Ken's Fergie 9/16 IVDD or FCE; Boxer/Pit

Hi and welcome to the Forum.  My name is Paula, what's yours?

The Forum depends on the diagnosis from a vet.  However with yours of FCE you may be interested in the comment from a neuro Dodgerslist works with when we wanted clarification about crate rest for FCE.
Strategies to help make crate rest go smoother with lots of tips and ideas from members:  dodgerslist.com/2020/05/14/strict-rest-recovery-process/


Fibro-cartilaginous embolism (FCE) is similar to a “stroke” in the brain

    -FCE is not generally painful where as IVDD is.
(Bagley: normally not progressive and is not painful; however, a small percentage of animals can have spinal pain Often the clinical signs are asymmetric. This disease is rare in chondrodystrophoid dogs.)
    -FCE shows no disc compression on an MRI, IVDD shows disc compression.
    -FCE the first 24 hrs the maximum damage is done, where as IVDD damage can be a progressive thing over days.
    - IF one sided neuro diminishment (with front &/or back legs), suspect FCE over IVDD

Please let us know what your own vet says & if proceed to a neuro consult, what the neuro says.

It sounds as though the ER vet "suspected" FCE but a firm diagnosis hasn't been given yet nor has advanced imaging been done to rule out IVDD. Therefore, "will keep her quiet" isn't enough. Strict crate rest should be done until you have received a definitive diagnosis. And please, no PROM until off of all meds. If there is any swelling pressing on the nerves of the spine which haven't been addressed by the meds yet, you don't want to do PROM if this is IVDD. Of course, this depends on what diagnosis is given in the days ahead and what recommendations are made.

Super tried and true tips for setting up the recovery suite, the mattress and more! —> www.dodgerslist.com/2020/05/14/strict-rest-recovery-process/

STRICT means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy whys: dodgerslist.com/2020/04/22/chiropractic/ ◼︎no dragging or meandering at potty times. ◼︎no PT for conservative dogs during 8 weeks to heal disc ◼︎At home laser or acupuncture for severe neuro damage is best. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment.

Of course, getting a definitive diagnosis is a reason to risk transport. Secure a crate in your car and pad out any extra space with rolled up towels/blankets so her body will not shift during breaking or cornering. Ask the vet for help getting her into the office as she shouldn't try to walk in and out.

Movement is what disrupts the scar tissue trying to form. If the disc tears then very likely neuro functions will worsen as the disc pressures the spinal cord. So your focus during the 8 weeks of restricted movement is to do everything possible to limit movement of the back to avoid loss of leg and bladder function, to avoid a surgery. No walks, only a very, very few footsteps to get the job done. You have more of a challenge than we do with our little dogs we can carry to see best how you can limit her footsteps The restricted area should be only enough to stand up, turn around and when lying down fully stretch out the legs. If she'll go on a pee pad inside, that might be helpful as you could just place the pee pad right outside of the crate door. Caster wheels can be purchased and put on wire crates so the crate can be wheeled outside. Do what it takes to limit the footsteps to potty. Keep the recovery suite by the exit door. Make a ramp over steps.

If you do not have a deck off a sliding door, then consider this idea. Obtain an ex-pen to use at potty times where you would enlarge the very small recovery suite area just a bit. Lay down a pee pad WITH the addition of urine from another dog or from Fergie on top. Always save a used piece of pee pad in a ziplock bag to use at potty time. Fergie can learn it is ok with you to pee on the pee pad, be sure to use the command go potty and when she does give lavish praise.

Yes, we do know of dogs going through an IVDD episode but exhibit no pain. Not having pain does not rule out IVDD. You had mentioned Chronic Type II IVDD in your first post. That type of IVDD usually does not exhibit pain, but it also usually happens very slowly over a period of weeks or even months where neuro function slowly worsens.

Pepcid AC should be given 30 minutes before the NSAID and then every 12 hours thereafter for as long as Fergie is on the NSAID. I'm not familiar with the relationship between Pepcid AC and a raw diet but as with any medication, you should always run it past your vet before starting. There may be medical issues that would affect a decision to give Pepcid AC.

Please keep us updated on what the vet(s) say. Healing prayers for Fergie.

Hi Ken! The trick to encouraging a poop w/o walking around and just limited to a very, very few footsteps:
    1. Command "go poop" when you see sniffing, hunching or other signs of near pooping. When she does poop praise her. Soon she will learn to sort poop on command.
    2. Create a visual as well as a physical potty area as described in the link Marjorie and I sent. To be specific:
    Carry to and from the recovery suite to the potty place and then allow a very few limited footsteps.  Tips for the large breed dog in carrying + more:   dodgerslist.com/2022/02/10/large-dog-care-tips-ivdd/

    No other dogs should be outdoor at the same time Fergi has potty time.
Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep Fergie’s back aligned and butt from tipping over.
    A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot.
    An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on!



MONITORING NEURO FUNCTIONS for a disc episode
As damage to the spinal cord increases, there can be a predictable stepwise deterioration of functions if excessive back/neck movement for example.
1. √ 9/16 Pain with initial tear of disc and ensuing swelling
2. √ 9/16 Wobbly walking
    √ 9/16  legs cross
3. √ 9/16  Nails/toes scuffing floor
4. √ 9/16 both rear Paws knuckle under.    
       ?      Dog is slow to correct or ____ can't right the paw(s) at all
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 general vet who gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS.
A quick overview of conservative treatment vs. a surgery:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

Mostly dogs are expected to be painful and are, indeed, quite painful with a disc episode, hence the reason for pain meds.
    However, there can be reasons why there does not seem to be any suffering with pain for some few dogs. Here are a couple of examples.
1) Linda Stowe the owner of Dodgerslist had a dog who did not show any pain except the initial yelp of tearing the disc.  "she did go down and was dragging both back legs and showed no pain except with the initial injury she yelped in pain.   She still had bowel/bladder control and definitely had deep pain.

2) A registered neuro vet tech explained: "An acute rupture has been known to be painful initially, but usually on exam, they are past that point.  These are the dogs that yelp when they rupture.  They can be very painful at that moment, but they usually begin feeling numb shortly after."

Until you have a firm diagnosis this is not a disc episode for Fergie but some other disease, make sure you are doing STRICT rest to prevent movement of the back and the neck. 

Thank you for all of this information, Paula. We returned from the vet who sent out a referral for a neuro. The vet pinched her toes and the skin next to her spine and Fergie showed appropriate responses, but when the vet crossed her legs, she was slow to correct. The same with the knuckling tests. The vet didn't give a diagnosis and agreed that Fergie should be on cage rest until she sees a neuro, even if FCE might be possible.

If this is IVDD and Fergie's not exhibiting signs of pain, should bed rest also be 6-8 wk long? And then physical therapy afterward?

Fergie would be a stage 2 or 3. How long does it usually take for her to neurological deflects to improve? 

Thank you. 

Thank you for the reply, Marjorie. I am keeping Fergie's potty breaks short. Her front right limps and her hinds are weak so I'm pretty much in full control holding up a harness in the front and a sling for the back. I am supporting most of her weight so she's just moving her legs without the extra weight. Do you think that's fine?  Sometimes she stands still unless I move her to another spot until she starts sniffing and hopefully pee and poop.  

The vets and I are stumped as to why her front right is lame. The ER vet thinks it's arthritic based on the fact that she bobs her head up and down as she limped. She does have a thickened elbow which suggests orthopedic disease. Is there a way to differentiate orthopedic / neurological for her front leg? If it's neurological, it's indicative of a cervical injury, is that correct? 

There's also the possibility of a spine tumor or degenerative myelopathy. Spine tumor is rare and DM usually progresses gradually, but I was told cases vary. I still have to wait until Monday [9/25] to hear back from the neurologist and hope that we could get an appointment soon.

Thank you. Because my pup's front right leg is limping, is there a way to differentiate orthopedic pain to neurological pain? On the front leg, there's no knuckling. The paw turns outward, and the elbow is bent. The leg can't seem to bear much weight. Balance is not affected. I searched through the Neuro corner but don't see such topic discussed. 

Thank you Paula. The only medication Fergie's on is 50mg Carprofen BID for indefinitely. Her vet already wanted her to be on it for arthritis before but I was only using it on an as needed basis because she was do 2-3 short walks daily without problem. She was slow to get up and down stairs but she rarely limped.

She started Carprofen on 9/16. 
I read that Pepcid AC lowers stomach acidity and might interfere with her raw diet. I did buy a box of Pepcid AC. Should I try doing 1 dose per day instead of 2? I have also used slippery elm which coats and protect the stomach lining. 

Here is a video of her limp before her hind leg became weak later that afternoon:


The ER vet saw this video and was sure that it was due to arthritis. 

Here are a few observations: 

Since the onset of paresis in her rear legs, her tail has been limp. But if I manipulate it ie manually wag it for her, the tail will wag for a couple seconds on its own. I think that's just reflexes right? 

Today on potty break she was much more active (I had to stop her from walking too fast). Also I did a knuckling test on her hind paws and they seem to correct much quicker than before. 

It's hard to gauge improvement when she's on strict bed rest and leashed potty breaks but she did get up on her own to reposition herself in bed and she was able to scratch her ears brief with her hind legs. It's been 8 days and I think her hind legs are stronger. 

Other than doing the knuckling test, what are some ways I can check if her nerves are healing? 

For FCE, some have suggested using an electric toothbrush on the paw to stimulate nerve growth; do you know if there's any science behind that? 

It's common for FCE or ANNPE to show improvement in a matter of days; what about IVDD?

Will continue to put her on bed rest until neuro appointment. 

Thank you. 

Unfortunately, UC Davis cannot offer an appointment. I made an appointment with another neurologist for 10/20 [appt]. Without an MRI, what would a full neurological examination tell us?

She's on ✙Pepcid AC. The vet also suggested tapering down the Carprofen to once a day after being on it for two weeks because her buns are slightly elevated.  

[MED LIST/HISTORY- Moderator's Note. Please do not edit
9/16 ER Dx'd FCE and PT
neuro damage: rear limb knuckling
right front limb: root signature pain?
On crate rest until advanced imaging proof of FCE
9/26 high BUN
carprofen as of 9/12: 50mgs 2x/day for 14 days,  √9/16 pain / _neuro
               as of ? TBA: 50mgs 1x/day for ? days, high BUN
✙Pepcid AC  20mgs 2x/day ]

Regarding her tail, it did voluntarily wag briefly last night, but most of the time it's limped. 

I came across this video and found the gait analysis extremely helpful:

She's on 20mg Pepcid AC 2x per day.

But vet suggested tapering down her Carprofen to 1x per day soon. 

Thanks.

The vet wants her to be on it [carprofen] indefinitely as long as bloodworks are fine.