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Dog pinched nerve
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Dog pinched nerve

I first took my dog to the vet on 11/8 he came walking down the hall and yelped in pain pulling up his left front paw, tilting his head and he was having difficulty shaking himself, and almost falling over to the right. They said he had a strained shoulder and put him on Tramadol 25mg every 6 hours but by Monday 11/11 he was getting worse and I noticed he was scratching his neck area alot and swiping the side of his face with his paw, tilting his head and still could not shake. Once the attack is over in a few minutes he regains all function, I called the vet back and told them I thought he might have a pinched nerve they still said it was his shoulder and w/o seeing him and prescribed an anti-inflammatory 2 x a day on top of the tramadol. I had him on those two medications starting on 11/11 but by 11/12 he started literally climbing the walls and could not settle down for more then 30 seconds this went on for 2 days he was so agitated I ended up taking him to the ER vet 11/14. He was seen by the Surgeon and the Neurologist who diagnosed him with Differential diagnoses include intervertebral disc disease ,Wobbler’s, neoplasia, infection, occult orthopedic disease, or auto-immune diseases.
They put him on the following meds with crating:

Rimadyl 25mg tablets Give 1 tablet by mouth every 12 hours

Tramadol 50mg tablets Give 1/2 tablet by mouth 2-4 times a day

Diazepam 5mg tablets: Give 1/2 tablet by mouth every 8 hours until gone.

Gabapentin 100mg capsules: Give 1 capsule by mouth once a day at bedtime until gone.

That was 11/14 and I see no improvement I find it odd he has such pain but has no issue scratching himself or turning his whole body to clean himself. My question is how long will it take for the meds to alleviate the pain and when should I start seeing improvement and or start considering possible other treatment and would prednisone be more effective?? He is healthy has an appetite.
234713_tn?1283530259
I think that intervertebral disc disease is probably high on your dogs list of differentials; followed by the other differential diagnoses with the addition of a tick born disease which is not listed.  Tick borne disease can be tested easily with a blood test and since it is not mentioned I assume that they have ruled it out.  Occult (orthopedic disease) just means hidden.  If X-rays were performed than orthopedic disease's would have been ruled out.  Unfortunately, disc disease, Wobblers, spinal tumors and others are most definitively diagnosed with an MRI which was either not offered for your dog or was prohibitively expensive.

Many of my colleagues and I have found that cervical disc pain can be intermittent and doesn't seem to follow the rules of disc pain in other areas of the spine and can fit the description of the symptoms in your dog.  

I do believe that a switch from a non-steroidal anti-inflammatory to prednisone or dexamethasone is an excellent idea.  The nonsteroidal must be stopped for 36 to 48 hours prior to starting the steroid, and 10 mg of Pepcid or other GI protectants should be added to help prevent GI problems.  I also highly recommend that you see a certified veterinary acupuncturist.  Acupuncture can help with treatment and can also be diagnostic.  Acupuncture can pinpoint an elusive lesion and than treat it accurately.   And, if the acupuncture treatment is ineffective after 2 or 3 treatments it can signify that the cause of the problem is not due to disc disease or wobblers, so you will have another answer.

Research studies have shown acupuncture to be as effective as surgery for disc disease in many cases. The following link is an example of a research study published in the Journal of the American Veterinary Medical Association, comparing decompressive surgery for disc disease and electro-acupuncture.  The findings show that the results were slightly better in the acupuncture group:  http://avmajournals.avma.org/doi/abs/10.2460/javma.236.11.1225.  

You can find listings for veterinary acupuncturists in your area on various holistic veterinary websites such as: http://www.ivas.org/, or http://www.tcvm.com/Resources/FindaTCVMPractitioner.aspx

Additionally, therapeutic cold laser therapy and/or physical therapy may also be effective.  I often use cold laser therapy and acupuncture together on painful patients.  You did not mention how old your dog is or what breed/combination of breeds he may be.  You are welcome to post this information for additional help.  For instance,  Dachshunds and Dachshund mixes are more prone to disc disease than other breeds.  Older Boxers are more prone to tumors.  Thanks!
3 Comments
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Avatar_m_tn
A general health screening was performed including a Complete Blood Count, Chemistry Profile, Urinalysis, and 4Dx test. The 4Dx
test was negative for Lyme, Ehrlichia, Anaplasma and heartworm. The remainder of the tests showed normal organ and bone marrow
function.

The vet also want me to keep him in a harness but just having the light material of the harness around his neck makes him scream in pain and he has taken to snapping at me if I approach him with the harness and by the time we do get a harness on him the 8 hours of rest he has had to heal is pretty much out the window so we just let him w/o any collar at all. But still limit he outside time and time out of confinement. He is otherwise very healthy and his appetite is great and he wants to play. We did remove all his toys so he has nothing to play with or go after.  He is only ten and a 20lb Papillon he is not over weight but just big for his breed and up until 11/8 a very very hyper healthy happy puppy.

I did want x-ray's I even offered to skip the x-rays and go right for the MRI just to get an answer and help him and they said no. I am not sure why but they seem reluctant to put him to sleep to perform the procedure.

Should I be seeing some improvement by now or take him back to the vet.
He seemed better lastnight after 7:oopm but then refused to take any medication and then was up all night barking and restless and this morning he had one slight case of pain and another acute attack of pain. He always itches his nick just below his ear and swipes at his lower jaw with his paw after the pain attack could this be an inner ear infection?? He no longer is favoring his left front paw which is the only thing that has changed since I started treatment.
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Avatar_m_tn
I looked into Acupuncture but with out a firm diagnoses would they still even perform any on him?
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234713_tn?1283530259
Aleda M Cheng, D.V.M., C.V.ABlank
American Animal Hospital
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