Inability to open his mouth & oral hemorrhage.
Neurology & Neurosurgery
The Neurology Service at Seattle Veterinary Specialists, led by Bethany DeVilbiss, DVM, Diplomate ACVIM (Neurology), and Mona Qahwash, DVM (residency trained in neurology) is responsible for the diagnosis and treatment of diseases that affect the brain, spine, peripheral nerves and muscles. One of the founders of SVS, Sean Sanders, DVM, PhD, Diplomate ACVIM (Neurology) provides occasional emergency support for the neurology service here at SVS.
Common conditions that are treated include:
- Seizures: Seizures affect approximately 5% of the canine population and are considered more rare in cats. Seizures are the most common neurological disorder of companion animals. Understanding what a seizure is, why they occur and how to treat them is the first step to take for your pet. SVS provide emergency management of seizures, as well as, long term management of challenging cases.
- Strokes: Vascular accidents (strokes and bleeding) in the brain and the spine are common conditions in older companion animals. As in people, there are many underlying risk factors that can lead to strokes in pets, such as hypertension, cardiac disease and kidney disease. Fortunately, companion pets often have a good recovery from a stroke. Management of a patient who has suffered a stroke is based on treatment of any underlying disease, supportive care while they heal and rehabilitation.
- Intervertebral disk disease: Degenerative disk disease affects most dogs to some degree as they age. In certain breeds, such as the Dachshund, about 30% of dogs will have an incident of disk herniation at some point in their life. This condition can be managed with surgery and conservative therapy (rest and rehabilitation). Successful management of disk disease is very common. Other similar conditions that involve the spinal cord include Lumbosacral Disk Disease (Cauda Equina Syndrome) and Cervical Spondylomyelopathy (Wobbler's Syndrome).
- Spine and brain tumors: Cancer of the brain and spine occurs in dogs and cats with about the same frequency as in people. Nearly all treatment modalities that are used for people are available for dogs and cats, including surgery, radiation therapy and chemotherapy. However, an important caveat is to preserve quality, as well as, quantity of life. Many brain and spinal tumors are benign and can be treated successfully independent on the age of the pet.
When your pet is affected with a neurological condition, it can be a very emotional and difficult time. We are here to help you through the process. The entire course of action can be divided into several steps that the Neurology Service at SVS will use to aid your pet.
A neurological exam combined with a thorough history is often enough to tell the Neurology team what part of the nervous system is affected (brain, different segments of the spine, nerves that leave the spine or muscles). This is referred to as the “neuroanatomical localization” and is the primary goal of the exam. Once the area of the nervous system that is affected is localized, a list of diseases that could affect that part of the nervous system is made (a list of differential diagnosis). We can then prescribe diagnostic testing to rule in or rule out the different diseases on the list. Once a diagnosis is made, treatment options and prognosis are then possible.
Advanced imaging techniques like Magnetic resonance Imaging (MRI) allow the clinician to “see” the brain and spine. Spinal fluid analysis is helpful to make the diagnosis of inflammatory conditions of the nervous system. Electrodiagnostic tests are used to evaluate the functions of nerves and muscles. Common neurodiagnostics include:
- Blood work: Routine testing of the blood can identify early disease and is used to help with preparation for anesthesia, which may be necessary for advanced diagnostic testing.
- Radiographs (x-rays): Radiographs can be helpful in the initial diagnostic phase and because they usually can be performed without anesthesia, are safe. We also use radiographs to screen older patients for cancer that may have spread to the lungs early in the course of the disease.
- Magnetic Resonance Imaging (MRI): MRI is considered the “gold standard” for looking at the nervous system. It allows us to see physical abnormalities of the brain and spine. It does have its limitations, for instance, we cannot see molecular or microscopic changes to the nervous system.
- Computed Tomography (CT scan): A CT scan may also be beneficial in imaging the nervous system, it too has its limitations. For example with CT scan, we get excellent images of boney tissues but limited benefit in evaluating the soft tissues of the nervous system.
- Cerebral Spinal Fluid Analysis (CSF). In certain cases, a CSF analysis may be indicated. Evaluating the fluid that surrounds the brain and spine can help with the diagnosis of meningitis / encephalitis (inflammation of the nervous system).
- Electrodiagnostics: We use electrodiagnostics to evaluate the muscles (electromyogram or EMG) and the nerves (nerve conduction velocity or NCV). Other tests such as repetitive nerve stimulation, stimulated single fiber EMG, and hearing tests are also available if indicated.
Treatment and Prognosis
Treatments such as anticonvulsant therapy, decompressive spinal surgery and tumor excision are routine procedures to the neurology group. The prognosis (predicted outcome) is dependent on many factors, which are all considered so as to allow for the most informed decisions possible.
Dr. Powers and her team are strong believers in making sure that his clients are aware of all the options available for any condition and will work hard to explain the disease and the benefits of the various therapies.
The Neurology Service believes that the healing process only begins with surgery. A thorough understanding of the disease, a combination of excellent patient care, comfort and physical rehabilitation are also necessary to ensure that the patient has the best possible outcome.
Frequently Asked Questions:
Q: Can my pet’s MRI be performed on the same day as the initial neurological exam?
A: Often we can perform the MRI on the same day. It depends on the number of cases that are scheduled for that day and any emergencies that may have shown up overnight. Usually, we try to schedule the MRI for another day, however, we try to be as accommodating as possible, especially if you are traveling from a far distance.
Q: What is the difference between x-rays, myelogram, MRI and CAT scans?
A: Click here
Q: What time should I drop-off my pet for MRI or surgery?
A: Your pet should be dropped-off on the day of the MRI or surgery on or before 9am. Special accommodations can be made if you a traveling long distances.
Q: When should I withhold food and water for my pet?
A: Please withhold food after 10pm on the night prior to MRI or surgery. It is very important that your pet have an empty stomach when undergoing general anesthesia. MRI or surgery may have to be rescheduled if your pet has not been fasted appropriately. A small to moderate amount of water is okay. Any medications that your pet is currently taking is also OK, unless they need food along with the medications.
Q: Can I give my pet a bath before surgery?
A: You may wish to have your pet bathed or groomed one week prior to surgery. Bathing and clipping cannot be performed for 2-3 weeks post-operatively. Do NOT give your pet a bath the day before surgery. Doing so actually increases the incidence of incisional infection.
Q: How much skin will be shaved on my pet?
A: Prior to surgery, your pet will have the skin around the surgical site shaved to obtain a sterile field. Please be assured that we shave only the area necessary to provide an adequate field for sterile surgery. Most patients will also have small areas shaved for placement of IV catheters, pain medication patch, or where the spinal tap is performed. Depending on the location of the spinal tap, a small square may be shaved at the base of the skull or just above the tail.
Q: Will my pet be monitored during anesthesia?
A: The neurology service is staffed by experienced licensed veterinary technicians, veterinary assistants, and veterinary technician specialists in anesthesia. Monitoring consists of ECG, invasive and non – invasive blood pressure measurement, oxygen saturation of blood, respiration rate and level of consciousness.
Q: Will I get a call after the MRI or surgery?
A: The neurologist or neurology service team will give you a call after the MRI or surgery as soon as your pet has recovered from general anesthesia. Please feel free to give us a call to check on the status of your pet or when your pet is scheduled for MRI or surgery.
Q: How long after the MRI is a surgery performed if needed?
A: For emergency procedures, the patient usually goes directly to surgery after the MRI. The neurologist will call you after the MRI and discuss the finding and surgical options. Oftentimes, non – emergency cases will often go directly to surgery if the procedure is considered standard and not complicated. Many elective procedure and long procedures are performed the next day or scheduled at your convenience.
Q: How long will my pet be in the hospital after an MRI or surgery?
A: Patients that have an MRI performed get to go home the same day, usually in the late afternoon or early evening. Patients will go home with complete discharges explaining the findings of the exam and any diagnostic tests that were performed. Hospitalization after surgery will depend on the surgery and how affected your pet was prior to surgery. In general spinal surgeries stay in the hospital 3 – 5 days and brain surgeries stay in the hospital 5 – 7 days.
Q: Who manages my pet’s condition following my visit to SVS?
A: A complete discharge letter is sent to your regular veterinarian. The neurology team will keep in contact with your pet’s regular veterinarian regarding long – term management of the case. The neurology service is very happy to answer any questions, however, for immediate concerns, please call your veterinarian as the neurologist may be in surgery or exam and may not be available to answer questions immediately. For the best management of your pet’s condition, it is essential that there is good communication between SVS, your veterinarian and yourself. The neurology services strives to return calls within 24 hours. Please do not hesitate to call if you feel there is a delay in getting back to you. We understand and empathize with any concerns you might have.