PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Nov 2, 2022 10:44:01 GMT -7
Welcome Sally, we are glad you joined us. Have you called the neuro back to let him know Splash is still in pain. You are his eyes and ears to let the neuro know meds need adjusting to get it just right for Splash. Thank you for providing a wealth of information. There are still some things that are hard to follow. Do you have a written report from the Neuro you could upload for us to read? That would help alot. Depo-Medrol was given as a shot? Dosed only on 1/29? No continued steroid pills (prednisone or ??) for at home? On 10/29 was Splash showing any neuro diminishment such as: knuckling under back paw(s)? Paws scuffing the floor? Wobbly walking? Conservative treatment for a large breed dog, often requires thinking outside of the box to carry out very limited movement of the back especially at potty time. Check out these care tips for a dog that is too heavy to safely carry to and from the potty place + many more ideas for at home care: dodgerslist.com/2022/02/10/large-dog-care-tips-ivdd/Let us know you are on the same page about just how strict the rest is. The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. STRICT rest means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy WHYs: dodgerslist.com/2020/04/22/chiropractic/ ◼︎no meandering at potty times. Very few minimal "footsteps" only to take care of business. ◼︎no PT for conservative dogs during 8 weeks to heal disc Transports are always a risk to the disc of too much movement to the early healing disc. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment. Vets who know IVDD will take phone updates and adjust meds over the phone especially for large breeds difficult to keep to limited movement during transports. Knowledge is key! Owner understanding ensures proper conservative treatment principals: ▶︎ 4 phases of healing, what it takes to heal each phase: dodgerslist.com/healing-the-disc/ ▶︎ Roadmap for your fridge. Stay the course, avoid dangerous detours for the healing disc: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf ▶︎ Super tried and true tips for setting up the recovery suite, the mattress and more! dodgerslist.com/2020/05/14/strict-rest-recovery-processLook forward to learning more about Splash with your answers and what meds have been adjusted (names, mgs, frequency) to provide full relief from pain round the clock. Is there an area of concern we can zero in on to assist? How did you find the Forum? a friend, a vet, Googling? |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Nov 3, 2022 17:41:21 GMT -7
Sally, the documents are not legible. You can email them to me. Splash has certainly been through a lot With the diagnosis of a disc episode and pursuing conservative treatment, the focus is on getting the disc to heal. With a large dog the concern is the ability to transport with minimal movement of the back. Not easy with a heavy dog. Just trying to think outside the box on how to reduce appt trips and to keep limited movement for Splash. Discuss with the neuro if steroid pills for at home use could avoid a risky car transport for Splash's early healing disc. Which way are you using to limit to minimal footsteps at potty time? With our small dogs you can see how serious we are when there is an absolute urgent vet visit needed during a disc episode to limit movement to the back and limit to very few footsteps. How are you handling with large size Splash? |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Nov 4, 2022 10:32:42 GMT -7
Sally, providing the CT scan document and the Neuro's report shed an abundance of information that changes the picture. Thank you for sharing this important information. Noted and renowned, Dr. Clemmons, DVM, Neurology and Neurosurgery (ACVIM) has provided a textbook clear explanation of Splash's specific type of IVDD more usual in the large breed animal like Splash. Dr. Clemmons explains the reason for steroid Depo Medrol in the LS space between the vertebral bones to see if Splash can be normal for extended time. Depo Medrol is a long lasting steroid. The Lumbar (L1-7) and sacrum (S1-3) spaces are located lower in the back up to the start of the tail. The "caudal equine" area is L6 & L7 through S3.  These are the things that stood out for me in Dr. Clemmons 10/30/22 report (Sally, view the full documents in your above post). It appears, it is NOT a damaged disc that needs time to heal but more a vertebral bone issue and bone spurs/osteophytes. A damaged disc would need limited movement to heal. The "worst" L2-3 Aug 21 bulging disc would have healed by Oct 16 and now is time to see if the nerves can learn to live with its aggravation and help with meds to do so. With a vertebral BONE issue, rest will not change this problem. Spondylosis is a general term for age-related wear and tear affecting the spinal discs. With normal aging process discs dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs/osteophytes).  Also to note, there are two kinds of IVDD:
Hansen I (Type 1) is a disease prevalent for small breed, short legged dogs. It is a prematurely aging disc starting at age one!
Hansen II (Type 2) is seen in large breed dogs. It is the normal slow aging process for intervertebral discs (IVD). Instead of an disc material escaping from the center of the disc as Hansen I does to severely compress the cord, there is a bulging and protrusion of the outer part of the disc wall with Hansen II.
Next time you have an appt with Dr. Clemmons, you will be able to clarify things based on your better knowledge of Splash's condition and re-reading Clemmons report. ----------------------------- Of note from Dr. Clemmons 10/30/22 report: CT findings: There is more of that [spondylosis] in the LS region where there is also a dorsal protrusion of the L7-S1 IVD which may contribute to the clinical signs and does not appear to be compressing the spinal nerves. the L2-3 appears to cause spinal cord deviation and may be the worst. Radiographic Interpretation: Spondylosis deforming, IVDD multiple (L2, L6, L7) Diagnosis: IVDD Lumbar multiple
Discussion and Recommendations:Splash does appear to have IVDD; however, there are multiple sites of involvement. As such, we did inject Depo Medral at the LS epidural space to see if this help with the clinical signs. If it does, then we may need to repeat this to see if the effects are long lasting and allow Splash to be normal for an extended period. Lumbosacral Stenosis: ...not uncommon to see the condition in large breeds of dogs. Disease of the low lumbar spine has a pronounced effect in that several nerves controlling locomotion, fecal and urinary continence and sensation to the hind quarters can be involved simultaneously or individually. Therefore, the syndrome of caudal equine compression can result in diverse symptoms and is often difficult to diagnose. Causes of Compression: Attenuation of the caudal equine may have several causes. Neoplasia infection (discospondylitis) acute disk extrusion, spondylosis, trauma or congenital spinal stenosis are among the lesions that may attentuate the caudal equine and may cause neurologic dysfunction. Diagnosis of Compression: ...with stenosis of the caudal equine usually exhibit intermittent lameness, feel or urinary incontinuence, or paresthesias and dysesthesias, such as evidence by tail biting, leg biting, genital licking, conscious proprioception deficits, and motor weakness. Lumbosacral pain. The lameness is usually related to dysfunction of the nerve roots comprising the sciatic nerve. Paresthesias are unpleasant sensory disturbances that often manifest as referred pain (lameness) or in various forms of self-mutilation of the tail, leg or extremity. The caudal equine is unique because large number of nerve roots are contained in a small area (L6 through S3). A single lesion can involve several nerves and may result in one or all of the aforementioned signs. The presenting symptom are often bizarre and mimic other problems, such as orthopedic disorder anal sacculitis, and tail-head dermatitis. In order to arrive at a correct diagnosis, a general examination of the entire animal and an orthopedic examination of the hind limbs should be performed first. ----------------------------- So in conclusion, you should follow Dr. Clemmons care for Splash's Hansen II type of disc, the bony spurs, the Depo Medrol injections and slow movement. The Assisi Loop may be something to investigate for Splash to help with pain now and from time to time in the future as an adjunct to help her lead a comfortable life. As for Tui-Na, I do not have knowledge about it. You might see what Dr. Clemmons says such as where or where not to apply this kind of massage in Splash's case. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Nov 4, 2022 10:56:26 GMT -7
Rest is not so important with her Hansen's II. Go to the appt with Splash. Depo Medrol IS the treatment for which Clemmons hopes to see success. Do the Depo Medrol. ALL movement should be slow and easy. Even taking those steps. Is there a ramp for the steps you can add. Use these ideas to help Splash with slick floors: dodgerslist.com/2022/10/08/traction-solution-improvementsWhen you are not with Splash to oversee she is slowly moving, then back in crate. You can further confirm exactly what crate rest should be for Splash. Let us know, too. With a suspicion of a Aug 21 disc episode, then graduation day would have long passed by. Confirm with Dr. Clemmons if Splash can now be very gradually introduced to famly life and physical activity over the course of a couple of months. Or if while under his care with Depo Medrol he wants some restrictions and what exactly that entails. If Splash is confirmed to have graduated, then we have LOTs of ideas for that slow and gradual conditioning and getting back to enjoying life with the aid of modern medicines if needed for comfort in enjoying life. |
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