Using the stairs

[Otis's friend]

My dog was diagnosed with ANNPE on Saturday after becoming paralysed on Friday. He seema to be doing well, but the contusion was bad (the neuro thought c.65% whwn he was discharged on Sunday, but the letter that's just come through says nearly 80% eek).

He's wobbly, but walking. His left leg is stiff and he's knuckling, but not always and he's in full control of his bowel and bladder.

Anyway we've just had the referral letter through and it says pen/crate rest for 4 weeks and room rest for two (the neuro said he only needed room rest for 2 weeks when we left on Sunday). It also says he can run after 8 weeks but no stairs for FOUR MONTHS. Obviously I want him to heal, and we have had him in a pen during the day, but a bedroom at night (he's doesn't jump on the bed and he's coping with so much change I made that as a pragmatic choice), but no stairs for 4 months. It seems like such a long time. We have 2 steps up to our house and 5 steps up to our garden. The letter talks about this in relation to surgery, so it's a copy and paste section as he didn't have surgery.

I know every patient is different and every recovery individual, but I was wondering how long everyone else was advised to avoid stairs?

[CarolC]

I've never heard of anyone being told not to do stairs with ANNPE, but ANNPE is a relatively new diagnosis and perhaps they are learning more about how best to manage it. Not doing stairs is standard with IVDD (intervertebral disk disease) and it sounds like they are treating it like an IVDD disk injury and trying to ensure that disk has the best chance to heal. It can take 6-8 weeks for a disk to heal properly, so that probably explains the timeframe. You might want to call/text them to clarify whether they accidentally included those instructions (in the copy/paste) or meant them to be there for your dog.

If those are indeed the instructions, then I think your answer will be assisting him up and down the stairs for a while. It's a hassle, but the two of you will get good at it, and I assume you'll be able to let go of it once he is past the steps, so you only have to do it on steps, not during the whole walk around the yard. There are some good harnesses that will let you lift his hindquarters on stairs. You may want to do some searching online. They have some on the Handicapped Pets site, or you could look at a Help Em Up harness.

How long can I leave the Help ’Em Up harness on my dog?
It can be worn for extended periods; however, we suggest that you give your dog breaks from wearing it. Let them sleep without it if possible or if you have a dog that needs a potty trip at 3am, take it off after they return. Also, watch for them chewing on it when left alone. If you are leaving it on for extended periods, please check for hot spots and overheating as it can become uncomfortable for your dog if left on for too long a time.

I am attaching a photo of a product that is no longer sold. It was called the Hartman Harness. I had one for my dog. It is a really good illustration of helping a dog up the stairs with an effective rear harness. Some harnesses can be left of all day, or most of the day. The Hartman was one of them. The main thing about any harness, to me, is convenience. If it is time consuming and annoying to put it on and take it off, you will hate it. Therefore I think whatever you pay to get a good one that you can leave on most of the day, and it does not drive you nuts, is worth it. I don't have much patience for equipment that doesn't work, especially if my back is bothering me. I tried several harnesses before I found one that halfway worked for Merlin (golden retriever), and it was the Hartman. Hope this helps.

[Otis's friend]

There was definitely a copy and paste element going on. And I guess it's better to be cautious than rush, but I've seen posts talking about using steps as part of PT. Also we used the stairs to build muscle in his thigh when he lost ot feom limping due to laxity. So it just seema a bit crazy.

That harness looks great though and surely there's a difference between letting him run up the stairs and supporting him usong a harness? And I don't understand why running is ok (my dog runa like fhe wind) after only 8 weeks but no stairs for 16 weeks. Just feels very generic.

I'll speak to the physio om Tuesday when we have our next app but she talked about being guided by the neuro, who's giving me generic advice. She is super nice and treated my dog before, but I'm wondering about switching to the physio at the hydro place. He's been going there once a week for 2 years so they know him well and perhaps can give me a more tailored plan.

The other significant thing is that the physio hasn't and won't see my dog unless I put a cone and a muzzle on him, and ai physically can't get both on. He can be snappy if he's stressed and pushed, but is handable as long as you go slow and pay attention to his signals. So all the advice she is giving me via phone (she can't do online consultations). So she can only give me generic advice as she can't even see my dog.

[CarolC]

And I guess it's better to be cautious than rush, but I've seen posts talking about using steps as part of PT. Also we used the stairs to build muscle in his thigh when he lost ot feom limping due to laxity. So it just seema a bit crazy.

Hi Otis's friend,
I totally agree it's confusing. Part of the confusion stems from the fact that the veterinary profession is still evolving on the treatment of ANNPE and I suspect they are still developing new best practices in real time. All the providers may not be on the same page (as with many health conditions) or some may be more up-to-date than others. I agree that feeling your way based on what you are seeing in your individual dog is important.

I'm sorry for a long explanation, but I want to try to summarize the history here, and I hope I get it semi-correct. Looking back on the forum, ANNPE was first posted in 2017. That is not because it didn't exist prior, but because they started widely calling it that only recently.

Before that, you used to hear of a "high velocity low volume ruptured disk", or a "missile disk". I see posts about that going back to 2006. They were describing the same thing as ANNPE but not calling it that yet. At that time, there was a Hansen scale for describing ruptured disks. Hansen Type I and Hansen Type II, which are still used. Some vets were using Hansen Type III to describe the high velocity disk extrusion, but this was controversial and not universally accepted. However it shows that the thinking at the time was that some vets were including all types of ruptured disks under the same general heading.

Hansen Type III discs are sometimes referred to as “missile discs”, “traumatic disc” or “low volume, high velocity”. These are non-surgical and result from the liquid nucleus pulposus hitting the spinal cord at high impact. There is no resulting compression as the material dissipates, but the cord experiences contusive injury.

The thing is, Hansen Type I and Type II are more likely to need surgery, while Type III/ANNPE usually does not. We had one case here that was called ANNPE where they did surgery, but that is the only one I remember and I wonder if there was some confusion around terminology that time, don't know. In recent years, they were saying that the treatment for ANNPE was physical therapy. I always found that a little confusing, because you still have a disk that ruptured even if surgery is not needed. It still needs to heal. But it isn't going to squirt out any more of the soft interior of the disk and cause further problems because it already ruptured and squirted out at high speed (exploded). When surgery is done on Type I and Type II, part of the purpose is to clean out the disk and any remaining nucleus pulposis, but with ANNPE it's not needed because the body basically did it itself already. Hope I have this right. I am not a vet.

There is another common cause of paralysis in dogs called FCE (fibrocartilaginous embolism). It is sometimes called a spinal stroke. It is caused by a blockage of blood vessels feeding an area of the spincal cord. It happens suddenly and can completely paralyze the dog when it happens. There is no surgery for it, and there is no pain after the first day or two. The treatment is aggressive physical therapy.

So in a sense, you have 2 general categories of paralyzed dogs here. One category that is helped by surgery with crate rest after surgery and then careful PT, and one that is not, but is helped by PT alone. It's extremely important to know the correct diagnosis for your dog, because doing PT on a dog with an intervetebral disk problem (Hansen Type I or II) could make the problem go from bad to worse. You could take a wobbly dog and make him fully paralyzed that way. On the other hand, doing unnecessary crate rest on an FCE dog will only delay the PT that could help him bounce back from it, which should be started as soon as possible.

But what do you do with an ANNPE dog? It's like IVDD because a disk blew. But it's like FCE because you don't do surgery for it, only PT. Here is the confusion you find your providers in. My non-medical, layman's understanding, until now, was that you did PT with the ANNPE dog as with the FCE dog. But if your vets are not agreeing on this, it is possible there is further development in the best practices for treatment. I'm not in a position to know.

But I guess the point I was going to make with this long explanation is, it is easy to find articles and videos and information on doing physical therapy for dogs online (thank goodness!), and not be clear on whether the information you are seeing (for example about doing steps) is designed for a dog with FCE (where all kinds of PT are done) or a post-surgical and post-crate rest IVDD dog. It matters a lot. I wouldn't hesitate to do steps on the FCE dog. However, the standard recommendation for IVDD dogs is that they never do steps again for the rest of their lives. Ramps are recommended, permanently. But again, where does this leave the ANNPE dog?

There is also a difference using steps to build thigh muscle with a hip problem, versus recovery from a spinal injury. When the problem is in the hip, you don't worry what kind of bending, twisting motion or forces of compression are going on in the spine while steps are used for exercise (because your dog does not have an injury in his spine). But with a disk injury, the dog's spine will undergo stresses going up and down steps, which could be harmful to the disks between the vertebrae. It could be harmful to a disk that is injured/bulging and about to rupture, or to a disk that ruptured and is trying to heal. They remain cautious about steps in IVDD dogs because if one disk blew, they worry it is possible another one might as well (some disk problems have a genetic element). I think statistically a second disk problem is unlikely after an IVDD dog has one disk problem, but it does happen sometimes. So like you say, they go with "better safe than sorry". But I have never heard of an increased risk of a second ANNPE after your dog had one, so I really don't know where this leaves you.

If I was in your shoes I'd probably be doing the same thing, and consult your different therapists and see what they say, and just used your best judgment. It sounds like he is doing really well. His body is healing and his abilities are improving. He is continuing to heal while you are scrambling to figure out the optimum treatment. It's frustrating to be dealing with uncertainty, but on the good side, he is doing well.

A good thing to keep in mind is, healing from a spinal injury continues for many months, and even years. Here is a post with examples illustrating how dogs continue to show improvement long after their injury. It isn't like, if you don't do everything perfectly during the first days/weeks, you will miss your chance of recovery. It's more forgiving than that. He will still continue to heal, and you are already helping him along that path.

I'm sorry it's not more clear cut. I wish it was. If your dog had IVDD or FCE it would be different. They have those all figured out. However ANNPE has the best outcome statistically of all 3 conditions, if I'm not mistaken, so in that sense it's fortunate that's what you're dealing with, in spite of all the confusion.

Oh, and re the harness, yes, it should ease the strain on him when doing steps, if that's what they want you to do. It will assist him not to have to put so much weight on his hindquarters, and you will control how fast he goes up and down. Especially since he's an active, high energy dog! I don't understand about running but no stairs either. Maybe the physio can explain the difference. I'd be interested to find out what they say, if you get a chance to ask.

[Otis's friend]

This is a really great response. Thank you for taking so much time to explain things so well.

The neuro went through the various possibilities with me before the MRI, including FCE and Hansen I and II, so I feel she was really clear then. Then she showed me the images and how it related to ANNPE, so I think that was pretty conclusive.

I guess I was just put off by the obvious cut and paste and that the physio wasn't actually able to see my sog to assess him and his progress. I understand her reasons (my dog is snappy when stressed) and she was good when she treated him before, but I've switched to a physio where he goes for hydro as he loves that place and that's a good start.

Thanks again, this forum is so helpful and I really appreciate this post. It's a bit mad how much of a newly recognised thing ANNPE is, but having a clear diagnosis can only help, I'm sure.