Mocha – Pug Myelopathy
Written by: Bryce Talsma
University of Florida College of Veterinary Medicine
DVM Candidate, Class of 2021
Name: Mocha
Signalment: 10 year old, female spayed, Pug
Diagnosis: Pug Myelopathy (aka Constrictive Myelopathy)
Assessment: Mocha first presented to Pawsitive Steps Rehabilitation and Sports Medicine in June 2018 following her diagnosis of pug myelopathy via MRI. Mocha had a several month history of progressive paraparesis (weakness in the hindlimbs) and intermittent fecal incontinence. At the time of presentation, Mocha was dragging her hindlimbs and scuffing her hindlimb paws when walking. She was having difficulty with slippery and uneven surfaces, long walks, stairs, and incontinence.
Reason for Presentation:
Rehabilitation therapy for pug myelopathy
Client’s initial rehab goals:
Improve ambulation
Initial Exam:
On physical examination, Mocha was found to be overweight with a body condition score (BCS) of 8/9. Her initial weight was 23lbs. She was observed to have diffuse muscle atrophy, suspected secondary to pug myelopathy, in the following areas: thighs – moderate to severe bilaterally with decreased tone, shoulder – mild bilaterally, paraspinals – moderate. When assessing the neurologic system, Mocha was found to have decreased paw placement (conscious proprioception) and hopping in the right hindlimb. These reactions were absent in the left hindlimb. The withdrawal reflex was decreased in both hindlimbs. There were no forelimb neurologic deficits or cranial nerve deficits noted.
No appreciable lameness was noted on gait assessment but Mocha demonstrated bilateral hindlimb paraparesis with scuffing and knuckling of both hindlimbs. The left was worse than the right. She was also noted to have mild bilateral carpal hyperextension on ambulation and confirmed on goniometry.
When assessing her posture, Mocha stood with her forelimb paws caudal to the shoulders and her elbows positioned close to her chest. Her hindlimbs were wide-based and cow-hocked. She was able to sit squarely and lay in a sternal position, but transitions required significant effort.
Rehab Goals Following Assessment:
The goals for Mocha are centered around maintaining and improving her quality of life following her diagnosis. A summary of pug myelopathy is provided below. For Mocha we wanted to improve her balance, proprioception and coordination as well as the quality of her movement. This would be supported by strengthening her core, hip, thigh, and shoulder muscles. Mocha’s quality of life would also be improved through promoting weight loss. Her initial goal weight was set for 20lbs, but as with all weight loss programs, the patient is monitored for appropriate weight loss until an ideal body condition of 5/9 is achieved.
Initial Plan:
- Consider using socks or boots to protect the hindlimb paws from abrasions due to scuffing during walks. It is important that these booties are removed following walks in order to allow maximum sensory stimulation throughout the day, however.
- The potential use of a hind-end wheelchair was discussed with Mocha’s owners. Unfortunately, pug myelopathy is a progressive disease, but a hind-end wheelchair allows the dog the freedom to explore again without falling down or injuring the paws. It can also assist in some of the home exercises Mocha would later be prescribed
- Start Mocha on once weekly rehabilitation sessions with the plan to decrease frequency based on clinical improvement.
Modalities Used:
Physical exercises including at home exercises
Underwater Treadmill
Massage
Pulsed Electromagnetic Field (PEMF)
Laser Therapy
VSMT
Acupuncture
Follow-Up: Since 2018, Mocha has continued to attend rehabilitation sessions with Pawsitive Steps Rehabilitation and Sports Medicine. She has been successful in her weight loss goals and is currently maintaining at a healthy BCS of 5/9. Her paw placement and hopping has improved in the hindlimbs. Mocha also has increased her thigh circumference by about 1.5cm bilaterally. She has been discontinued off steroids and her owners report that she seems stronger overall. Pug myelopathy is a spinal condition that results in progression of signs from hindlimb ataxia (weakness) to paralysis over time due to a complex of spinal abnormalities. Consistent physical therapy and rehabilitation exercise are an important palliative treatment to preserve muscle strength and spinal walk, as is seen here in Mocha’s case.
To learn more about pug myelopathy, please see the blog post by a veterinarian at the following link: https://pugrearataxiaparalysis.com/what-is.html