Intervertebral disc disease in Beagle
Question: Dear Dr. Richards:
Hello. I have been going over your site and previous questions and cannot find the answer to mine, so here goes.
I have a five year old Beagle who about six weeks ago suddenly, overnight, began to have a lot of trouble rising the in morning or after long periods of rest. It is mainly in his lower back and hind quarters where he shows the most strain. Once he is up and warm he has no problem running, barking, jumping and playing. We were told is was not most likely arthritis as arthritis usually does not set in overnight. We were told it might be a pulled muscle, or back strain from a number of reasons from playing to just moving wrong. He has been stretching constantly and has some noticeable muscle cramps. On his lower back where is back legs begin on either side of his spine he has large noticeable muscle cramps that are extremely tight. He loves to have them massaged but they do not seem to loosen. We have been to our veterinarian constantly since this began but have had no luck finding out what is wrong or how to elevate it. For now they put him on Rimadyl and Robaxin to ease with the pain in the hope that he just pulled something and the medicine would work like a Band-Aid so it could get better. But it is not getting better, but worse. We took X-rays and they really showed nothing significant. There was a slight misalignment in a lower vertebra but very slight so were left with no real conclusions to draw. We are now going to go see a Chiropractor and see what they say. I am not sure what to do at this point and just keeping him medicated does not seem like a real answer to the problem. Any ideas? Any at all? Please reply. Thanks.
Christy
Answer: Christy-
A very likely problem in a beagle with the signs you are seeing is intervertebral disc disease. This only shows up on X-rays about 70% of the time, so it is hard to be certain that this isn't the problem even when there is no evidence of it on plain X-rays. When clinical signs persist it is best to consider having a myelogram or MRI exam. I think of the MRI as the first choice, when it is possible to arrange for one. Sometimes bilateral rupture of the cranial cruciate ligaments looks a lot like a back problem, due to the reluctance of the patient to bear weight on either rear leg. This doesn't sound quite like what you are describing, though. We have seen kidney infections that looked a lot like a dog had back pain, with rigidity of the back muscles and reluctance to move and more rarely this can be a sign of an abscess in the retroperitoneal region (between the lining of the abdominal cavity and the big muscles of the spine), although most dogs with this problem also have fevers. Beagles sometimes get polymyositis (inflammation of multiple muscle groups) and polyarthritis (inflammation of multiple joints).
The best treatment for disc problems in which there are no significant neurologic deficits, such as weakness or paralysis of the rear limbs, is to use a non-steroidal pain reliever, such as carprofen (Rimadyl Rx), rest and time to allow the area around the disc to heal. If neurologic signs develop, then surgery is a better course of action and should be done as quickly as possible, preferably within 48 hours of the onset of neurologic signs. If another problem is present, different therapy would be required, of course.
If your vet is unable to make a diagnosis and the visit to the chiropractor did not help, either, then it might be a good idea to ask for referral to a veterinary neurologist or veterinary school where it may be possible to have an MRI exam.
Good luck with this. Hopefully you are seeing improvement by this time.
Mike Richards, DVM 10/16/2000
Please pass this along to any of your questioners/clients who are mulling over this type of surgery...
The difference the surgery made in my dog was phenominal. We picked him up on Saturday (surgery the previous Thursday) and there is only a hint of a limp when he goes up and down the two steps to get outside. Quite unlike the wobbly back end he had when we took him in.
He does not appear to be in any pain, at least not any major pain. He is on Rimadyl and antibiotics. He has to be cage rested for two months, and this is having an affect on his morale, he thinks he's being punished!
He's bald from about 2 inches aft of his withers to about 2 inches forward of his tail head with an 8" incision (30 staples) that starts just behind his shoulders.
I've taught him a new command, "Go to jail," meaning get in your cage. (I built a large enclosure for him, so he has plenty of room.)
I don't think I've ever seen a surgery in man or beast that gave such an immediate, positive result. Even if the results do come back as a tumor, I count the surgery as worthwhile, just in the obvious, immediate relief it gave to ma dawg.
PS. This is the same dog I told you about months ago who would sometimes get some frightening convulsions that I was eventually able to attribute to bad intestinal cramps. I'd take him outside for a bowel movement, and he'd be fine.
Rick
Question: Yo, Doc,
Your email was helpful. The surgery was yesterday and so far so good. Scaramouche had a mass--which confused me because I had no idea he was Catholic. (Sorry, Lutheran humor--which is NOT necessarily the same as sorry humor from a Lutheran!)
The tissue was sent off to a pathologist. While the surgeon isn't sure if it's disk material or a tumor, his gut reaction is that it's a disk. If a disk he got it all. If a tumor, he probably didn't get 100% of it.
But the ol' boy is doing well from the surgery and he should feel a whole lot better. If it's a tumor we'll see what everyone has to say. The plan is consult with our surgeon, then to Ohio State, and then perhaps on to Mississippi State.
We will do what we can to improve his quality/quantity of life. We will have to play a lot by ear. There is little to be gained for him to pursue an aggressive treatment if he only has 6 months. On the other hand, to do nothing if there is a reasonable expectation of recovery would be unconscionable. The outcome would likely fall between those two limits.
You might help me understand how disk material could be confused with a tumor, however. I think of a disk as a cartilaglnous material not unlike what we often found in our USMC chicken salad and a tumor to be more gelatinous.
It's not that I doubt the surgeon, but rather my understanding of anatomy.
Rick
Answer: Rick-
I have not been around any surgery involving the spine since I was in vet school, but I remember the disc material extruded from ruptured discs as looking more like toothpaste. The disc is actually a cartilaginous sac with a gel like material in it, that sits between two vertebrae and cushions the spine. In chronic disc disease the material can be any consistency from the gel state to calcified material. Tumors can make tissue look a lot like toothpaste, too. In addition, some tumors calcify, so either one of these could look like disc material without a microscopic exam. In addition, hemorrhage may occur in conjunction with disc ruptures and the inflammation in the surrounding structures, such as the epidural fat that is also present in the spinal canal, can all make figuring out exactly what is there pretty confusing. The potential for confusion is one of the reasons that this surgery is best done by a specialist or surgeon who sees a lot of these cases --- and as you found out, even they get have a hard time being certain of what they are seeing sometimes.
Hopefully, this is a disc and the surgery will allow the spinal cord some relief.
Mike Richards, DVM 8/14/2000
Question: 9 year old Dal. Been having rear end limping trouble which mimicked an athletic injury: torn ACL or cartilage. It would apparently clear up, then return.
Finally it got worse and after several trips to the vet it started affecting both legs, so we went to see a surgeon. A myelogram showed a constriction in his spine, in an area where the trouble would logically be causing the symptoms we are seeing.
He's done pretty well on the prednisone, but he walks like his butt is drunk!
The surgeon and an independent tech looked at the results and feel that it is probably a tumor. The dog is scheduled for surgery this Thursday (8/10) to find out exactly what the trouble is. Obviously we are hoping it's a disk.
I'd like to know what kind of questions to ask the surgeon if it's a tumor.
If it's the worst case scenario I'm going to need a couple of opinions before I give up. I know a student at Mississippi State's Vet school who said she'd try to fix us up with someone there and Ohio State is close to us.
He was a surprise 20th anniversary gift from my wife and is not only the sweetest natured dog I've ever had, he's a hiking partner, enthusiastic canoeist, helps me run with my sister's horse, and is a cherished friend. (I take the blame for him when he passes gas--seems the least I can do!)
Sorry about the short notice. Rick
Answer: Rick-
Tumors that affect the spinal cord may originate from the spinal cord itself, or they may arise from tissue around the spinal cord. It helps a great deal to know which is the case. It may not be possible for the surgeon to tell you this, immediately, but it should be possible to determine this from a biopsy sample taken at the time of surgery.
The distinction is important, because it makes a big difference in how the tumor is treated and in determining its prognosis, if the tumor type can be identified. Even if the situation looks really bad during the surgery, it will help to have a sample of the tumor, unless a decision is made to consider euthanasia during the surgical procedure.
There are some tumors that can be removed surgically but this is not usually the case. It is usually necessary to try to remove some of the tumor, to try to relieve pressure, or to remove bone around the tumors, to try to relieve pressure on the spinal cord. It is helpful to the surgeon to know how you feel about these procedures.
Did you elect to have surgery just to be sure that there wasn't a mistake in the diagnosis? If this is the case, and you do not want to pursue aggressive treatment in the face of a poor prognosis, your surgeon should know that in advance.
If you are hoping for any improvement in the length of time that your dalmatian is more comfortable or to delay the onset of more serious clinical signs, then you should also be sure the surgeon knows that.
If you are willing to take a bigger surgical risk in order to try to get a better outcome, that should be clear, too. If you are frightened that things will get worse and you want your surgeon to be cautious if that is possible, it is just as important for that to be known in advance.
I think that you should be sure that your surgeon knows where you are at the time of the surgery, so that if some sort of decision has to be made, you are available to help in the decision making. If you have a beeper, give someone at the surgeon's office the beeper number, for instance.
I wish that I could give you very specific advice but you have to know more about the tumor and in order to do that, you have to have the surgery done.
Mike Richards, DVM 8/10/2000
Question: Dr Mike We have a 9 year old German Shepherd. She continues to limp after the following interventions; 1) X-rays of hips and extremities (no signs of dysplasia). We have also tried 30 days of Rimadyl, 60 days of Cosequin. The dog seems to improve over a short period of time. I notice she begins to drag her left hind leg after walking very short distances (less than around the block). She also shows difficulty intermittently when trying to climb stairs. She may be fine for a week or so, but then a relapse occurs for no known reason. She also seems to improve with baby aspirin for a short time. There does not appear to be any obvious swelling or soft tissue edema. We hope you can help. Dale
Answer: Dale-
There are two strong possibilities with the symptoms you are seeing.
The first is degenerative myelopathy, which is a disorder that occurs primarily in German shepherds and involves degeneration of the sheath that covers nerves. As the sheath deteriorates nerve function also deteriorates and this leads to weakness in the rear legs. There is no treatment for this condition which has proven to be consistently successful but there is a published treatment protocol by Dr. Clemmons from the University of Florida. There are some details on this treatment on the web site and Dr. Clemmons had a web site detailing the treatment which you may still be able to find online.
The other possibility is a spinal disc problem or lumbosacral instability. Either of these conditions can also cause the symptoms you are seeing. With the recent availability of MRI examination for dogs there is a feeling among some vets (most notably the ones at Colorado State and the the University of Washington (I think)) that disc disease is much more common than degenerative myelopathy. Dr. Ludgren from CSU is a strong advocate of MRI imaging and your vet could talk to her about it, I'm sure. She has posted a lot of information on the Veterinary Information Network (tm) about this condition which your vet may be able to access if he or she is a member of this service.
Early intervention is best for the spinal disorders, so it would be a good idea to ask your vet about referral to a veterinary neurologist who has the capability of doing an MRI exam. I have referred a couple of patients to facilities with MRI machines who ended up getting myelograms (dye studies of the spinal canal) which I don't think is as effective a technique for looking for disc problems like those that Dr. Ludgren is reporting.
The disc problems and degenerative myelopathy both tend to have poor responses to anti-inflammatory therapy, which is one reason to be suspicious of them instead of hip dysplasia, which does usually respond at least partially to anti-inflammatory and analgesic medications.
Hope this helps some. If you need more specific information on these conditions I will try to find it for you.
Mike Richards, DVM 6/14/2000
Question: Mike I was judging a field trial this past weekend when another judge approached me for advice because of Striker's successful Cauda Equina repair. As you might expect, that success in terms of Striker's finishing his field championship and really being very competitive this spring caught many people's attention. This fellow has a 5-6 year Vizsla male that appears to be suffering from cervical disc disease. His vet did the diagnosis based on obvious deficient and Xrays. The dog's front leg lameness has gotten progressively more frequent, to the point that he wasn't run this past weekend. Here's the deal: Based on my vets successful Striker repair, I told this guy I wouldn't let anyone near my dog's spine with a knife but my vet and he should at least let him look at the dog and get a Myelogram. His vet, who was very lukewarm on Striker's surgery, is being very discouraging in this case. You don't have any write-ups on neck disc problems on your site, but I gather that surgery is substantially different than Cauda Equina, more discs involved, approach from below, more hospitalization et al. This owner's going to see my vet in the next couple of weeks, but he's been told that the surgery's very expensive, unlikely to help and might well leave his dog paralyzed. Under these circumstances, can you offer your experiences with cervical repairs and suggest the critical, detailed questions he needs explore with my vet? I really appreciate your help. Bob
P.S. I'm looking forward to receiving your Mom's book in time for my granddaughter's 1st birthday next weekend.
Answer: Bob-
I think I better start with this warning. I have absolutely no experience with patients having cervical spinal surgery that I can remember except for two cases of wobbler syndrome in dobermans, that I can remember.
I do have several references that list prognoses for various cervical spinal conditions based on the clinical symptoms and location of the lesions. So I can provide only as much insight as the references allow.
I do think that it is a good idea to see a specialist, first to confirm the diagnosis and second to get the opinion of someone who actually does this sort of surgery. The reason that I think that getting the opinion of an orthopedic or neurosurgeon who has experience with these cases is so important is that most vets, including me, are reluctant to send clients away to specialists when great cost is involved and the outcome is uncertain. There is a tendency to worry that the client will be upset at both the specialist and the referring vet in these cases and that long term, that hurts the referring vet more. So there is a strong tendency to be conservative in making the recommendation to see a specialist. The other reason is that the surgeon almost always thinks that surgery is the answer, because that is the nature of surgeons. They sometimes are happy with outcomes that don't really seem total victories to the referring vet, or the client. So it seems better if they hear the downside before they talk to the surgeon. Anyway, that may explain the reluctance to refer. It took me a long time to get to the point where I decided it really was the client's money and that they had to live with the outcome, so it really ought to be their choice. As informed a choice as possible, of course.
OK, on to the prognosis for surgery. This from "Small Animal Surgery" by Theresa Welch Fossum and others. For neck pain alone (this is what we see BY FAR most commonly in practice), the recommendation is to use conservative treatment with anti-inflammatory medications and rest. The prognosis is good. For patients with neck pain that won't respond to medications and won't go away on its own, either, with disc material causing the pain, the recommendation is the ventral slot surgery and the prognosis is very good. For patients with noticeably gait abnormalities who can still get around good and have neck pain, the recommendation is to do the ventral slot procedure and the prognosis is still good. When the dog can't get around much but can stand, at least, but retains normal sensory nerve function in the front legs, the prognosis is favorable. For dogs with difficulty walking and reduced sensory nerve function in the front legs, the prognosis is guarded.
The ventral slot surgery does seem more difficult than the laminectomy procedures done for disc problems the thoracic, lumbar or lumbosacral regions. It doesn't give quite as good a view of the spine and there are potential complications from the positioning of the nerve roots and venous sinuses when taking this approach. So you want an experienced surgeon, but I don't think it necessarily follows that the risk is too high to be acceptable. It is just a factor to be considered.
The really critical questions in this case, that I can think of, are 1) is it certain that this is cervical disc disease? A myelogram or MRI may be necessary to confirm this and to confirm the site of the lesion. 2) Are there sensory nerve deficits in the front limbs? If so, how severe are they and how does that affect the prognosis? 3) What follow-up care is necessary and is it possible for the dog's owner to provide it? 4) What is the objective of the surgery, from the owner's perspective and will the outcome meet that objective --- there is a big difference between a comfortable happy pet and a working dog. Is the prognosis for continued field trialing different than the prognosis for a comfortable life?
Hope this helps some. I'm sorry that I can't offer much personal perspective on this. I am thinking that I have been pretty lucking in my career when it comes to this problem. I can only remember a couple of dogs that I thought would benefit from surgery. The owners declined. One called me a quack for suggesting it -- really, I'm not making that up. I just mentioned it because I really can understand the vet's reluctance to push for surgery, even though I don't necessarily agree with that stance.
I called my Mom and she is sending the book. She's usually very prompt but if you don't get it by Tuesday, let me know. I have a couple of generically signed copies and can send one so that you at least have the book. We can fix the dedication later, in that case.
Mike Richards, DVM 4/22/2000
Question: Dr Richards, please dont kill me, I have more questions! I have another dog, a Pekinese mix, 3 years old, male. He has had herniated disk and was paralyzed at the hind legs last August. Thank Buddha he had a successful surgery and is back to normal now.
I know jumping and begging (stand on hind legs) may cause pressure on his spine so prone to the same problems again. However, what about running? I talk my dogs for an hour walk every day and I always let them run freely. However, everytime I see JJ run, I am worried it would hurt his spinal cord or that one of the disks may start to dislocate gradually, and then he may be paralyzed again. But I hate to leash him all the time. Can you tell me if running is bad for the spine please, or should I restrict his activity and keep him on leash walking. He is 22 lbs.
Answer: Lily
The best thing that you can do for a dog with spinal disc problems is weight control. Since it is a lot easier to control weight in a pet that is getting adequate exercise, I would favor letting your Peke run some. It is a good idea to avoid jumping and high impact activities but running should not be a big worry.
I hope this helps some.
Mike Richards, DVM 3/19/2000
Question: I'm sorry if this is a duplicate request. I have been having trouble with my email and I'm not sure this was ever actually sent. Thanks for your time. Dr. Mike, My German Shepherd recently had a hemilaminectomy for a ruptured disk, L3-L4. She also has spondylosis L1-L7 but is otherwise healthy. She is a 6 year old, spayed female who we believe was bred by her previous owners. I have a couple questions. What effect could the spondylosis possibly have on her future in regards to quality of life and functionality? Just what can happen to her? And, her rupture was described as a Type 1 Hanson's rupture which was noted to be "unexpected in this type of dog". What differentiates this type of rupture from others and why would it be unexpected in her? Thanks for your time. P. K.
Answer: P.-
We had some email problems, too --- so it is hard to say what might have happened, but I am sure I wrote an answer to this question once. But that doesn't matter, because I found a better answer when searching for information this time, anyway.
Dr. Hansen described two types of disc herniations --- Type 1, in which the material in the center portion of the disc herniates through the outer layer and into the spinal canal and Type II, in which the outer material itself bulges into the vertebral canal. Type I lesions are supposed to be more common in small breeds of dogs with short legs and long bodies (dachshunds, beagles, etc.). Type II lesions are more common in big dogs.
So in a German shepherd, Type II lesions would be more typical. I think that the advent of MRI has changed the thinking on this, though. I read recently that myelography was not as good at finding the lesions associated with herniation of central disc contents through the outer layers in many instances and that these types of lesions were showing up in MRI exams of dogs previously thought to have degenerative myelopathy (my interpretation of board discussions on the Veterinary Information Network in which the words Hansen Type 1 and Hansen Type II never appeared).
Spondylosis is very very common in older dogs. Most of these dogs never show any clinical signs that can be attributed to the spondylosis, even though their spines look really awful on X-rays. So when a dog does come in with signs that appear to be neurologic and appear to be associated with the spinal cord region in which there is significant spondylosis, it isn't acceptable to just assume that the signs are due to the spondylosis and treat with anti-inflammatories or corticosteroids. It is necessary to try to figure out if there is a disc herniation, lumbo-sacral instability or degenerative myelopathy. If any of these conditions is suspected, magnetic resonance imaging (MRI) is superior to any other diagnostic test for ruling out disc herniation and lumbosacral instability.
MRI exams are not yet considered to be a routine procedure in veterinary medicine and are not available everywhere. For that reason, myelography (X-rays taken after dye is placed in the spinal canal) is still used more commonly. It is a clear second choice at this time but may be the only available option.
That got a little off track, but the summary is that spondylosis is probably not a problem in most dogs in which it occurs. Therefore, it is best to look for other possible causes of neurologic signs if they occur again in the future and resort to blaming the signs on the spondylosis only if no other problem can be identified.
Mike Richards, DVM 12/4/99
Q: Dear Dr. Richards:
I've just become a subscriber to vetinfo primarily because I've been researching a problem on my 9 year old, female greyhound that the vets have yet to be able to diagnose.
I was reading your article about the compatibility between client and vet which has some similarities to my own case. My wife and I are active in rescuing greyhounds in South Florida and have adopted 3 ourselves. We have always gotten excellent and competent diagnosis and treatment from our vet especially since they treat many of the local racing greyhounds. Recently, however we've been shuttling our little girl between there and another vet specializing in neurology. After about 3 weeks of tests including:
Chest x-rays Spinal Tap CT Scan Liver Biospsy Electrocardiagram Tests for thyroid, adrenal, diabetes, erlychia, and many others,
we are no closer to an answer. Needless to say, after all this testing, and the expense, we are rather exasperated and desparate to find out what could be wrong with our dog. This has also strained the relationship between us and our vets, because as the mystery deepens, the vets seem to be withdrawing from the case, that is, we get the feeling that they'd just like to see us and our problem child dissappear. Thus, the reason for my note. Here's what happened to Brandy:
9-9 On evening walk, she displayed some dragging of her right rear leg, with the toenails scraping the pavement. (this happened to her once before over a year ago, but never recurred until now).
9-10 Got her out of bed in the morning, she was disoriented, she walked out the front door, staggered for a few steps, and fell over on her right side, and went into a seizure (duration was no more than 30 sec.)
Rushed her to vet. At this point she could not stand. They injected her with prednisone and after about an hour she regained her ability to stand. They ran tests on her all day, we took her home on 20mg Pred. 2x per day.
She continued to be extremely weak and lethargic for over a week. She was panting heavily at the least bit of activity, she began loosing weight rapidly.
9-17 The right rear leg numbeness would only occur late at night (seemed that as the pred pill wore off, the right rear leg began to disfunction). At this time we also noticed a bloating of her abdomen which became very obvious when seen next to her diminishing waistline.
We took her into the neurolgy specialist for the spinal tests which all came back normal.
9-20 She seemed to regain her energy level and almost started getting back to normal except for the continued abdominal bloating and no gain in weight even though she developed a voraciuos appetite. The next thought was her liver because she was eating well but not re-gaining weight.
9-27 Liver biopsy done. The neurologist advised us that the prednisone may be causing some of her symptoms (heavy panting, voracious appetite, possibly even the bloating).
9-30 Liver biopsy showed she had a liver problem (hy.....), that the vet felt was due to the prednisone (however, she only began taking the pred in the last couple of weeks which the vet then said did not make sense as it would unlikely effect her that dramatically that quickly).
10-2 In the mean time as we began reducing her dose of pred, her rear right leg problem began to resurface. We took her back to the vet where our vet there prescribed Rimadyl to be administered 48 hrs. after her last pred dose.
She got her last 5mg dose of pred on 10-2. On 10-3 (today) she could hardly get up to walk, and right now it appears that her entire back end is slowly becoming inambulatory (almost as if paralysis is setting in).
Now, I'm no vet, but I hardly think Rimadyl is going to solve her problem.
When I left the vet yesterday moring, I asked him to please call the neurlogy specialist and discuss this case, as I felt together they might be able to come up with some other ideas.
However, in the mean time my baby continues to deteriorate -- she's now lost about 10 pounds (from 68 lbs. to 58 lbs.), and I fear she will be rear end paralyzed by the end of the day. One other note -- the nuerology vet feels it is not epilepsy. Please let me know if you have any advice on this case.
Thank you, Rege
A: Rege-
I don't have much that I can offer even though I have been researching this some.
The weakness in the rear limbs may still be a disc problem, despite the neurologic testing. With the recent availability of MRI scans, according to Dr. Ludgren at CSU and researchers at one of the other vet schools, it has been possible to document spinal problems that simply couldn't be documented any other way. It may be worthwhile to consider finding out if there is anyone in your area who has access to an MRI machine and who can read the films from it. This usually means going to a veterinary school or large referral center. Unfortunately, MRI is considered to be superior to CT scans for looking for some of these problems. I know that you have spent a lot already and understand that it isn't an easy choice to pursue another diagnostic test of this expense, especially since a CT scan is a very good test.
I can't explain the fainting/seizure episode, either. It just doesn't seem to fit in with spinal injuries and doesn't seem too likely from liver disease unless it is worse than it seems from your note. Perhaps a heart problem, such as an arrhythmia that is intermittent? These can be very hard to find but a cardiologist might be able to help. It is sometimes necessary to do specialized ECG testing with a Holter monitor to find intermittent problems.
Weight loss like you are seeing always makes me think of cancers. They can be hard to find, too. And they can cause all of the symptoms you are seeing. Sometimes the only thing you can do to find cancer is to keep going back and rechecking the same things over and over again until it chooses to appear.
Your vets probably do feel uncomfortable about the amount of testing and expense you have gone through, so far. You may have to reassure them that you understand the necessity of keeping going with testing in order for them to be aggressive about it, if you wish to keep going forward with trying to find a diagnosis. Alternatively, you may wish to ask for referral to a veterinary school, just because they have a lot of specialists in one place and sometimes that helps in really difficult cases.
I wish I had better advice and I hope that your girl is hanging in there or even improving.
Mike Richards, DVM 10/7/99
Q: Dr. Mike --- I'm a new subscriber with a tough question:
I need your advice to determine the efficacy of spine surgery on a 6 year old male Brittany. The dog's been diagnosed with cauda equina syndrome, which I believe is accurate.
The dog is a field trial animal that kept slowing down in competition after 15-20 minutes at 21/2 years of age. Repeated work-ups concentrating on liver, heart and lung functions, including a stint at VA Tech Vet school failed to find the cause of what was termed "exercise intolerance." The dog never limped or showed signs of any pain.
Last fall my new vet had the dog flinch during an examination. X-rays revealed herniated disc(s?) in the area where the leg nerves exit the spinal nerve bundle to the rear legs. I should note that dog had for a long while failed to empty its bladder normally, repeatedly dribbling small streams. In fact he'd been previously checked negative for prostate swelling and stones.
We put the dog on Rimadyl and had a dramatic improvement within 2 weeks. The dog ran flat-out for 40 minutes to the point that I could barely catch him. He also urinated in a continuous stream, effortlessly. His whole demeanor sparkled, like a young puppy/derby.
Unfortunately that improvement was short lived, although the dog, with a Banamene shot, placed in three field trials in October/November 1998. Today the dog is clearly in some pain. We switch from Rimadyl to Etogesic without improving his condition. He can run at a modest pace for 15-20 minutes and then jumps into a pickup with hesitation. His urinary problem has also returned. While I might continue to use Banamene once or twice a month, the dog's losing muscle mass as he can't be exercised heavily.
One other data point, I noted your page spinal pain write-up suggests that infection is sometime the cause. During the 3 year period between onset and CES diagnosis, I felt the dog improved any time it was on antibiotics (Doxycycline & Primor) for another conditions. The improvement wasn't nearly as marked as that reaction to Rimadyl, but appeared encouraging (perhaps a placebo effect?). I had him on Doxycycline for 60 days at one time when we thought it might help.
Given long period of time since the initial CES onset, what would you advise regarding surgical options. Can this dog be made well again? My suspicion is that a surgeon would be only too happy to cut; I need a more detached recommendation. His initial reaction to Rimadyl thrilled me, but it couldn't be sustained. We doubt the problem is congenital, as he has 7 AKC/AmerFld Field Champ littermates.
Looking forward to any direction that you provide. Robert
A: Robert-
I am a general practitioner, so I have no personal experience with these surgeries to relate to you, except that we have had two or three patients undergo surgery and all improved. One dog was not completely normal post surgery but was showing pretty severe neurologic deficits prior to surgery. Discospondylitis (infection of the disc between the vertebrae) is one of the differential diagnoses when cauda equina syndrome is suspected, so that has to be considered as a possibility. It is supposed to be more common in large dogs. In some cases it is possible to culture a bacteria from the blood or urine that is associated with that problem. X-rays are useful in differentiating the conditions, too. Discosponylitis can often be seen on plain X-rays. At the present time most of the surgeons that I have contacted about this who have access to magnetic resonance imaging (MRI) heavily favor this as the most effective diagnostic technique and feel that it is worth considering even when the diagnosis is known so that surgery can be planned more effectively. Not all veterinary orthopedic and neurologic surgeons have access to MRI technology, though. All of the symptoms that you have seen are suggestive of cauda equina syndrome so it does seem very likely. In general, spinal surgery does work better when it is done earlier in disease processes, but most of the time there are benefits even much later after the disease has progressed.
If I have the chronology figured out correctly, he is about 5 1/2 years old at this point? If so, he has a long time to live with this problem and that makes surgery seem more appropriate to me, too. It may be possible for the surgeon to give you some idea of the likelihood that he would be able to return to competition with full ability but I can't do that.
The article in the Compendium on Continuing Education from 1988 had a 90% success rate reported with surgery -- those are pretty good odds.
Sixty days should have been long enough on antibiotics to rule out discospondylitis, as long as it was an appropriate choice (it is better when a culture can be obtained and the antibiotic chosen based on that -- but not always possible to get this).
I'll be glad to research this further if you have other questions as you go through the process of making up your mind.
Just as an aside, I really have a lot of faith in the neurologists at the Virginia-Maryland Regional College of Veterinary Medicine, especially Dr. Shell. I know that no one is perfect but she has been very good for most of our clients. I know that they were not able to make the initial diagnosis for you but I still think they are a good choice for the current diagnostic and surgical needs if you chose to consider them.
Mike Richards, DVM 3/4/99
Spinal Disc problems- Weimariner
Q: Hello,
I was wondering what to do for my weimariner so I got on the internet to seek out some help and hopefully you can.
My vet said (after x-rays) that my weim. has a problem with a couple of vertebra that are too close together. He asked if he had ever been injured before. I have had my weim. since he was 8 weeks old and he has never been injured (he is now 9 and 1/2 yrs. old). The vet said that the spinal cord nerve is getting pinched and causing severe pain. When an episode occurs (5-6 times per hour-the poor guy) he slightly hunches his back, tries to walk but it's usually a stagger, stops and lifts his left front paw, sits down, lies down, puts his head down and sometimes his head is turned to the right, and there is usually a twitch just above his left shoulder blade by his neck. He usually suffers through this pain for five to ten minutes.
The vet said I need to keep him calm and in a small area during the day while I am work (the less movement the better). The vet also gave me a perscription for Rimadyl (75 mg. twice per day). We are being very careful with the Rimadyl as his liver enzymes were elevated at the onset (which seemed to be right now). His two A's (can't think of what they were) and his cholesteral were pretty high in his blood test. I can't believe the liver enzymes (I really do of course) because he gets fed Canine I.D. dog food. Gets walked about a mile every day. Gets lots of love and attention. Goes almost everywhere with me and look what happens! I feel so helpless and bad for him.
The vet told me that this healing process would take ~5 weeks as these episodes are very painful for the dog (as I can truely believe as it takes my little buddy right down to the floor with pain). The vet also said that if it doesn't get better there is always the option of taking him to a neurosurgeon.
I trust in my vet. I want to know if you have ever heard of something like this and if so, what happened?
It is all so sad to me and I want to know if it sounds like we are doing the right thing. I love my dog very much. He is my buddy and I want to be here for him like he is always here for me.
So sad in northern Michigan, Nancy-
A: Nancy,
It sounds like your dog has a problem with one of the discs between two spinal vertebrae based on your email but it is not possible to be certain of this. The treatment plan your vet is following is a pretty standard plan for this type of problem. If there is not a good response then I would seek referral to a veterinary neurologist, as long as this is practical and financially feasible for you, since specialists see the more difficult cases and often can help when a general practitioner has tried the options for treatment available to him or her in a general practice.
It is always hard to decide what to do about Rimadyl (Rx) when there are signs of pre-existing liver disease but I personally think it is reasonable to use it as long as liver values are monitored carefully when the situation warrants strong pain relief.
There are many older dogs that appear to be normal and who are eating good diets who have elevations such as the ALT and alkaline phosphatase in liver enzymes. These can occur for a number of reasons and are sometimes transient. Rechecking the values is the best way to get an idea of the chronicity of the problem. If it persists other liver tests such as bile acid response tests, ultrasound exam or liver biopsy may be necessary to determine the cause for the problem.
Good luck with all of this. I hope that your weimaraner is already improving.
Mike Richards, DVM
Q: Dear Doctor, Our seven-year old Rambo, who is likely a poodle/bichon fris mix, infrequently had trouble jumping up on the bed or into the car, episodes that lasted a day or so and left. But yesterday he and his room-mate Cocoa get very exercised at a possible intruder into our yard and enthusiastically ran from the porch in full bark to chase it away. Amid the barks there was a yip of pain that I think came from Rambo. In any event, when we called them back to the porch, Rambo was obviously impaired, inable to keep his rear legs in gear or in full support of his 17 pounds. He can barely walk but does manage and this morning it's a little worse. I've read your site on spondylosis and other possibilities which you suggest could be "degenerative myelopathy, spinal cord tumors and ruptured cruciate ligaments (partially arthritic in its effect)." He presents the same inability to jump up, of course, but the accompanying symptoms are much worse than we have seen before. Suggestions, please. Thank you and aloha from Hawai`i ,Bill
A: Bill-The most common cause of weakness and pain associated with the spine is intervertebral disc trauma or disease. The unfortunate thing about our choice to build this site in a question and answer format is that the most common diagnoses are often not covered as extensively they should be --- because there is less question about the problems at the vet's and because people tend to understand them a little better.
The spine is composed of a long series of bones connected through a series of ligaments with a shock absorber -- the disc -- between each connection. If support was the only job of the spine there would be a lot less pain associated with injuries to the disc area, probably. But the spine serves as a conduit for the spinal cord, too. This very large bundle of nerves runs through the center of the spine and the individual strands of the bundle exit between the vertebrae at whatever level is necessary to do their job. The nerves pass between the outer edges of the disc and the boney protrusion of the spine. As long as everything is in its place this arrangement works fine. When the disc bulges or is damaged and calcifies it can put pressure on the exiting nerves leading to visible clinical signs of dysfunction in the area served by those nerves. By carefully considering where weaknesses and pain are exhibited it is possible to tell which discs are likely to be damaged.
If the disc is just putting a little pressure on the nerve there may only be pain. If the disc is damaging the nerve more significantly then weakness or paralysis will occur. In the case of pain alone it limiting exercise and utilizing a non-steroidal anti-inflammatory medication may be all that is necessary. If there is is weakness then corticosteroids or even surgery may be necessary to alleviate the problem.
In a dog with pain and weakness in one or both rear legs there is a strong likelihood of an intervertebral disc problem. Other possible causes of problems do include the ones you listed from searching our site as well as localized injuries that sometimes mimic disc problems. When both cruciate ligaments in the knees rupture at the same time the resulting disability can strongly resemble the weakness and disability associated with disc injury. It may be possible that luxation of both patellae at the same time could also produce similar signs.
It would be a good idea to have Rambo examined by your vet if there is any residual sign of weakness and if you have not done so already. There is no really good way to prevent recurrence of disc disease, except weight control if that is necessary, that I am aware of. If paralysis should occur rather than just pain, it is imperative to seek veterinary help immediately. If this is identified as a disc disease problem it is also a good idea to discuss surgical correction with your vet in advance of the need. If paralysis should occur it is necessary to operate to relieve pressure within 24 to 48 hours of the onset of paralysis for best effect. This means that it is best to know in advance where such surgery is done, how you can get there, what it costs and if you can afford it so that the major decisions are already made.
Hopefully Rambo is already feeling a lot better and will never have a progression of clinical signs that makes all this decision making necessary.
Mike Richards, DVM
Q: What does it mean when a dogs tail is 'locked' down.? My 5 year old lab is being treated for lameness and a possible hip problem (no final diagnosis yet). She's on Rimadyl -which does seem to be improving the problem. The vet asked whether her tail was down. We told her no but, last evening the dog's tail dropped for the first time ever and remains so this morning. Any suggestions? Thanks. RCS
A: RCS- I would worry about an injury in the caudal spine with an inability to move the tail or an unwillingness to do so. This sign is sometimes seen with perianal fistulas or other rectal problems and it can be behavioral but that doesn't seem likely in your dog's case. Once in a while this will be the sign that shows up with anal sac impaction, too. Given the overall history it seems more likely that your vet is worried about a spinal problem, though. I hope things are much better now.
Mike Richards, DVM
Chronic disc problem - treatment
Q: Dear Dr. Mike, I want to thank you for all you've done for my dog Tasha. If it wasn't for you, I wouldn't have possibly followed up with getting a second opinion from another veternarian! She has had weakness in her rear legs, which she hadn't had previously, which caused her to continually to fall. You had mentioned that she could possibly have spinal problems, or possibly it could be systemic... Her previous veternarian diagnosed it as arthritis, without taking x-rays. To make a long story as short as possible, I took her to a different veternarian today and she took x-rays and found that my sixteen and one half year old dog had disc disease. She also said that she saw very little arthritis in the upper part of her legs. She gave my dog a cortisone injection, and if the blood work is normal, will have her take Cortisone tablets for about two weeks tapering down to half a tablet in the last five days. I was wondering, if you wouldn't mind, could you tell me if this is a very effective treatment for disc disease ( approx. 4 discs seem to appear compressed in x-rays and are spaced out from each other), and if it doesn't work, would a Orthopedic specialist be the next step. The vet. had "mentioned" surgery, as something possible down the road...I feel it would be too much to put her through at her age. Do you? Are there any other drugs that are effective?
A: Cortisones work better than anything else early in intervertebral disc disease, probably. There is still some controversy over that among veterinarians. I think they help.
For chronic disc problems anti-inflammatory and pain relieving medications are sometimes more effective. Chiropractic and acupuncture treatments are advocated by some vets, too. I don't have much experience with these treatments, though.
Surgery is often effective for back problems but it does not always help. Age itself is not a consideration as far as the surgery goes but you do have to think about the length of time recovery takes and how much of Tasha's remaining lifespan that might be. It makes the choice harder to make in older dogs. If paralysis occurs it may be the only effective treatment and it must be done very quickly if that happens -- so it is best to know what you really plan to do at that time, if it occurs. Hopefully it won't!
I hope Tasha is doing much better. Mike Richards, DVM
Q: Dear Dr. Mike, My dog was reciently diagnosed with Disc Disease of her spine and has been put on Prednisone, 5 mg. tablets given twice daily. She has been on the medication for about a week, and is much improved in strength and stability of her rear legs and comfort level. Today, unfortunately, she has been arching her back as though she has back pain and has been panting and the house isn't overly warm. I am assuming the panting is associated with the painful back. Could I possibly give her some aspirine and how much? I don't want to give her any medication that might conflict with the Prednisone. She weights 17lbs., and I would ask my vet. but, it's Sunday and they aren't in their office. Thank-you So Much!
A: Aspirin can be used for pain in dogs but I am reluctant to use it in conjunction with prednisone. Somewhere I read that aspirin is more likely to cause ulcers when it is given at the same time as prednisone. I can't even remember where but I have been afraid of using them together ever since.
It is acceptable to use narcotic pain relievers like hydrocodone in conjunction with prednisone. We use this combination in our practice when more pain relief seems necessary when we are using prednisone.
If the pain continues this may be worth asking your vet about. Mike Richards, DVM
Q: Dear Dr. Mike, I have a yellow labrador retriever. Her name is Casey and she is one and a half years old. We purchased Casey from a "backyard breeder". As with most Labs, Casey loves to retrieve a ball. About every other day for some time, I have been taking Casey to a nearby park around 5:30am for some retrieving and exercise. She truly enjoys this activity. On March 30, 1997 I was throwing the ball when I noticed that Casey started to limp and one of her hind legs appeared to be paralysed. A little later, she was unable to move her hind legs at all. My vet took her in at about 7:30am. He is a good vet but I question his diagnosis. He claims that Casey has "degenerative disk disease". How can a one and a half year old puppy get such a disorder? Is it truly genetic?? Is surgery (at close to $2,200 ) the only way to treat the disorder? How can I tell if the dog is in pain?? Also how can I read up on the disorder. Can you recommend a book or internet site??? She has been on cortisone and muscle relaxers for about ten days and appears to be doing better. She walks with a wabble and seems to have little strength in her hind legs. I am trying to consider the quality of her life as a dog with great heart and spirit but without the use of her legs. I think it may be more humane to put her down. In your experience, can a young dog recover form this without becoming an invalid?? I would appreicate your advice!! Thank You,
A: I think that you might be more comfortable with the diagnosis if your vet had referred to it as "intervertebral disc disease", rather than "degenerative disc disease". This disorder does occur in young dogs. I can not answer the question about the genetics of this problem. It seems to follow family lines in some dog breeds but it appears to occur randomly as well.
Sometimes it is possible to be pretty certain that this problem is occurring based on X-rays. Other times, the diagnosis is harder to make without a myelogram or computed tomography (CT)X-ray examinations.
Many dogs will recover over time, without surgery, if paralysis is not present. In other dogs, surgery is really the only viable option -- this is particularly true when there is sudden paralysis. In this case, a decision on whether or not to do surgery should be made as quickly as possible -- within the first 24 hours is best. We have had patients recover from paralysis even when their owners could not afford surgery but it does not happen with regularity and it takes very dedicated owners to care for a paralyzed dog, even one that is making progress towards recovery.
Casey sounds like she is doing remarkably well given the severity of the signs you have seen. Your vet can give you some idea of a prognosis for recovery. It would be a good idea to ask about referral to a veterinary neurologist or orthopedic surgeon if your vet feels that there may be a benefit from surgery -- or just to give you a better idea of what has happened and what the prospects for Casey's future are. A decision like euthanasia should be made from the most informed perspective possible.
Good luck to you and to Casey. Mike Richards, DVM
Q: We have a 5 year old dachsund, Charlie.. Lately, he has been acting really odd. He used to love attention but now he cries when someone tries to pet him. When my Mom comes to visit and bends down to pet him, Charlie runs away with his tail between his legs. He acts like he is afraid and is very skittish even with just my husband and I. We try not to make any sudden moves and treat him gently but that hasn't seemed to help..What would make him started acting this way and is there anything we can do to make him more at ease?
A: The most likely problem in your Dachshund is probably a spinal disc causing pain. It would be best to have your vet check on this. If it is the problem your vet can help your dog.
Mike Richards, DVM
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...