Saturday, May 28, 2016

IVDD - the first 2 weeks

On May 5th, Summit turned 11 years old. That morning he suffered a herniation of a disc in his neck, known as intervertebral disc disease (IVDD). For a few weeks prior he had been exhibiting occasional neck pain - manifesting when he turned his head to the right - but on this morning there was extreme pain and a root signature. A root signature is the medical terminology for a dog holding its front paw up when it is caused by compression of the nerve root (where it exits the spinal cord).

The following day we had an appointment at the local referral centre for a CT scan to confirm the suspected diagnosis and surgery to follow. There are different degrees of severity with IVDD, ranging from just mild pain all the way to complete paralysis. Summit was in the lower mid range of that scale as his pain was more serious and he had the root signature, however he was otherwise neurologically quite normal. The CT is used to identify the exact disc that has herniated, in Summit's case it was C4-5, so that the surgeon knows where she is going. The surgery involves making a window in the vertebral bone and carefully scooping out the herniated disc material that is compressing the spinal cord and nerve roots. Since Summit was neurologically normal prior to surgery, he was expected to be fairly normal after, though some dogs do experience a little bit of a set back.

It was a huge blow then, when he recovered from the anesthetic, to realize that he was completely paralyzed in all 4 limbs. The only thing he could do was lift his head. I spent several hours at the hospital with him that first night, as I was very upset and concerned that after putting him through all this I may have to euthanize him. The staff also couldn't get him to eat or drink, so I fed him while I was there. His run was a little cozy for the two of us, but we got snuggled in together on all his blankets and snoozed together, had some snacks, and listened to some music. I was too upset to really be able to document any of it. I took a couple photos, but no videos.

That night I drove home in tears, and when I got there the girls both met me at the garage door which caused me to burst into hysterical tears. I was so inconsolable that my boyfriend, who hadn't seen Summit since before surgery, thought he must have passed away. I guess in that particular moment, to me it was almost one and the same. After all, how do you care for a quadraplegic 30 kg dog long term?

The next morning he didn't seem any better (it was the weekend, and I decided to go twice daily in order to feed him), which was demoralizing. After talking with his surgeon, we decided to start him on steroids to see if that would help the inflammation that might be causing some of the paralysis. The difference between that morning and the evening was immense, in very small ways as is the case with neurologic cases. I arrived that evening and noticed that he had some tone in his tail. In the morning I had noted that his tail was completely limp, like a noodle. I also found that he had some reflexes in his back legs. He still couldn't really move anything voluntarily, but I was really heartened to see some improvement. It was probably the best Mother's Day gift I could have gotten, considering the circumstances.

Mother's day in the hospital with my best boy.
The next day I stopped by in the afternoon, with the plan to take him home later that night, and found that he had some voluntary movement in both front and back legs. Squishing into the run with him, if I was laying on his leg he would try to pull it away. He also was shifting himself around a little, trying to get comfortable. He was eating for the technicians, though they commented that he seemed a lot less depressed when I was visiting. That evening, two technicians carried him out to my truck using a special "Help Em Up" harness, and I took him home. At this point he was still unable to really move, still had a urinary catheter in (because back to the question of caring for a 30 kg quadraplegic, carrying him outside multiple times a day would have been incredibly difficult and probably uncomfortable for him), was on 3 or 4 different medications, and needed to be flipped from one side to the other at least 4 times daily to prevent pressure sores. But, the benefit of being a vet and having another person in the home to help, was that at least I could bring him home where he belonged.

A "cake pawp" I bought in Toronto for his birthday.
Home at last. I think he looks pretty happy about it.
The next morning I got a welcome surprise and a heart attack at the same time, when we woke up to find Summit sitting up in sternal, on the opposite side to the one we'd put him in the night before, but on the bare hardwood floor.

The morning after coming home, able to hold sternal position for the first time.
After that experience we turned the living room floor into a sea of dog beds so he could just flop from one bed to another. It worked for the most part, though we did sometimes still find him in the gap between beds, or half on the hardwood. This especially seemed to happen when he pooped as he'd try his hardest to get away from it, usually to his detriment because he would not only end up on the hardwood, but also covered in poop as a result of his uncoordinated flailing.

A sea of dog beds
A week or so later we started to notice him watching us longingly whenever we would head to the backyard with the girls, so we found a quiet evening and carried him out to enjoy it with us.

We also started to see him sleeping in more normal positions, like the one below. It may not seem like much, but a few weeks ago he couldn't even curl his legs into this pretzel position.

The rest is still to be determined. He is making great progress but there's a long way to go yet. The majority of the improvement happens within the first 6 weeks after surgery, so we have a few more yet to go before we know exactly how much better he's going to get. Here's a video so far:


Janette Ash said...

Thinking of you and Summit during this trying and emotional time. So happy he is improving. Please keep us updated. XX

George said...

Thanks for sharing your experience of herniated disk with dog.