Well, Flash had xrays to see what is causing the pain. Rachel thought it was arthritis in his hips, so we first put him on Metacam. However, although it did help a little, it didn't make a huge difference, so we went for the xrays, but it turned out that all his joints look absolutely fine.
Our next step was a referral to The Grove Vet Centre in Fakenham. So Flash had an MRI and fluids taken from his knees (and from the spine, but the vet couldn't get any from the spine) as well as blood tests. All the scans and test results came back fine - and there was no sign of degenerative disc disease either. So it was all a great puzzle.
Here's Flash on 27th April home after the MRI:
It was only when the referral radiologist that found the possible problem: articular facet subluxation. In other words the tiny facet joints in the spine dislocate and cause pain because of that. Here is a copy of the report I received:
Diagnostic interpretation:
Lumbosacral vertebral column
There is subluxation of the cranial articular process of the first sacral segment in relation to the
caudal articular process of L7. The cranial articular process of S1 has moved forward into the dorsal
aspect of the intervertebral foreman. By doing so it attenuates the L7-S1 foreman bilaterally reducing
the space of the exiting L7 nerve roots. However this subluxation is static between the flexed and
extended views and between both series the nerve roots can be observed exiting the cranial aspects
of the foramina surrounded by perineural fat signal. There is very little associated osseous
remodelling and only very mild degenerative change is present within the L7-S1 intervertebral disc.
The spinal cord and cauda equina run centrally along the vertebral canal without attenuation. The
other intervertebral discs demonstrate some mild dehydration however no significant protrusion or
extrusion is evident.
Conclusions:
1) Static L7-S1 articular facet subluxation and attenution of the intervertebral foramen bilaterally.
2) Nodular splenic and liver changes.
3) Intrapelvic urinary bladder.
Additional comments:
In all images there is evidence of subluxation at the L7-S1 facet joints. The cranial displacement of
the cranial processes of S1 attenuate intervertebral foreman. Despite the static appearance of this
subluxation on these images I am concerned that with aggressive action this process will move
further cranial and be a cause for L7 nerve root entrapment and injury. This could account for the
pain is described in this patient. If this is the case on rest and at inflammatory therapy should result in
a clinical improvement have a repeat concussion of these nerve roots is likely to occur with normal
exercise in the future. It was the first time Simon Gilbert (referral vet) had come across this. So today I have now started Flash on Gabapentin and from tomorrow also Rimadyl (as the metacam didn't help greatly). I really hope this will help him! He looks so uncomfortable on walks, particularly on the way home. He is better after a day's rest, but still slows up considerably on the way home. I will then also add acupuncture to see whether that will help. For now there will be no further hydrotherapy as I feel that is making things worse at the moment.
On the sofa next to me on 2nd May:
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