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Why doxies are not little people with back problems
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
LAURIE ASKS:
Hello! Wondering if you can help me with a question? I’ve been asking several vets about IVDD. I have back issues and a herniated disc in my lower back and could barely walk. My Neurodoc gave me an injection of cortisone steroid combo done with a dye injection and xray light. I was pain free within 24 hours and walking fine. Why can’t this be done on our fur babies? Also I hear there is a shock absorber type of injection that works like expansion foam to surround and protect the disc. Thank you for your time and any feed back is appreciated,
ANSWER
This is a good question and highlights some of the differences between canine and human anatomy (spinal cord and intervertebral disks) and the pathology associated with them.
The canine spinal cord extends further down the vertebral column than humans. Therefore, most of the clinical signs in humans with lower back intervertebral disk disease are related to spinal nerve irritation versus spinal cord irritation (spinal nerves are more resilient and more likely to respond to medical management – steroids).
Also, the majority of clinical signs in dogs related to intervertebral disk disease is due to extruded disk material (nucleus pulposus herniating through a rent/tear in the annulus fibrosus) into the spinal canal. On the other hand, in humans the majority of clinical signs is related to protruding intervertebral disk (bulging of the annulus fibrosus and nucleus pulposus).
There are some cases where we do, after the appropriate diagnostics are performed and a diagnosis is obtained, use injections of steroids versus surgery. However, it does require heavy sedation or general anesthesia.
So, the first step with your pet would be to perform imaging of the spine to know exactly what and where the underlying cause is.
Regarding the “expansion foam” injection – due to the tearing of the annulus fibrosus there is the risk of “expansion foam” getting into the spinal canal and causing exacerbation of clinical signs secondary to compression of the spinal cord.
Unfortunately, due to anatomical and pathological differences between canines and humans treatments that help one species do not always translate directly the other species and may actually cause harm.
Thanks for your good question.
Andrew
Head Tilt after a myelogram
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
LINDA ASKS:
Can a myelogram be the cause of head tilting? How long could the tilting last?
ANSWER
When injecting the contrast agent (dye) around the spinal cord in the neck most of the time it is injected right behind the head where the brainstem turns into the cervical spinal cord.
There is the potential for the needle that is used to inject the contrast to irritate a part of the brain stem responsible for balance (the vestibular centers). I would not get too concerned about it being permanent until he is out a good 1-2 months. Even then, most of the time it is not anything that will cause serious quality of life issues. If you feel that it is, there is the potential to talk with a veterinary rehabilitation doctor about techniques that can help your dog compensate/adapt to the balance issues.
Please let me know if you have any other questions.
Andrew Isaacs, DVM, Diplomate ACVIM (Neurology)
Gait after surgery
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
PEGGY WANTS TO KNOW:
My dachshund, Daphne, had a hemi laminectomy on 4 months ago. I am just concerned because she is not walking normally now in April, her front legs look so funny when she is walking kinda stiff, maybe because she is trying to walk fast? The surgeon doesn’t want her to bunny hop. Never has told me to do any kind of PT. I have taken her to a licensed veterinary acupuncturist 4 times now, but didn’t start until March. Was I too late starting, should I continue? I just don’t know what to do, the acupuncturist thinks I should not have her on strict confinement, that I should let her have complete observed freedom.
ANSWER
I’m sorry to hear about all that Daphne has been through.
At this point it would benefit Daphne to have some physical therapy. Your finances are better spent on physical therapy than acupuncture (not that acupuncture will hurt, but physical therapy should take priority). It is never too late to start physical therapy.
Daphne’s thoracic limb gait is pretty typical. She is compensating (shifting the weight forward) due to the decreased function with her pelvic limbs,
Take care,
Andrew Isaacs, DVM, Diplomate ACVIM (Neurology)
Grunting a sign of pain
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
OWNER ASKS:
Hello, I have a 3 year old Shih Tzu who has been diagnosed with IVDD. She has spent the last three days at the vet and has been given steroids.
She was sent home yesterday with steroids but no other medication.
She has some movement in her back legs and can get around some on her own. Whenever she moves or is moved to go outside she tenses up her stomach and grunts. Is this a sign of pain? She does not yelp or whine so I am unsure if this is a sign of pain or just part of the IVDD. My vet says he does not think she is in pain. What should I do? Thanks, Ty.
ANSWER
It sounds like she has the potential to be in some discomfort. It is not going to hurt to ask your vet for some pain meds on top of the steroids.
Typically, we like to use gabapentin +/- tramadol. By no means do I want to second guess your vet, but it wouldn’t hurt to see if the meds help with the grunting as a trial to see if she is uncomfortable as long as your vet does not see any contraindications.
The use of a GI tract protectant in cases that are receiving NSAID’s or steroids would definitely be warranted under the supervision of the patient’s veterinarian.
Dentals with an IVDD dog
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
JEFF EXPLAINS:
I have two miniature dachshunds named Moses and Aaron. They are biological brothers from different litters. Moses is 8 years old while Aaron is 6 years old. On August 31, 2015, Aaron was walking down the stairs from the bed, and his back legs gave out on him. He literally tumbled down the few remaining stairs and collapsed on the floor. My heart broke. He could not walk. So, I called his veterinarian who brought us to the small animal clinic at Texas A&M in College Station. Since Aaron still had feeling in his back feet, the physicians decided that crate rest and anti-inflammatory medication would be a good option. I decided not to have Aaron undergo surgery. I followed the instructions to the letter. Today, Aaron is back to walking on his own. I am extremely cautious with him and his brother. I have tried to decrease their jumping episodes by holding them whenever the doorbell rings, etc. Aaron no longer climbs up and down. I literally pick him up and place him down. I am doing everything in my power to avoid another disc issue.
Now, Aaron has to undergo a dental cleaning this Saturday in which he will be placed under anesthesia. I never thought about the issues of others handling him while he is unconscious. I am extremely careful whenever I pick him up and place him down. I never torque his body. In fact, whenever I go to pick him up from the couch or bed, he automatically rolls on to his back, thus allowing me to roll him into my arms.
I believe I saw an article written a few weeks ago concerning care of a pet undergoing anesthesia who has IVDD. It highlighted the issues of greater injury due to improper handling under anesthesia. If someone pulls or tugs on him, if someone rotates his body in the wrong way… It also spoke of how to pick the pet up as well as the injuries a dog could sustain from improper handling. I am worried sick about leaving Aaron into the care of others who might not move him in the correct manner. I do not want anyone to do anything which could possibly re-injure him. We have come so far with a great deal of work.
Do you have any information which I could possible give to the nurses at the Banfield Pet Hospital which could remind them on how to handle a dachshund suffering from IVDD, specifically one who under anesthesia?
Thank you very much for your assistance.
Humbly,
Jeff
ANSWER
There is always some risk with anesthesia, but as long as Aaron is handled appropriately the risk of a disk problem is outweighed by the risk of dental disease.
I do not have any specific material for your vet, but would let them know to make sure her front and back legs stay in the same plane (no torsional stress, like you have been doing at home).
Andrew
[Editor’s note: See: “Precautions” for more dental day tips and ideas]
Non-steroidals (NSAIDS) vs. Steroids
Neuro Corner Answers
Dr. Jared Galle
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, spinal trauma, wobbler syndrome, inflammatory brain disease, and developmental brain abnormalities (hydrocephalus and Chiari malformation).
Question
JODY: Good day doctors,
I have a 12 year old female dachshund. Last week, she was diagnosed by a veterinary neurologist as having IVDD, following an MRI and a lumbar puncture as well. The lumbar area shows one disc that is of concern. His first line of treatment is Metacam for 3 weeks and then return for an appointment. I took her to this veterinarian subsequent to a very quick and almost un-noticeable episode of her dragging her left back leg for about one second. Having had a number of dachshunds I wanted to have her assessed before a crisis arose.
My question is this, looking now at the literature I am seeing that corticosteroids are being used rather than NSAIDs, so I am a bit puzzled at his choice. I would like to read your thoughts before I make an call to him to ask him to help me understand his decision to use the NSAID rather than another medicine. Thank you very much.
ANSWER
Hi Jody, this question certainly opens a can of worms concerning the medical treatment of IVDD in dogs.
I should begin by saying that there is no study to support using corticosteroid (steroids) or NSAIDs for treating IVDD in dogs. Older recommendations to give high-dose, injectable steroids immediately after spinal trauma (ex. IVDD) were based on large human studies. The current recommendation in people is to not give high-dose, injectable steroids with spinal trauma. Based on this, most veterinary neurologists do not give injectable steroids.
On the veterinary side, you will find three medical treatments for IVDD:
- 1. Oral steroids
- 2. NSAIDS
- 3. No medications
The recommendation to treat IVDD in dogs with steroids or NSAIDs is often a personal preference since there is no study to support either drug. Both medications are used to treat pain caused by inflammation. Some neurologists will recommend NSAIDS because there are fewer side-effects when compared to steroids. You should ask the neurologist why he/she recommended NSAIDS over steroids. He/she may have a good reason.
The most important component when treating IVDD medically is to keep your pet crated.
Dr. Jared Galle, DVM
Diplomate ACVIM (Neurology)
STRICT Rest length of time
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
ROBBIE ASKS:
We took our 9 pound toy poodle to the emergency vet because she was shaking and would not eat. They did an x-ray and thought it was IVDD. They gave us tramadol for pain and told us to strictly crate her for 2 weeks. This was on Feb. 4 of this year.
We did this and she seemed to recover but mid April, 2 days ago, she started with the same symptoms. Our vet has recommended we see a neuro vet. My question after doing a lot of reading online and finding Dodgerslist is if we crated her long enough?
Was it only 2 weeks because she is a toy poodle not a dachshund? The night we were at the emergency vet a dachshund came in with back pain and they were instructed to crate it for 6 weeks.
Any additional information would be appreciated. We have not been given any other meds but the tramadol for pain. Bella can walk and go to the bathroom and the tramadol seems to control the pain. We will do anything we need to do for Bella and want to be sure we do whatever is best to try to prevent this from recurring?
ANSWER
With the second go around ideally it would be nice to know what you are up against. However, if advanced imaging (MRI, CT) is not going to be feasible then by no means is a longer cage rest time wrong.
Coonhound Paralysis
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
MARJORIE ASKS:
After reading the article below on Coonhound Paralysis, is there a difference in symptoms between this and myelomalacia that we see in so many dachshunds? How would you tell the difference when an IVDD prone dog is brought to your clinic?
“Coonhound Paralysis is a peripheral (outside of the spinal cord) nerve disorder. It is suspected to be an immune-mediated (the body attacking itself) destruction of the conductor material around the nerves exiting the spinal cord. This disease is initiated by an organism that has been transferred from contact with a raccoon. Dogs of any age or breed that have had contact with a raccoon within 7-14 days previously should be suspected if there is a progressive weakness to paresis or paralysis starting with the rear limbs and working forward. Rarely are the front limbs affected first. Rapid muscle atrophy is commonly seen. Occasionally facial paralysis, change in bark, or difficulty eating or breathing are seen. Recovery is usually complete but can take weeks to months.” http://www.tops-vet-rehab.com/injuries.html
ANSWER
Yes, we see Coonhound Paralysis (polyradiculoneuritis) 3-5 times a year. On exam it is pretty easy to tell the difference from a disc episode. With Coonhound the reflexes are decreased in all limbs and with support conscious proprioceptions (CP) are intact.
With myelomalacia there will be lack of deep pain sensation and with Coonhound Paralysis sensation is maintained. With Coonhound Paralysis only the ventral nerve roots are involved (decreased to no motor function), but the dorsal nerve roots (sensation) are maintained.
Fears with IVDD
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
BRENDA WRITES ABOUT HER 3 Y.0. DOXIE:
I was not aware of IVDD until after we got her and now I realize that age 3-8 are the main IVDD years. I feel overly worried about IVDD and am wondering if it can be diagnosed before she would have any issues, or better yet, ruled out so I don’t have to worry so much about it?
ANSWER
Brenda,
Having a Dachshund is a wonderful thing and should be enjoyed.
Granted, they are a breed with a high incidence of IVDD, but this does not mean you need to go through the rest of her life worrying about her developing IVDD. There are precautions that help decrease the chances of her developing IVDD, but you need to let her enjoy being a dog. The goal is to minimize high impact activities: no jumping on/off of furniture (beds, sofas, windows, etc), walk outside on a harness (no neck leads), no tug of war or play toys that they “shake to death”, no tearing up/down stairs, no full body tackles by other dogs, etc.
To guarantee she does not develop IVDD you would need to keep her locked up in a cage her entire life. The reason you take pleasure in having her is that she has a good quality of life and you are able to take part in her enjoying it. So, you need to strike a balance between her quality of life and developing IVDD. A helpful approach is to look at both of your lifestyles, living environments, and personalities and decide what modifications are reasonable and what are not reasonable. After deciding what modifications you are going to make stick with them and then start enjoying her.
A similar analogy would be teenage children getting their drivers licenses. This is a time in their life when they are more likely to get in automobile accidents, so to prevent this we could keep them from driving, but they would be miserable. We do have them take drivers education class, encourage them to drive the speed limit, wear their seatbelts, no texting, pay attention to other drivers, etc. (and we don’t get them a convertible sports car). They may get in an accident, but at least we have taken all reasonable precautions to help prevent it.
Unfortunately, there is no way to diagnose IVDD beforehand. In addition to taking the above precautions, the key is recognizing the early warning signs that she may be developing IVDD. If you are able to identify IVDD early most of the time she can be treated with conservative medical management and will not require diagnostics. The first thing you will notice is her “not acting normal”, “just being off”, “reluctant to play”, or “a little slower”. At this point a visit to your veterinarian for an exam would be warranted. If no obvious abnormality is noted by your veterinarian to explain her being “off ” then keep her strictly cage rested for a minimum of 2 weeks and then slowly reintroduce activity. If at any point she starts to act drunk, wobbly, or scuffs her toenails alert your veterinarian immediately and consider advanced diagnostics (MRI or CT/myelogram).
Please let me know if you have any other questions. Remember, enjoy your Dachshund!
Take care.
Conservative treatment (medications, rest and time)
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
TACOMA WA WRITES:
My 2 year old dachshund stopped jumping and seemed unsure if she could traverse steps. A couple of days later, she was barely walking, barely if at all eating or drinking (even her special food “chicken”). A couple of days later not moving by choice at all. If I put her on the floor, she mostly stays where I put her, waiting to be rescued, at times when I take her out to pee she will take some shaky steps to potty, then sits down as her legs are too shaky. A couple of days later as I was holding her she pooped runny all over my lap. Instead of peeing on the potty pad she has peed all around in very erratic ways. Her hind legs seem to get close together and she swings her bottom down. Yes, I know take her to the vet, but i can’t. I ashamed to say i don’t have the resources. please give me any information you may have gained in your years of practice. Does it sound like a typical progression of dachshund disc problems, that given rest may likely heal on its own, or does it sound like a situation where it is only going to get worse, and not much hope at better, and I should simply suck it up and put her down, so she does not have to continue to suffer. Thank you in advance for any information you may share.
ANSWER
By your description it does sound like your dog likely has intervertebral disk disease. Ideally, it would be best for you to go into a vet to get instructed on urinary bladder management and talk about potentially using steroids. Some dogs respond well to medical management and it would be worth giving it a try. In the meantime, it is very important to keep your dog strictly inactive so as not to get any worse. Dodgerslist is a great resource for trying to manage intervertebral disk disease and helping improve your dog’s quality of life.
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