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Thursday, February 14, 2013

Stopping Treatment Too Soon

Here's an email from Sandy....

Hello Dr Bren, I have a 7 year old doxin. DANICA she holds her neck head down. I noticed when turning to the right it's like there is a catch or a musle spasm. I have had her on prednisone 2.5 once a day and metocarbol and tramidol. She showed great progress with in 4 weeks. Gave her some freedom. And now we are back to square one. I have kept her in the  kennel the whold time. She is red dappel named Danica I am asking for our take on this. My vet says we may have prematurely let out of the kennel. Could this be neurological? Disc? I would appreciate any feed back.

Okay, first let me get my anal retentive personality out of the way....It's Dr. BERN, and the breed is DACHSHUND   I normally don't correct or edit emails, but for some reason this one bothered me a bit.


I can only speculate based on this brief email, but based on the limited symptoms mentioned I would suspect a partially slipped disc in the neck or back, or a pulled muscle.  A x-ray should be performed in cases like this to rule out a potentially serious disc displacement, though it should be understood that mild displacement and muscle injuries won't show up.  If there was nothing obvious on the radiographs I would agree with a plan of antinflammatories (prednisone), muscle relaxants (methocarbamol), and pain medication (tramadol).

Injuries like this should be kept on restricted activity for a minimum of four weeks, though honestly it can take six to eight weeks for such injuries to fully heal.  It is entirely possible that she was given too much exercise too quickly.  In fact, this is the most common reason for re-injury or a failure of resolution of symptoms.

Let me pause here and mention that one of the most frustrating things for a vet is to find out that a client stopped treatment too soon.  There are specific medical reasons why we treat for a certain period of time.  If you stop giving medication or otherwise following the directions before the recommended time is up, you could see a relapse of the problem.  Antibiotics take time to work, and we normally want to keep them up for a period of time after complete resolution.  Tissues take time to heal and just because a pet starts to act better doesn't mean that they are completely healed.  Our knowledge and training lets us know how long to continue treatment.  Stopping therapy earlier than this without consulting with your vet can lead to problems. Listen to your vet and consult with them before making therapeutic decisions.

If Danica is still affected, definitely talk to your vet.  Treatment may need to be continued for a longer period of time, especially the exercise restriction.  If this doesn't fix the problem you need to expect the potential of specialized tests, especially a myelogram (where they inject dye around the spinal cord to make it show up better on radiographs).  Again, talk to your vet.