Kim's Poppy 5/11 conservative Cocker

Oh, my, your Poppy is surely a beauty, Kim! I have such a soft spot for Cockers. Two surgeries and three conservative care episodes? I'm so sorry Poppy's been through so much. I see that this one's mild, though, thank goodness. Does she still have any other neuro deficits besides the bladder control? Jeremy was really getting some good control of his feet and could turn around without his hips going over right before this disc episode. I'm nervous as to how he's going to be when his crate rest is over in three weeks. I do see some wobbly legs and knuckling is back but his legs are getting stronger and he does sometimes correct the knuckling.

How long does Poppy have left on crate rest? Jeremy has three weeks. This has been the longest summer ever! Jeremy is so active and this is rough on both of us. It wasn't so bad when it was sweltering hot and humid here in NJ the past month but now it's gorgeous out there and we're both miserable. We have so many parks and hiking trails around here and I know Jeremy would love a quick dip in the lake or at the beach. But it is what it is and I'm so grateful this episode wasn't as bad as the first one.

I've had people tell me that Jeremy must just have gotten lazy about peeing in the house and that he should have control back. I know he doesn't have control. He's very proud of the fact that he rings bells on the doorknob when he needs to go out. He just doesn't even know he's going. He's very ashamed when he has accidents. I've luckily gotten much better expressing him than I was at first so we manage OK.

Please keep in touch and let me know how Poppy's doing. So nice to meet you!

"This is the hard part! Poppy is super stoic. She doesn't show pain easily. After her two full ruptures, the only signs were a little shivering and ataxia, then paralysis. All 3 vets (regular DVM, neurosurgeon and rehab specialist think she's in pain though)."

Prednisolone and Tramadol given for two weeks with tapering dose starting 5/14/13
Clavamox 125 mg 2x day for Staph cultured UTI since July 18

Currently on Supple Spine 550 mg 1 tablet 2 x a day started 7/29/13 (from rehab vet)
Currently on Neurotrophin PMG given 1 table once daily (from rehab vet)
Wants me to start her on fish oil to help with inflammation

Poppy has had neuro deficits since her April 2012 T11-T12 laminectomy. She touched the top edges of her paws ever so slightly to the ground, like she was walking on her toes.


Since the May 11 incident she has been much wobblier, seems to have less traction on her feet, and has more balance problems. She shows delayed CP reflex in both hind legs. Reflexes are much worse on right side than left.

Yes, she does pee after sniffing, but cannot empty her bladder on her own. I express after she pees some, 4 times a day. She seems to have lost all sense of potty training. When she has to go, she will go. She started only by dribbling urine, but April 2013 she started making very small puddles. This aspect remains unchanged since her April 2012 surgery. Rehab vet feels she has sphincter control, but bladder itself may have improper neural infiltration in her bladder. The Neurotrophin is supposed to help the nerves.

Eats normally, drinks normally

Poops normal. She pooped in her sleep for a year post surgery April 2012, but since switching to a raw diet (Nature's Variety frozen medallions), she's stopped doing this. Squats normally to defecate and vets indicate good anal tone.


OK - here's the situation. Poppy's regular vet saw her for a UTI July 18. He indicated she's had some muscle atrophy in hind legs since he last saw her May 13. This is to be expected because of the crate rest. We agreed to take Poppy to a vet who specializes in rehabilitation.

Saw

Hi Kim!

Glad you have unlurked and welcome you officially to Dodgerslist!  Poppy is so handsome!  

Conservatively treated dogs follow a plan of 8 weeks of quiet and rest to allow the disc to fully heal. Dogs on conservative treatment are limited only to a few minimal footsteps at potty time, so the hydrotherapy should wait until 8 weeks of crate rest has been completed.  Laser therapy and or Acupuncture are  fine to do during conservative treatment..Just don't do anything that creates movement of the back and spine or the disc could herniate which means more pain for Poppy and more vet bills.. 

Conservative Treatment Is not invasive, avoids surgical risks; no guarantees of return of neuro functions. Good prognosis with mild symptoms and even those with deep pain sensation still intact may be able recover nerve function.

Depends on an anti-inflammatory to reduce swelling in the spinal cord. Some dogs can get the swelling down in a couple of weeks others need a steroid for more like a month. Glucocorticoids are synthetic versions of the body's naturally occurring steroid, cortisol. Steroids are basically the most powerful anti-inflammatories when dealing with IVDD. Most often used when there has been loss of neuro functions (i.e. legs, bladder control)

NSAIDs (non-steroid anti-inflammatories) are also used most often when neuro functions are intact and there is pain only.

Depends on owners commitment to time of 8 weeks of little movement to allow the disc itself to heal and form good scar tissue, waiting til after crate rest for any active PT rehabilitation. Nerves are the slowest part of the body to heal. Nerves can take weeks, months or even a year+ to regrow and return function.

Acupuncture or laser light therapy helps to relieve pain and stimulate nerves to heal, it can be started at any time.

Medications can be as low as $4 for each prescription with generic programs at Walmart, Target and local grocery store pharmacies.  There are other diseases that can mimic a disc problem, your vet will rule those out with appropriate tests.

Is this a new disc episode, Kim? From what I can tell from your posting, she had surgery in April, 2012 and then a milder episode on May 11, 2013 for which she's been on crate rest and has completed. Now, on July 29, 2013, the doctor says she has compression from a bulging disc. Is that all correct or am I misreading?

If this is a new disc episode, she needs crate rest again, not rehab.

Hi Kim,

If Poppy is showing symptoms of having a bulging disc/ pain, it's a signal that all is not well  and  if  he isn't crated he could rupture that disc.. Rehab is a wonderful thing at the proper time..after crate rest.  

Metacam without Pepcid AC (Famotidine) 30 minutes before is taking a real gamble. Giving  Metacam with food is correct though.  We follow Vets that are proactive in preventing stomach ulcers BEFORE they happen instead of treating an ulcer or stomach bleed after it happens.A Disc episode is more than enough to deal with..  Prevention is the better of the two options.  The Neurologist at Purdue University Vet teaching Hospital; where we took Tyler said IVDD dogs are predisposed to stomach acid problems and she sent Tyler home with Pepcid AC as part of his prescriptions..They are teaching the next generation of Veterinarians and are up on all the latest treatments.

The other problem is a dog on Metacam may start to feel a lot better and overdo and that is why not to allow a dog on medication to be out of the crate...

"Patients with intervertebral disk disease will have varying degrees of disability. Rehabilitation protocols must be individually tailored to meet patient's needs during the recovery process. These protocols should be designed by a veterinarian certified in veterinary rehabilitation. If your dog is showing signs of IVDD, it is not recommended to start a rehabilitation program without first having a full neurological evaluation." Written for Dodgerslist by Dr. Michael Wolf, DVM, Dr. Med. Vet. Diplomate ACVIM (Neurology), CCRT

Kim it depends on what the thought is about what is causing the pain in the lumbar area. IF is it arthritis for example, then walking about is a good thing and there is not much worry about overdoing things other than maybe some sore muscles.  However, if there is any suspicion or hint the tenderness is due to a disc, then 100% STRICT crate rest 24/7 only out to potty is necessary to prevent worsening of the tiny disc tear. Take a look at this video on what happens with mild disc symptoms of pain only and the dog is allowed to move.

If there is the slightest suspicion of a disc problem and the dog is on Metacam…that would be dangerous. The dog will feel better and be inclined to overdo…that is the reason for crate rest when on meds and doing conservative treatment….. to protect the disc from further tearing and the spinal cord from nerve damage.

We are not vets so we do can't diagnose or prescribe meds.  All that is dependent on your finding a vet who knows IVDD and asking many questions to your satisfaction.  This quote is especially true for owners of IVDD dogs:  "Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain!"Dr. Nancy Kay, DVM, ACVIM  www.speakingforspot.com/PDF/Medical%20Advocacy%20101.pdf

Maybe I need to get her an MRI just so I know if its disc related or not. I cannot afford to do a 3rd surgery on her, but at least I'd know if the disc has healed enough from the 2 1/2 months of crate rest she has gotten, or if she needs to do more 24/7 crate rest. What do you guys think?

I'm a registered veterinary technician and have done extensive reading on IVDD. I am tied up in knots with wondering what to do! I'm definitely a person who asks questions and I do feel comfortable questioning the dr, but his reasons for wanting her to sit and stand and this point are reasonable and understandable. He wants the muscles to get stronger to help support the back.

When I touch her back, she seems perfectly comfortable. I can't get any symptom of pain from her. She is so stoic it makes diagnosis very difficult. The rehab specialist felt she MAY be in pain because when he did the neuro exam, her skin rippled when he used the hemostats to pinch her skin on the side of the upper lumbar area. He also used his fingers to feel that area of the spine.

The rehab specialist has treated many IVDD dogs, that's what he specializes in, so I'm so confused as to whether or not I need to take her to the neurologist again. An MRI here in Orange County (so cal) is about $1200 to $1500. I don't know what to do.

I have had her in strict crate rest again, just because I know that won't hurt her, until I make the decision of what to do - MRI and consult with the neuro or follow the instruction of the rehab specialist and do modified crate rest with mild exercises and swimming.

Very interesting video Paula. Thanks for posting that. I hadn't seen that one before. To clarify, Poppy is not crossing when she walks or knuckling. You can see that walking isn't 100% normal because of nerve damage from her April 2012 rupture and surgery. I was mistakenly calling the walking on slight tip toes, knuckling, which I'm learning now from the video that it isn't. She clearly has some nerve damage.

I can't get an appt with the neurologist until next Tues so I will continue crate rest until then. Thank you ladies for your help. I really appreciate it.

Poppy had laser treatment this morning [8/2] at the rehabilitation vet specialist's office and after examining her, he feels that she's getting stronger, so evidently the meds and rest are working! Just wanted to let you all know.

I have been looking into the peanut or the egg shaped rehab ball too - highly recommended by our accupuncture Vet. I am gong to get my husband to build me a balance board too - just a board with half a little wooden ball nailed under it so that it wobbles a bit - the bigger the ball the bigger the wobble - so we will start with a marble sized ball.

Kim, so then the diagnosis was that the July observation of pain was not due to another disc episode, but rather arthritis, or muscle soreness which does not require crate rest but for which Metacam was prescribed? We need to change the subject line then.

Is she on any medications as of today?

So has anyone had success using the FitPaws balance discs, Donut, Peanut or wobble boards? Anyone have an easy way of making Cavaletti rails. The FitPaws one is almost $200 so I thought I'd ask in case someone has a suggestion. Poppy is 23 lbs, 18 inches from front paws to back paws and 14 inches at the withers, so I thought maybe the blue size Peanut would be ideal for her. Anyone have any thoughts?