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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.