Sep 24, 2013
The lady owner phoned me to ask whether her poodle should receive more medication.
"Is the dog's head still trembling a lot?" I asked her to send me a video by email.
"Much less," she was happy that the dog was eating and putting on weight. This was the dog that was diagnosed as needing glucosamine by Vet 1 and referred for CT scan by Vet 2 as the dog was shivering and trembling fast in her body and would not eat or drink.
The husband remembered me as I had successfully operated on a bladder stone in another poodle in 2009 and asked for another opinion as the referral vet would charge CT scans from $1500 - $2000.
"I remember seeing such a case in a sheep with Scrapie in Glasgow University in my 3rd year at Glasgow University as the lecturer was demonstrating one case," I said to Dr Daniel. "The sheep was trembling in his head and body. In this dog, I would say she has cerebellar ataxia. Causes can be varied. There is no treatment for it in general."
Dr Daniel did a blood test which indicated a liver disorder or infection.
Other than preventing the dog from falling down and hurting himself as he is clumsy, there is apparently no treatment if it is an acquired cerebellar degeneration or tumour.
What is the cause of this trembling of the whole body? This condition is rarely seen in Singapore, in my experience of over 30 years and I did confirm with another vet who had 20 years of experience in small animal practice in Singapore. So Dr Daniel was fortunate to see one case.
"What is the treatment?" is what the owner wants.
"Just sending the dog home and waiting for another week to observe if the dog recover is not the solution," I said to Dr Daniel. "The dog is not eating and drinking the owner is worried."
I prescribed some anti-fits and other medication and asked the owner to call me in 7 days' time. She did it today. The dog was still clumsy but had put on some weight as she was eating. Cerebellar ataxia has varied causes including infections, degeneration and neoplasia and so it is extremely hard to cure unless the cause is known. For the time being, the dog is eating hungrily and that is what the owner is happy about. Some nervous system diseases have no cure and the intentional tremor symptoms can only be controlled by drugs. Only at necropsy or autopsy can the cause of this condition be diagnosed and euthanasia or death is not acceptable to the wife who loves this dog very much.
I will need to review again. It is such a rare case that I have not seen it for the past years of practice at Toa Payoh Vets. I doubt there are more than a handful of such cases in Singapore and so it is a big challenge to diagnose and treat
No cerebro-spinal fluid, CT scan and MRI scan were done owing to financial restraints and so the vet must practise within the means of the owner.