Cassandra's Pumbaa 4/28 conserv; Grad 6/23

Cassandra - 
I'm not a mod, and I'm not a veterinarian qualified to offer medical advice - I'm just a fellow mini dachshund mom who has been there/done that and I understand the uncertainty and anxiety you are experiencing.  I wanted to just offer you some empathy and let you know that it's *very* easy to second-guess yourself when choosing conservative treatment.  It's easy to think you're doing the wrong thing - and the reason it is so easy to second guess is that you  don't see the immediate results with Conservative Treatment that many (not all) people see from surgery.  However, surgery is not the right answer for everyone.  With our dog, we went to see the surgeon to understand all our options.  Even though we aren't well-off, we went in fully prepared with a plan to finance the surgery.  However, in our case, because our dachshund was older and had other complexities, the surgeon *strongly* advised *against* surgery, even though she did think surgery would successfully fix the immediate issue. I was devastated and really thrown for a loop!  (She was right though - one of her concerns was that our dog was very, very likely to herniate another disc shortly after surgery and we'd be right back where we started after laying out $10-12K with an old dog who already had some significant health issues.  Sure enough, right on schedule, a few weeks after she would have had the surgery, while she was still on strict crate rest, she herniated another disc.  The surgeon was also concerned that at her age she wasn't going to handle the anesthesia and recovery well (she had had some issues with anesthesia during a dental procedure a year prior and that wasn't nearly as long a procedure).  So there were lots of good reasons, in our case, not to recommend surgery.  

I'm not suggesting that surgery is right or wrong for your dog - I don't know enough of the circumstances, presentation, health history, etc. to even venture a guess.  However, what I *do* know is that many, many dogs do really well with conservative treatment.  And even dogs who remain down dogs can do very well in the long-term.  These early days of crate rest are really hard.  They are a time of absolute uncertainty and difficult decision making.  Bear in mind that you are less than a week into your treatment plan.   Eight weeks (minimum) of strict crate rest is the gold standard of conservative treatment.  No laps, couches, beds, etc.  It's rough, but it has the best results.  The idea is to minimize movement as much as possible to allow time and space for the scar tissue to form around the damaged disc.  Meanwhile, because you are still very early in the diagnosis, if you are feeling uncertain about your decision, you certainly can explore your options, if it is a financially feasible option for you.

One of the most nerve-wracking things about choosing Conservative Treatment is that you just can't KNOW whether it would have been better to go another route because, well, you didn't go another route!  You can't simultaneously go two routes and know both outcomes and then choose one, right?  If only!  What I can tell you with absolute certainty is that you are making the right decision for your pup right now with the information and resources you have available to you.  There is no wrong decision here.  Whatever you do, as long as you are committed to doing it right, you've made the right decision for your pup. The important thing right now is that if you've committed to conservative treatment that you really commit to doing it and doing it right.  That means no matter how cute your pup is and no matter how big those puppy-dog-eyes get, you can't say "oh just this once you can sleep with me because it makes me sad to listen to you whimper in your crate and leave you all alone!"  Because *that* won't help your pup at all.  For some people, adjusting to not having their pup nearby is difficult, so they put their pup in a stroller/bassinet and keep their pup nearby all day/night.  This keeps them at a level they can see you/you can see them and keeps them confined with limited movement, but allows you to move them around from room to room without picking them up and putting them down.  You just wheel the stroller from room to room.  Or you can put a crate elevated and on wheels so your pup can always be with family.  No need to isolate your pup and make them feel lonely.  Crate rest is about love, not punishment!!  The book "Honey, Have you Squeezed the Dachshund?" is a terrific resource and it talks about setting up the "Taj MaCrate" - the very BEST crate experience you can create for your dog.  I love that, and it made me feel really good about crating my dog who was otherwise inexperienced with crates.  She hadn't been crated in the 11 years she'd been with her previous owner, so I had never crated her in the 2 years I had had her before she had her IVDD injury.  The first time I ever purchased a crate was AFTER my dog lost the use of her hindquarters!  But we absolutely turned it into the Taj MaCrate for her and I encourage you to do the same!  (I also encourage you to get the book "Honey, Have You Squeezed the Dachshund?" It's a terrifically accessible and informative book!  I make absolutely no commission on the book, but at this point I think I probably should - I spend so much time plugging that book!)

Did you make the wrong decision to go with Conservative Treatment?  NO!  Should you have explored surgery?  That's a choice only you can make - but it's certainly not too late to get a surgical consult if you want to know more. (But you don't have to!) But please know that you are doing the right things for your pup.  You are taking great care of your pup.  You love your doggo and your doggo loves you!  No one is judging you for going the conservative route vs. the surgical route.  Many, many, many people choose conservative treatment for their dogs and have successful recoveries!  


IF (and only iF!) you want to explore surgery as an option, seek out a neurologist/neurosurgeon/spine surgeon/orthopaedic surgeon (different hospitals will give different titles, but in my area, all three titles are veterinary specialists who will assess and perform surgery on dogs with IVDD).  Remember, getting  consult with a veterinary neurologist/surgeon does not obligate you to proceed with surgery.  All it does is open up some options for you.  Admittedly, it can also have the effect of muddying the waters also, but for us - it offered clarity.  Here are some things we considered while deciding what we would do:

1.  If we spoke with a surgeon, would we give serious consideration to surgery?  If not, no point in paying for the surgical consult.
2. If we were going to consider surgery, could we viably find a way to pay for it?  How?  Surgery right now in our area is running between $9-11K (realistically, it's closer to $10-12K, and that's for one disc and 3 days of hospitalization after surgery.  These numbers include the diagnostic MRI required for the surgery).  My initial response to $9K was "um, no, absolutely not, we do not have that kind of money ever, no way, no how, how would we ever do that? our credit isn't even that great, I'm not even sure we could get a loan for it, omg, how?"  I'm happy to give you details privately - but we did ultimately figure out how to finance this with a multi-layered approach, including some help from family and some creative financing, so that I was able to go to the neurologist knowing that if surgery needed to be on the table, money wasn't going to be the deciding factor that made us pull it off the table. (Just an aside - do you have pet insurance? I'm assuming not, but many people who DO have pet insurance assume that IVDD is excluded and it usually is not unless the injury occurred prior to the date the policy became effective - there's usually an exclusion period after first buying the policy - somewhere between 10-30 days, but as long as the injury occurs after the exclusion period, expenses related to IVDD are almost always covered minus the deductible.  It's rare that pet insurance covers the full cost of surgery (policies rarely cover more than $10,000 minus the deductible, and most people don't buy policies that cover that full amount anyway), but they can take a big chunk out of the expense.  Our dog was a senior dog with other health issues when we adopted her, so any meaningful pet insurance policy was prohibitively expensive (upwards of $300+ per month, whereas our 4 year old dachshund is $38/month for a $10K policy with a $500 deductible).  But i just wanted to mention it just in case you do have a policy that you were overlooking.  Ask the surgeon to provide a written estimate for any recommended treatment/surgery before you leave the consult.  Our surgeon emailed it to me before she even left the consult room.
3.  Does my dog have any contraindications for surgery, such as any medical conditions that would make the risks of anesthesia too great to risk having the MRI and surgery? If so, surgery isn't an option anyway.
4.  Is there any reason to suspect that these symptoms are being caused by something *other* than IVDD/disc herniation? (e.g. spinal tumour, bone fracture, other soft tissue damage, etc.).  In that case, is it worth getting an MRI, even if you aren't going to consider IVDD surgery?
5.  What is the name of the surgery that the surgeon anticipates performing? What does the surgeon anticipate will be the expected recovery time, likelihood of recovering mobility, and likely quality of life improvement after surgery?  Does the surgeon think your dog can have a reasonable quality of life without surgery?
6.  Does the surgeon even *recommend* surgery?  This seems like a no-brainer, but like I said, our surgeon actually talked us out of surgery.  A good surgeon will absolutely tell you when surgery just is not the right option.  If the surgeon doesn't think surgery is the best course of action now, what are their recommendations?
7.  IMPORTANT: Does the surgeon think surgery needs to happen RIGHT NOW, or can you keep trying the conservative treatment.  If conservative treatment is still okay for now, what should you be looking for to determine that it is time to change course?  Generally speaking, when a dog stops feeling "deep pain" (which only your surgeon can properly assess - it's not something you can assess at home - you need training to assess it), that's when surgery becomes more urgent in terms of how effective it is likely to be (surgeons will say that the longer you wait after deep pain is lost, the less likely you are to have a full function recovery from surgery - while this isn't a universal truth, it *is* one of the [many] guidelines they use to determine how emergent surgical intervention is).

I'm sorry for babbling a bit.  I hope some of this was helpful and I hope that you feel a bit better.  This is a slow and agonizing process sometimes, but you are doing the right thing for your beautiful dog.  This is the hardest part.  It WILL get easier.  Feel free to PM if you just need to vent or need some support.  I'm always happy to talk/be vented at.

Much love and support,
Karen Cohen
fellow dachshund mama

Thank you for your response to our original post. I cannot tell you how much I appreciate it and I've read it three times so far.

We are not sleeping. Pumbaa cries every night. He hate sleeping in his crate. I hate it for him. And he cries all.night.long. I love him, and I will do what it takes to try and fix him... but I just have to say: We are so tired, and tired leads to crankiness, and crankiness leads to not having patience with the grandchildren.

As my mother would say: "This, too, shall pass," and I know it will, only 6.5 weeks to go... or 10.5 if there is no progress is 8 weeks.

And Joe wants to talk to the neurosurgeon, because the acupuncturist says she doesn't know if it will make a difference. He just may never walk again.

You mentioned ideas on how to pay for the surgery, and I'm all ears. I don't know if surgery is the right option, my heart tells me it is not, but Joe, my husband, who is generally more emotional, is being very cerebral, currently, and wants to talk to a neurologist and consider surgery.

And isn't it too late for surgery? It's been 10 days since he went down, and longer since we first saw symptoms (a yelp here and there, a stumble a few times, slowed down walking, etc., has probably been closer to two and a half weeks).

I'm feeling like a horrible person, terrible dog mom, being so oblivious, obviously careless with him, or how would this have happened... but if surgery would help him walk again, or conservative treatment, and I just do not know what to do.

We tried tapering off prednisone but he was still in pain. We are giving him gabapentin and CBD, which seems to help the pain.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
11.3 lbs 5 y.o.
name of NAID that stops May 30
prednisone as of 4/28: 2.5mgs 2x/day for 10 days, 5/7 a test taper for: √DATE?pain / _neuro; date of final pred taper dose?
gabapentin 50 mgs 2x/day
Hindquarter weakness 2x/day
Pumbaa needs GI tract protector, Pepcid AC, on board for duration of prednisone! ]

He will NOT settle in the crate. He bounces and cries and barks, and the bouncing is constant.

We express him every 2-2.5 hours, except at night, where he will sleep until 4:00 am but ONLY on the bed. We created a small nest for him, and he stays in it until 4:00, where he’ll crawl out to wake us up.

He’s not resting enough in the crate because he won’t rest in the crate. We put it in another room, put a cover over it, put it on my desk, put it on my nightstand, he does the same thing no matter what, throws his body, bounces and barks and cries.

I do not know what else to do.