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A Neurology Emergency During The COVID-19 Crisis

02 June 2020

Annette Wessmann DrMedVet DipECVN PGCertAcPrac FHEA MRCVS

European and RCVS recognised Specialist in Veterinary Neurology

 

Vinnie, a 5y male entire Dachshund, presented to me like a typical Dachshund emergency. He had pain in his back for a week, yet deteriorated suddenly and quite markedly overnight.  He was borderline ambulatory paraparetic on the day of presentation. Yet, nothing is normal any longer during the COVID-19 crisis. Like many practices, our way of working has changed completely. Vinnie was considered an emergency and thus we were more than happy to take Vinnie into our care.

Practising social distancing at Pride Veterinary Centre means that we are not allowing clients into the hospital and so instead we take the history by phone, which is what we did for Vinnie. The client was clearly concerned about Vinnie and confirmed that Vinnie was distressed and had deteriorated.  The next step is to take Vinnie in. I wore my face mask and go out to find the client’s car.  The client handed Vinnie over to me, and Vinnie appeared to be quite concerned to be handed over to this unknown person from the arms of his beloved carers. This is the hardest thing for both the client and the pet, I believe, giving their pet ‘away’ on a car park to a kind of stranger without having seen us in a consult. They have not seen how caring we are with their pet. I also feel that the pets react differently. So, we take a little bit more time so the pet gets to know to us and trusts us first.

My examination confirmed what the client and the referring veterinary surgeon reported. I phoned the client again and we agreed that it was best for Vinnie to undergo an MRI and spinal surgery if a compressive disc lesion was confirmed.

MRI showed a marked right-sided ventrolateral T13-L1 extradural lesion compatible with the expected disc extrusion (Hansen hernia type I). A right-sided T13-L1 mini-hemilaminectomy was performed under the same general anaesthesia, and removing a large amount of disc material decompressed the spinal cord. This surgery made a slightly smaller hole where I left the associated articular facet intact compared to the traditional hemilaminectomy where the associated articular facet is removed.

Additionally, I performed fenestrations where I made a small hole in the disc space itself to remove nucleus pulposus material from the disc space. This reduces the risk of future disc herniations in the treated spaces. In my opinion, there is sufficient evidence in the literature supporting that fenestrations limit disc herniation in the treated space. This is combined with another study reporting that many clients are less inclined to proceed with a second surgery in case of further disc herniations, due to concerns about the pet’s wellbeing or financial restrictions.

Considering these aspects, I performed fenestrations at 5 intervertebral disc spaces, from T11-L3 in Vinnie, as these are the most commonly affected disc spaces. No significant deterioration occurred after surgery and Vinnie retained his voluntary urination. He was discharged 2 days later, once he did not require injectable pain medication anymore. Our very experienced neurology nurses provide post-operative support at the time of discharge and thereafter despite the lockdown. This is mostly done by phone and video explanation of physiotherapy to be applied at home.

We always try to find the right balance between providing excellent care for the pet and financial concerns, which have become a particular concern in these times for many of our clients. Communication is key and we are all aware of that.

Vinnie is a very sweet little boy. It took a day or two to gain his trust, but then he was so very sweet and really enjoyed the cuddles. We are all very pleased that Vinnie is doing well, enjoying his walks and bringing joy to his family in these challenging times.

 

Call 01332 678333

Speak to one of our friendly team about how we can help with your pet’s needs.

 

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Email us with any questions you might have and we’ll get back to you as soon as we can.

 

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