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Post by pookie on Jul 14, 2014 15:03:31 GMT -7
Our dog has been on medical management for more than 6 months. She's a very small, light-boned greyhound, about 35 pounds and about 2 inches shorter than any other female greyhound i've met (and yes, we are sure she is not a whippet).
She had a major collapse in the winter after showing more minor symptoms of decline that we did not really jump on. We did not have an MRI done, but she's believed to have IVDD in her cervical vertebrae, and our vets have her on a maintenance dose of prednisone every other day.
She got better after her collapse, to the point where she was reasonably mobile, if somewhat unsteady. She has very little feeling in her right front leg, but she was walking on it until recently.
More recently, she has started bending the leg at the pastern, and walking on her bent pastern which is clearly awkward. One of our vets suggested we buy a carpal brace for this, since she seems to be able to stand and support her weight if we sort of pose her in he right position. Despite the sensory deficit in that foot and lower leg, she seems to be able to move the upper leg and was walking much better until recently.
The vet who made the splint recommendation said that he had tried making removable splints and that they were difficult to get right, so he pointed us to the internet and recommended we buy one of the splints or braces on the handicapped pets sites. At this point, her leg has been bent for more hours of the day than it should be (she tends to sleep with it bent), and I think her tendons have contracted a bit, which means we need to start with something on the soft side that can help her stretch her tendons back to a more normal position and that she can wear comfortably even when she sleeps. She has very thin skin, and we need something very soft and well-padded to avoid abrasion.
We have been trying to stretch her tendons to he normal range of motion with with physical therapy, but i don't think that has been very effective.
If anyone has experience with this type of problem, and can recommend the type of splint and/or brace we should be buying for her, we would find that very useful.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Jul 14, 2014 16:09:23 GMT -7
Welcome to Dodgerslist. My name is Paula what is yours? There is no such thing as a "maintenance dose of pred" for a disc episode. 100% STRICT Crate rest 24/7 for 8 weeks is to allow the disc to heal. Steroids such as pred is to get the swelling down ranging from 7-30 days. Pain meds are giving while the swelling is being address so the dog can heal in comfort. Nerves that provide for leg function heal by themselves on their own time schedule. So can you tell more about why the pred...are you seeing signs of pain that the vet is using pred to get painful swelling down since Jan 2014? Pain signs: shivering, trembling, yelping when picked up or moved, reluctant to move much or slow to move, tight tense tummy, head held high or nose to the ground, holding front or rear leg like a flaming not wanting to bear weight, not normal perky self? Are you doing range of motion to prevent the ligaments from tightening and the joints from freezing up? The very, very lightest least aggressive range of motion and leg massage is necessary for paralyzed legs during conservative treatment once a dog is off all meds and pain free. The information highlighted in PINK pertains to a dog who can't walk. www.dodgerslist.com/literature/massagepassiveexercises.htmKnuckling is a sign of nerve damage, that can take time to heal. If the knuckling is something recent, then that is signaling something more is pressing on the spinal cord.  Phrase the question to your vet in this particular way</font>: "is there any medical reason my dog may not take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5MG Pepcid AC (generic name is Famotidine) 30 mins prior to steroid. This directory very good for learning about each of your dog's meds: www.marvistavet.com/html/pharmacy_center.htm -- Eating and drinking OK? How are poops today- normal color and firmness, no dark or bright red blood? -- If there is pain or neuro diminishment, dogs can benefit greatly with acupuncture or laser light therapy. These therapies can be be started right away to help relieve pain and to also to kick start energy production in nerve cells to sprout. So if this therapy is in your budget, seek out a holistic vet. ahvma.org/Widgets/FindVet.html www.serenityvetacupuncture.com/index.php/faq_/ [one vet's overview/prices] Chiropractic is not recommended for IVDD dogs. |
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Post by pookie on Jul 14, 2014 17:40:55 GMT -7
Hi Paula, Thank you for responding and for your suggestions. My dog was on strict rest in the beginning, and she did improve - not to 100% functionality, but to reasonable mobility and happiness. But every time we tried to taper down the prednisone, she would get worse and we would have to start again. Her rear leg on that side is much more functional than her front, but when we tried to taper the pred her rear gets worse and she will lose her 'righting reflex'.We took her to a neurologist early on, and he tried to switch her from prednisone to gabapentin. She threw up blood while on gabapentin, so we did not continue it. We also did not continue with the neurologist because he seemed not to be very interested in the medical management option (he never called us back when we reported the blood - that told us a lot about him) Thank goodness we have caring g.p. vets who were there for us. The neurologist told her to encourage walking outside where there was good footing, but then we had snow or mud for the next three months almost continually. We have mats down in the house for footing. I'm thinking of putting in a vinyl wood-grain type of floor because they seem to have better traction than our current smooth wood floor. We started giving her sucralfate because of the gabapentin incident, but we weaned her off that because she doesn't seem to need it and must be timed to be given a set time before feeding and meds. It was difficult to get the timing right and she seems okay without it. She gets 35 pounds 10mg prednisone every other day, which is not a very high dose. I found this article about steroid ulcers in humans which indicated that it is usually not a problem with people unless they are taking very high doses. 1.usa.gov/U5xKwCShe has had digestive issues her whole life, and her poop is about the same as it was before this disk problem cropped up - sometimes fine, sometimes loose. In addition to her regular diet we feed raw bony chicken parts (mostly feet) which is the only thing that has ever helped. She seems immune to the action of anti-diarrheal drugs. She gained some weight since this began, which was a good thing in her case. She was a bit too thin, and has always been so. Her appetite is okay. The only difference I'm seeing with the prednisone is that she is drinking and peeing more than before, and that's a common side effect. The only other drug she is on regularly is a twice weekly antibiotic dose to help with her gums. As to pain - she does sometimes yelp or show pain when we lift her. She's not very active, and the turned in pastern has slowed her down quite a bit. She has had a lot of medical peculiarities her whole life but she's always been a determined, spirited dog. I don't expect her to recover to 100% but she was doing better in the spring, and was walking on all four feet and enjoying life more as a result. I would like to get her some support for that leg, because she was able to figure out how to walk with it even when she could not feel it much, if at all. We did not find acupuncture to help in the past with other dogs who had disk problems. This dog does not really tolerate veterinary care with good grace. I think she would feel aggrieved and stressed with being poked. I'm not against acupuncture - I just haven't found it to be curative of very much. Is laser therapy a holistic modality? I thought it was more mainstream. I know they use it a lot for horses. I will ask around to see if any of the small animal vets in my area have that. The equine vets usually won't do dogs. Thanks again for all the information. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Jul 15, 2014 9:14:35 GMT -7
Hi again, my name is Paula what is yours?
So often it is the steroids that do the GI tract damage starting with nausea, vomit, leading to bleeding ulcers. Sighthounds have different metabolisms and can be slower to process meds out of the body than other breeds so maybe the gabapentin could have caused the problem, that we have never seen reported with dachshunds and other small breed dogs.
I would seriously look into getting Pepcid AC (famotidine) on board to diminish the acids pred increases. Dogs are not people. We see multiples of 1000's of dogs here and we so often see when the stomach is not protected nausea, not wanting to eat, vomit, bleeding ulcers. We follow the vets who are concerned about being proactive.
Pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. The amount of water in the diet makes all the difference. To loosen the stool, add equal parts water to each kibble meal along with a 2-3 teaspoons of plain canned pureed pumpkin 1x a day. To firm up the stool add 2-3 teaspoons pumpkin to kibble and no extra water 1x a day. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potoato.
I would see a 2nd opinion from a different boarded neuro (ACVIM) about what is going on so long and to rule out other things that might mimic IVDD.
It maybe if surgery is not an option, then a low dose pred treatment has to continue long term to keep the swelling down.
Do you see typical neck signs of pain in addition to yelps. when lifting: holding front or rear paw up like a flamingo (not wanting to bear weight), holds head in unusual position: head high or nose to the ground?
If you have a splint prescription , you would need to go by the neuro (ACVIM) guidelines. We have never seen that prescribed here for knuckling. When the body's can self repair that nerve damage, then the dog will know where his foot placement is and want to correct it.
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Post by pookie on Jul 17, 2014 23:13:16 GMT -7
Hi again,
I don't think she's in pain most of the time. Her head posture is relatively normal. As to holding up a foot, that would be quite a feat, as she's walking on one pastern. We have tramadol and use it as needed, but we don't use it much.
In the past, we tried the vet neurologists with practices that are about an hour away - not both with this dog, but on different occasions. We were not impressed. Both seemed to be either unable or unwilling to offer much help unless an MRI was done. One of them took personal calls during the visit and then explained things to us in the most condescending manner, describing the function of the nerves and spine as if we were learning it in 3rd grade biology class. He might as well have sung the song "Dem Bones" - that was the level of information we got from him.
Years ago, we used a vet neurologist who did not have an MRI and he was extremely helpful and could do a good differential diagnosis after a careful physical exam. I would use him again, but he has retired. I don't want to anethetize this dog for an MRI. She has some unrelated health issues that make this risky.
For many reasons, we will not considering surgery for this dog. The people I've talked to who have had disk surgery done on their dogs have mostly advised us against doing it. Also, the anesthesia risk for this dog is much more serious than for an otherwise healthy one.
Thanks for the diet/diarrhea tips, but we've got that under control. She's on canned food, so water content is pretty much fixed. Chicken feet are more effective than pumpkin in my experience, and are a more species-appropriate food IMHO. Plus, she loves them and they help clean her teeth. I used to have to drive a good distance to find chicken feet, but they're in my local supermarket now, and are relatively cheap.
We made an appointment for an evaluatio at a clinic that has a laser and does P/T, and I'll try to report back next week, after we've seen that vet. I hope the p/t person is versatile, because my dogs have not liked the water and this one in particular would most likely freak out if we tried the p/t water treadmill. I suspect the p/t and laser vet will tell us if a splint would help.
Thank you Paula, for all of your advice.
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Post by pookie on Jul 25, 2014 11:14:20 GMT -7
,Update: We took our dog to a hospital with a physical therapy center and a laser. The p/t intake vet first sort of told not to have high expectations, that our dog would not be normal again. However, she wasn't normal before the spinal trouble (a couple of vets who saw her thought she had a cerebellar issue that was congenital). We just want her more mobile, and the vet thought that was a reasonable goal. He said he was unaware of the removable splints, and said he'd look them up before our next visit. We asked him to look at the one on the Thera-paws site. It looks most suitable, but has to be ordered and sent to a vet who custom-fits it.
He gave us 3 exercises for home p/t, and then she had a laser sesssion. The laser went fine. The p/t at the vet hospital also went okay. The p/t at home is not going well at all.
The 3 exercises were putting her on uneven surfaces, such as a mattress for balance. That one is not a problem.
Another exercises is stimulation of her flexor reflex by touching or if necessary, pinching her toes. All four feet, though her problem is mostly on one side. Our dog is intimidated and very passive at a vet's office so the vet's demo went fine. At home, it went like this: I would try to touch, tickle and then press on her toes or webbing between the toes with gradually increasing force. (The vet said to pinch and use fingernail to stimulate if necessary). There would be no response, no response, no response, and then a reflex plus a snarl and snap. After a few tries it did not go well. It was agitating her and although her biting was all "air snaps" of warning, I did not want her to progress to actually biting.
So I switched to the range of motion stretching. Unfortunately, I had set off her protective instincts and she did not want anyone messing with her legs or feet AT ALL. For the next day or so, she gave me the hairy eyeball whenever I came near her, though she still let me feed her and pick her up. I didn't dare try to touch her feet or legs for therapy, though.
I called the physical therapist at the practice who said that either we could muzzle her (which I am disinclined to do - my dog would feel victimized and helpless and she's got enough issues already. I don't want to ruin our relationship). She also said we could just stop the exercises that she objects to and they'll reassess next week.. Which is to say, 2 out of the 3 exercises overall are not being done right now. I am thinking of spoon feeding her canned food - a spoonful in exchange for a stretch, and see if that is enough to sweeten the deal for my dog and change her attitude.
So I'm a little discouraged here. We have another laser and p/t appointment scheduled for next week. A friend who is a vet has also recommended a physical therapist who she thinks is extraordinary. That lady is 1.5 hours away, and we can't make that trip on a regular basis, though. I'm thinking about calling her and asking if she thought she might be able to help with a limited number of visits to advise us on more tolerable exercises, though.
That's where we are now. On the bright side, we think the laser might have helped some.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Jul 25, 2014 13:47:50 GMT -7
It sounds like you are saying then the Pookie is not having a current disc episode that would cause pain, would cause nerve loss more than what she had.
I think finding another PT person would be a good idea if there is no current disc episode going on. She could show you a few things to do at home making the longer trips fewer...good idea!
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