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Any Guidance Appreciated

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SammiB
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Any Guidance Appreciated

Post by SammiB »

This is a desperate post. I’m hoping that someone on this forum has seen something similar and can offer some kind of guidance.

A month ago my dog started showing very minimal lameness in his leg rear leg. Seriously, it was so insignificant that if you didn’t know my dog, you wouldn’t have noticed it at all. I took him to my primary vet for what I thought might be a sprain. My primary vet suspect a fibrocartilaginous embolism (FCE) and put him on meds (pain and steroids) to hold him over until his neurology appointment. A week later at neurology, he had an MRI and spinal tap and they said it looks like a clear cut FCE with some spinal swelling.

Fast forward a month and my dog has continued to decline. They’ve tried different meds (steroids and just recently antibiotics). I’ve taken him to a holistic vet and he was worse after chiropractic and accupuncture. He’s been to neuro a few times. I’ve changed his diet. He is scheduled for another MRI Tuesday but we are now at the point of neither back leg functioning. He has also started to experience pain within the past 3 days (since the chiropractic visit....which had been suggested by multiple vets.) He still has bladder and bowel control, he eats and drinks, etc but his legs have both given up and the pain seems to be bothering him enough that he had to go back on pain meds because he wouldn’t get up to go to the bathroom which distressed him a lot. Everyone is stumped and still swear that it looks like a classics FCE on the MRI but isn’t responding like it should.

Has anyone seen anything like this? I’m desperate. He still has deep pain and superficial sensation in both legs.....they just aren’t working and hes lost muscle mass and overall gone down hill quickly. Tuesday’s is either gonna provide answers or more questions which will likely result in my dog being euthanized for fear that whatever is going on will continue progressing. He’s not even three years old yet so I’m just hoping that someone, somewhere has seen something like this and can offer some insight.

He doesn’t have any recent vaccine. He has been tested for lots of diseases (full panel for tick born diseases, toxoplasmosis, etc) but the results are still pending. The MRI showed no contrast to indicate cancer or lymphoma but he had been on steroids for a week so it could have been masked. Up until the pain set in, his personality was still in full effect. Please help....
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CarolC
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Re: Any Guidance Appreciated

Post by CarolC »

Hi SammiB,

I am not a vet. I agree it's kind of puzzling. If it was an FCE, there should be no pain a month later, and symptoms would not appear worse, rather it would tend to improve. Did they show you the results of the scan so you could see it for yourself? [EDIT: Re-read your explanation of the spinal swelling on the MRI.]
SammiB wrote: Sat Jan 01, 2022 8:09 pm I’ve taken him to a holistic vet and he was worse after chiropractic and accupuncture. * * * He has also started to experience pain within the past 3 days (since the chiropractic visit....which had been suggested by multiple vets.)
It sounds like (from what you say) possibly the chiro or acupuncture treatment has caused him a new soreness that was not there before, that has nothing to do with the FCE. And it sounds like he is not bearing weight because he now has a new kink in his back (for lack of a better word) that hurts, not because of the original neuro issue. As you say, he still has bowel and bladder control, and he can still feel his feet, it just hurts to stand up right now, possibly because of something that happened in the treatment. If you are able to trace this new pain to the chiro/acupuncture appointment, then it sounds like he has 2 separate and unrelated things going on, the FCE which is likely to improve, and the chiro/acupuncture-created-pain which may now require treatment of its own. It's a little like going to have your tonsils out, and while you are in the hospital you slip and break your wrist. Now you have 2 problems. It would be nice if you only had one, but they can both be treated separately.

It's frustrating if you were trying to help him and someone inadvertently caused him a new problem, if that's what happened. I remember that Murphy's Dad here had a negative experience with acupuncture for his dog...it can happen.

It may be hard to prove the chiro or acu treatment caused it, but you know your dog and you know what happened when. They may or may not think they did anything to cause a problem, so you may not get anywhere pursuing that, but I would not give up on a dog because he had an FCE which is likely to improve, and bad luck with one of his treatments, which caused a new problem that is hopefully temporary.

Is there another physical therapy place available in your area where you could get him evaluated for PT? I would think hydrotherapy (the underwater treadmill, or else swimming) might be good for both his FCE and to help him work through this newly acquired soreness in his back. You might ask your regular vet what they think about that, and see if they would give you a referral.

I'd be inclined to seek treatment for the back pain and not make any permanent decisions. If he's got something progressive, wait until you are sure. I wouldn't let anyone talk me into putting a dog down because something *might* be progressive. I'd absolutely wait for all of the test results, and even then I wouldn't be in a hurry or let anyone rush me into anything.

I'd want a really good explanation of why another MRI is needed. MRIs are expensive. What will another MRI show that the first one did not? I'm not sure I'd be in a hurry to get another one, but it's up to you, it's a judgment call.
:confetti:
SammiB
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Re: Any Guidance Appreciated

Post by SammiB »

I really appreciate your input! After reading what you had to say, I started thinking that maybe the chiropractor/accupuncture did more harm than good. I decided to step out on a limb and give him a dose of prednisone (he’s been off it since the day after Christmas because they wanted to get an MRI that wasn’t “tainted” by prednisone....in case it was hiding something). I only gave him a 10mg dose about 2 hours ago but I noticed that he started to get a bit restless. He kept grabbing at me with his front paws and trying to pull himself so I thought he wanted to move. I sat him up in the sitting position and with limited help, he used his right leg to push himself to standing position. (He hasn’t stood up in two days. He literally got to the point today where he was knowingly and very stressed about it...using the bathroom in a prone position.) It definitely took a lot out of him to spin himself around and change positions because now he’s sleeping like a log but he did it and that is better than yesterday or earlier today. I don’t know if it was the low dose of prednisone, time, or maybe the antibiotics kicking in but it’s the first sign of any positive improvement that I’ve seen in weeks.

As far as seeing the MRI for myself, I did but I can’t for sure say I know what I was looking at. There was an area just in front of his rear flank that was obviously larger than the rest of his spinal cord though I couldn’t see any blockage. It didn’t look as though any of his discs were pushing on the cord except for the very last one near his tail but the vet said it wasn’t enough to be causing the symptoms we were seeing. On the transverse view, the butterfly pattern was not observable and the outter edge was a thicker white than the rest. I can ask the neurologist to send me copies of the MRI. He’s been great about communication. So far the only thing I can say that I am disappointed with is the fact that neither my primary vet or the neurologist did the full gamete of blood work. I had to take him to the holistic vet for that. Actually, when I circled back to check.....neither the neurologist nor my primary vet had even screened for Lymes disease, which is why I asked the holistic vet to run every single panel possible. That was a bit disappointing.

I’m wondering if we gave the prednisone a long enough time to actually work. The side effects were so extreme and I definitely wasn’t prepared for them....that after about 5 days on the immunosuppressive dose, I was begging for help. He wasn’t getting better, only worse. He never slept and when he did, he consistently breathed so hard that I was concerned. He would quiver after doses. It was a terrible experience....but him off of them hasn’t been that much different. He still breaths hard all night and pants most of the day. His body temp still runs hot. The only real difference is that off of prednisone....he isn’t chugging as much water. Everything else is basically the same.
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CarolC
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Re: Any Guidance Appreciated

Post by CarolC »

Hi SammiB,

I need time to think before I reply on this, as you gave a lot more information. I started to ask yesterday and then didn't...what breed or breeds is he? Is he by chance a pug or frenchie or Boston terrier?
SammiB
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Re: Any Guidance Appreciated

Post by SammiB »

He is a boxer. He’ll be three on February the 11th. I’ve also got one of his litter mates (brothers) so I’m going to get a pair of DM DNA tests just to see if that’s what’s going on and if there is any chance that I’m going to go through this experience in the future with his brother. I’m in contact with his parents owners and most of his litter mates and none of them seems to be experiencing anything like this.....but I figured checking for DM gene markers couldn’t hurt.

He is definitely wanting to get up more today but still isn’t supporting any weight on the rear end. He peed in the middle of the night and I heard him moving around so I went to check and he had moved himself away from the accident.....unfortunately, I wasn’t awake (as I already get up several times a night for meds and to move him) so I can’t tell if he knew it was happening at the time but he DEFINITELY knew afterwards because he was trying to get as far away from it as possible.
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CarolC
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Re: Any Guidance Appreciated

Post by CarolC »

I did not realize you had a large dog. Caroline's boxer, Buster, was 98 pounds and prednisone didn't agree wth him either. In his case it caused diarrhea. I am a little confused on the immuno-suppressive comment. They use a higher dose when they want it to be immuno-suppressive, and a lower dose when it is being used as an anti-inflammatory. Was he on a high dose?
https://www.petmd.com/pet-medication/prednisone-prednisolone wrote: 0.5 mg/lb for anti-inflammatory effects
1 mg/lb to suppress the immune system (cats may require even higher doses)
Here are a few replies in scattered form. I don't think any of my comments are helpful for what you really want to know, which is what is going on, and I'm sorry for that.

Your comment that he's had a fever was interesting, but not something that is usually seen here. Most common types of paralysis such as a blown disk, FCE, spinal fracture, DM, or birth defects do not have fever as a part of the condition. The only ordinary situation I can think of where a dog that is paralyzed from these more common conditions will have a fever is maybe if they develop a urinary tract infection. I do not think that is a likely case here, because you sound like someone who would have caught it already if he had one, and he's had a lot of vetting. Also, he still has bladder control, and this is more common in incontinent dogs.

It is possible for a dog to be kind of in-between, where he has enough bladder control to initiate urination and he looks like he's going normally, however he may not get himself completely empty every time, either because he can't quite feel he's not empty or doesn't quite have the muscle control as a result of his neurological status. DM is a condition where the dog might develop partial bladder control like this. There's an easy solution, where you stand over the dog while he is urinating and let him do as much as he can, then assist him at the end by applying pressure to his bladder to be sure he's empty.

There could also be a situation where a dog might get a UTI simply due to waiting too long to urinate, such as a dog that suddenly can no longer run to the back door to let you know he needs to be let outside, and knows he's not supposed to potty in the house. I had a friend who got a UTI travelling because she didn't want to use the restroom on the plane so she "held it" too long. So I suppose UTI is a possiblity to consider. You sometimes notice other signs with UTI, such as a foul odor or dark color in the urine, but not always. Sometimes there can be a bladder infection without those obvious signs.

As far as him wetting his blanket, I would highly recommend belly bands (aka malewraps, male doggy diapers). They are a godsend for an incontinent male dog. So easy to use, they keep him cleaner and reduce your laundry.
:malewrap:
They will catch the wetness if he urinates. They are a wide band that goes around the waist with velcro and holds an absorbent pad over his male area. I am attaching a photo of my Merlin who wore wraps 24/7 for 3 years. I could go into all kinds of detail on this, but am just suggesting it for now.

MerlinRamp.jpg
MerlinRamp.jpg (42.45 KiB) Viewed 1215 times
It sounds like you also need a good support harness if you don't already have one. They sell all kinds on the Walkin' Pets website, or some people also like a full support harness like the Help 'em up harness for big dogs. You may want to consult with a rehab therapist, or possibly use your common sense in deciding what harness to use for him. I would think (?) maybe one of the full support harnesses would be more comfortable for him. I was told a long time ago that you do not want to put a lot of lift on the extreme rear of a dog with a back injury, you want more even support along the body. I don't think it would have mattered as much when you were just dealing with FCE. With FCE all of the damage that is ever going to be done by the embolism occurs in the first day or so, and you won't make it worse using the wrong harness later, unlike a herniated disk. However if he now has a pinched nerve or something from the chiropractic, I would think even support along the body would be more comfortable.

I have always felt like whatever you spend on a harness is money well spent. A dog carries about 60% of his weight on his front legs and 40% on his hind legs. That means that with a dog like Caroline's boxer, Buster, at 98 lbs, she was lifting about 40 lbs with the sling on his hindquarters. If you can choose a harness that is most ergonomic for you and your back and your shoulder, etc., it will make it a lot easier for you.

I'm now picturing all the appointments you've gone to in the past month, and factoring in a large dog. It's a lot of effort. People who haven't done it wouldn't understand! I like to encourage people, if you have a large dog, do not hesitate to ask for help when you go to an appointment. You will have to get him into the car at home, but when you arrive, ask them if they could send some of their strong young techs or kennel helpers out to bring him in for you. After the appointment, ask if they could put him in the car. You will still have to assist him from the car to the house when you get back home, but it reduces the lifting you had to do. Some places will send out 2 people and a gurney if it's a really big dog.

Lyme disease comes with fever. When will you get the results back on the test? I agree, I wonder why they didn't order testing, and you had to do it. That does seem very strange. :?
SammiB wrote: Sat Jan 01, 2022 11:59 pm I’m wondering if we gave the prednisone a long enough time to actually work. The side effects were so extreme * * * It was a terrible experience....but him off of them hasn’t been that much different. He still breaths hard all night and pants most of the day. His body temp still runs hot. The only real difference is that off of prednisone....he isn’t chugging as much water. Everything else is basically the same.
I'm going to say something really silly :blush: but is there a chance he was exposed to Covid ? Dogs do get it, it does cause some of the symptoms you describe (the fever and the breathing), and they can test for it. It's almost laughable to even mention it...

I have a dog who was diagnosed by a neurologist as "open for" FCE/ANNPE. That's what they think he has, but unfortunately he was surrendered to a shelter at the time of his paralysis and imaging was not done. I liked the neurologist a lot and she recommended acupuncture for him, so I took him. I had read that there could be a small chance of complications if a needle hits a nerve. All I can say with my dog is, the needles were not right near the spine itself, and it looked like they were only in the skin really. After she put them all in, they would fall over sideways during the 15 minutes he had to wait with them in. So at least the way my vet did it, I didn't think there was much risk if any.

They say you should not do chiropractic for a disk problem. However your vets thought this was an FCE, not a disk problem. But that being said, I don't see how chiropractic would help an FCE. Maybe it could, I'm only a layman. I have personally had a lot of chiropractic for mechanical issues with my back, issues of alignment or dislocated ribs, so I know it is helpful for that. An FCE is not a mechanical problem, it's a nerve injury, so again, I'm not sure why they recommended chiropractic adjustment. In my imagination, it almost sounds like he had everything properly aligned as a healthy 3-yo dog before the FCE, and a chiropractic manipulation misaligned something or caused a pinched nerve maybe? That could be totally wrong, I don't know.

My experience with acupuncture with my dog was, I couldn't really be sure it helped. I ended up about 55/45 thinking maybe it helped a little. They wanted to give him herbs with the acupuncture for best results and I declined because he has a swallowing problem. I don't know if he might have gotten better results with the herbs.

What I do know is that the statistics on improvement for FCE are extremely high and recovery is the norm. Most FCE dogs go on to lead normal lives, but it does not always happen right away. In general, the nerve injury caused by the FCE is going to take time to heal whatever you do. I think patience and TLC and daily PT are the way to go. My one vet said sometimes the best medicine is 'Tincture of Time'.
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critters
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Re: Any Guidance Appreciated

Post by critters »

I don't have any idea what might be going on, but if it were me I'd keep on unless I or he couldn't. You have so much pending, which may give answers, and Carol's given you so much good information. I, too, wonder if there may be more than one thing going on? :whale:
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CarolC
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Re: Any Guidance Appreciated

Post by CarolC »

SammiB wrote: Sat Jan 01, 2022 11:59 pm As far as seeing the MRI for myself, I did but I can’t for sure say I know what I was looking at. There was an area just in front of his rear flank that was obviously larger than the rest of his spinal cord though I couldn’t see any blockage. It didn’t look as though any of his discs were pushing on the cord except for the very last one near his tail but the vet said it wasn’t enough to be causing the symptoms we were seeing. On the transverse view, the butterfly pattern was not observable and the outter edge was a thicker white than the rest.
I could definitely look right at the imaging and not know what I was seeing. I'm glad to have them display the images and point out what they found, but I mostly nod and try to follow what I'm being told.

Did you get any hint from the commentary that maybe the images were not as clear as they might have liked? I keep wondering why they want to do another MRI, and it would make sense if they weren't satisfied with the images the first time.

Did you notice any difference in activity or development between him and his brother the first year?
SammiB
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Re: Any Guidance Appreciated

Post by SammiB »

The second MRI was intended to visualize if there was any progression in the segment of swelling.

As far as differences between him and his brother, there have only been a few things. Generally, he has always been more anxious and a little smaller. His brother is a big wimp and Duke is.....a tiny a-hole. His brother actually had more medical issues. He had an non-descended testicle and showed elevated liver enzymes on most of his blood panels. Which was weird because Duke was always the one that had trouble with meds and with anesthesia when he was neutered. I even called the vet back to make sure they didn’t mix the two of them up.

He seems like he’s turned a positive corner in the last 24 hours. He’s becoming much more mobile. Even though he’s not using his back legs, you can see that he’s trying to use them to push himself to a standing position. When he sleeps, he stretches his back legs out and spreads his toes.

I did get some blood work back today (not all of it, but some). I’ll try to attach a photo of it. His WBC and neurotrophils were high and his liver enzymes were elevated. Most everything else was normal.
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Re: Any Guidance Appreciated

Post by FYI »

SammiB wrote: Sat Jan 01, 2022 11:59 pm I’m wondering if we gave the prednisone a long enough time to actually work. The side effects were so extreme and I definitely wasn’t prepared for them....that after about 5 days on the immunosuppressive dose, I was begging for help. He wasn’t getting better, only worse. He never slept and when he did, he consistently breathed so hard that I was concerned. He would quiver after doses. It was a terrible experience....but him off of them hasn’t been that much different. He still breaths hard all night and pants most of the day. His body temp still runs hot. The only real difference is that off of prednisone....he isn’t chugging as much water. Everything else is basically the same.
https://www.pawlicy.com/blog/prednisone-for-dogs/ wrote: Digestive tract ulceration (which can manifest through bloody vomit, bloody or black stools, loss of appetite, and high fever)
https://dodgerslist.com/2020/02/24/healing-pain/ wrote: Stomach protection with any anti-inflammatory drug
PepcidAC-famotidine Pepcid AC (Famotidine) Is used with ALL anti-inflammatories to avoid serious gastrointestinal damage. For some dogs Pepcid AC needs to be accompanied with yet another protector, Sucralfate, when there are signs of GI problems of diarrhea, vomit, bloody stools.
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