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Post by Joanne & Trixie on Jun 14, 2020 6:47:36 GMT -7
Thank you for accepting us. Trixie we noticed just wasn’t herself. We noticed shecwas Trembling and shaking frequently. Not jumping onto furniture eg beds, lounges - whimpered to be picked up onto bed. Then my daughter and I noticed her legs splay at times, if she tried to move quickly. We had been going on lots of walks during lockdown but one day she refused to go on a walk. Then we discussed how she is slower on a walk, never wants to run or sprint or pull. No longer playing with toys or fetch and was not keen with opening the dog door at times So I took her to our VET who did emergency blood tests which were clear. The Vet did another exam and realised she’d missed Trixie’s paws not flipping back. She suggested rest in a crate and see her in 10 days. But no change so we were referred to the specialist vet who examined her and we had the MIR. ★1 4 Kg/ 8.82 lbs 7 y.o Codeine 30 mg - 1/4 tab twice per day Meloxicam 0.2 ml once a day [Moderator's Note. Please do not edit
4 Kg/ 8.82 lbs 7 y.o.
Meloxicam as of May 22: 0.2 ml 1x/day
6/5? or 6/10? family vet: paw knuckling
6/12 MRI, specialist recommends surgery
Codeine 7.5mgs 2x/day
needs GI tract protector, Pepcid AC, on board w/Meloxicam! ]★2 What breed? Mini Fox Terrior What is your dog’s name? Trixie Your name, too? Joanne ★3 diagnosis of IVDD? Yes 1. Generalised intervertebral disc disease, with multiple slight protrusions. 2. Compressive intervertebral disc protrusion T13/L1, central and left. Small Animal Specialist Surgeon MvDr FACVSc ★4 Local VET 22 May In crate since 23 May for rest Carried to toilet outside Returned to VET Friday 5 June No change or improvement, walking wobblier Appointment 11 June with Specialist Vet MIR - 12 JuneSurgery booked 18 June★5 Is there still currently pain - meds seem to be assisting with pain ★6 Eating and drinking OK? Yes but not drinking water so I add extra water to her meals Poops OK - yes ★7 Yes wobbly walks and wags her tail  ★8 bladder control - Yes |
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Post by Ann Brittain on Jun 14, 2020 7:14:10 GMT -7
Welcome to Dodgerslist, Joanne
Thanks for the information about Trixie's IVDD diagnosis.
Was Trixie tested for signs of deep pain? And if so, what were the results?
Did the vet discuss conservative treatment (crate rest) for 8 weeks? Trixie has been on crate rest for approx. 3 weeks. Did something happen to change the treatment from conservative to surgery? I ask because normally when a dog is still able to walk, even wobbly walking and tail wagging, crate rest and meds are usually recommended to reduce inflammation and give your dog time to heal for a longer period of time
If surgery is recommended, it is usually scheduled as soon as possible to avoid further damage to the spine and to give your dog the best chance of recovery. I'm also curious about the delay until June 18.
It would also be helpful to know how Trixie's symptoms appeared. Did she go down suddenly? Or gradually start to show symptoms of pain and loss of function. Has she had any previous issues with IVDD?
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jun 14, 2020 13:45:27 GMT -7
Joanne, I would also like some clarity in the sequence of events, if you would. Subject line said 6/8 surgery. I appears that she has not yet had surgery, but one is schedule for June 18. Please confirm if she is still on conservative treatment of meds and strict rest and has not yet had a surgery.  As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. May 22 Pain caused by the tearing disc & inflammation in the spinal cord 2. May 22 Wobbly walking, legs cross/splay 3. Nails/toes scuffing floor 4. June 5 Paws knuckle under, paw doesn't or is slow to flip back properly on the ground. June 5: increased wobblyiness
5. Weak/little leg movement, can't move up into a stand 6. Legs do not work at all (paralysis, dog is down) 7. Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. Tail wagging with joy is lost 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. Of great value to you for a quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservativeDECOMPRESSION OF THE SPINAL CORD Surgery immediately removes the offending disc material and the pressure on the spinal cord. Conservative 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 (e.g. generic: prednisone, dexamethasone, etc.) 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 (e.g. Rimadyl® (carprofen), Metacam® (meloxicam), etc.) TIME Surgery. Neuro (ACVIM) or ortho (ACVS) surgeons find a window of not more than 12-24 hrs from loss of deep pain sensation (DPS) gives the best chance of spinal cord decompression aiding the body to self heal nerves.The more hours that pass after 24 hours it is thought the less chance for nerve recovery for the surgical risk. Because offending disc material has been removed PT can be started as soon as the surgeon directs during 4-6 weeks of post-op crate rest. Trust only a board certified surgeon about existing DPS. Identify easily a happy tail wag which is the next expected neuro function to return. Conservative treatment 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. GUARANTEE AND RISK Surgery is an invasive treatment with trauma to the body and includes surgical-associated risks; no guarantees of return of neuro functions. Conservative is not invasive, avoids surgical risks; no guarantees of return of neuro functions. Joanne, make good decisions for your dog based on the best information and understanding you have at the time Neuro Surgeon Dr. Isaacs, DVM, ACVIM (Neurology) wrote for the Dogerslist IVDD community: The decision to pursue surgery depends on multiple variables. Any dog can be managed medically. However, typically the decision to treat medically versus surgically is dependent upon the risk:benefit ratio. If the same outcome can be obtained medically versus surgically then it is wise to treat medically. On the other hand, if there is a better outcome associated with surgery versus medical management, surgery warrants consideration. Again, this does not mean that medical management can not be pursued, it just may not be ideal. In general, situations where surgery warrants strong consideration include dogs that have lost motor function (plegic) and have questionable to no deep pain sensation. Full article: www.dodgerslist.com/literature/surgery.htm |
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Post by Joanne & Trixie on Jun 16, 2020 6:06:42 GMT -7
Hello, Thank you for your response. As there had been no improvement with crate rest and her hind legs had got weaker the Specialist VET recommended we commence surgery. The surgery was booked into his first availability which is on the 18 June. Though, if she shows any sign of going down on her legs we are to immediately go to their emergency for immediate surgery.
The initial Consultation with specialist was 11 June
Grade 2 myelopathy, paraparesis worse on the right side ddx: IVD extrusion, neoplasia
BAR, wagging her tail but extremely anxious. MMs pink, HR 100/min regular
RR 24/min
Hind limbs ataxia
No panniculus reflex
Forelimbs normal
Marked painful response to right hind limb extension No overt painful response to T-L spine palpation Withdrawal reflexes present normal
The MRI findings: 12 June
MRI Examination Region: Spine, Indication / Reason:
1. Three weeks history of hind limbs ataxia and back pain. Initially noted change in willingness to go out for walk, willingness to jump. Was hiding in her bed. Progressed to unsteady on her hind limbs.
More comfortable now, wagging her tail but still unsteady on both hind limbs.
Initially treated with Meloxicam, now receiving Codeine.
Examination:
T2W sagittal FSE T1W sagittal
T2W sagittal STIR T2W transverse T1W transverse T2W GRE
T1W post-contrast sagittal
T1W post-contrast FS transverse.
Findings:
Generalised reduced T2w nucleus pulposus signal of the intervertebral discs. The patient has 7 lumbar vertebrae and paired ribs on T13.
Bulging of the annulus fibrosus at numerous sites, including:
T12/13, slight protrusion, central, with slight compression and only attenuation of the ventral extradural fat.
T13/L1, moderate prtrusion, central and left, with moderate compression. There is spinal cord displacment and attenuation of the extradural fat
L1/2, slight protrusion with no spinal cord compression
L2/3, slight protrusion with attenuation of the ventral extradural fat only.
L4/5, slight protrusion, central and left, with very slight spinal cord compression.
L7/S1, slight protrusion, with very subtle cauda equina compression/displacement, without narrowing of the neural formaina.
Conclusions:
1. Generalised intervertebral disc disease, with multiple slight protrusions. 2. Compressive intervertebral disc protrusion T13/L1, central and left.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jun 16, 2020 9:13:58 GMT -7
Joanne, please do let us know when you've heard back from the surgeon on the June 18 surgery- how Trixie is doing. We'll be thinking of you and Trixie with best wishes for a good surgery.
How old is Trixie?
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Post by Joanne & Trixie on Jun 16, 2020 23:35:40 GMT -7
Thank you Paula. Trixie is 6 years old and will turn 7 in July.
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Post by Joanne & Trixie on Jun 18, 2020 5:54:42 GMT -7
[SURGERY June 18]
Trixie Surgery Update: I spoke to the Vet specialist at SASH late this afternoon .....and.........Trixie is wagging her tail! This is a really good sign he explained so early after spinal surgery. She also was moving her legs and tried to roll over in the cage too late today. They didn’t try to get her to stand though as it is too early and they want to ensure they are managing her pain relief well he said.
All the VET nurses are caring for her so well and have nicknamed her Tiny Trixie.
The disc that was removed was the size of a large pea - which the vet reported was very large to be squished into the spinal cord. Especially in a tiny ▼3.7kg doggie.
[Moderator's Note. Please do not edit
▼3.7kg/ ▼8.16 lbs 7 y.o.
Meloxicam as of May 22: 0.2 ml 1x/day
6/5? or 6/10? family vet: paw knuckling
6/12 MRI, specialist recommends surgery
6/18 surgery - moving legs!]
When we dropped her off this morning we found she has lost more weight even though I have been hand feeding her extra cooked chicken this week.I will call mid-morning and was advised I might even get to visit her tomorrow afternoon!
Thank you everyone for your care and concern. Your support has been very much appreciated by us all. Trying to sort out a recovery suite now, the Small Animal Specialist Hospital suggest a playpen rather than a crate. So I will go and see what I can find. Also a colleague suggested i buy a red light bulb to shine on her back to promote healing. Not sure what to transport her home in - a crate ? I worry the handling of putting her in an out if she can’t walk will hurt her. Maybe I am overthinking it but I don’t want to undo anything.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jun 18, 2020 7:11:55 GMT -7
Joanne, really appreciate your sharing with an update on the surgery today! Being able to move legs is really great post-op. The surgery itself causes a lot of swelling and some temporary setback in neuro functions. So being able to do a happy wag and move her legs is good. As my surgeon told me they are not a china doll post op. Just pick her up as you normally do by supporting both ends and keeping the back horizontal to the ground. The hospital will have transitioned her to oral pain meds and monitoring that they do the job before discharging her. So you ought to be able to care for her without causing any pain due to the proper combo of pain meds being on board. Start a list of questions now so on discharge day you get an answer for each of your concerns: Here's a starter list of questions to which you can add some of your concerns to ask your surgeon: www.dodgerslist.com/literature/dischargequestions.htm This page is good reading by Dr. Isaacs, ACVIM (neurology) as he explains many post-op questions for our IVDD community: meds, crate rest, PT and discharge day. www.dodgerslist.com/literature/surgery.htm See if there are any other things you can do to make post-op crate rest go smoother with these very useful tips and ideas: www.dodgerslist.com/literature/cratesupplies.htmFor transport you may find a pet carrier with mesh sides & top to see out of OR a wire crate that opens from the top the easiest to use. That recovery suite should allow her to easily turn around in and stretch out her legs when lying down. The idea is that post-op Trixie is safe in a recovery suite so she can't dart off, jump up or down during the car trip. 
Look forward to your next update when you know more from the surgeon. |
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Post by Joanne & Trixie on Jun 19, 2020 0:05:42 GMT -7
I spoke to the Resident VET this morning who was really pleased with her progress. She had slept and rested well, had done a big wee over night. Also, her bladder was empty when he checked that morning so she did not need to be expressed. She was still a bit anxious so he recommended that we visit. So my eldest daughter and I were able to visit Trixie today at SASH. She is in the Special Care Unit in the quiet section with a 24 hour Vet nurse looking after her. She has eaten some cooked tuna and then chicken that I brought in plus she even stood up on her little legs to take a few steps. She is doing brilliantly ❤️❤️❤️ The Vet was in surgery but Tegan the nurse explained she is on a ‘cocktail’ of strong drugs. It was so wonderful to give her a cuddle for a short time.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jun 19, 2020 6:40:04 GMT -7
Joanne, your visits with Trixie are surely the highlight of her day and very spirit lifting. Great news she no longer needs expressing! When the cocktail of meds is transitioned over to oral ones, Trixie should be able to be discharged to home. Thanks again for sharing the update.
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