Re: Post-op disc dog

[Guest guest]

Sorry don't have much time to answer fully but would agree 100% with Jeanine and Rick. I too love these dogs because you can make such an improvement with them. Have a number of patients that were told by the surgeon that the surgery was successful but will never walk again and they are walking now!Take care of the bladder, do the proper exercises, E stim , hydro, acupuncture whatever you can do. Remember where the generator for motion is in the quadriped. You can be successful with most of these dogs. Dr Jan Huntingford Essex Animal HospitalSent from Jan's IphoneI'm very new to rehab (still practicing mostly small animal medicine and dabbling in rehab whenever I have a chance) and have yet to take the neuro course (I wish September would come sooner), but yesterday my boss came to me begging for help. He had a consult with a young couple that just spend $5000 to do back surgery on their Dachshund Friday and were considering euthanasia by Monday. They are completely overwhelmed...8 month old baby, school, and now they have a paretic puppy that is incontinent. The dog had surgery after loss of deep pain (they are not sure when deep pain was lost but from what I can ascertain it could have been at most 24 hours pre surgery. They were given VERY grim prognosis (internist they saw said she has never seen a dog walk again after loss of deep pain and surgeon said she has had 1 dog walk again after surgery if it had loss of deep pain prior to surgery). Despite the pessimistic outlook they did proceed with surgery, but are now regretting that decision and feel back for their dog and are really stressed.They feel keeping him alive is unfair to him and they are quickly becoming very overwhelmed. Rehab was discussed and they were sent with PROM exercises and it was recommended to get rehab 2 days/week with therapeutic exercise, hydrotherapy, laser, etc. However the surgery/rehab facility they went to is an hour and a half away so they didn't want to make the drive. Enter me...trying to convince the owners that after spending the money on surgery to at least try to give the dog a chance. But they are very stressed and severely limited on funds after dropping $5000 for surgery. Since I don't have a lot of experience in rehabing post surgery disc dogs I wanted to see if some of you with more experience could give me your opinion on success rates for dogs with loss of deep pain prior to surgery. The surgeons gave very poor prognosis and I wanted to see if anyone has a different take or that prognosis is accurate even with rehab. I think if I can give the owners some glimmer of hope that they may be more inclined to try. I talked with them for a long while and they are holding off euthanasia for now and I promised to come up with cost of several different treatment plans and cost from the conservative home-care program to day boarding at our hospital so we can do the exercises, laser, hydro, etc for them but I also wanted to get opinions on prognosis from those of you that have more experience rehabbing disc dogs. What chance do we have to get an ambulatory and continent dog back or are we looking at a likely cart for life candidate? (I discussed the possibility of a cart with the owners and I can tell you that if this is his prognosis they will likely euthanize before going that route :-(Thanks in advance for your input!Sent from iCloud

[Guest guest]

P.S. A well fitting cart can be a great exercise tool versus an eventuality. They get good work to their paraspinsls and maintain a correct posture. I think they do little movements with postural muscles that are difficult to impose during ther ex. Also psychologically can be beneficial for dog and I find give owners a rest and a boost.Sent from my iPhone

Could not agree more about the early signs of improvement versus just pre-op status!Sent from my iPhone

,

Welcome to the discipline of veterinary rehabilitation medicine. I am always amazed at our well-meaning colleagues that offer their pessimistic opinions with little if any experience in the management of spinal cord injury postoperatively. First the spinal cord in IVDD is not severed but rather injured, with the later there is always a chance for healing, restoration and recovery. More observation time is needed monitor the patient for any signs of improvement. I suggest video of neuro examination to record current status and compare to future examinations. I think bladder management is critical at this time, with the severity of the SCI (probable T3-L3?) I would suspect an upper motor neuron bladder with detrussor paralysis or impairment. Phenoxybenzamine or Prazosin is probably needed combined with assisted eliminations. Over distention injury can result in permanent bladder issues. Also monitor for infection w/ periodic u/a.

Passive ROM exercises of pelvic limbs, especially lower limbs to prevent flexor contracture and passive stretching of the ventral paraspinals to prevent acquired kyphotic posture. Any stimulation of muscle contraction aids in reducing disuse atrophy, assisted standing, toe pinching, etc.

While I include preop neuro status and immediate postop neuro status in my establishment of prognosis I would also consider early signs of improvement very important, even if minor. Additionally, dogs do not have to have complete return of all neuro function to pelvic limbs in order to ambulate successfully. I am sure others will have experienced based comments on similar patients.

Rick Wall, DVM

The Woodlands, TX

=

=

[Guest guest]

These guys can recover and the best response happens when started early.   Many do very well even when bleak at onset.  2 cases:  a 10 year old Cardigan corgi who had surgery at 5, basically paralyzed half of his life as he could only take 1-2 steps and then drug himself around.  In 90 days he was walking, learned how to run and chase boys playing football, had a funny hitch but bowel function was controlled by him.  He did great for 4 ½ years.  Last summer began to decline but he is 15 now, still happy, just needs help.   Another Dach given less than 2% chance of ever walking with surgery.  They did not have surgery.  Started walking 2 weeks later and 7 years has not relapsed.  Just 2 of the many stories. My program: #1 – Alpha-Stim microcurrent therapy.  This is not estim.  There is significant research by Bjorn Nordenstrom, MD and in Becker, MD’s book “Body Electric” as well at Candace Pert’s “Molecules of Emotion” that substantiate this, in addition to others referenced in the horse wound article posted on the website that was published in the Journal of Equine Veterinary Science in 2005.  www.Alpha-Stim.com  go to the veterinary section.  I have categorized all the CES and MET references by mode of study and have attached them here.   This device can do what others do not.  One like this I would have the AS-Trodes on 24 hours a day for 5-7 days then switch to the BID-TID treatment.   I script these and send home for the clients to do treatments there.  Saves them money.     #2. – Exercises by owners at home specific for neuro rehab.  I have a DVD available at www.animalPainVet.com if you are not familiar with all of them #3. – Webmaster harness and a what we call “giddie-up”.  Similar to the Bottoms’Up but those are too wide for these little guys.  We make them out of horse halter cord. #4.  – Standard Process & MediHerb supplements for  the nervous system.  B vitamins move electricity and those need to be increased.  Also some specific for nerve healing and reducing the NTA bombardment of injured tissue. #5. – Underwater treadmill There are more miracles waiting to happen.  Have fun creating them. Best, Ava Ava Frick, DVM, CACAnimal Fitness Center, PCUnion, MO   From: VetRehab [mailto:VetRehab ] On Behalf Of KrellnerSent: Tuesday, May 15, 2012 8:20 AMTo: vetrehabSubject: Post-op disc dog I'm very new to rehab (still practicing mostly small animal medicine and dabbling in rehab whenever I have a chance) and have yet to take the neuro course (I wish September would come sooner), but yesterday my boss came to me begging for help. He had a consult with a young couple that just spend $5000 to do back surgery on their Dachshund Friday and were considering euthanasia by Monday. They are completely overwhelmed...8 month old baby, school, and now they have a paretic puppy that is incontinent. The dog had surgery after loss of deep pain (they are not sure when deep pain was lost but from what I can ascertain it could have been at most 24 hours pre surgery. They were given VERY grim prognosis (internist they saw said she has never seen a dog walk again after loss of deep pain and surgeon said she has had 1 dog walk again after surgery if it had loss of deep pain prior to surgery). Despite the pessimistic outlook they did proceed with surgery, but are now regretting that decision and feel back for their dog and are really stressed.They feel keeping him alive is unfair to him and they are quickly becoming very overwhelmed. Rehab was discussed and they were sent with PROM exercises and it was recommended to get rehab 2 days/week with therapeutic exercise, hydrotherapy, laser, etc. However the surgery/rehab facility they went to is an hour and a half away so they didn't want to make the drive. Enter me...trying to convince the owners that after spending the money on surgery to at least try to give the dog a chance. But they are very stressed and severely limited on funds after dropping $5000 for surgery. Since I don't have a lot of experience in rehabing post surgery disc dogs I wanted to see if some of you with more experience could give me your opinion on success rates for dogs with loss of deep pain prior to surgery. The surgeons gave very poor prognosis and I wanted to see if anyone has a different take or that prognosis is accurate even with rehab. I think if I can give the owners some glimmer of hope that they may be more inclined to try. I talked with them for a long while and they are holding off euthanasia for now and I promised to come up with cost of several different treatment plans and cost from the conservative home-care program to day boarding at our hospital so we can do the exercises, laser, hydro, etc for them but I also wanted to get opinions on prognosis from those of you that have more experience rehabbing disc dogs. What chance do we have to get an ambulatory and continent dog back or are we looking at a likely cart for life candidate? (I discussed the possibility of a cart with the owners and I can tell you that if this is his prognosis they will likely euthanize before going that route :-( Thanks in advance for your input!Sent from iCloud

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INDEX TO ANIMAL STUDIES.docx

Index animals CES 1pg #2.docx

cES Biography.docx

[Guest guest]

Thank you all for your words of encouragement, I will pass those along to the owners and hopefully convince them to at least bring the dog in for a solid eval to see where we stand after surgery. I was pretty confident that you would give me some hope for success despite the surgeon's negative outlook, but I didn't want to give the owners a false hope since I have little experience. Thanks againReply to sender | Reply to group | Reply via web post | Start a New TopicMessages in this topic (6)Recent Activity:New Members 2Visit Your GroupSwitch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use.

[Guest guest]

Would love to talk to you, but would it be better if I waited until after they bring ie in for a full eval so we can see where we stand just to give you better info?Thanks...Sent from iCloud Hi , Doxies with IVDD are my true love, having one of my own! Yes I have seen dogs without deep pain ambulate again. What I get most frustrated with is referring surgeons giving timelines for a "black and white" answer, i.e.( If the dog doesn't walk by 12 weeks post op, they will never ambulate), which completely disregards any progress that may have been made in that time.I think the best thing we can for owners, especially when Money is a factor, and given the amount of time that may need to occur for healing, is to teach them proper positioning. How to place the dog in sternal and square sitting. Too many times these little doxies heal but during that time they are not positioned correctly and end up with stifle and hock extension contractures, and probable lateral trunk flexion. All of which can be prevented with owners positioning the dog correctly. Also weight bearing, weight bearing, weight bearing, in assisted standing, with anterior posterior, medialLateral and diagonal weight shifts. Also, especially with the short legged breeds I find that the slowest treadmill speed may be too fast for them initially post surgery. I think the UT is a great modality when used for the correct client, but I think too often it is prescribed when a patient may not be ready for it, or another modality (such as exercises, postural work) may be much more appropriate. Each case really needs to be evaluated for thd appropriateness of each modality such as the UT, at any given point in time.Just a caveat, I saw a doxie post IVDD surgery that had increased resistance to passive stretch at their rear legs(some might say tone). The rear legs were too weak to overcome the increased resistance, flex the joints, move forward in space. The owner was told by another clinician that the dog wasn't walking because he was only on the treadmill for 15 minutes instead of 30 (even though the only rear leg motion on the treadmill was hip flexion because the stifles and hocks were stiff in extension, and the rear muscles were weak). I recommended dc'ing the UT and instead we focused on postural work (flexing the stifles and hocks in a sternal and square sit position) so the joints were weight bearing while flexed. Owners did this religulously when theywere with the dog. And we did some ther ex, in addition to vet doing acu and chiro. Dog began walking ( on land), UT speed too fast for dog even though he could walk on land. I have a step by step guideline( just my own guide noted anecdotally through time with patient experience, not a cookie cutter) I use for these guys in terms of when they are ready for progression of certain exercises/ skills and many markers I use to note slight progress ( there can be very slight changes that point towards continual improvement). I think we as experienced rehab cliniciansneed to be able to pick out the intermediate signs of progress ( versus just walking or not) to guide our clients and referring vets as well as our treatments.Running late to a two legged patient, but please feel free to call me if you want to talk.Like I said, these little ones are my passion, especially since I'm a mom to one and would like to help if I could.Jeanine Freeberg, PT, DPT, C/NDTSent from my iPhoneI'm very new to rehab (still practicing mostly small animal medicine and dabbling in rehab whenever I have a chance) and have yet to take the neuro course (I wish September would come sooner), but yesterday my boss came to me begging for help. He had a consult with a young couple that just spend $5000 to do back surgery on their Dachshund Friday and were considering euthanasia by Monday. They are completely overwhelmed...8 month old baby, school, and now they have a paretic puppy that is incontinent. The dog had surgery after loss of deep pain (they are not sure when deep pain was lost but from what I can ascertain it could have been at most 24 hours pre surgery. They were given VERY grim prognosis (internist they saw said she has never seen a dog walk again after loss of deep pain and surgeon said she has had 1 dog walk again after surgery if it had loss of deep pain prior to surgery). Despite the pessimistic outlook they did proceed with surgery, but are now regretting that decision and feel back for their dog and are really stressed.They feel keeping him alive is unfair to him and they are quickly becoming very overwhelmed. Rehab was discussed and they were sent with PROM exercises and it was recommended to get rehab 2 days/week with therapeutic exercise, hydrotherapy, laser, etc. However the surgery/rehab facility they went to is an hour and a half away so they didn't want to make the drive. Enter me...trying to convince the owners that after spending the money on surgery to at least try to give the dog a chance. But they are very stressed and severely limited on funds after dropping $5000 for surgery. Since I don't have a lot of experience in rehabing post surgery disc dogs I wanted to see if some of you with more experience could give me your opinion on success rates for dogs with loss of deep pain prior to surgery. The surgeons gave very poor prognosis and I wanted to see if anyone has a different take or that prognosis is accurate even with rehab. I think if I can give the owners some glimmer of hope that they may be more inclined to try. I talked with them for a long while and they are holding off euthanasia for now and I promised to come up with cost of several different treatment plans and cost from the conservative home-care program to day boarding at our hospital so we can do the exercises, laser, hydro, etc for them but I also wanted to get opinions on prognosis from those of you that have more experience rehabbing disc dogs. What chance do we have to get an ambulatory and continent dog back or are we looking at a likely cart for life candidate? (I discussed the possibility of a cart with the owners and I can tell you that if this is his prognosis they will likely euthanize before going that route :-(Thanks in advance for your input!Sent from

iCloud

[Guest guest]

Long dogs are great. You will see more of them then probably anything else in rehab, or at least I have. As others have posted, you may even grow to love them. Here is one of my latest ones, he had no deep pain going in and coming out of surgery but is functionally ambulating today, 6 weeks PO. Here's a little promo video of his case: http://youtu.be/4tVOY6_L22gGood luck and just keep your conversations real and honest with your client.Robby J Porter IIICertified Canine Rehabilitation PractitionerLouisiana Veterinary Referral CenterAnimal Rehabilitation CenterMandeville, LA70448Main Hospital: ext. 208lavrc.comtwitter.com/LAVRCfacebook.com/LAVRCyoutube.com/user/LAVRCfacebook.com/louisianaCOP*********************************************************************************************************This document, and any attached information is proprietary, privileged and confidential property of the Louisiana Veterinary Referral Center (LAVRC) under applicable law and is intended exclusively for business use by all LAVRC employees and intended recipients with a legitimate LAVRC business need. The reproduction, dissemination, distribution and/or disclosure by unintended recipients is unauthorized, strictly prohibited and may be unlawful (Privileged and confidential pursuant to La. R.S. 13:3715.3).If you have received this transmission in error, please immediately reply to the sender and delete this information from your system. To: VetRehab Sent: Tuesday, May 15, 2012 1:18 PM Subject: Re: Post-op disc dog

Would love to talk to you, but would it be better if I waited until after they bring ie in for a full eval so we can see where we stand just to give you better info?Thanks...Sent from iCloud Hi , Doxies with IVDD are my true love, having one of my own! Yes I have seen dogs without deep pain ambulate again. What I get most frustrated with is referring

surgeons giving timelines for a "black and white" answer, i.e.( If the dog doesn't walk by 12 weeks post op, they will never ambulate), which completely disregards any progress that may have been made in that time.I think the best thing we can for owners, especially when Money is a factor, and given the amount of time that may need to occur for healing, is to teach them proper positioning. How to place the dog in sternal and square sitting. Too many times these little doxies heal but during that time they are not positioned correctly and end up with stifle and hock extension contractures, and probable lateral trunk flexion. All of which can be prevented with owners positioning the dog correctly. Also weight bearing, weight bearing, weight bearing, in assisted standing, with anterior posterior, medialLateral and diagonal weight shifts. Also, especially with the short legged breeds I find

that the slowest treadmill speed may be too fast for them initially post surgery. I think the UT is a great modality when used for the correct client, but I think too often it is prescribed when a patient may not be ready for it, or another modality (such as exercises, postural work) may be much more appropriate. Each case really needs to be evaluated for thd appropriateness of each modality such as the UT, at any given point in time.Just a caveat, I saw a doxie post IVDD surgery that had increased resistance to passive stretch at their rear legs(some might say tone). The rear legs were too weak to overcome the increased resistance, flex the joints, move forward in space. The owner was told by another clinician that the dog wasn't walking because he was only on the treadmill for 15 minutes instead of 30 (even though the only rear leg motion on the treadmill was hip flexion because the stifles and hocks were stiff in

extension, and the rear muscles were weak). I recommended dc'ing the UT and instead we focused on postural work (flexing the stifles and hocks in a sternal and square sit position) so the joints were weight bearing while flexed. Owners did this religulously when theywere with the dog. And we did some ther ex, in addition to vet doing acu and chiro. Dog began walking ( on land), UT speed too fast for dog even though he could walk on land. I have a step by step guideline( just my own guide noted anecdotally through time with patient experience, not a cookie cutter) I use for these guys in terms of when they are ready for progression of certain exercises/ skills and many markers I use to note slight progress ( there can be very slight changes that point towards continual improvement). I think we as experienced rehab cliniciansneed to be able to pick out the intermediate

signs of progress ( versus just walking or not) to guide our clients and referring vets as well as our treatments.Running late to a two legged patient, but please feel free to call me if you want to talk.Like I said, these little ones are my passion, especially since I'm a mom to one and would like to help if I could.Jeanine Freeberg, PT, DPT, C/NDTSent from my iPhoneI'm very new to rehab (still practicing mostly small animal medicine and dabbling in rehab whenever I have a chance) and have yet to take the neuro course (I wish September would come sooner), but yesterday my boss came to me begging for help. He had a

consult with a young couple that just spend $5000 to do back surgery on their Dachshund Friday and were considering euthanasia by Monday. They are completely overwhelmed...8 month old baby, school, and now they have a paretic puppy that is incontinent. The dog had surgery after loss of deep pain (they are not sure when deep pain was lost but from what I can ascertain it could have been at most 24 hours pre surgery. They were given VERY grim prognosis (internist they saw said she has never seen a dog walk again after loss of deep pain and surgeon said she has had 1 dog walk again after surgery if it had loss of deep pain prior to surgery). Despite the pessimistic outlook they did proceed with surgery, but are now regretting that decision and feel back for their dog and are really stressed.They feel keeping him alive is unfair to him and they are quickly becoming very overwhelmed. Rehab was discussed and they were sent with

PROM exercises and it was recommended to get rehab 2 days/week with therapeutic exercise, hydrotherapy, laser, etc. However the surgery/rehab facility they went to is an hour and a half away so they didn't want to make the drive. Enter me...trying to convince the owners that after spending the money on surgery to at least try to give the dog a chance. But they are very stressed and severely limited on funds after dropping $5000 for surgery. Since I don't have a lot of experience in rehabing post surgery disc dogs I wanted to see if some of you with more experience could give me your opinion on success rates for dogs with loss of deep pain prior to surgery. The surgeons gave very poor prognosis and I wanted to see if anyone has a different take or that prognosis is accurate even with rehab. I think if I can give the owners some glimmer of hope that they may be more inclined to try. I talked with them for a long

while and they are holding off euthanasia for now and I promised to come up with cost of several different treatment plans and cost from the conservative home-care program to day boarding at our hospital so we can do the exercises, laser, hydro, etc for them but I also wanted to get opinions on prognosis from those of you that have more experience rehabbing disc dogs. What chance do we have to get an ambulatory and continent dog back or are we looking at a likely cart for life candidate? (I discussed the possibility of a cart with the owners and I can tell you that if this is his prognosis they will likely euthanize before going that route :-(Thanks in advance for your input!Sent from

iCloud

[Guest guest]

Robby,

nice video!

Rick Wall, DVM

[Guest guest]

Well I'm bummed. It's my day off and I went in to work this morning to call the

doxies owners and had to leave a message on their answering machine. I left my

email hoping they would reach me that way and told work to call me if they

called back. Well they did...to say they talked to the docs at the specialty

clinic and decided to put him to sleep:-(. Came in at 5pm and put him down.

Really wish they would have just given me a chance to help. Thanks to all of you

that responded for your advice better luck next time I suppose.

Btw...the video was great wish I would have had a chance to show that to the

owners:-(.

Sent from my iPhone

> Robby,

>

> nice video!

>

> Rick Wall, DVM

>

>

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Hello, could not agree more with your comments! My favorite reaction is when

just by caressing the hair between the digits, the dog responds by contracting

the paw.

However, I am a little lost, what do you mean by " Remember where the generator

for motion is in the quadriped. "

Natalia Kontogeorgou,

DVM, CCRP

My Pet Care

31 Hroon Polytexneiou str.

Chalandri 15231

Athens, Greece

tel: +302130052902

www.mypetcare.gr

info@...

>

> Sorry don't have much time to answer fully but would agree 100% with Jeanine

and Rick. I too love these dogs because you can make such an improvement with

them. Have a number of patients that were told by the surgeon that the surgery

was successful but will never walk again and they are walking now!

>

> Take care of the bladder, do the proper exercises, E stim , hydro, acupuncture

whatever you can do. Remember where the generator for motion is in the

quadriped. You can be successful with most of these dogs.

>

> Dr Jan Huntingford

> Essex Animal Hospital

>

> Sent from Jan's Iphone

>

[Guest guest]

Hi all

Sorry to hear about the dog. I skimmed this thread quickly but what I didn't see

any one bring up is the prognosis. There are papers ( sorry standing in line at

Starbucks do can't reference) that dogs that are deep pain negative and

surgically decompressed within 24 hrs actually have a 50/50 chance of walking!!

The majority recovered deep pain within 2 wks, almost all by 4 wks (of ones that

recovered). Not to say it it is zero after the 4 wks but much less likely.

Too late for this one but hopefully not for the ones coming after

Thanks

Au, DVM, DACVS, CCRT

Ohio State University - Veterinary Teaching Hospital

Sent from my iPhone

[Guest guest]

Those were the numbers I remembered. I may still call the surgeon/rehab person and see if there was a reason they were so much more pessimistic Sent from my iPhone

Hi all

Sorry to hear about the dog. I skimmed this thread quickly but what I didn't see any one bring up is the prognosis. There are papers ( sorry standing in line at Starbucks do can't reference) that dogs that are deep pain negative and surgically decompressed within 24 hrs actually have a 50/50 chance of walking!! The majority recovered deep pain within 2 wks, almost all by 4 wks (of ones that recovered). Not to say it it is zero after the 4 wks but much less likely.

Too late for this one but hopefully not for the ones coming after

Thanks

Au, DVM, DACVS, CCRT

Ohio State University - Veterinary Teaching Hospital

Sent from my iPhone

[Guest guest]

Thanks Rick, here's my latest from just a few days ago: http://youtu.be/hIlDbOZmQC8Robby J Porter IIICertified Canine Rehabilitation PractitionerLouisiana Veterinary Referral CenterAnimal Rehabilitation CenterMandeville, LA70448Main Hospital: ext. 208lavrc.comtwitter.com/LAVRCfacebook.com/LAVRCyoutube.com/user/LAVRCfacebook.com/louisianaCOPfacebook.com/SuperPanThePanofSteel*********************************************************************************************************This document, and any attached information is proprietary, privileged and confidential property of the Louisiana Veterinary Referral Center (LAVRC) under applicable law and is intended exclusively for business use by all LAVRC employees and intended recipients with a legitimate LAVRC business need.

The reproduction, dissemination, distribution and/or disclosure by unintended recipients is unauthorized, strictly prohibited and may be unlawful (Privileged and confidential pursuant to La. R.S. 13:3715.3).If you have received this transmission in error, please immediately reply to the sender and delete this information from your system. From: "Rick Wall, DVM"

To: "VetRehab " <VetRehab > Sent: Tuesday, May 15, 2012 1:53 PM Subject: Re: Post-op disc dog

Robby,nice video!Rick Wall, DVM------------------------------------