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Chiropractic therapy (aka VOM)
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:
Is chiropractic treatment a therapy that can be considered with a dog suspected or known to have IVDD?
ANSWER
The short answer is that I would not advise chiropractic care in a chondrodystrophic dog (Dachshund, Shih Tzu, Lhasa Apso, Pekingese, Basset Hound, Beagle, etc.) with clinical signs suggestive of intervertebral disk disease.
Without a diagnosis, the degree of spinal cord compression is unknown. An adjustment to a dog with severe spinal cord compression could result in a deterioration of the clinical signs to the point of being completely paralyzed and maybe not being able to feel their toes.
Advanced imaging of the spine (MRI/CT/Myelogram) allows your veterinarian to make an informed decision. In some cases, chiropractic treatment may warrant consideration. However, without knowing what is causing the clinical signs it would not be advisable. ~Andrew Isaacs, DVM
Back braces – 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
LINDA STOWE, FOUNDER DODGERSLIST, WRITES:
We keep getting questions about the back braces on DodgersList. We have said there needs to be more research to see if they are really helpful for an IVDD dog and if you want to try it, work with a specialist. I imagine most people buying these will let the dog wear them for a few days and then they’ll end up in the closet. They are not handy to get on and off and adjust. I don’t know about how comfortable they would be or what harm they might do. What is your opinion about using back braces with an IVDD dog?
ANSWER
I totally agree with your statement.
Here is my take: There are a variety of “back braces” available. Unfortunately, I am not aware of any that have been tested in a controlled laboratory setting or in a clinical study. Therefore, as a general statement, “back braces” should be used under the supervision of a veterinarian familiar and knowledgeable with the treatment of intervertebral disk disease.
What to ask the surgeon
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
ELIZABETH ASKS:
Hi! We are bringing our 9.5 year old female dachshund to see a neurologist. Her regular doctors seem to think she has IVDD, which I think she has too from what I read. We are bringing her meds that her vet put her on (pain killer, muscle relaxer) and was wondering what questions I should ask the neurologist.
ANSWER
We are sorry to hear that your Dachshund may have neurologic problems and we wish her a speedy recovery.
As long as you are seeing board-certified neurologist (ACVIM), your pet will be in good hands and you shouldn’t have to ask too many questions. The main questions that should be answered or addressed after the neurologist evaluates you pet are:
1. Is this a neurologic problem?
2. Is a neurologic work-up indicated (ie. myelogram, catscan, MRI, spinal tap, blood tests)?
3. What are my treatment options (medical versus surgical)?
4. What is the expected prognosis and outcome with each treatment option?
Best of luck with your pet!
Prognosis- walking or spinal walking?
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
ANN ASKS:
Ann writes: Our Buster recently went to the neurologist for his follow up visit 6 weeks after surgery for 2 herniated disks. The Dr. said he had no DPP and we should get him a cart as Buster would never walk again. She didn’t seem to give any value to the improvement Buster has achieved since he came home. He’s gone from total paralysis of his hind legs to being able to move both legs, his tail also moves and he pulls himself up to stand on all 4 legs for short periods.
The 2 Drs. at our local vet clinic were surprised by the diagnosis. They weren’t eager to contradict the neurologist or to get our hopes up, but they say it can take months to recover from major surgery.
Because Buster is improving, we are continuing PT, water therapy and acupuncture. We did get Buster a cart which we were told was for rehab as well as mobility. We’re trying to be realistic about our dog’s progress, but the conflict between what we’ve been told and what we see happening with him is confusing.
In your experience, do you find that most dogs with no DPP 6 weeks after surgery never walk again?
ANSWER
Hi Ann. So sorry to hear about Buster.
In my experience, dogs that do not regain deep pain perception (sensation) after 6 weeks rarely regain it. Notice, I didn’t say never! These dogs often times will regain motor function and appear to “walk” once they get their legs under them. When this occurs we call it SPINAL WALKING. The “walking” is actually reflexes in the rear limbs being stimulated, which gives the appearance that the dog is walking. These are involuntary movements and do not require the input from the brain to occur. If you watch carefully, the front legs and back legs are not in sync with each other. We do see paralyzed dachshunds that never regain deep pain perception but spinal walk several weeks or months after surgery. These dogs live a great life!
My advice… continue the physical therapy and water therapy. It sounds like Buster is regaining motor function in his rear legs and may be starting to spinal walk. He may surprise everyone and spinal “walk.”
There is a video on Dodgerslist showing spinal walking. Be sure to check it out: https://dodgerslist.com/spinal-walking/
Best regards and thanks for the question.
After crate rest activity
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
ERIN ASKS:
I have a 6 year old miniature dachshund that has been diagnosed with IVDD. She has been on crate rest, currently in week 5; planning on 8. At the completion of 8 weeks, how do we know that she is healed? Do we just let her start to walk around gradually and watch how she does? At this point, she does have some movement in her hind legs, but not perfect by any means. She is definitely showing improvement though. Thank you for your input! It is appreciated!?
ANSWER
Good question.
I’m glad to hear your dog is doing well.
The key is to SLOWLY reintroduce activity after the 8 weeks if rest. If at any point when reintroducing activity you notice him getting painful or less coordinated you need to cage rest him again and consider diagnostics (MRI, CT, or myelogram). Make sure that life long he is on a harness for outdoor activities, not doing high risk activities (jumping on/off sofas/beds, going up/down stairs, etc.) to help prevent another flare up.
X-rays
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
JULIE ASKS:
I was referred to your site by a fellow dachshund lover. I have a rescue who is approximately 11 or 12 years old. I have had him for 5 years with no known back problems. This morning he woke up crying and dragging his back and sort of wobbly and drunk like. I took him to the vet who did an xray. No herniated disc. The x-ray showed some narrowing of discs but nothing glaring. We have him on anti inflammatory and painkillers. My concern is throughout the day it seems to have gotten worse and he can’t stand to even pee. Not sure what to do next. Please help?
ANSWER
The x-rays are helpful for excluding diseases that involve the bone (fracture and tumor), but unfortunately do not let us know about disk herniations.
With the dramatic decline it would be worth visiting with your vet about referral to a specialists for advanced imaging (MRI/CT). This would allow confirmation if it is a disk and the degree of compression. With this information you will then know if surgery is warranted to help give him the best odds of recovering. If this is not feasible then talk with your vet about urinary bladder management and discuss the potential of switching from non-steroidal anti-inflammatories to a steroid.
Arched or humped back
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
SHARON ASKS
What causes the hump on the back that some IVDD dogs develop?
ANSWER
Dogs with IVDD can have a “hump” or “bump” appearance to their back in three situations: pre-surgical (medical management), immediate post-operatively, and long term post-operatively.
If they have a painful back or neck they will assume a posture that minimizes movement of the spine. Typically, they will arch their back and bring their front and rear legs closer together in an effort to decrease discomfort. This is similar to a human with a bad back – it hurts to stand up straight so they hunch over to help relieve the pain.
Another scenario where we see dogs develop a “hump” or “bump” is shortly after IVDD surgery. First, to perform surgery the hair on the back is shaved off. This in itself will cause the spine to look more prominent. Secondly, when closing the incision the fat under the skin can bunch up and create a “hump”. A seroma (a pocket of fluid under the skin) can also occur post-operatively and create a bump. Lastly, an uncommon cause would be an infection. If you notice a “hump” right after surgery, you should contact your veterinarian and have your pet evaluated. Most of the time it is nothing to be concerned about, but it is better to be safe.
We have seen dogs that have a slight arch in their back 2 months or more after surgery. There is no definitive answer as to what is causing this. We speculate that it could be that the muscles are still healing. Part of the surgery involves elevating muscle off the bone/vertebrae and it never re-attaches perfectly like before surgery. So, the spine will be a little more prominent than before. Regardless, this is not a life-threatening problem when seen and when the hair regrows will be hardly noticeable.
If you are concerned about any bump or hump it’s best to have your veterinarian check it out.
Panting cause
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
PAULA ASKS:
Panting is a recognized side effect of Tramadol, what is the reason… anxiety related or ? Is panting plus pupil restriction related and is there a way to ID tramadol as the cause for panting? What can the owner do to comfort the dog? Can continued heavy panting be a concern to cause health issues and a reason to get vet help?
Panting with steroids, can be related to intolerance to temperature and is a temporary side effect. Is there anything other than increased circulation of air, a cool surface to lie on that would help
Panting with pain, how frequently do you observe this sign in your practice with a disc episode as opposed to shivering, yelping, reluctant to move, arched back, etc.?
Panting is not listed as a side effect by the FDA for NSAIDs. There are owner anecdotal reports of NSAID-related panting and Web postings by DVMs saying panting is an overdose sign of NSAIDs. www.1800petmeds.com does lists panting as an overdose symptom. In your opinion is panting while on a NSAID commonly an indicator that the NSAID should be stopped at once and vet help sought?
ANSWER
To be honest I am not certain of the cause for panting with tramadol. If it is noted, the owner should notify their vet and if no response is optioned by the time the next dose is due either not give or give 1/2 the dose. If the panting becomes a concern for the owner it would be best to take the pet into their vet or ER. Most if the time it is not going to cause health issues, but better to be safe than sorry.
The panting with steroids can also be anxiety related too, so sometimes something to distract the dog helps.
The other signs you describe (shivering, yelping, reluctant to move, arched back, etc.) we appreciate more than panting in cases with intervertebral disk disease. I frequently appreciate panting when the dog is anxious secondary to having a full bladder, or needs to defecate.
Panting with NSAIDS is a tough one – similar to tramadol. If it is noted the owner should either not give or give 1/2 the dose when it is due again and notify their vet. If the panting becomes a concern for the owner it would be best to take the pet into their vet or ER. Most of the time it is not going to cause health issues, but better to be safe than sorry.
The hard part with a panting dog is most of the time the dogs are not on a single medication and it can be difficult to determine which of the meds could be contributing. So, it is matter of going with the most likely cause first and down from there.
Take care,
Andrew
Cart dogs- Multiple disc issues possible?
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
If a dog is already in wheels due to IVDD and not likely a chance of recovery, can the spine get re-injured to where the spine is worse? Where the dog is in constant pain? Needs another surgery? Needing to try conservative treatment for the re-injured area? ~Frenchie owner
ANSWER
Unfortunately, the answer is yes – dogs in wheels can have another disk issue either at the same site or a different one. Issues that can arise are pain and more severe neurological deficits. In cases where the pain is not responding to medical management or the neurological deficits are more severe surgery could be considered to address quality of life.
Andrew
Sleeping position
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
My 4 year old girl, Olive, had surgery last monday… I am just wondering… she is wanting to sleep on her sides (she was always one to do this pre- surgery).. for the first many days she tried to sleep on her stomach and I propped rolled towels on either side of her to keep her straight but more and more as the days go by she is rolling over to her sides and stretching out a bit more (she seems most comfortable this way)…. is this ok? I am so paranoid of her hurting herself again.
ANSWER
You can feel comfortable letting Olive sleep in whatever position she feels most comfortable. You just want to avoid her making quick or jolting movements that would stress the surgery site out.
Andrew
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