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Most of you already know about my Sophie Sue and the severe neck pain (due to intervertebral disc disease) that landed her at the specialist’s place last week. So many of you wished her well and sent hugs and smooches in her direction (for which I’m eternally grateful), but since then I’ve been remiss in reporting on her condition.

So here’s an update—with some basic facts on her disease tossed in for your learning pleasure. (Sorry for the repetition for those of you who’ve already tuned in to Sophie’s saga.)

First of all, let me say that Sophie’s doing extremely well. It’s no hyperbole to say that she’s like a new dog after her surgery. The first 24 hours were rough but it’s been smooth sailing ever since. Here’s a recap of the situation:

Sophie’s neck had been hurting since Thanksgiving. First it was a reluctance to jump and a reduced spring in her step that informed me of her discomfort. She never cried or whimpered as so many owners might expect to observe in the event of  severe pain. Whenever I touched her neck (as if to massage it) I felt a marked tension in her muscles. Whenever I tried to move it she’d steel her muscles against the pressure.

Pain meds helped but didn’t fix her sluggishness and general malaise. X-rays revealed only a tiny bit of calcification (bony proliferation, as with arthritis) between a couple of the vertebrae in her neck, but this circumstantial evidence made it likely that this was the cause of her suffering: intervertebral disc disease.

With IVD (short for intervertebral disc disease), the disc (which acts as a cushion between the two vertebrae adjacent to it) has become diseased and the material inside it “slips” or “bulges” onto the sensitive nervous tissue of the spinal cord.

Dogs who suffer from IVD may simply shake (with pain) or refuse food. They may walk with a hunched back, as this can occur not only in the neck but between any vertebrae in the entire length of the spine. X-rays will often be inconclusive in diagnosing intervertebral disc disease, revealing no evidence of the calcification we saw in Sophie’s case (these changes take time to develop).

If the vertebrae affected are in the upper neck, all we typically see is pain, as in Sophie’s case. Lower down in the back, the discs will often push hard enough to actually cause paralysis, the manifestation of intervertebral disc disease most feared by knowledgeable Dachshund owners. These cases require emergency surgery but are often handled medically and with physical therapy due to the high cost of surgical intervention ($1500-$4500!).

Exercise restriction and pain relief is key for non-paralyzed dogs. But gentle massage and other therapeutic modalities (acupuncture, for example) can be helpful here, too. (Sophie had Reiki to help control her discomfort).

With neck pain, it’s often hard to decide whether to go for surgery to relieve the intense discomfort some dogs suffer. So many things can go wrong when working in this delicate area. We risk anesthetic reactions, reactions to the contrast material used in the myelogram (the X-ray procedure involving a spinal injection used to highlight the cord’s outlines), severe swelling of the spinal cord as a result of removing the offending disc material, etc.

But the end result has been worth all those risks, and not just because Sophie did so well. Truly, I had no idea how much pain she was in until I saw how gloriously happy and active she’s been ever since. From a post-surgical perspective, it’s clear that her pain must have been incredibly debilitating. From this free-and-clear vantage point, it seems unconscionable to have allowed her to continue to suffer.

Yet I can’t help thinking about the expense involved for most pet owners in serious IVD cases. Sophie had two blown discs. The surgery was a lengthy one. She required intensive post-surgical care for over 24 hours. Who can afford all that? After all, it comes to well over $4000 (at most hospitals) after all’s said and done.

As a vet, I get a discount from the vet surgeon (typically the only kind of vet qualified to undertake these procedures). Otherwise, it might not have been so easy to make the decision to take her to surgery (and God knows it took me long enough to push past my fears and get the deed done).

Enough musing and gnashing of teeth. The important thing for this mommy is that Sophie’s better. She’s looking for cats to chase and trotting all over the house, following me everywhere as she always did before her disc-related pain. Consequently, I’m a big believer in taking chronic pain sufferers to the OR rather than let them languish in intermittent discomfort for the rest of their lives—if you can afford it, that is.

Comments
Its always nice to read good news. We've had more than our fair share of visits to the orthopedic surgeon but I would do it again without hesitation
# Posted By Jules | 2/6/08 6:15 PM
A friend has a 9-year-old Rottie who has had two disk surgeries on his neck (I think both surgeries were successful; a different disk ruptured at a later date). She was able to afford it because her pet insurance covered the majority of the expense. She has VPI, which isn't even one of the higher-rated plans according to http://www.petinsurancereview.com/ -- she said that it's important that the vet treating the dog state that the problem is not hereditary or congenital or they won't cover it. My guess is that if she had a dachshund, they would not have paid.
# Posted By Mary | 2/6/08 6:18 PM
So glad that Sophie Sue is so much better! As a volunteer with Boston Terrier rescue and Frenchie rescue, I have seen a few cases of owners who can't afford expensive surgery and surrender the dog. However, I have found that it isn't just about money.... it's about how people think of their pets. If their pets are as important as their children, no amount of money will make them turn down a necessary surgery. If their son tore his ACL playing sports, would they decline surgery? NO....even if they had to pay a few thousand dollars out of their own pocket. The same should be true for our pets. Unfortunately not everyone feels the same way I do. I don't care if I had to put myself in debt or re-finance my mortgage to pay for a necessary surgery. I would never give up my dog.
# Posted By Tara | 2/6/08 6:29 PM
Awesome to hear that Sophie's doing so good! Thanks for sharing. IVD is such a nightmare to deal with.
# Posted By Pam Holt | 2/6/08 6:40 PM
I am so happy that it worked out! I was beginning to worry after we didn't hear anything. You have just made my day - so glad your little darling is doing so well!
# Posted By Cindy | 2/6/08 6:41 PM
I am glad that she's doing so well!
# Posted By katie | 2/6/08 7:10 PM
So glad to hear that Sophie Sue has recovered nicely!

Dr. Khuly, you have echoed my sentiments almost verbatim on the short article I've written & going to print, about my experience dealing with IVDD and successful sugery for my Sealyham Pearl.
Yours is much better written, though.
# Posted By Barbara A. Albright | 2/6/08 8:00 PM
Glad to hear that she's doing much better.

I can tell you feel much better as well... =)
# Posted By Stacy | 2/6/08 10:16 PM
Yay, so glad Sophie Sue is on the mend!
# Posted By Creature of Habit | 2/7/08 9:07 AM
Yes, honestly - I couldn't afford it, and if she was my dog, I would have (tearfully) put her to sleep. I couldn't afford that kind of money for myself, much less my dog. It makes me fearful as a pet owner to read these stories, because I know what that kind of injury/disease means for my family. Glad she's doing better.
# Posted By Anna | 2/7/08 10:10 AM
I'm so glad to hear that the surgery went well. My terrier mix got a slipped disc lower in vertebrae from jumping out of bed one morning a few years ago, and we had to make some tough decisions. I guess it's much better these days for dogs who don't have the surgery, but I ended up opting for the surgery which was about $3k. She was walking again in 4 days, and except for a little hop every now and then, you'd have no idea from watching her.

Of course, it's not always so good. We had a family member who went through the same thing and opted for surgery in the Bay area where it's much, much more expensive. His dog never recovered and didn't adjust to being a wheel chair dog very well.
# Posted By Jen (SLC) | 2/7/08 10:17 AM
Here's another push for high-deductible pet insurance for those really big emergencies. I don't think I could live without it if I didn't have access to professional discounts and courtesy payment plans. Even with these, I'm considering a couple of companies' plans very seriously. I just couldn't live without knowing I did everything I could.
# Posted By Dr. Patty Khuly | 2/7/08 10:23 AM
Praising God that Sophie Sue is doing so well and looking forward to frequent updates on her healing!

mb
# Posted By mb | 2/7/08 10:27 AM
YAY! It's a
# Posted By Shasta | 2/7/08 11:08 AM
Regular Sophie's Miracle!

(and a bad typer - ARGH)
# Posted By Shasta | 2/7/08 11:09 AM
How much is the average cost for pet insurance?

I find it annoying when people say that it's a matter of love and devotion, etc. and that no amount is too much. I don't love my pets any less because I won't jeopardize the REST of my family's needs and life to do everything possible medically for a pet. Some people just can't afford the extreme emergencies that come up rarely. And the answer, "Don't have a pet then," isn't an answer because what, the joys of pet ownership are only for people who are rich or have thousands of dollars to spare for this? I can provide for my cat's basic needs but I cannot afford thousands in surgeries, diagnostic tests and the like. Of course I would do so for my husband - but I can't justify that kind of cost for my pet - not when it would deeply impact our human lives.

There are those of us who are loving yet practical because we are conscious of our monetary limitations.
# Posted By Anna | 2/7/08 3:06 PM
Anna, I certainly wouldn't fault anyone for not going through back surgery with a dog. It's expensive. There are risks to the dog. It might not work. And in my case, it was very, very messy and time consuming. I think a lot of people are in a situation where they just can't deal with those issues, and they opt to take other approaches. When my vet weighed the options for me, she told me that there were options other than the surgery that weren't euthanasia and that my dog could have a decent quality of life paralyzed.

I'd never fault anyone for deciding not to do it. It's a personal decision and everyone's situation is different. Deciding to take a different route doesn't mean you don't love your dog.
# Posted By Jen (SLC) | 2/7/08 3:41 PM
Thanks for that, Jen. It's something that I hear a lot, and it frustrates me since while I've luckily never been in that position, I could be some day with a pet, and while I hope my finances would allow it, I don't know.
# Posted By Anna | 2/7/08 5:04 PM
Thanks for that, Jen. It's something that I hear a lot, and it frustrates me since while I've luckily never been in that position, I could be some day with a pet, and while I hope my finances would allow it, I don't know.
# Posted By Anna | 2/7/08 5:04 PM
Anna: I constantly find myself in a position where I have to console my clients for their inability to pay for major pet health issues. Not everyone can make the trip to the specialty hospital. That's life. There should be no guilt as long as you've weighed your personal and financial limitations carefully. Easier said than done, I know.
# Posted By Dr. Patty Khuly | 2/7/08 6:38 PM
Absolutely. If my Mona Cat got sick and needed an operation, I certainly would try as hard as I could to pay for it. Right now she's a healthy, happy 8 year old kitty and hopefully will stay that way!
# Posted By Anna | 2/8/08 9:31 AM
HELP! Monty my 14yr old soft coated wheaten terrier - we were just told by the emergency vet that he has IVD - from an xray. We just (12days ago) moved from Boston to Seattle. He seemed fine except that when we arrived and for the first 2 days he seemed to be stoned (walking almost into things) I thought it was just acclimation. By the 6 day here he was unable to move his head to the left so I took him into the emergency vet (I thought it was his hips that was bothering him). the dr said that he had pulled a neck muscle and give him his regular Cosquen and Rimidol and add Timodol (sp all wrong). So we did that. (tues night) by fri he seemed normal and fun loving so after carrying him to potty from temp housing all week, we went for a short walk on his new harness - he tried to get out of it, i picked him up and we came in. On sat (and til today) he has been holding his left leg gingerly (almost off the ground). We went back to emgy room last night (Tues) and was given muscle relaxers - nothing changed. Tonight I called the Dr and he told me that the radiologist reviewed and IVD - so to give him only preidon (starting tonight) and codine and keep him in a crate 24/7! what do i do----- lost in seattle and crying!
# Posted By Nicole Brown | 2/20/08 10:49 PM
Nicole: Follow all of my instructions above:
1-Strict rest!
2-Regular meds (as directed)
3-Start saving your pennies--consider that surgery might be helpful if things don't improve in a few weeks.
Best to you and Monty--I feel your pain!
# Posted By Dr. Patty Khuly | 2/21/08 10:38 AM
Dr Patty, how big should his crate be? The one we have now he can lay fine but not stretch out and when he lays flat on his belly his head hits the front wherein he has to hold his head to one side or the other. I was going to go to the pet store now to get a playpen- what do you recommend?
# Posted By Nicole Brown | 2/21/08 10:50 AM
One more question: should I take him to the nureologist to be consulted with? Or just rest for a week on the meds?
THANK YOU so much for the help~ sleepless in seattle
# Posted By Nicole Brown | 2/21/08 10:59 AM
Nicole: Sounds like your crate is actually OK. It should be ig enough to stand up and turn around in to shift positions. A playpen is a nice adjunct, especially while you're home and coking in the kitchen, for example, or have guests over.

And yes! A boarded surgeon or neurologist is a must! (I assumed you had done that part already). Please note: Surgeons think their tissue handling expertise and constant experience in the OR makes them far better at these surgeries. Neurologists think surgeons have no business touching the spinal cord. I think it's all about TRUST. Getting an opinion from one of each and (if you must go to surgery) select the one that you feel most comfortable with or who your regular vet feels is most capable of helping you.
# Posted By Dr. Patty Khuly | 2/22/08 7:38 AM
I Just stumbled upon this posting after googling IVDD Boston Terrier as I have just had my 2 year old Boston Terrier (Parker) diagnosed with suspected IVDD (cervical).

www.parkerandcompany.blogspot.com

This was a photo I took of him two days ago and didn't realise that he must of been in pain then. He rarely sleeps likes this and is doing so now as he seems to not want to sleep on his side. I am thinking a blow up inflatable collar might help? Any suggestions?

It all started with a few crys and yelps when landing after a jump or when out on hikes.... I assumed on most occasions there must be a foreign body in his paws and just kept checking them all.... then I decided it must be down to his mild patellar luxation and all the trees down from Hurricane Ike that we've been having to hurdle on our walks in the woods lately.

Today in said woods - Parker was lagging badly... then I noticed he would not life up his head. Just his eyes were looking up at me. I immediately picked him up and he was panting and making sounds like he was having difficutly breathing. He was REALLY clenching his neck and trembling feverishly with his jaws clamped shut. I got my hands in his mouth to check for an obstruction, when I noticed his toungue was turning BLUE! Not a good sign.....

We sat there for about 15 mins as I held him and regulated his breathingmassaging his throat. He was still in his crouching head down pose but his breathing was better- albeit panting. I then carried him the 1.5 miles back to the car (and he's a big 29lb Boston - not fat - just really muscular, people think he's a Frenchie all the time).

IVDD is the suspected diagnosis - and he's been ordered 4 week crate rest (I don't even OWN a crate) and meds: Rimadyl / Tramedol and Famotidine. I think the rest will kill ME more than him - and I'll still have to walk my other critter crazed mutt! I also have to go buy a harness to avoid any pressure to his collar/neck on the little walks I can take him on.

I hope surgery isn't needed (as I've been unemployed since May) but will happily pay for this treatment if necessary.... I just am confused as to if the 4 week rest/wait will make matters WORSE if indeed surgery is the only answer? He's really pathetic and sad right now - trying to fall asleep (he's pretty sedated still) in a sitting up position.... he really doesn't want to lie down.

Any additional advise would be really helpful - I was thinking would a "blow-up" collar be helpful to avoid the side-to-side / up-down head movements that hurt so much??
# Posted By Clare Cassar | 9/22/08 7:04 PM
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