06/24/2026
We have a really special Work-Up Wednesday for you this week with not one but TWO patients. These two boys are such interesting cases, and we hope you agree!
Patient: Patient A - 5 year-old neutered Poodle X | Patient B - 2 year-old neutered Lab/Pittie X
Presented for: Patient A - Anxiety, OCD-type behaviors, difficulty relaxing, painful defecation | Patient B - Resource guarding, aggression towards housemate dogs, hyperarousal, dribbling urine
History: As listed above, both patients were presented for very different behaviors. Their backgrounds also vary greatly with Patient A having come from a breeder during the height of COVID lockdowns and Patient B coming from a shelter as an adult stray.
Where we come in: Patient A's consult led Dr. Emmons to an internal medicine referral for him. The difficulty settling, vocalizing/posturing when eliminating, compounded with new vomiting, made sense to think something wasn't sitting right in his tummy. After work-up with an Internist including bloodwork and an ultrasound yielded little answer on what was going on with him and hind/back weakness and pain presented itself, Dr. Emmons moved this to a neurologic concern and an additional referral. For Patient B, the dribbling urine and physical exam finding of hind-end instability immediately moved to sedated workup and radiographs at EVH. Once confirmed by a Radiologist there was unevenness in the hind muscling on x-ray, we referred the Patient to a Neurologist. Sadly, the first referral led to no diagnosis as Patient B was taken away from the owner for exam noted no pain or weakness. *Reminder - we mentioned on a previous Work-Up Wednesday we cannot always trust physical exam in hospital as patients are in fight, flight, or freeze most of the time!* Desperate for answers, the owner asked for a second opinion, and Dr. Emmons was able to refer Patient B to another Neurologist with more advanced imaging.
Take-aways/outcome: Why did we bundle these two? Well despite their difference in patient signalment, background, and presenting concerns, they do have two big similarities. First and foremost, two owners who were their biggest advocates along with Dr. Emmons and the EVH team to chase down answers and relief. And second... they were both diagnosed under a Dynamic MRI (dMRI) with Tethered Cord Syndrome (TCS). TCS is difficult to diagnose as it is a condition where the fibers of the spinal cord are not anchored properly or stretched into the spinal canal. Say what? That means in the crazy network that is our (or a patient's) spine/nervous system, there can be a myriad of symptoms because what is pinched/stretched then impacts what is experiencing pain or a deficits. It is also challenging to diagnose without the proper imaging like a dMRI which captures the movement of the spine versus just stagnant images where you may not be able to see the abnormalities in just one shape of the spine. So now what? TCS can be managed with therapeutics like acupuncture and physical therapy, along with steroids, but more definitive treatment involves surgery. These two dudes will be pursuing surgical "detethering" with their neurologist to find long-term relief for a much more comfortable life with many, many years ahead!
TCS is a relatively newer diagnosis in veterinary medicince. If you'd like to learn more, there is a great webinar series put on by Dr. Nita Hynes Resident, ACVB and Dr. Rachel Lampe DACVIM(Neuro):
Webinar recording on behavioural and neurologic presentations for newly recognized condition in dogs, Occult Tethered Cord Syndrome.
