7/30/2019 Kramer's Vet Visit May 6/13

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May 10, 2013

No referring DVM

Patient: Kramer, 6-month-old intact male Dachshund

Owner: Rangan, Jenell

Case #: 85373

On May 6, 2013, Kramer was seen for recheck exam. The following is a summary of that visit:

History: Ms. Rangan reports that Kramer continues to be getting a little weaker, has a harder time supporting

weight on his front legs, and also seems slightly weaker on his hind legs. She also commented that his breathseemed odd.

Exam Findings: Bright and appropriate. Playful, but awkward. He stood with mild carpal hyperextension

and was slightly plantigrade. Proprioception markedly decreased in all limbs. Good withdrawal responses inall limbs. The patellar reflexes are now hyper and may demonstrate clonus. No spinal hyperesthesia detected.Normal cutaneous trunci response. Normal thoracic auscultation. I thought his breath was not unusual for a

puppy.

Assessment: His exam findings seem to have changed, and now appear to be more suggestive of upper motor

neuron (spinal) disease/dysfunction than of peripheral nerve or muscle dysfunction.

Comments and Recommendations: In early April, we had submitted lab samples to test pre- and post-

prandial bile acids and to perform screening for a genetic metabolic disorder. Bile acids testing was normal,ruling out a porto-systemic liver shunt. A variety of tests were performed by the metabolic testing lab at the

University of Pennsylvania. This was to screen for some of the more common genetic metabolic disorders

that can cause neurological disease. The types of diseases I am talking about include errors in metabolism

caused by deficiency of necessary metabolic enzymes, often referred to as lysosomal storage disorders, as wellas inadequate amounts of necessary amino acids or organic acids. Kramers metabolic screening was

relatively normal. The only abnormality was a slight positive reaction on the test for

Mucopolysaccharidosis. However, the lab indicated that a slight positive test in such a young animal is most

likely normal.

Based on the current exam findings that are more suggestive of spinal cord abnormalities, a spinal MRI scan

and CSF analysis are my recommendations to further investigate his unusual weakness and coordinationproblems. It is important to note, however, that I think the chance of finding something fixable seems small.

As said before, Kramers overall long-term prognosis is uncertain at this time, since both the underlying cause

and progression of his condition are unknown. It remains possible that he could live a long time with his

impairment and just be a special needs dog.

Thank you again for allowing us to share in Kramers care. When we see him again, we will keep you posted.

If you have any questions or comments, please do not hesitate to call.

Sincerely,

Robert A. Kroll, DVM, MS

Diplomate, ACVIM (Neurology)