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Animal Health – General (Expert Forum)
Sudden swelling in neck
Answered by
Arnold L Goldman, D.V.M. - General Practice
Canton Animal Hospital LLC
CT
This forum is for general pet health questions, such as questions about medications, parasites, vaccines, infectious diseases, breed specific and genetic problems.
Sudden swelling in neck
by chasha33, Nov 04, 2009 06:48PM
Sun afternoon i was bathing my Peke with Malesab shampoo and he started acting unusual then his neck started swelling.He was acting very off balance and his color was getting pale.I immediatley gave him a tsp of Benadryl ,he weighs 12.6lbs.I rushed him to the E.R. trying to keep him alert.When we arrived the swelling had decreased maybe 20%.It looked as if a baseball was under his skin right below his ears.Also it looked like a Charlie horse half way around his head.The Dr on call wanted to send him on to U.T. in Knoxville for surgery right away.She said that he had a ruptured disc in his neck.She also detected a grade 4 heart murmur.An hour later there was a shift change ,The next Dr said that since he was walking around and the swelling was subsiding that we could wait and see my regular vet the following day.His x-ray showed narrowing of the C2 C3 area.She heard a grade 2 1/2 to 3 murmur.I brought him home the following morning,He was still a little swollen,But acting normal.His regular Dr and another Dr in the clinic could not detect any murmur,So there was no need for any EKG or ultrasound.Also the swelling in his neck had almost completley subsided.There was no ruptured disc at all. But at the time he was showing all the signs by the physical exam of a ruptured disc.My Question is,What could have caused all of this.Also how can there be a murmur detected and then it be gone.Can extreme pain be the cause of that?Any opinions would be nice?
Type of Animal
:
Dog
Age of Animal
:
7Years old
Sex of Animal
:
Male
Breed of Animal
:
Pekingnese
Last date your pet was examined by a vet?
:
November 01, 2009
State/Province
:
TN
Country
:
US
Blood Test Results
:
All within normal ranges
X-Ray Results
:
Narrowing of the C2 C3 Disc
Doctor's Answer
by Arnold L Goldman, D.V.M., Nov 08, 2009 04:22PM
, Nov 08, 2009 04:22PMTo: chasha33
Dear Chasha33,
Having not examined your dog at the time of all this I can only speculate as to what went on at that time. Perhaps the dog experienced an extreme contact dermatitis to the malaseb product resulting in inflammation, with swelling and pain.
Non-specific signs like this ("swelling") often pose a diagnostic dilemma that different veterinarians with different types and levels of experience may interpret quite differently. The way we are supposed to operate is to gather all signs and symptoms together, at least in our minds, and then create an exhaustive list of "differential diagnoses", essentially all possibilities that fit the signs, and only then use tests and imaging studies to eliminate all but one, the actual diagnosis. That is a better approach than simply choosing a likely diagnosis to run down without further evaluation.
I think your experience may reflect a bit of unwarranted presumption on the part of the doctors initially looking a the dog. Perhaps they also spoke a bit too soon, in as much as typical intervertebral disc disease has a different set of signs (acute onset pain, possible motor function loss to a limb or limbs,and absent any swelling visible on the body surface.)
The idea of sending a dog to a tertiary care (university or large referral center) for surgery absent a diagnosis or a reasonable suspicion of one seems a bit excessive, based upon what you have shared so far. On the other hand, referral in the face of a difficult or poorly responding condition is never wrong, as higher levels of expertise may then be brought to bear on the pet's problem.
As far as heart murmers: they may be inconsistent, are also subjective at times and their existence or degree can be dependent on the hearing, the experience and the stethascope quality available to the listener.
Hopefully your dog is well now. If so, have that murmer ausculted (listened to) again to see if its still there. If so, further testing may be warranted.
Very best regards,
Sincerely,
Arnold L. Goldman DVM, MS
Having not examined your dog at the time of all this I can only speculate as to what went on at that time. Perhaps the dog experienced an extreme contact dermatitis to the malaseb product resulting in inflammation, with swelling and pain.
Non-specific signs like this ("swelling") often pose a diagnostic dilemma that different veterinarians with different types and levels of experience may interpret quite differently. The way we are supposed to operate is to gather all signs and symptoms together, at least in our minds, and then create an exhaustive list of "differential diagnoses", essentially all possibilities that fit the signs, and only then use tests and imaging studies to eliminate all but one, the actual diagnosis. That is a better approach than simply choosing a likely diagnosis to run down without further evaluation.
I think your experience may reflect a bit of unwarranted presumption on the part of the doctors initially looking a the dog. Perhaps they also spoke a bit too soon, in as much as typical intervertebral disc disease has a different set of signs (acute onset pain, possible motor function loss to a limb or limbs,and absent any swelling visible on the body surface.)
The idea of sending a dog to a tertiary care (university or large referral center) for surgery absent a diagnosis or a reasonable suspicion of one seems a bit excessive, based upon what you have shared so far. On the other hand, referral in the face of a difficult or poorly responding condition is never wrong, as higher levels of expertise may then be brought to bear on the pet's problem.
As far as heart murmers: they may be inconsistent, are also subjective at times and their existence or degree can be dependent on the hearing, the experience and the stethascope quality available to the listener.
Hopefully your dog is well now. If so, have that murmer ausculted (listened to) again to see if its still there. If so, further testing may be warranted.
Very best regards,
Sincerely,
Arnold L. Goldman DVM, MS
Post Comment
Without giving the impression that I actually know whether your dog does or does not actually have a murmer ( I dont), I think you have seen how subjective listening to heart sounds can be. Some veterinarians (and I have at times been one of them) may be fooled by "synchronous respiration" (breathing coincidentally timed with heartbeats) as well as simple "overinterpretation." of what one is hearing. On the other hand, noisy exam rooms, movement of the pet and talking all may inhibit hearing of murmers. Experience, circumstances, and modern amplified stethoscopes all may help in sorting out the reality.
If you are still concerned, have a board certified veterinary internist or board certified veterinary cardiologist examine your dog. A simple consultation is inexpensive and does not obligate you to further testing or procedures. If the specialist feels there is no murmer, or an insignificant one, then you likely can forget it. This is the cheapest screening test you can have done.
Narrowing of intervertebral disc spaces may be a sign of intervertebral disc disease. Again in the absence of true clinical signs and unless the narrowing is marked in degree, this is an interpretation open to subjective assessment. If the dog is not painful and has no neurologic deficits, there ought to be little to worry about. Perhaps, have your doctor submit his/her x-ray films to a board certified veterinary radiologist electronically, or otherwise, for interpretation.
See the trend here? It is always a good idea to have inconclusive results re-evaluated, but by someone with advanced training and skills in the given area. Otherwise, you may end up trying to parse best out of three opinions from general practitioners. We each have a basic knowledge and skill set, and we also have our own strengths and experience sets in defined areas but for better or worse we are not all of equal facility in certain specialties such as ophthalmology, dermatology, orthopedics, neurology, cardiology etc. Thats why there are specialists! In confusing or complicated cases, its often a good idea to get a specialty consultation to break a tie and sort out the truth.
Good luck and please keep us informed of your dog's progress.
Thank you.
Sincerely,
Arnold L. Goldman DVM, MS
Chan
You might want to inform all the doctors involved of the outcome.
Perhaps there are lessons to be learned by all here.
Very best regards,
Arnnold L. Goldman DVM, MS