Diagnosis
Following admission and a full examination , Ruby had conscious thoracic radiographs taken , to rule out megaoesophagus and to assist in confirming the working diagnosis of polyneuropathy . Blood samples were taken for full analysis , including haematology and biochemistry , which showed some generalised inflammation but were otherwise unremarkable .
The following day , Ruby was placed under general anaesthesia so electrodiagnostic tests , such as electromyography ( EMG ) and nerve conduction tests , could be performed . These tests gauge muscle activity and nerve conduction velocity when the muscles / nerves are individually stimulated with small needles [ 8 ] . The tests showed no decrements of the nerves during conduction velocity testing , but some mild delays in F-wave latency were detected in both front and hindlimbs .
The F-wave represents the time it takes for the muscle to respond after the nerve is electrically stimulated . A normal F-wave without latency would show as initial stimulation followed by a flat line . Figure 4 is a graph from Ruby ' s nerve conduction test , which shows a delay in the muscle response after her tibial nerve was stimulated . Such abnormalities are commonly seen in patients with neuromuscular disorders . These results helped to confirm the working diagnosis of polyradiculoneuritis . The test is specific to ventral nerve roots , so patients with this disease process often show abnormal results [ 7 ] .
Treatment and nursing care
While hospitalised and following her anaesthetic , Ruby developed pyrexia , harsh lung sounds , and increased respiratory rate and effort . Thoracic ultrasonography was indicative of aspiration pneumonia , which is commonly seen in patients with lower motor neuron conditions such as polyradiculoneuritis [ 7 ] .
Ruby was started on antibiotic therapy consisting of co-amoxiclav 20 mg / kg [ 9 ] given intravenously three times daily , and had regular venous blood gas sampling to monitor her carbon dioxide levels . Her oxygen saturation was regularly monitored by pulse oximetry . Oxygen saturation is important to monitor in dogs with lower motor neuron conditions such as polyradiculoneuritis , as they can have poor intercostal movement , which will impair exhalation [ 7 ] .
Alongside the monitoring and antibiotic therapy , Ruby was propped up in sternal recumbency , rather than being turned regularly , and positioned on a wedge so her head and chest were elevated ( Figure 5 ) [ 7 ] . She was nebulised and thoracic coupage was performed every 6 hours to help elicit a cough and move any secretions from the narrower bronchi to the larger airways in the lungs , to help maintain her lung health while she was recumbent and to help her remain as comfortable as possible .
Figure 4 . Ruby ' s electrodiagnostic graph , showing F-wave latency after her tibial nerve was stimulated with a repeated electrical pulse .
While Ruby was under the same general anaesthetic , an attempt was made to obtain a lumbar cerebrospinal fluid sample to rule out parasitic or inflammatory causes , but the sampling was unsuccessful due to anatomical variation .
Figure 5 . A dog ( not the case study patient ) lying in sternal recumbency on a wedge to elevate the chest .
Physiotherapy exercises such as assisted sitting and standing with the help of an inflatable peanut to support Ruby ' s weight were performed . As Ruby improved , food was used to encourage her to take steps , and she was fitted with a Help ' Em Up harness [ 10 ] ( Figures 6 and 7 , page 49 ) so the veterinary nursing team could assist her walking as she became stronger .
48 Veterinary Nursing Journal