My CRAZIEST Case of 2021

[@judithcohn3036]

This is my grand puppy! His owner isn’t the only one thrilled to have Fionny back❤️

[@DVMCellini]

:)

[@sophiesheu]

I love this medical-mystery type of video! Can you do more of this kind? Thank you!

[@joannebryant6217]

I’ll bet the owner is so very happy that she decided to get the MRI done! I LOVE this type video…it’s so interesting to hear about the entire process and I enjoy hearing the detail about forming the differential diagnoses. Having patients that cannot verbally express their symptoms pushes diagnosing to an entirely different level. 👏👏👏👍👍👍

[@DVMCellini]

thanks for checking it out!

[@mandymorrow5473]

Good job, Doc! I know that sweet dog would've thanked you for not giving up on him if he could!

[@lindsaypcohn5198]

He is very grateful, as am I ☺️

[@elidiaelidia6579]

hello doctor, Thanks for sharing this case! I work with neurology in Brazil, and it's great to see cases and discussions from respected colleagues

[@sjbock]

Great (clear, simple) explanation of a complex issue. You make a great teacher as well as a great vet.

[@DVMCellini]

Glad you enjoyed it thank you

[@cliveferguson1260]

WOW! Now this is why I love veterinary medicine. To be able to help out Fin and his owner must be extremely gratifying feeling. This is motivation to keep on studying!!!!!!!

[@DVMCellini]

These are the types of cases you focus on in your career. Help those you can.

[@jodymichelle4965]

That was a great case. The first dog I ever had developed hindlimb weakness and ataxia. A myelogram and spinal tap were done and she was diagnosed with GME and treated with the same drugs. I have since seen a few other dogs that ended up being diagnosed with Meningitis and they never really presented quite the same way. I’ve definitely never seen an MRI like that! Your furry patients and the less furry owners are very fortunate to have you in their corner.

[@taramoonshadow363]

You have a GREAT philosophy, doctor. You are an inspiration!

[@DVMCellini]

🥰 thanks!

[@saljranggabilmomin]

We need more videos like this, Speaking as a fellow Veterinarian. Its such an Insightful Guide 👍.

[@joycebliefernich6955]

Thank you for explaining so well and showing the MRI results. For us veterinary technicians in training this was an excellent teaching moment! Much appreciated!

[@mariafernanadacacerescarde3590]

would love more of these step by step clinical case videos! Very interesting!!

[@scrub_itoff9849]

So interesting, engaging and educational video 👍🏻

[@pandachance1]

Great presentation and great outcome. I have a 12 y.o. GSD with polyneuropathy. It did my heart good to see Finn improve and living his best life. Thank you for posting. ❤

[@davidg1290]

Great outcome! You trusted your training and trusted yourself to apply it with this case! In learning to fly airplanes in the clouds or limited visibility we’re taught to trust our instruments and rely on them regardless of what our senses tell us about our orientation in the sky. A rough analogy to what you did in this case. Glad Fionn did so well and I hope he continues to thrive!

[@DVMCellini]

Thanks David!

[@KaylaPatrickmusic]

This made me tear up! So interesting, thanks for making this video!

[@DVMCellini]

Glad you enjoyed it!

[@pamelaroundy9814]

I saw you comment on a Vet Ranch video and was very interested in what you had to say. I'm so glad you did. Now I'm following you

[@DVMCellini]

Thanks Pam!

[@DVMCellini]

Also which video? I’ve lost track and can’t seem to find it. Was it this video?

[@Trit0n1]

This is such a great example. And super interesting. Well presented and explained.

[@DVMCellini]

thanks boss i appreciate that

[@carmenalvarez6590]

👏 Glad he’s better. I appreciate these type of videos. Thank you.

[@bajazzogiggles]

Great, informative video! Thank you. Please share more :)

[@janetroush5775]

That's fascinating. What great outcome!

[@selenagomez4058]

Thank you for sharing this interesting case!! I would love to see more videos like this!

[@damiansnow6170]

Second year vet med! This is so interesting and motivational. I’m learning a lot

[@DVMCellini]

Glad you liked it damian

[@CoolInOlympia]

Great job, doctor!!!!

[@DVMCellini]

Thank you!

[@sherrydawson6253]

Omg u should still be partying your self on the back. Well done Doctor. U gave him back his normal life. I could tell rt away the difference of his MRI. That's so amazing 👏 yes give us more cases. Such a happy out come with Finn!!

[@kahla8596]

Great video! You explain things so well! Great job.

[@sticky9129]

They thought my husky had lung cancer 6 months ago. His x-rays were the were horrible since he already has chronic bronchitis and other issues. Ended up being blastomycosis. Thank goodness for vets and pet insurance.

[@realzhella6817]

This is so interesting....I always found it intriguing how a vet could be treating a dog one day and a snake the next day..like how do u guys even know the anatomy of such vastly different animals...hats off

[@zhvanrekani1408]

Thank you for helping animals 🙂

[@DVMCellini]

you're welcome

[@anpanmomdesu]

Bravo! 👏 It must've been so rewarding! What an interesting case! You explain really well. Maybe you can teach CE's!

[@tulipp3666]

I really liked this video! Thanks for explaining your thought process in treating this animal. Please make more videos like this!

[@DVMCellini]

Thank you!

[@lacepaws499]

Loved this video! More of these please! So glad for the dog great job!💜🐶

[@DVMCellini]

Thank you! Will do!

[@gracielac.p.reiser4320]

Thanks you, James. Very interesting, and you presented the case very clear and with all the explanations!!. Happy for fionn. I would like to see more case studies.

[@DVMCellini]

Glad you enjoyed it

[@angeljohnson234]

This is awesome. Too bad you're not still in Chicago. You could figure out what is wrong with my pup.

[@antonprokopenko3202]

4th year veterinary student from Russia here.info that you presented is great,than you!

[@DVMCellini]

Wow, thank you

[@primetime1169]

I love how you presented this. Direct and simple without going around in circles. Sick of the other docs on here, like that one Radiologist on youtube that just yaps and yaps 👀

[@DVMCellini]

☠️

[@billygoat7060]

Wow! So cool going through your whole thought process to form a diagnosis. So many moving parts to consider.

[@DVMCellini]

thanks boss!

[@joshuahorner2639]

Great work!

[@JamesRansom]

Such an awesome case. Awesome channel. Keep it up dude! These video case reports take a TON of effort but they are worth it. Thanks for sharing.

[@DVMCellini]

Thanks man

[@greyhndz]

Great case! A few questions from a human medical person: Have you seen demyelinating disease in small animals (similar to MS)? Did his trigeminal nerve function return or did he have permanent denervation? Did you consider an advanced tickborne disease (at least prior to seeing no neutrophilia in CSF). Did you send CSF out for Cx or any other studies? Neuro diagnostic dilemmas, my favorite! Would love to see more case studies from your files. Totally enjoying your content. 👍

[@bradcooke5383]

Degenerative myelopathy is common in large dog breeds. Highest in German Shepherds.

[@DVMCellini]

his trigeminal nerve function returned - muscle atrophy resolved and so did his vestibular function, both of which is spectacular to improve like he did. I ran a PCR panel on all sorts of infectious diseases (on the actual CSF) and they were all negative.

[@tc8591]

Well done Dr.

[@DVMCellini]

thank you tom!

[@lchaconxo7932]

Me, an accountant, watching this like 👁👄👁

[@DVMCellini]

ha thanks laura

[@calliemtb]

nice! I may have to refer my neuro cases to you-- (S/A general practice in Tulsa)

[@DVMCellini]

Please do! If not in person I can always help via my consultation website www.vetneuroconsult.com

[@tjwilsonster]

Fascinating!

[@Danny_jrt]

awesome video!!!

[@yarnmaniacs8936]

Great video!!! Love all the cliff notes on the procedures too. Can you share why animal ER medicine is so expensive??

[@michelleurrutia8305]

It's actually a fraction of the cost of human medicine, it's just that most of us as human's don't confront the majority of the costs associated with our healthcare because we have insurance that pays for it. It's the same with animals. A $5000 visit can become a $200 visit with insurance, it's just that most people do not get insurance for their pets and then want to point the finger at veterinarians for the consequences of their own actions. You wouldn't show up at the ER uninsured, receive a CT and a splenectomy and owe any less than 20K (minimum), but people balk when the same at a veterinary hospital is 8K. It's the same, (if not more work when you consider the limitation of supplies, size of the patients, diagnostic process considering veterinary patients can't speak, etc. ). for the veterinarian to do. I recently had a fainting episode and the hospital elected to do a diagnostic workup that my insurance deemed unnecessary and only paid for treatment related to the fainting episode (i had hit my head) and I was billed 14,000...for a CT, a chest X-ray and EKG printout, and some bloodwork. Mind you when I get a CT, I can just be put in the machine and told not to move. We can't do that to animals so its a fully anesthetized procedure requiring a skilled professional to monitor anesthesia throughout the procedure. It would still cost less for me to CT a dog than what I paid out of pocket for my own. To do everything I just said where I used to work in NYC (an expensive place to be with regard to veterinary medicine), we'd probably charge a client about 3,500 total for all of that despite the fact that it would probably take us 3 times as long to accomplish when you factor in restraining or sedating for radiographs, catheter placement and hematology, anesthetizing, etc. 3500 compared to 14000 is not so bad.

[@DVMCellini]

Is it that expensive?

[@yarnmaniacs8936]

Last year was a really expensive year for us after our chorkie had a first round with HGE…it was awful, poor girl. She’s much better now but on steroids for the rest of her life also. The bills came up to $7k after a 7 days stay at the ER…thankfully, pet ins saved us and covered 90% of the bill!

[@hannahclee2]

@@yarnmaniacs8936 Was the $7000 for the entire 7 day stay in hospital? While $7k is obviously a boatload of money, that would equate to about just under $42/hour to pay for multiple trained staff, including veterinarians, supplies, in-house lab diagnostics, etc. I don't mean to belittle the concern about cost because it *IS* a large amount to spend, but sometimes I find it a bit easier to digest large estimates when I try to think about all the different aspects required to provide the best care for my dog. Also, BIG KUDOS ON HAVING PET INSURANCE!!! I wish more people knew about pet insurance and utilized it more. Some larger workplaces may offer some variation of pet insurance in their benefits package. I'm glad to hear that your chorkie is doing well. She is lucky to have you looking out for her best interest :)

[@stephengrisoli5811]

Love the video and happy for Finn! Did lack of WBCs or bacteria in the CSF eliminate infection from the differentials? If not, were you worried about immune suppression making an infection worse?

[@DVMCellini]

i would say so. it would be hard for an infection to produce real mild changes like that (though viral disease in particular certainly can)

[@alejandrogarcia3912]

I dealt with worse than that and I dont brag about it online

[@DVMCellini]

Cool! 😎

[@juliac3933]

Thank you for sharing! What could have triggered the inflammation?

[@DVMCellini]

Likely just good ol idiopathic.

[@girloantaalexis7787]

Hi Doctor! Could you describe the trigeminal nerve deficits that this dog had in the firs exam? Thank you!! Great job ❤

[@lindsaypcohn5198]

I’ll (owner) do my best: significant muscle atrophy behind the right eye (giving that caved-in head appearance), loss of nerve function on the right hand side of the face (lip numbness, loss of some vision in the eye), some propriception of front right paw, and other balance issues.

[@bradcooke5383]

Very interesting case Doc. Was that a Dr. Delahunta cameo? Question: can the blood and protein from the spinal tap results be a contamination from the puncture?

[@DVMCellini]

Good catch! Yeah that was Dr. D. The blood was a contaminant but I didn’t think it was enough to explain that high of a protein elevation.

[@Xiaooooom]

Hi Dr. Cellini, I was wondering if you worry about using corticosteroids if lymphoma is on your ddx? We learned that patients usually improves but then the lymphoma will come back and will be resistant to other treatments. Love the content!!

[@DVMCellini]

no because when it comes down to it prednisone is part of therapy for lymphoma and if we're talking CNS lymphoma then the pet will need every reasonable medication possible. also, i'm not sure lymphoma becomes "resistant" after some prednisone. i need to double check but i think that might have been debunked.

[@ThatSuzanneSchmid]

Interesting. My eldest dog is nearly 12 and looks a bit like this dog. I'd like to learn about Vestibular Disease in dogs. Do you see this often? I had an elderly female dog affected by this on two occasions. It was very scary trying to keep her safe while this was happening.

[@DVMCellini]

All the time!

[@Ashfleigh]

Was it a concern that the inflammation would return after tapering Fionn off the steroids? And if it did return, what would have been the next step?

[@DVMCellini]

Oh yeah that's always a concern. My plan was to try another round of chemo if it came back, and re-up the prednisone dose. Basically just restart the plan, but maybe extend the dosing for a longer period of time this 2nd go round.

[@Noseqquiero]

HIPAA applies to veterinarian medicine as to human medicine right?

[@lukecurrey4467]

Hav you ever worked with sled dogs? I’m a prevet student who recently visited a husky kennel that had heritable Siberian husky polyneuropathy.

[@DVMCellini]

no but i have done it in norway and its awesome

[@comesahorseman]

I'm curious if this dogs owner had pet health insurance? In my region, I know that MRIs @ Tufts are *not* cheap!

[@lindsaypcohn5198]

Hi from the owner - I did not have pet health insurance (at the time I got him the options weren’t good), but I did have some savings and a supportive family. The MRI cost about $1500-$2000 iirc. The chemo drug was actually very affordable. I believe there are now much better pet health insurance options and it’s a good idea to have it.

[@nechamia]

human neuro here. I am curious to know if you guys obtain contrasted sequences and what the ddx is for b/l V enlargement. i would have thought shwannoma but its too symmetric so im curious if there's an antibody syndrome that has been associated with this presentation

[@michelleurrutia8305]

We do utilize contrast! The latter question is a bit above my pay grade...still a veterinary student lol.

[@DVMCellini]

hey doc! we did and they lit up like a christmas tree. i cut it out to trim time a bit on the video. I assume "b/l V" means "bilateral cranial nerve V enlargement"? If so - differentials are really 2 things: lymphoma or auto-immune neuritis. Infectious is possible (I ran a CSF PCR panel on like 15 organisms and it was negative) but in dogs its auto-immune 99/100 times. We don't know what triggers it either.

[@nechamia]

@@DVMCellini thanks V is 5th cranial nerve e.g trigeminal . I may have mistakenly assumed cranial nerve numbering is conserved across our species. if this was a human damn well we would have autoimmune antibody assays to attempt to catch a pathogenic Ab. it may tie in to potential for relapse or whether its associated with a paraneoplastic phenomenon. if the latter we would hunt for a cancer

[@charbelsaadeh2029]

What if it was an infection ? Wouldn't he have gotten worse ?🤔

[@DVMCellini]

I left this out but I ran infectious disease testing on the csf and it was all negative.

[@charbelsaadeh2029]

@@DVMCellini thanks for replying! Absolutely loved this video btw