feedback and encouragement I received that day helped me keep on going. The rest of my attention was in trying to get her bowels regulated by food, medication, exercise, monthly acupuncture and chiropractic (no, not the same chiropractor who assured me not to worry about Kyra’s tail), body balancing with QXCI machine (up to 3 times per week for 3 months) and anything else I could think of (homeopathic remedies, consultations, herbal drops). The foods and drugs we tried and/or are trying include: Best Breed German Dog Diet (I started with this after her surgery – lots of stools and diarrhea) Hill’s Ultra ZD (In August, after a bad flare-up, we switched her to this food and it worked great) Select-Care, Sensitive (Nerve damage caused Megacolon and we decided to try a new food) Hill’s Ultra ZD again since the Select-Care didn’t work. Valium – for her bladder Amoxicillin – post op Phenyoxbenzamine (Dibenyline) for Bladder Atony ($7 each in U.S, $222/180 pills from U.K.) Sulfasalazine – for the IBD Prednisone – for the IBD Propulsid/Cisapride for the IBD Metamucil for IBD Aloe-Vera for digestion Spectrobiotics to keep gut balanced Bethenachol (for bowels although more commonly used for bladder) Herb Lax – A Shaklee product made up of herbs. Other medications for bladder infection and e-coli infection Oct. to January she had many enemas, The nerve damage caused Megacolon so we’re been trying new food, IV drips, and finally a colon cleanse under anesthesia. Her coat has grown back. She has attended 3 herding clinics since this is obviously an outdoor activity and her bowel problems can be overlooked. Her attitude, energy, drive, and overall zest for life has not diminished one iota. My other three dogs can’t keep up with her. White Shepherds with a diagnosis of Inflammatory Bowel Disease and Cauda Equina Syndrome: § Day's All That Jazz, OFA H/E, TT, HC, CD. Born May 25, 1993, died November 3, 2001. Sire, Hoofprint Sundance. Dam Hoofprint Day Light Star. Sibling: Day's I.Q. Breeder: Debbie Martin § Crystal’s Lady in Red “Kyra” (See above) White Shepherds with a diagnosis of Inflammatory Bowel Disease and Perianal Fistulas: § Royal Mason Dixon Lilly White. Owner: Donald Dobbs. Breeder Jean Reeves. Sire: Reeves Royal Angus Von Tasz, Dam: Moonshadows Royal Starburst. Date of birth: April 2, 1997. Treatment: surgery for the PF. § Royal Dinah of Willow Wood. Owner: Jacki Wheeler, Breeder Jean Reeves. Sire: Royal Sir Isaac’s IQ, Dam: Moonshadows Royal Starburst. Currently, as of 2/4/03, she is undergoing the treatment with Cyclasporin. This is an expensive drug with a treatment time of 2 months. § Crystal’s Chancellor. Owner: Dave & Linda May, Breeder: Pam & Larry Koons Reeves Sire: Reeves Royal Angus Von Tasz, Dam: Hoofprint Emerald. Treatment with food and antibiotics. The diagnosis of PF is uncertain at this point. § Other White Shepherds with a diagnosis of Lumbosacral Stenosis Braehead’s Bow Wow Samantha, Sire: Lyndons Angus, Dam: Braehead’s Alexis Special, Owner: Jeff Marks, Breeder, Susan Ewart, As of Christmas 2002, Samantha is still walking a mile each day at the age of 9. § Crystal’s Li’l Pistol Von Tasz. Owner: Michelle Koons. Breeder: Pam and Larry Koons. Sire: Moses Lacsar Von Tasz, Dam: Hoofprint Emerald. Luger has no symptoms from this condition which was discovered when tests were performed for other reasons. He is already 10 years old and is one of our top performance dogs and is still going strong. Kyra’s progress as of September 3, 2003, just 17 days before her 8th birthday She maintains a weight between 72 and 75#. She is energetic and as driven to play and be involved as she always was. She urinates totally on her own. She has four meals each day. Her medication still includes 10 mg. of Prednisone every other day, 1 Dibenyline (for bladder), and 2 Bethanacol in the morning and 2 Bethanacol at bedtime to help motility of her bowels. She has a bowel movement about every three days. Her coat is still plush and is white again – she had a lot of staining from the diarrhea, bleeding, etc. She has monthly chiropractic and acupuncture treatments. She is competing in agility and in herding but at a much slower and easy-going pace. We’re having a lot of fun and I’m thankful to have a second chance with her. Kyra died at home on June 26, 2005, just three months before her 10th birthday (a full three years after her diagnosis and surgery).  On that last day she looked beautiful.  She asked for attention from my husband, Dick, who she usually ignored.  Did she know this was her last chance to make amends?  She swam in her pond in the afternoon.  And then she started to go down and died around 6:30 PM.  "She is always in my heart and she is always at my side." 
COMMENTS FROM DEBBIE MARTIN Having been responsible for breeding a dog that was affected with both Inflammatory Bowel Disease and Cauda Equina Syndrome, I have had to learn much more about these diseases than I ever wanted to. CES is a malformation of the spine. It is often referred to as an instability of the spine. This instability can cause discs to protrude and compress the spinal cord. It may cause swelling within the spinal column that will also compress the spinal cord or it may be a narrowing of the spinal cord (spinal stenosis) that also puts undue pressure on the spinal cord. Initially, CES, may or may not cause neurological symptoms of the hind legs, anus or urinary system, but the malformation will lead to eventual loss of control of the bladder, bowel and often the hind legs. This instability can be extreme, as in Kyra and Jazz's case, or may be mild enough that obvious symptoms are not exhibited until the dog is much older. Many German Shepherds have been diagnosed as having Degenerative Myelopathy in their older years, when in fact, they may actually have CES. CES is now believed the number one cause for German Shepherds that lose control of their hind end as they age. In extreme cases, the first symptom of CES is the tail. The tail will be painful and the dog may lose the use of their tail. As in Kyra's case, her accident with the door may have been because she already could not control her tail enough to get it through the door before it was closed. The reason for the confusion in obtaining a diagnosis, is that the only way CES can be diagnosed is by MRI or CT scans. Normal x-rays do not reveal the malformation of the spine. The only correction possible in the extreme manifestations of this disease, is spinal surgery to relieve the pressure on the Caudal Equina Nerve bundle. If surgical correction is not done, there will be loss of bowel and bladder control. Surgical intervention has a 100% success rate if it is done before the nerves controlling the bowel and bladder are affected. Once the bowel and bladder have been affected, the improvement from surgery is greatly decreased because the nerves have already suffered extensive damage from being compressed. Inflammatory Bowel Disease is often found in dogs that have CES, not always, but often enough to be noted. No one knows what the connection is. In Jazz's case, she did not have chronic diarrhea or difficulty defacating, but, any change of diet would cause her to have e xplosive diarrhea. This reaction to food was extreme enough, that when Jazz was eventually euthanized due to injuries sustained in a car accident, I asked for permission to have bowel biopsies performed post-mortem. It was confirmed that Jazz had Eosinophilic Enteritis. IBD is another disease that is difficult to diagnose. It is also a disease that differs in severity from dog to dog and is a disease that is not commonly seen by the veterinarian. The only sure method of diagnosis is a bowel biopsy, which is an invasive and expensive procedure. German Shepherds are noted for their "touchy" digestive system. I suspect that this disease is more common in our dogs than we would like to think. It is also a disease that has varying degrees of severity. It is also a disease that will worsen with repeated flare-ups. The damage to the bowel is cumulative. In most cases, the simplest way of confirming the presence of this disease, is by doing a food trial. If changing the food relieves the symptoms, then the assumption can be made that there is an inflammatory process in the bowel. IBD is commonly controlled with a combination of diet and medication. This disease is never cured. Both of these diseases require early intervention to minimize damage. As Judy has said, it is important that we all understand these diseases. These diseases are not common in the general dog population and our veterinarians may need our guidance and knowledge of the diseases that affect our dogs, to be able to obtain a correct diagnosis and develop a treatment plan. Description of IBD and links to websites and help lists VETERINARY INFORMATION SERVICE   Inflammatory bowel disease (IBD) usually refers to a chronic inflammatory disease anywhere in the gastrointestinal (GI) tract, including the stomach, small intestine (duodenum, jejunum, ileum), and large intestine (colon) The term implies a process of long duration as opposed to sudden onset. Because IBD affects many areas of the GI tract it probably has many different causes. More traditionally, IBD has referred to chronic inflammation of the small or large bowel excluding the stomach. The disease is classified by the predominant inflammatory cell found invading the wall of the bowel. Such classification may allude to its cause. However, this method of grouping is not always possible and location of the lesion will help its classification. IBD is usually found in younger dogs but, it can extend to middle age dogs. There is no strong relationship by breed however, IBD does seem to affect some breeds more often than others. The most common form of IBD is lymphocytic-plasmacytic IBD  (LPIBD). This term describes the cells that are found microscopically when a biopsy of the leison is examined. Most biopsies are obtained by abdominal surgery or by endoscopy if available. Biopsies are important to rule out other causes such as: dietary hypersensitivity, lymphoma, histoplasmosis (a fungus), bacterial infection or overgrowth, and malassimilation problems. The predominant cell type, lymphocytes and plasma cells represent a chronic stimulation of the immune system. Because of this response, IBD is typically thought of as an immune mediated disease and therefore treated with the various immunomodulating therapies. Current thoughts are that the GI tract has been sensitized by some bacteria or food antigens that determines the ongoing immune response. Complexes are formed from antibodies against food antigens, bacteria or bacterial byproducts. These antigen-antibody complexes (ABC) induce the release of destructive chemicals into the area and tissue destruction results. The destruction is indiscriminant. The quantity of ABC's produced may influence the long standing nature of the disease. Signs of IBD are dependent on the location of the problem. Disease in the stomach or upper small intestine are frequently associated with chronic vomiting and weight loss. Diseases of the jejunum, ileum, and colon are associated with chronic diarrhea, weight loss and infrequent vomiting. Small bowel diarrhea is often watery with a large volume of feces and the patient acts sick. Large bowel diarrhea is associated with straining, some blood, mucus, small volume of feces and frequent attempts to defecate. Once IBD is suspected, strict dietary changes are fundamental for long term results. Often diet will control the disease but in the majority of cases anti-inflammatory drugs are added to quiet the immune system. Often, the use of anti-inflammatory drugs at the beginning is enough with controlled diet to stabilize the chronic inflammation. However, the disease in most cases goes into periods of remission with repeated flare ups. Certain breeds (Wheaton Terriers and Basenjis) are more predisposed to progressive disease. Diet is chosen to produce the least amount of ABC stimulation. A true hypoallergenic diet should contain a very good single protein source that is highly digestible, so as not to be available for immune stimulation. There are now commercial diets available through veterinarians and some knowledgeable pet food stores that contain only one source of a hypoallergenic protein such as lamb, rabbit, turkey, venison, fish or duck. Many diets listed as hypoallergenic contain other ingredients and caution is order. These are usually combined with a good source of carbohydrates such as rice or potatoes. Commercial diets insure that essential vitamins, minerals and fatty acids are included. Fiber is often a vital component of long term care. Quality fiber aids in the development of beneficial colonic flora and enhances the digestive process. In addition, diets free from preservatives and food additives may provide relief for some patients that are sensitive to these chemicals. Anti-inflammatory therapy involves immunosuppressive drugs, metronidazole, or Salycilates. The mainstay of anti-inflammatory drugs are corticosteroids.  Prednisone and methylprednisolone are powerful anti-inflammatory drugs that can produce impressive results. They have minor short term side effects that include increased drinking, eating and urinating. Long term, these drugs can cause Cushing disease if alternative therapy can not be achieved for control of IBD. Sulfasalazine is commonly used to control large bowel IBD. It has no long term side effects, however it can cause a dry eye syndrome and occasionally will cause salicylate toxicity. Metronidazole is used because it is anti-inflammatory, anti-protozoan, and is a good antibacterial for the small bowel. The only side effect is vomiting. Other drugs that are being tried include cyclosporine and eicosapentanoic acid, a fatty acid found in fish oil. Eicosapentanoic acid(Derm Caps) is a drug often used in veterinary medicine to decrease the inflammatory response of inhaled allergies. The only side effects are a shiny coat. IBD involves a great deal of patience by the dog owner but most dog will gain relief with some variation of therapies. The disease is life long and will require regular attention. 1/16/97 Veterinary Information Services
DISCLAIMER: THIS ARTICLE IN NO WAY ESTABLISHES A CLIENT-VETERINARIAN RELATIONSHIP. THE INTENT OF THE ARTICLE IS TO COMPLIMENT THE USER¹S CURRENT VETERINARY EDUCATION. NO CLAIMS ARE MADE AS TO CONTENT. THIS ARTICLE IN NO WAY REPLACES THE CLIENT-VETERINARIAN RELATIONSHIP. Description of CES with links to websites and help lists Lumbosacral Stenosis (Cauda Equina Syndrome) by Holly Frisby, DVM Drs. Foster & Smith, Inc. Veterinary Services Department Lumbosacral stenosis has also been termed lumbosacral instability, lumbosacral malformation, lumbosacral malarticulation, lumbar spinal stenosis, lumbosacral spondylolisthesis, lumbosacral nerve root compression and cauda equina syndrome. All these terms describe arthritis of the joint between the last lumbar vertebra and the sacrum, which is one of the bones that makes up the pelvis. This arthritis narrows the canal through which the spinal cord and nerves pass through. The intervertebral disc between the vertebra and the sacrum is often abnormal as well, further narrowing the canal. The arthritis and disc disease put pressure on the nerves coming off the spinal cord. The symptoms of lumbosacral stenosis, then, are a result of nerve injury. What are the symptoms of lumbosacral stenosis? The most common sign of cauda equina syndrome is pain. The pain may occur in the back, in one or both hind legs or the tail. The dog usually has difficulty rising from lying down but once he begins to walk about he works out of the stiffness. There may be muscle loss in one or both rear legs. The dog may have difficulty urinating or defecating because of the pain, may become incontinent, or may be unable to urinate. Some dogs are unable to move their tail, or have severe pain if the tail is moved. Often dogs will have a shuffling gait, and scuff their toes. Some dogs will chew on their pelvic area, hind limbs or tail, sometimes creating considerable damage by this self-mutilation. Many of the signs seen with lumbosacral stenosis can mimic those of hip dysplasia, and the two conditions need to be differentiated. Which animals are at risk of having lumbosacral stenosis? Lumbosacral stenosis occurs most commonly in large breed dogs. German Shepherds appear to be more likely to develop this condition. The condition can be acquired, meaning the dog started out normal and then developed this condition. Or lumbosacral stenosis can be a congenital condition, meaning the dog was born with the abnormality. Either way, the symptoms generally do not occur until the dog is between 3 and 7 years of age. Lumbosacral stenosis is rarely seen in cats.  How is lumbosacral stenosis diagnosed? The veterinarian will ask the owner for a history of when the symptoms developed, etc. A physical exam will then be performed. The hind limbs will be manipulated in various ways to determine which positions are painful. The veterinarian will also do a neurological exam, including testing the reflexes, to determine which nerves may be injured. Radiographs (x-rays) are taken to evaluate the spine and pelvis. The findings can be very suggestive of lumbosacral stenosis, but are not sufficient to make the diagnosis. To achieve a diagnosis, special procedures must be performed by injecting dye into the affected area and re-radiographing. Depending on where the dye is placed, the procedure is called myelography, epidurography, or diskography. These procedures must be done under anesthesia. Displacement of the dye by the abnormalities in the bones and intervertebral disc confirms the diagnosis of lumbosacral stenosis. How is IBD treated? Depending on the severity of the condition, amount of pain the animal is experiencing, overall health of the animal, financial restrictions, and other factors, lumbosacral stenosis is treated surgically or nonsurgically. AWSA UKC WGSDCI WSCC CH U-CD , CDX TT HC CGC OFA H&E (Excellent) October 28, 1992 - May 8, 1999 (Bloat)Owner Jean Reeves Breeder Diana UpdikeAWSA UKC WGSDCI WSCC CH U-CD , CDX TT HC CGC OFA H&E (Excellent) October 28, 1992 - May 8, 1999 (Bloat)Owner Jean Reeves Breeder Diana Updike    AWSA UKC WGSDCI WSCC CH U-CD , CDX TT HC CGC OFA H&E (Excellent) October 28, 1992 - May 8, 1999 (Bloat)Owner Jean Reeves Breeder Diana Updike    Nonsurgical treatment: If the condition is mild, dogs may be treated with strict rest for 6 to 8 weeks. Anti-inflammatory medications such as prednisolone are given. In many cases this can relieve the symptoms. However, when the dog becomes more active, the symptoms can return. Surgical treatment: There are two different surgical techniques used to treat lumbosacral stenosis. In the first, the bones are fused together in as normal a position as possible. This prevents abnormal motion between them, and reduces the risk of further arthritis. In the second technique, part of the bone and the intervertebral disc are removed to reduce pressure on the spinal cord and nerves. In either case, dogs must be confined for 2 to 4 weeks after surgery, and may also be placed on Prednisone therapy. For dogs who have difficulty or are unable to urinate, the bladder must be manually expressed several times a day. What is the prognosis for dogs with lumbosacral stenosis? The outlook for dogs with lumbosacral stenosis is dependent on the severity of symptoms before treatment. Dogs who are mildly affected may be able to return to normal function. For those who are incontinent or unable to urinate prior to treatment, the prognosis is much poorer.
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