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Monday, October 1, 2012

Dachshund Week: Back Problems, Part 1

For some reason I've had several questions related to dachshunds, especially comments on a post I made three years ago on back problems in this breed.  So I decided to jump in and answer all of them in the next couple of days, doing a sort of "Dachshund Week".  Here's the first one:  

Reading up on these Dachshund back issues recently as our 4.5 year old male - half mini, half regular size dachshund has a compressed/ruptured disc. He initially showed signs of problems while we (his owners) were on vacation. Pet sitters informed us they thought he'd hurt his right hip. Upon our return 1 day later, I gently tested his flexibility/pain threshold in his leg but nothing set off the pain. He would cry out in pain randomly but seemed fairly normal aside from mild lameness in his right leg. Two days after the onset of the symptoms we noticed his back-end was unstable/wobbly. We contacted our vet who moved schedules to get him in ASAP and did the X-ray. Since, he's been on steroids for three days and is showing improvements in controlling his legs but is still somewhat unstable. The meds are definitely helping his pain threshold but what I didn't realize is that the damage, once done, cannot likely be undone. A dachshund back surgery in Hawaii is $6K minimum (talked w/ multiple hospitals), which is more than we can spend on a military salary. We've contemplated flying him back to the states to get the surgery but is it even worth the risk if the damage is already done? He's under a strict crate regimen and gets out four times per day to go to the doggie bathroom. Nerve damage is an extremely slow recovery process but what remedies outside of surgery have proven most beneficial for people with this unfortunate problem? I worry we may be postponing a surgery that could prove helpful to try alternative solutions which could possibly create a worse situation in the long run. Will he always be in pain/limited without the surgery or is it possible for him to recover to a point that he's pain free again? What happens to the hard part of the ruptured disc when no surgery is done? Will it move back into place? Thanks for your thoughts!

Spinal and nerve damage is always hard to predict, so it's impossible to say whether or not a problem can be reversed.  The key is rapid treatment and possible surgery.  The longer you wait the more likely it is to be a permanent problem.  Unfortunately it's hard to say how much time "longer" is, though sooner is always better than later.  Surgery is most successful if performed within the first few hours to day or two at the latest. The goal of surgery is always to have the patient be free of pain (once the post-operative period is over) and ideally to get some degree of functional return.  But it's never predictable and you don't know how successful it will be until the patient heals.

In this case I don't think that flying him back would be worth it. You have the costs of flying and the potential for him being jostled around in the airplane.  Any money you might save on the surgery is probably going to be taken up by travel costs.

Other than surgery treatments are limited.  Obviously steroids (glucocorticoids) are a key in recovery, even though the research has shown that any benefit is minimal at best.  This is where clinicians differ from researchers, as all vets have seen cases recover on prednisone and rest.  I know a vet who does acupuncture (more Western-based than Eastern) and she says that in some cases this treatment can work.  However, you have to find a vet who is trained in this modality.  With any non-surgical treatment the patient can certainly eventually be pain-free and even completely recovery, though the odds are much lower than with surgery.

During surgery the slipped portion of the disc is completely removed, taking away pressure from the spinal cord.  Without surgery that hard central portion of the disc remains in the spine.  The initial inflammation may be reduced, which results in improvement of symptoms, but the disc is permanently damaged.  These cases may be a ticking time bomb, as that hard center can move back against the spine at any time, and it will be easier the second time since the wall of the disc has already ruptured.  In my cases that are successfully treated non-surgically, I always warn the client to be even more vigilant because it could happen again quicker and more severely.

In this case my recommendation would be to do a consultation with a qualified surgeon and have them evaluate the specifics of the case to determine whether or not surgery is even still an option at this point.



12 comments:

  1. Nice post, I saw quite a few Dachshunds when on clinics and neurology and we saw a LOT of them! :(

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  2. My dog, who is not a Dachshund, recently injured her back jumping off the bed. The vet gave her some pain killer, muscle relaxant, and steroids. We did x-rays and the vet said it was a crushed disc and explained some of the unpredictable prognosis. She doesn't appear to still be in pain, which she only ever really demonstrated when she tried to jump. She isn't limping or showing neurological impairment.

    My concern is about how long I should keep her in her crate resting and how I can help her get some of her energy out. She is a poodle mix and has so much energy it is ridiculous. When we go out to the bathroom, she is dancing around, jumping at the back door, and lunging to play with other people and dogs. I carry her up and down the stairs, but I'm worried she will not be able to heal.

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  3. I had the sweetest dachshund in the world, and I just had to put down Friday. Last Monday night she went to her crate like she does every night, and Tuesday morning she came out dragging her hind legs. I took her to the vet who explained there was something wrong with her back and the disc pressing on her spinal cord. She tested her back paw and explained she still had the deep pain sensation, and prescribed her Prednisone, muscle relaxers, and pain pills. She explained that since she couldn't feel her back end, she wouldn't know that her bladder was full, so we may have to try to express her bladder at least once a day to get the urine out. She explained that it just wouldn't let go on it's own, but may overflow a little as it got full. She gave us a brief tutorial and scheduled a follow up visit. I tried and tried and couldn't get her to urinate that day without much luck. The next day when I finally did, I noticed there was some bleeding with it, but thought she may just be going in heat. We expressed her bladder a few more times that evening, but by Wednesday she was still bleeding almost constantly. Thursday we went back and saw a different vet because we were getting concerned about all the bleeding. She referred us to an emergency surgeon who was going to consult with us. He advised us that she had now lost the deep pain sensation in her back feet and her bladder had gotten distended, and that is where all the blood was coming from. He said if the surgery is performed within 12 hours of them losing the deep pain sensation, they have around a 75% recovery rate. After that window, it drops to 5-50% and it probably wouldn't work on her. We took her home, and decided we would still take care of her and love her even if she was paralyzed, but our main concern now was her bladder and the bleeding. Every 5 hours we were up taking her out to express her bladder, hoping we could maybe flush the blood out and get her bladder to go back down. Unfortunately, by Friday morning, there was still no change and she was starting to be in pain and cried whenever she was picked up. We went back to the vet to make sure she didn't have an infection. Two hours before, we had expressed her bladder, and when we got to the vet, she explained that it was already full again, and once it was distended, it probably would never go back down and eventually, the muscle would start to die off, especially with us having to express an already damaged bladder. We decided, it was only right to let her go out peacefully and not have to suffer any longer. It was the hardest decision we have ever had to make, and it is bringing me to tears just typing this.

    I say all of this to just reiterate what you have said. If you notice your dachshund having back problems, or something not right with their back legs, please get them to a vet or emergency vet ASAP. If they are not urinating on their own, learn to express their bladder (there are numerous videos on YouTube and articles on the internet on it) and if you can't do it, go to a vet or emergency vet to get it taken care of. If they tell you they need the surgery, don't wait. As I said, the surgeon told us they only have about a 12 hour window before their chance of recovery drops to virtually zero. I'm not a vet by any stretch and can only speak on the hellish experience and heartbreak I have just had with my sweet Marble, and I wouldn't wish this on my worst enemy.

    In closing, even if I don't know any of you, thank you for reading this far because it's been at least therapeutic to get this all out. Thank you so much for writing this informative article, as maybe it will help other dachshund owners, and even myself when the time is right and I can move on to another one in the future. I wish I would have seen this or known about this issue sooner, because right now I would give anything and everything that I own if I could just go back one week.

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  4. What do you think of laser treatments for these back issues? My 4 yr old standard doxie recently hurt her back while running and playing. I just started laser and ridaydl pills twice a day. However, after 2 laser treatments, she seems to be even MORE wobbly.

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  5. I think the jury is still out on laser therapy. I've seen some evidence that it could really work, but I think it depends on the nature of the injury. If it's muscle and skin I could see lasers being more effective. But for pressure on a nerve I'd be skeptical about whether or not it would do any good. However, I have no personal experience with it so don't consider myself qualified to make a strong recommendation for or against it.

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  6. We are bringing our 5 yo female long haired doxie home after 1 night at the hospital. Out of the blue 2 nights ago she suddenly lost control of her back legs, with no specific injury. It all happened within a few hours. We cannot afford surgery (it was quoted at 5-7K)so have been forced to opt for "conservative management." The first night she has already been given one dosage of Rimadyl and after no change, she has been given 1 steroid infection and will start dexamethasone w/ strict crate rest. She still has deep pain sensation in one leg with the other one being a little stronger, with just mild proprioceptive loss. Still, I am wondering how much hope we should have in terms of her ever improving. I understand there are stories of doxies regaining the ability to walk after a month or more of 24/7 crate rest. Pleae let me know your honest opinion!

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  7. Unfortunately cases like this are very unpredictable. When nerve damage occurs there is no way to predict whether or not it will ever return. Even with surgery there are no guarantees of full return to normal, though it has the best chance (assuming it's performed in the first hours or days). I would classify her chances of improvement as guarded, just based on the history of these cases. Talk to your vet as he/she will have a better idea of her specific condition.

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  8. Thank you Dr. Bern. Belive it or not, when you told me that her chances of improvement were "guarded" I was happy. She came home from the hospital Tuesday and the good news was that she seemed to show a slight improvement in that one overnight at the hospital. The vet there says she felt perhaps the Mannitol IV in conjunction with the Dexamethasone injection helped bring down a bit of the swelling in the spinal cord that night. She is now on Prednisone, Tramadol, Sucralfate, Misoprostol, and Famotidine.

    The biggest hurdle when we got home was getting her to eliminate. Finally about 18 hours, she finally peed, but in her crate. It was another day before she was able to defecate. I felt that every time I took her out of the crate to help her try, I was making it worse. Finally another 18 hours and out of the blue, she indicated that she wanted to come out of her crate and immediately peed and pooped on her own yesterday. I feel it was a real turing point. That was yesterday. Today, I was able to carry her out the grass and help her with a sling and she once again went. We feel a bit more optimism today, although I still have concern that she may hurt herself trying to go.

    All in all it has only been less than 5 days since the start of the episode. I think the fact that she has not gotten *worse* is something to give us hope. Question: is there a typical pattern of recovery? When would we know if she has hit a cliff where there will be no more recovery? Or is it impossible to tell...each case unique? We are 100% ready to be in this for the long haul and know to take it day by day. Just thought you may have seen quite a number of these cases that you would have a little more insight for me.

    Any thoughts are appreciated.

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  9. Unfortunately each case is completely unique and therefore it can be unpredictable. In general the longer you go without improvement the less likely you are to get anything further. However, I've even seen that "rule" broken. That's why these cases can be so hard to manage.

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  10. That is sort of what I thought. Thank you.

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  11. Going through all this now... 5 yr old mini that had surgery less than a year ago and now we are back to her not being able to walk or pick up her back end... she started on the steriods and no improvement yet... luckily she is still urinating on her own. Can't afford another surgery. Hoping for the best... Any suggestions would be appreciated.

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  12. Going through this now... 5 yr old mini ... already had one surgery and recovered and now this is second round and can't afford second surgery... she is on steriods and crate restricted. no feeling in one leg and still able to urinate on her own... would love some advice outside my vet to see if anything else can be tried... Don't want to have to put her down... Suggests are much welcomed. Thanks in advance

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