Clark's Fast Facts: Intervertebral disc disease (IVDD)

° Cost of Surgery °  Crate Rest  ° Drug knowledge  ° Handicapped & Happy? ° Veterinarians: all equal? °  What to expect  before & after surgery  ° What is IVDD?  ° Success rate of treatments  ° Symptoms of back problems ° Treatment: non-surgical vs. surgery  ° X-ray, myelogram, MRI, CT

Get up to speed on IVDD: 1. Shortcut through IVDD in a nutshell the essentials to protect and care for your dog. 2. Disc Disease DVD is a must have for all Dachshund owners. 3. Road map to implementing Conservative Treatment 4. Surgery vs. Conservative Treatment 4. Answers about IVDD surgery 5. Join the Dodgerslist Support Group to talk about your dog.

Note: I am not a vet. This is information I've collected via research and thru personal experience.

Please consult with your own vet to see what's right for your Dachshund.

Cost of Surgery Varies widely through out the USA. Be sure to check out the University Teaching Vet Hospital in your region There are many variables in total surgery/post op costs, length & difficulty of surgery, preventative fenestration, PT such as water therapy, in addition to how many days stay in hospital after surgery, etc. DO NOT go by price alone. One good way to reduce the risks of surgery is to choose a specialist, a board certified vet: neurological (ACVIM) or orthopedic (ACVS) surgeon, who has been well trained to do the surgery and has plenty of experience and practice with IVDD surgery. Working on the delicate spinal cord is a very tricky and complicated surgery. Look into Care Credit for no or low interest credit.

 

Here are  current reported costs. http://www.dodgerslist.com/literature/surgerycosts.htm

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X-Ray, Myelogram, MRI, CT

X-ray/radiography is used generally to rule out other conditions as x-rays only show bones and no soft tissue such as herniated disc material pushing on the spinal cord.

"... calcified discs do not necessarily mean that this particular disc is going to rupture. It only means that the dog very likely has IVDD and this chalky appearance to the discs is only a "normal" part of the abnormal aging process of such a dog's discs.

Your Veterinarian may point these calcifications out to you on your dog's radiographs. Do not be mislead into thinking that these calcifications are the only problem area if your dog is experiencing back pain or has suffered a disc rupture. In fact, most often, the actual site of the disc rupture is NOT at one of these calcified spaces. " from Dodger'sList Calicified Discs: What They Are and What They Mean in the Dachshund Back., Laurie Miller, Surgical Vet Tech.

x-ray of a dog's spine showing bone

MRI of a dog's spine showing detail of bone and soft tissue discs and spinal cord

The following three type of pictures require anesthesia. (As with any general anesthesia, complications may arise. Even though rare, anesthetic death can occur. With the use of modern anesthetic protocols and monitoring devices, the risk of problems with anesthesia is minimal) so recommended if surgery will be an option and is done prior to going into surgery.

Myelography is often the first choice as a veterinarian can perform the procedure himself. General anaesthesia is used. This procedure involves inserting a needle in the bag (dural sac) that surrounds the spinal cord. Dye (which can be seen on radiographs) is then injected. Radiographs (x-rays) are made to see where the spinal cord is being compressed. Myleograms are invasive. They do not give the same detail as MRI, and also have a degree of risk, siezures..

CT and MRI require anaesthesia to keep the doxie still and are non-invasive and gives multiplanar images of structures being evaluated resulting in cross sectional images with no superimposition of structures such as ribs. Bony changes are seen very well with CT but soft tissue differentiation is not as good as in MRI.

MRI results in excellent soft tissue detail and reasonable detail of bone and cartilage. MRI is considered the gold standard.

If surgery will not be an option and other diseases mimicking IVDD have been ruled out, then err on the side of symptoms being IVDD and put the doxie on strict crate rest for the next 8 weeks and go with conservative medical treatment from your vet until a diagnosis otherwise has been found.

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Symptoms & behaviors of IVDD

· Head held high or nose to the ground with neck discs · Reduced activity · Slower movement · Stiffness or difficulty climbing stairs · Difficulty with walking and jumping · Very tense abdomen · Hunched back due to muscle tension · Crying or shaking · Inability to move rear legs · Loss of bladder and bowel control

If your doxie exhibits any of the above signs however mild, immediately restrict movement by placing him in a crate and take him to a vet. IF your dachsie is dragging his legs/ has stopped using his hind legs completely, lost bladder control THIS IS AN EMERGENCY! Get your dog to a board certified neuro (ACVIM) or ortho (AVCS) surgeon specialist as soon as possible if surgery is an option for your family. Only a specialist's advise on surgery should be considered. General vets are not qualified to provide surgical opinion as to whether surgery is indicated or not.  Without good training in this disease, mistakes can be made in correctly identifying a critical neuro responses called deep pain sensation or not emphasizing necessary crate rest. Neuro or Ortho specialists deal with IVDD cases, many each day. They accurately access DPS. After a dog is paralyzed there is a window of 12-24hrs from loss of DPS that surgery can STILL be successful. The longer after 24 hours, chances are reduced for success. Precious hours can be lost with a vet that is not specialized with IVDD. Often it is money well spent to get the right treatment immediately from specialists who know this disease, than to go from general vet to general vet trying to find one who knows IVDD.

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Crate rest is the single most important part of conservative treatment short of surgery (or until surgery is indicated).The dog owner will play an instrumental role by understanding the critical need for STRICT crate rest. Keep your dachsie extremely quiet during the recovery period of 8 weeks for conservative treatment and 6 weeks if post op. The dog will be carried to and from potty area and allowed only a few steps on a leash. 100% STRICT crate rest 24/7 only out at potty times 8 weeks is required for those undergoing medical (conservative) treatment. The benefit of surgery is PT can be started when the surgeon directs it. If the dog is doing medical (conservative) treatment, the steroids often help a dog feel better, so that they'll want to run or jump or move in ways that could disrupt the disc trying to form scar tissue which often leads to even more damage to the spinal cord. Some dogs do not like the plastic crates and do better with a wire crate or wire panel fence that provides more visibility. How to do proper crate rest. A good list of supplies and ideas to make crate rest go smoother. A road map to understanding what makes conservative treatment work and when to expect the various parts of the healing process to happen.

Care and Support Forum for IVDD dog owners

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Medical management (non-surgical) vs. Surgery

Medical treatment (conservative treatment) of drugs combined with 8 weeks of crate rest and acupuncture is a good approach as long as the dog is only displaying walking problems and/or discomfort. But once paralysis of the legs occur or loss of bladder control, more aggressive therapy surgery can be a consideration...hours count in spinal cord damage. If surgery is an option, do not delay. Do know that many dogs with partial paralysis or are completely paralyzed, given enough time have been able to regain "normal" function without surgery.  Essential reading to weigh the the difference of the two treatments (conservative and surgical): http://www.dodgerslist.com/literature/healingsurgery.htm    Dr. Isaacs, ACVIM (neurology) answers questions for those deciding whether surgery or to stick with conservative as well as what to expect with surgery, post-op, etc. :  http://www.dodgerslist.com/literature/surgery.htm

Sometimes surgery is not an option financially or medically. It can still a good idea to have a consultation with a neuro or ortho specialist if you feel your vet is not comfortable with conservative treatment. The specialist has much more experience with these cases than the general practitioner vet does, that they can make a proper evaluation and prescribe proper conservative treatment medications.

Whether your dachsie is paralyzed or mobile, showing signs of pain after several attempts to go off meds while on conservative treatment, then surgery may be a consideration to prevent a life of pain and discomfort caused by herniated disc material pressing against the spinal cord.

Laser light therapy and/or acupuncture is used for relieving pain and inflammation and to help stimulate nerves to regenerate. General relaxation is also a benefit. Acupuncture can be done with needles or with cold laser therapy directed at the acupuncture points. These therapies can be started at any time with a post-op or conservatively treated dog.  More information and directory: http://www.dodgerslist.com/literature/healingacupuncture.htm

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What is IVDD?

Since there is no way to tell if your dachsie puppy has the disease and whether symptoms will show up later in life, it is very important: 1) to make sure your dog is used to a crate in case of a future need to confine 2) not to use stairs, 3) not to jump up or down on furniture (get ramps for your home). Sitting up, standing on back legs, tug-o-war are no, no's. Switch to using a harness for walks, the collar is too stressful on the spine. Index

Success rate of treatment

100% STRICT confinement 24/7 to a recovery suite (wire crate, ex-pen, pak n play) for 8 weeks to immobilize the spine except for being carried to and from potty place is all important.  How to do crate rest: http://www.dodgerslist.com/literature/CrateRRP.htm 

Typical meds: steroid to reduce swelling. Until swelling goes down there will be pain, muscle relaxants and pain relievers help to mask the pain. Release of pressure on the spinal cord is measured by a decrease in pain. Healing of the disc is is accomplished only with time and limited movement...there are no meds to heal a disc. If a dog is allowed too much freedom too soon the disc will leak again and dog can be back where he started--or worse.  How the pain relievers work: http://www.dodgerslist.com/literature/healingpain.htm   How the anti-inflammatory drug work:  http://www.dodgerslist.com/literature/healingsweling.htm

You will need to provide care for your doxie, no matter which treatment is used- 6 weeks of post op crate rest or 8 weeks of crate rest with conservative treatment. Return of neuro functions can take weeks to months, even as much as over a year dogs have been known to walk again. If the cord is too severely damaged the dog will never walk. However it is in the cards for all dogs to return to a pain free, loving and happy life again whether walking or using a wheelchair.

There are many factors that affect the outcome of your dog's injury. The two most important factors are the severity and duration of the injury. When paralyzled, there is one last indicator of neuro function left, deep pain sensation (DPS) When there is no DPS the innermost part of the spinal cord has been damaged. There is still a good chance for a successful surgical outcome if surgery is performed 12-24 hours from loss of DPS. The more hours after 24 hours, chances are reduced. Many general vets do not have the training to correctly interpret the DPS test of pinching the toe bone, crucial hours can be wasted while the delicate spinal cord deteriorates. If your dog is paralyzed that is an emergency, go to a neuro or ortho specialist ASAP. A specialist has the practiced eye and years of training to correctly perform a neruo exam. You will need to provide crate rest for your doxie, no matter which treatment is used. Recovery of leg functions can range from weeks to months, even as much as over a year dogs have been known to walk again. If the cord is too severely damaged the dog will never walk.

Doctors have no way to measure the amount of cord damage, nerves that are not totally damaged grow about 1-3mm a day. So think positive and never give up hope. Doxies don't read the statistics and their bodies often surprise us.

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Handicapped and happy???

There is hope for all dogs. Dogs live in the moment. They don't pity themselves or pine away for the days when they could walk. They adjust and move on. Paralysis does not mean you and your dog can not live a full happy life! In time your new routine will be normal. Of course you will be making a commitment of extra effort for your special needs doxie. It's all about getting a schedule and setting routines. All us special needs moms and dads have done it, you can too! Doxies with permanent disabilities can enjoy life in their wheelchairs exploring the woods, running in a meadow, going for walks with you. Remember we don't put people to sleep just because they can't walk. Watch how Tabby gets on with the good life. Watch Clark win the race against an able dog.  Index

"The greatness of a nation and its moral progress can be judged

by the way its animals are treated." -- Gandhi

 

Drug knowledge (This is not a complete list of drugs that could be used in IVDD treatment)    NOTE: some of the meds used for IVDD dogs such as Prednisone, can be purchased at Wal-Mart or Target at their $4/30 tab per Rx price. Just ask your vet for an Rx script. These are the typical medications vets use in treating a disc episode.

----Steroids are used for their anti-inflammatory effects. The initial swelling of the cord due to impact of a disc bursting into the spinal cord is a type of inflammation that responds especially well to the corticosteroids and their neuroprotective effects . Steroids affect many body systems not just the target area of the spine and a blood panel is recommend to test health of the organs before using. For example suppression of immune and inflammatory systems may result in increased susceptibility to secondary infection (UTI). Gastric ulceration (stomach problems). Steroids are often accompanied by GI protectant drugs (such as over the counter Pepcid AC) to avoid potential stomach damage. Allow at least one week if switching over between prednisone and NSAID's. Steroids must never to stopped abruptly, they need to be tapered off. Note: A genetic predisposition for diabetes is suspected in Keeshonds, Puliks, Cairn Terriers, Miniature Pinschers, Poodles, Dachshunds, Miniature Schnauzers, and Beagles. Most dogs are diagnosed between 4 and 14 years old. Any dog suspected of having an insulin related disease, should have tests run before using steroids.

NOTE: Steroids are NOT pain killers. Dog will be in pain until the swelling starts to go down. A general analgesic pain medication such as Tramadol and possibly methocarbamol for the pain from muscle spasms are typically prescribed. Nothing worse than to get your dog home to find later that night or on the weekend pain kicks in and you have nothing on hand.

----NSAIDs (non steroidal anti inflammatory drug): ETOGESIC (etodolac), RIMADYL (carprofen), METACAM (meloxicam), DERAMAXX (deracoxib), PREVICOX (firocoxib), ZUBRIN (tepoxalin), NOVOX (carprofen), ASPIRIN   A blood panel is recommended before using NSAIDs to test the health of organs.

Although they [NSAIDs] have never been reported to be neuroprotective in spinal cord injury models, there has been a long-standing interest in these drugs because of their potential to block prostaglandin production...None of these drugs have been tested extensively for neuroprotective effects. Experimental Therapies of Spinal Cord Injury. Wise Young, Ph.D., M.D. Last updated 7 January 2002. 

NSAID have minimal benefit in acute spinal cord injury and increase the risk of complications, especially if used in conjunction with corticosteroids. ("Trauma" The Merck Veterinary Manual. © 2006; Merck & Co., Inc.Whitehouse Station, NJ USA.) http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/100713.htm last accessed 11/28/2007

• Do not mix aspirin, a NSAID, or steroids along with another NSAID.
• 10 to 14 days is recommended when switching to another veterinary NSAID from aspirin
• Pfizer recommends a 5 to 7 days a washout from the body before changing from one NSAID to another or to a steroid. Vets who practice safe medicine follow the 5-7 day washout out period to avoid bleeding ulcers and other gastro-intenstinal problems.
• NSAIDs should be approached cautiously in dogs with kidney, liver, heart and intestinal problems.
• Never give your dog an NSAID unless directed by your veterinarian.
• Don't assume an NSAID for one dog is safe to give to another dog. Always consult your veterinarian before using any medication in your pet.
• Only give the NSAID as prescribed by your veterinarian. Do not increase the dose, the frequency, or the length of time you use the drug unless first discussing this with your veterinarian.
• Ask your vet to prescribe something like Pepcid AC (famotidine), Carafate to protect the stomach lining and decrease stomach acid secretion.
• Red flag signs that the GI tract needs more protection: not eating, not drinking, vomit, loose stools, black or red blood diareah. When http://www.dodgerslist.com/literature/healingacupuncture.htm (famotidine) is not sufficient as it is for most dogs, sucralfate is added for double protection
• FDA information is a must read if you are giving a NSAID to know what to monitor for and action to take: http://www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm196295.htm
  

----Pain Relievers

Treating pain early usually brings quicker and better results. Healing occurs faster when pain is under control. Pain affects blood pressure, heart rate, appetite, and general mood. Until all the swelling is resolved on the inside via surgery or conventional medical treatment, there will still be a source of pain. Herniated discs, damaged spinal cord require a significant amount of time to heal. New tissue must be generated. Swelling must have time to subside. Pain is so important to the overall well-being of a patient that it has become the 5th cardinal sign of human assessment. (Philips DM. JCAHO pain management standards are unveiled. J.Am Med Association 284(4):428-429, 2000) Institutions can risk their federal funding if they do not routinely assess for pain.

• Tramadol is an atypical opioid which is a centrally acting analgesic (pain reliever), used for treating moderate to severe pain. Adverse reactions are nausea, vomiting and panting. Does not cause gastric bleeding. Can be given with either a NSAID or steroid.

----Muscle Relaxers

• Robaxin (Methocarbamol) exerts its effect by acting on the central nervous system (i.e., the nerves that control the muscles) rather than on the muscles themselves.  Methocarbamol can be used in any condition where painful muscle spasms should be reduced for patient comfort. An oral dose of methocarbamol is active in the body approximately 30 minutes after administration with activity peaking in 2 hours (in humans). Has some sedative properties. Sensitive animals will salivate or vomit.
• Valium (Diazepam) The injectable form of diazepam is often used in anesthetic protocols. Diazepam is rarely used as a tranquilizer for animals as it simply not very strong and not very reliable. Diazepam may have a stronger than expected effect if used in conjunction with Tagamet (Cimetidine). Anti-acids may slow the onset of effect of diazepam.

----Neuropathic pain (abnormal signals from the spinal cord) treatment

This type of pain is uncommon and usually felt at or below the level of the injury. Abnormal signals from the nerves damaged by the SCI feel like mild tinglings to very painful on-fire sensations causing a dog to lick, chew and in some cases chew off a foot, penis, or more tragic lethal damage. These abnormal signals explain why a paralyzed dog can feel neuropathic pain in an area that otherwise has no sensation. Many different medications are used for neuropathic pain, including antidepressants at low doses, anticonvulsants such as Neurontin (gabapentin), narcotics (morphine, codeine) or NSAIDs. Sometimes combinations of drugs work better than a single drug. Dog must never be left alone without an e-collar or no-bite collar. These symptoms can periodically surface during the dog's lifetime.  

Vets are finding good success with harder to control pain during a disc episode by using Gabapentin along with Tramadol and Methocarbamol.

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Veterinarians, all equal?

As a lay person, it's hard to know if your vet has prescribed the proper medical treatment. We tend to trust that we are placing our pets where they will get safe, effective and the most-up-to date procedures. As with any profession from your hair stylist, car mechanic to your own doctor, you realize some are better than others. Same with vets, some are more personable, smarter, skilled and do more research.

 

A general vet can't possibly be as up-to-date on specialized areas as a neurosurgeon can. You would not go to your own general doctor for brain surgery, you'd be referred to a specialist, a neurosurgeon. If at anytime you question something, or just don't feel right, seek a second opinion, consult with a specialist, do your own research on the Internet, communicate with support groups who've been there/ done that. Be an educated consumer so you understand what your vet is saying and ask good questions, your pet so depends on you! Join DodgersList for education and support.

 

Comments from a vet's perpective:

"Many people know the symptoms of one disease very well...Veterinarians are almost all general practitioners. Most work on several species of animals and treat disorders of all body organs and systems medically and surgically. Inevitably, they are not going to know the medical problems of every single dog breed or cat breed well. They are not going to have "cutting edge" knowledge about every organ system in their head. It is very easy for a non veterinarian to learn the medical problems of one or two breeds in more depth than their veterinarian. It is a little more difficult, but not close to impossible, for a lay person to learn more about a particular organ system than the average veterinarian. Especially if it affects a beloved pet of theirs...My knowledge of veterinary medicine surpasses almost every lay person's knowledge, in general. That gives me the ability to research many topics more quickly than a lay person can. It doesn't take me as long to get "up to speed" as it took a particular client to acquire an in-depth understanding of a particular disease affecting their pet.

Please let your vet know what treatment level you are looking for. If you want the best care for your pet, say so. If you want your vet to provide the best possible compromise between the hypothetical "best treatment" and the "best cost" treatment, let her know. Don't allow your vet to take multiple X-rays and fix a fractured leg and THEN tell him that you really only wanted to spend $25. Your veterinarian really is trying to understand what sort of care you want for your pet"

Mike Richards, DVM. http://www.vetinfo.com/aboutvets.html

 

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