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Neurological Disorders Resources. Treatment and care for pets having pain or trouble walking or standing due to spinal injuries or neurological disorders like IVDD, FCE and DM.
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samtowery80
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Post by samtowery80 » Wed Nov 18, 2020 4:05 pm

Hi all. Exactly five weeks ago my best buddy, Dexter, jumped off the tail-gate of our pickup truck and immediately showed hind-end weakness. Dexter is a 65 lb., 9 year old pitbull mix. I was out of town, but my boyfriend rushed him to our vet where, over the next 3 hours, he became totally paralyzed. The vet put him on a high dose of Prednisone and Tramadol, and sent him home.

Two days later my boyfriend took him back in to the vet because Dexter had not improved. During the second visit the vet called me, I was still out of the state dealing with a family emergency, to inform me that she had called the nearest hospital offering MRI and surgical intervention, and that my boyfriend should immediately take Dexter there. The vet also told me the hospital, two states away btw, told her I could expect to pay $12,000+. I was devastated. Unfortunately for Dexter, I don't have that kind of money.

I was able to fly back home a few days early and immediately drove with Dexter 6 hours away for a second opinion at Bridger Veterinary Specialists in Bozeman, MT. He received a CT scan and physical exam. The physical exam showed very little if any deep pain response. The two specialists there told me his CT scan revealed no compression or evidence of swelling, but they expected it could be a high velocity, low volume disc injury (ANNPE). They said surgery would not help or would have less than 5% chance of helping. They also ordered a spinal tap which subsequently showed no evidence of meningitis, but did show elevate protein levels which is indicative of trauma. The vets told me to get Dexter in rehab asap - no cage rest required.

Two days later I found a local rehab facility and have been taking Dexter there 3 days a week for acupuncture, laser therapy, oxygen therapy, physical therapy ... you name it, we are doing it. We have also been doing hydrotherapy, physical therapy, and NMES machine treatment at home.

The improvements are so slight that sometimes I think I am imagining things. He (slightly) jerks his back feet away when I touch them, his very atrophied leg muscles tremble when we do physical therapy, and we got a tail wag four days ago that lasted about 3 seconds. He hasn't wagged his tail again so I wonder if it was some type of reflex.

He is generally a happy guy and definitely enjoys his wheelchair time, fetching, getting loved on, and especially eating! I am better than I was the first two weeks. I can't even remember the number of times I broke down crying then, thinking how unfair life was and wondering if I made the right decision not doing the surgery because a 5% chance is a 5% chance, right? Getting him off the pred has helped with bathroom issues tremendously so my sanity has been preserved.

I am wondering if anyone has gone through something similar and if five weeks is too early to assume Dexter is as good as he is going to get. We will give him all the time he needs and if he doesn't get any better I guess I'll be expressing his bladder and shoving Q-tips up his butt for the next five years or so. For his sake and the sake of my pocket book, though, I'd like to know if continuing the very expensive physical therapy is worth it. If we cut back, what has worked for other pups - acupuncture, laser, etc? Is hydrotherapy worth it even if he can't move his back legs yet?

Any advice, wise words, or encouragement is appreciated! This is hard.
Dexter.jpg

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CarolC
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Re: New to this

Post by CarolC » Wed Nov 18, 2020 10:02 pm

:group:
Replies in blue...
samtowery80 wrote:
Wed Nov 18, 2020 4:05 pm
Hi all. Exactly five weeks ago my best buddy, Dexter, jumped off the tail-gate of our pickup truck and immediately showed hind-end weakness. Dexter is a 65 lb., 9 year old pitbull mix. I was out of town, but my boyfriend rushed him to our vet where, over the next 3 hours, he became totally paralyzed. The vet put him on a high dose of Prednisone and Tramadol, and sent him home.

Two days later my boyfriend took him back in to the vet because Dexter had not improved. During the second visit the vet called me, I was still out of the state dealing with a family emergency, to inform me that she had called the nearest hospital offering MRI and surgical intervention, and that my boyfriend should immediately take Dexter there. The vet also told me the hospital, two states away btw, told her I could expect to pay $12,000+. I was devastated. Unfortunately for Dexter, I don't have that kind of money.

It may make you feel better to know, of the people who have come here with an ANNPE dog, I can only think of one who did surgery, as it's usually not done.

I was able to fly back home a few days early and immediately drove with Dexter 6 hours away for a second opinion at Bridger Veterinary Specialists in Bozeman, MT. He received a CT scan and physical exam. The physical exam showed very little if any deep pain response. Deep pain perception can return later even if it is absent at the time of injury. My dog had a spinal fracture and no deep pain sensation before or after surgery. They tested her again at 149 days (that's almost 5 months) and said she had it. The two specialists there told me his CT scan revealed no compression or evidence of swelling, but they expected it could be a high velocity, low volume disc injury (ANNPE). They said surgery would not help or would have less than 5% chance of helping. They also ordered a spinal tap which subsequently showed no evidence of meningitis, but did show elevate protein levels which is indicative of trauma. The vets told me to get Dexter in rehab asap - no cage rest required.

If he has had both a CT and a myelogram, and they did not see a disk issue, then that sounds like he's been examined very thoroughly. There are 2 common conditions where a dog is suddenly paralyzed and it isn't IVDD. One is FCE and the other is ANNPE. They are both treated with physical therapy. Here are some statistics:
https://veterinaryrecord.bmj.com/content/181/11/293 wrote:
Two hundred and one dogs were included. Outcome data were obtained via medical records and telephone questionnaires. MRIs were blindly reviewed by three board-certified observers, obtaining substantial to almost perfect interobserver agreement on diagnoses (κ=0.635–0.828). Presumptive ANNPE and FCEM were diagnosed in 157 and 44 dogs , respectively. Ambulatory function was regained in 99 per cent of cases, with persistent motor deficits in 83.6 per cent and 92.5 per cent of dogs with presumptive ANNPE and FCEM, respectively. The presumptive diagnosis was not associated with motor function recovery, recovery times or urinary continence. Faecal incontinence was five times more likely in dogs with presumptive ANNPE (23 per cent) compared with presumptive FCEM (7.5 per cent).

The way I read these statistics, they had 201 dogs with either FCE or ANNPE.
  • 99% of the dogs regained the ability to walk.
  • 83.6% of the ANNPE dogs showed some remaining signs in their walk. (Dogs will walk, run, play, and live normal lives, and you may be able to see something in their gait..but they don't care.)

Two days later I found a local rehab facility and have been taking Dexter there 3 days a week for acupuncture, laser therapy, oxygen therapy, physical therapy ... you name it, we are doing it. We have also been doing hydrotherapy, physical therapy, and NMES machine treatment at home.

He's a lucky dog.

The improvements are so slight that sometimes I think I am imagining things. He (slightly) jerks his back feet away when I touch them, his very atrophied leg muscles tremble when we do physical therapy, and we got a tail wag four days ago that lasted about 3 seconds. He hasn't wagged his tail again so I wonder if it was some type of reflex.

Yes, that is the way recovery from spinal injury happens. It's by baby steps. My dog was completely paralyzed by a spinal fracture. My dog's recovery was very slow. It seemed like about once every 6 weeks or so, if I really stretched my imagination, I would think I could maybe see a tiny bit of progress. The best thing might be if you keep a list or a journal of the little things you notice, or think you notice, or wonder if you maybe imagine. All those tiny improvements add up, and one day you look back and see how far you've come. Every day the nerves are improving a tiny bit more in the background, even if you can't see it. Do not worry about muscle atrophy, muscle tone comes back when the nerves improve.

He is generally a happy guy and definitely enjoys his wheelchair time, fetching, getting loved on, and especially eating! I am better than I was the first two weeks. I can't even remember the number of times I broke down crying then, thinking how unfair life was and wondering if I made the right decision not doing the surgery because a 5% chance is a 5% chance, right? Getting him off the pred has helped with bathroom issues tremendously so my sanity has been preserved.

Are you having any issues with dribbling between expressing? You know about male wraps, right?

I am wondering if anyone has gone through something similar and if five weeks is too early to assume Dexter is as good as he is going to get. Yes, way too early. It's still early days. :D We will give him all the time he needs and if he doesn't get any better I guess I'll be expressing his bladder and shoving Q-tips up his butt for the next five years or so. For his sake and the sake of my pocket book, though, I'd like to know if continuing the very expensive physical therapy is worth it. If we cut back, what has worked for other pups - acupuncture, laser, etc? Is hydrotherapy worth it even if he can't move his back legs yet?

You've learned to express his bowel and bladder. You've got him a wheelchair that fits and he likes it. You've given him all the best vet care and found a rehab place and started rehab. You have been doing and are doing everything to maximize his recovery. I hope you can stop for just a minute and tell yourself, "Yes, we really are doing everything right, we won't have any regrets."

Time is the hard part, honestly. It just takes time. My one vet called it Tincture of Time. Spinal injuries heal very slowly, much more slowly than a broken bone, for example. Most of us, when we find ourselves in this situation, have no real experience with a slow recovery from anything, unless you are an unusual person who perhaps had an elderly relative who had a slow recovery from something major such as a stroke. But anyway, it partly just comes down to time. You're doing everything they recommend. However, you are in the very early days and it's going to take time and waiting can be the hard part, but seeing the tiny little improvements does help keep you going.


There are several issues with PT. One is the work and time involved in loading him in the car to take him to therapy. I am not sure if it is you or your boyfriend who is taking him. You have a fairly large dog. They say a dog carries 60% of his weight on his front feet and 40% on his hind feet. So every time you are sling-walking his hindquarters you're lifting about 26 lbs. I assume you are having to lift the whole 65 lbs when you put him in the truck. There are some types of equipment that can help you get a heavy dog in the car if you need help. If you want links on equipment ideas, just ask.

My 63 lb golden retriever went down in the rear and I learned to ask for help. You will have to get your dog in the car to drive to PT, but when you arrive at the facility, ask them to send help out to the car to bring him in. They probably have some strong young kennel helpers who can do that and save you the extra lifting--take advantage of it! They can also put him in the car for you when it is time to leave, so let them! You are still going to have to carry him back into the house when you get home, so you've got enough lifting to do for each appointment.

You can cut back as needed and still get there. You can do more exercises at home, and the key is doing them consistently even if it looks like they aren't helping. The rehab place should be able to give you a list of exercises to do with him at home, and then perhaps you could take him for PT less frequently. (They may already have you doing exercises at home.) I'm not a vet or a rehab therapist, but my opinion/experience is that hydrotherapy is the best therapy there is. Even if he is not moving his hind legs yet. The exercise of moving his front legs is sending signals to his hind legs and it's overall conditioning. If you can possibly keep doing it, I would.

At home, I would be bicycling his legs, pressing up on his paw pads (resistance exercise) to see if you can get him to push back, and rubbing his feet and legs. His body needs to re-map the pathway from his brain to his feet, and the more you stimulate his feet, the more you give it to work with. If he sits on the sofa with you while you watch TV, you might want to just massage his feet a little bit, or do it for a few seconds every once in a while during the day. That can all be done with him lying down. If you can do it without killing yourself, assisted standing would be good at home. You'd need some kind of rear harness to support him. It may take two of you, one to hold him up with his harness and one to place his feet. Some people have also bought their own peanut ball to use at home.

If money is an issue, a lot of people will start out going 3x a week and then continue going just 2x a week, or once a week if that's what you can afford, and do exercises at home between sessions. Steady PT over time is the key. Doing more intensive PT and trying harder doesn't really give quicker results, because he can only do as much as the nerves are ready for. You are working to maximize his recovery, and the body/nerves will heal at their own rate. I do not know how your rehab place does it, but some places offer a package (X number of sessions which include certain modalities for a certain price) or you can pay as you go. You might ask what options are available and see what is the most affordable one.

I do not know if they are itemizing his treatments, but the ones I would want to keep the most would be hydrotherapy and physical exercises. It is harder for you to do physical exercises at home because of his size so it is worth paying for. The other treatments are good, but if you have to cut some out and keep some, I would keep hydrotherapy and physical therapy at the rehab place (and the e-stim at home).

Your dog has a very sweet smile.


Any advice, wise words, or encouragement is appreciated! This is hard.

Yes, it is hard. Nobody should ever underestimate the amount of stress and work that goes into this, it's real, and the first weeks are the hardest. Better days are coming!

samtowery80
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Joined: Wed Nov 18, 2020 3:37 pm

Re: New to this

Post by samtowery80 » Thu Nov 19, 2020 8:37 pm

Hi Carol! Thank you for the detailed and very thoughtful reply. It means a lot.

It does make me feel much better to know that most people with ANNPE dogs have opted out of the surgery and I teared up reading the stats you provided from the study. 99% regained the ability to walk! I could care less if Dex's gait is a little wonky and like you pointed out, he definitely doesn't care :) In fact, I don't really think he cares that much even now. Fetching and hiking is just as fun in a wheelchair as far as he is concerned.

I've been really worried about the loss of deep pain since every vet I talked to, and there have been MANY, has told me the lack of deep pain means he will most likely never walk again. Dex is pretty stoic when it comes to me messing with his feet so I think he is absolutely feeling it when his leg twitches or feet jump slightly, but the vets tell me it is most likely reflex. Like I said, he isn't the kind of guy to snap or even look at me when I mess with him, even when he wasn't paralyzed. He is more likely to look in the other direction and pretend it isn't happening. I do get a disgusted look once in a while lol. It's great to hear that even if he doesn't have deep pain perception and all the twitching, pulling, toe curling is reflexive, the deep pain may come back!

You keyed in on what we've been trying so far - everything and all at once, and I am taking to heart your advice that nerves take time to heal and trying to "rush" the healing process doesn't work. At least that's what I took away from your comment. I am going to speak with the rehab vet tomorrow about stopping the laser and acupunture, or at least cutting down to once every two weeks, and continuing the hydro and physical therapy once a week there. We will continue everything at home, too. The rehab vet gave me a bunch of simple exercises, we have the peanut shaped exercise ball, and our hottub is now Dexter's rehab pool. Will miss that post-ski soak, but he is more important.

I did purchase the Help Em Up harness to easily get him in and out of the car, but if you have other recommendations for equipment I'll take them. The harness is not the easiest thing to get him in and out of quickly when he wants to go outside. Question - should I be sling walking him as much as possible? For example, should I take him in the yard several times a day to see if he will start to go pee on his own instead of expressing his bladder inside? He is so strong in the front end that he tends to pull me all over the place in the sling and he can't put any weight on his back legs so I haven't been doing it much ... It's much easier for me to express him when he is laying on his side btw. He dribbled all over the place for the first 3 weeks and I got a few belly bands, but I think I have the expression down or he has better control because he hasn't dribbled or had an accident for the past couple of weeks so I'm not using them anymore. Can't go at all on his own yet, but not doing laundry every second of the day is nice!

Did your dog ever regain the ability to walk and if not was he/she happy anyway? Just wondering because it sounds like you also had a long, tough road. Thanks so much, Carol. I feel like I've been thrown a life line :)

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CarolC
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Re: New to this

Post by CarolC » Fri Nov 20, 2020 4:01 pm

Hi, blue again... This message has about 10 links, I don't usually give so many. You might want to only skim some of them and come back later if they seem to apply. :)
samtowery80 wrote:
Thu Nov 19, 2020 8:37 pm
Hi Carol! Thank you for the detailed and very thoughtful reply. It means a lot.

It does make me feel much better to know that most people with ANNPE dogs have opted out of the surgery and I teared up reading the stats you provided from the study. 99% regained the ability to walk! I could care less if Dex's gait is a little wonky and like you pointed out, he definitely doesn't care :) In fact, I don't really think he cares that much even now. Fetching and hiking is just as fun in a wheelchair as far as he is concerned.

'Wonky' is a common word around here! During recovery the two issues tend to be crossing (they get their feet crossed and trip themselves) due to the drunken ataxic gait, and knuckling, which leads to raw spots on the feet when the toes curl under. But dogs get through that in time, and there are some good options for knuckling now.

I've been really worried about the loss of deep pain since every vet I talked to, and there have been MANY, has told me the lack of deep pain means he will most likely never walk again. Dex is pretty stoic when it comes to me messing with his feet so I think he is absolutely feeling it when his leg twitches or feet jump slightly, but the vets tell me it is most likely reflex. Like I said, he isn't the kind of guy to snap or even look at me when I mess with him, even when he wasn't paralyzed. He is more likely to look in the other direction and pretend it isn't happening. I do get a disgusted look once in a while lol. It's great to hear that even if he doesn't have deep pain perception and all the twitching, pulling, toe curling is reflexive, the deep pain may come back!

That is funny the way you describe him, it really shows his personality. :D Yes, 'stoic' is a term vets use, too. Deep pain is subject to interpretation by the vet and could be missed. This might be an old wive's tale, but I've heard (??) that dogs are good at hiding pain because of their position in a pack. Supposedly a dog pack will sometimes turn on a weak member, so survival means not showing it. I don't know if that's really true, but it would make sense.

I also think something else that may not be scientific, but I feel like when you see a dog that is kind of copacetic about the whole thing, it just makes me think he somehow knows everything is going to be OK.


You keyed in on what we've been trying so far - everything and all at once, and I am taking to heart your advice that nerves take time to heal and trying to "rush" the healing process doesn't work. At least that's what I took away from your comment.

That's about right. :pardon: You're pretty much going at his pace because he's going to heal on his own schedule, and not the vet's schedule or the family's schedule or anyone else's. There is one phenomenon I noticed with my dog and have heard others report as well, which is that they may seem to be making next to no progress for the longest time, but when things finally get to a certain point, then you start to notice the pace of visible improvements seems to pick up.

I am going to speak with the rehab vet tomorrow about stopping the laser and acupunture, or at least cutting down to once every two weeks, and continuing the hydro and physical therapy once a week there. We will continue everything at home, too. The rehab vet gave me a bunch of simple exercises, we have the peanut shaped exercise ball, and our hottub is now Dexter's rehab pool. Will miss that post-ski soak, but he is more important.

Ohmygoodness, you have a hot tub and an peanut ball? Woohoo!! You mention you will miss the post-ski soak, which I think means you'd rather not share the tub with him? I don't have a solution for dog hair, but if the problem is him doodling in the water, they make a doggie diaper for rehab with a cord-lock tail to keep the pool clean.

I did purchase the Help Em Up harness to easily get him in and out of the car, but if you have other recommendations for equipment I'll take them. The harness is not the easiest thing to get him in and out of quickly when he wants to go outside.

I haven't used it but it's supposed to be one of the best harnesses. I think one of the virtues of that harness is you can just leave it on him during the day. My dog wore a male wrap and I put handles on it like a belly harness. Since he was wearing his wrap 24/7, than meant he was also wearing his belly harness 24/7, which was perfect for me because I don't have the patience to hassle with a harness every time my dog needs to go out, and also my back does not appreciate squatting down and fussing around putting it on him. He also wore a standard chest harness so I had something to grab in front if needed. It is a huge help if you can streamline little (really not-so-little) things like this harness issue. No way would I be able to put up with having to put a harness on my dog multiple times a day for weeks or months, especially if you are working and on a tight schedule.

Here is an idea for converting your car to make dog transport easier, and for parking in a way to make getting him in easier.

One of the members here used a lift table from Harbor Freight to get his 90-lb dog in the car (this is also recommended by the degenerative myelopathy website).

Another family used a medical hoist shown in this thread to get their dog into a van or SUV. It's expensive but Grizzy is a huge dog.

Here is one more idea that will work in certain situations.


I can also think of a couple of options for lifting indoors (not for getting him in the car). The first one is an engine hoist I used with my dog. (Here is an update.)

The other one is something new (to me) but it looks like it would work. It's a Doggie Lift you install in your doorway. It might work to get him into his cart, and it doesn't cost much. Again, I only learned of it a month ago and haven't used it and don't know if there are any issues.


Question - should I be sling walking him as much as possible? For example, should I take him in the yard several times a day to see if he will start to go pee on his own instead of expressing his bladder inside? He is so strong in the front end that he tends to pull me all over the place in the sling and he can't put any weight on his back legs so I haven't been doing it much ...

I would think getting him on his feet several times a day, even if it is just to walk him up and down the hallway, is a good idea if you can do it. I'm sure he would love to go outside, too. If he sniffs a spot and urinates, that would be wonderful, but even if he's not to that point, just walking is good. I assume you have his feet up in stirrups when in the cart?

I know what you mean about him heading off as soon as you get him on his feet, basically dragging you like a sled dog. My golden retriever, Merlin, would do that. The way I look at it, when you calculate the amount you are lifting when you lift the dog's hindquarters (26 lbs for your dog) remember that you are "lifting" more when he decides to make a run for the door and he's pulling on your back/shoulder/etc.


One solution is giving the dog some free time before you try to get him to focus on standing and placing his meet correctly. That may mean putting him in his cart and letting him work his energy off for half an hour. Once he gets that out of his system, you'll have a dog you can work with better. I think you said he's 9, so maybe he isn't as crazy as a 2-year old, but it will probably help to let him get some exercise to settle down. Here is a really cool idea one guy dreamed up, to exercise his dog indoors.

It's much easier for me to express him when he is laying on his side btw. He dribbled all over the place for the first 3 weeks and I got a few belly bands, but I think I have the expression down or he has better control because he hasn't dribbled or had an accident for the past couple of weeks so I'm not using them anymore. Can't go at all on his own yet, but not doing laundry every second of the day is nice!

Did your dog ever regain the ability to walk and if not was he/she happy anyway?
Yes she did, but it took us a long time (unusually severe injury, displaced spinal fracture) and we were both very happy even before she did. One thing I learned was not to try to predict my dog's recovery timeline by what I saw in other dogs. I very much remember the early days after my dog had her spinal surgery. I searched the Internet and could not find a case exactly like my dog's, but I found one I could relate to, a beagle named Murphy. After reading Murphy's story, I began to expect in the back of my mind that my dog would stand at a certain timepoint like Murphy, and then walk at a certain timepoint. Like Murphy. When she didn't, I was very distressed, I would almost say crushed. I didn't realize until then how much I had built it up in my mind that her recovery was going to proceed exactly like Murphy's. And boy, was I wrong. But she learned to walk again on her own schedule, and it was worth waiting for. Just wondering because it sounds like you also had a long, tough road. Thanks so much, Carol. I feel like I've been thrown a life line :)
Very glad you are here. :banner:
I hope the recovery goes more quickly, especially with the size of the dog and winter in Montana! :cold: It might be tough, but let's hope it won't be too long.

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critters
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Re: New to this

Post by critters » Thu Nov 26, 2020 11:00 am

:whale: I can't add much to the discussion at the moment, but do you know about bladder meds? I've only skimmed the posts. For instance, in my experience Bethanechol was better for a floppy bladder, and phenoxybenzamine (PBZ) was better for a spastic one. It's been a long time since we've used either, though. Also be aware that spinal cord injuries frequently cause zaps or other funny feelings as the nerves heal, and gabapentin and Lyrica (newer) can be loads of help with that. Some critters have done serious damage to themselves when they hit. I can't remember now whether my Buddy, who had been hit by a car, or Koi, who'd been shot in the spine, was the one that did 2 rounds of gabapentin, as has Ares, who has nerve damage in his shoulder. Just notes in case you need them...

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