IVDD Diagnosis

My 5 year old female, Sasha, has been diagnosed with IVDD on 6/10. She was prescribed Prednisone 20 mg and is also on Tramadol 50 mg and Methocarbamol 500 mg. She was doing better until yesterday. When I came home from work my husband told me that she yelped once in the afternoon when she was getting up. In the evening she yelped once or twice when she was getting up or laying down. She is eating and drinking water this morning, so I'm sure that is a good sign. I am waiting for the vet to open so that I can tell him what is happening. She is also ducking her head down and then back up again occasionally from the pain. She wasn't doing this before. I'm interested to know of others experiences with IVDD. I feel so helpless and I am physically sick myself now worrying about Sasha.

Hi Sorry to read that Sasha isn't so well, hopefully the vet will be able to help her with her pain.
Please excuse my ignorance, but what exactly is IVDD?
Best wishes,

It's Interventrebular Disk Disease.

Here's some information from the web.
Intervertebral disc disease is a relatively common condition in dogs. Fortunately, most dogs who have this condition, do not end up paralyzed, but rather have pain that can be treated with either non-steroidal anti-inflammatories (such as Metacam, Rimadyl or Previcox) or steroids (such as Prednisone or Dexamethasone). However, some dogs can be very seriously affected and end up with paralysis.
Intervertebral Disc Disease

The intervertebral discs are the spongy cushions that are between each of the vertebrae (bones) in the spinal cord. Have a look at the xray of a dog’s spine. You can see that between each of the vertebrae there is a black space. This area is not actually a space, but rather it is made up of cartilage (which does not show up well on xrays). On this xray there is an area where the disc space is extremely narrowed. This dog has intervertebral disc disease (IVDD).
There are varying degrees of IVDD. Most dogs will have spinal pain that improves over time with anti-inflammatory medication. However, if the disc protrudes and pushes up on the spinal cord this can cause paralysis. Sometimes a surgery can be done to remove the offending material. However, this surgery is very expensive and not all dogs are candidates for surgery.
IVDD is most common in daschunds but can happen in any breed of dog.

I would guess they will probably wish to Xray again or do some other kind of scan to check for any further deterioration. Was she MRId to exclude syringomyelia? Unfortunately this would have many similar signs and could need to be treated as a separate pain issue. The things she was being treated with til now would also help with SM though not the best approach generally (that's quite a high dose of prednisone; I take it myself and am on half that amount and working down at the moment, though it might be fine as a short term dose; I'd want to ask about that high a level if it has been going on daily for weeks/a year -- I am not sure if your date of 6/10 means June 2010 or 6 October last, or June 10 this year...).

Vets are not generally very good at understanding or even knowing about SM so it might be worth asking for a referral to a neurologist who can check for neurological deficits in a clinical exam and advise as to whether this might be SM rather than/in addition to IVDD.

I've had several senior/geriatric Cavaliers that have had IVDD. I had a consult with an orthopedist in each case; there is one in Atlanta that I think is especially good. X-rays have very limited application in diagnosing IVDD. I had very good results in several cases using acupuncture - always from a certified veterinary a/c practitioner. My drugs of choice for IVDD are Robaxin (methocarbamol) and Tramadol. I try to avoid steroids if possible (and quickly move to alternate day therapy if I use them).

Strict rest is important - no stairs, no jumping, short trips outside just to potty. I used crate rest when I wasn't with the dog to closely supervise.

With a 5 year old, I would definitely consult a neurologist because we now know that IVDD can be a misdiagnosis when the problem is really SM. MRI would rule IVDD and SM in or out definitively. Those are high drug doses - how much does Sasha weigh?

Pat

Clare Rusbridge wrote an article about neurological diseases in the cavalier King Charles spaniel in 2005, and her first section was on "conditions causing spinal pain". She wrote: "The CKCS is a chondrodystrophic-type breed and as such is prone to Hansen type I disc extrusions." So, she seems to have narrowed down the most predisposed category of IVDD in the breed.

She writes further: "Management of disc disease may be medical (analgesia and exercise restriction for at least four weeks) or surgical. Surgical management is preferred for dogs with significant paresis or paralysis. For the optimum chance of return of function, dogs without deep pain perception should have decompressive surgery performed within 24 hours of loss of function."

Amazingly, there is not a webpage about this on http://cavalierhealth.org !!!

If it gets to that point, we can discuss types of surgery such as decompression and fenestration but you are not anywhere near that so I wouldn't study up on it right now!

Pat

Just got back from the vet. He is treating her with an antibiotic now. Her white blood cell count was 24,000. Apparently, normal is 12,000. Regarding the high does of Prednisone, she is taking 1/2 of a pill for each dose which is once a day. He also gave her an injection of pain killer and she is knocked out now.

She was diagnosed on 6/10 (June 10th). Sorry for the confusion. My brain is not functioning very well from the lack of sleep over the last few days.

I don't know much about white blood cells with respect to dogs. Can someone give me some feedback on this?

Can someone explain to me what deep pain touch compression is?

Sasha is not paralyzed. I'm assuming this is a good sign.

RodRussell said:

Clare Rusbridge wrote an article about neurological diseases in the cavalier King Charles spaniel in 2005, and her first section was on "conditions causing spinal pain". She wrote: "The CKCS is a chondrodystrophic-type breed and as such is prone to Hansen type I disc extrusions." So, she seems to have narrowed down the most predisposed category of IVDD in the breed.

She writes further: "Management of disc disease may be medical (analgesia and exercise restriction for at least four weeks) or surgical. Surgical management is preferred for dogs with significant paresis or paralysis. For the optimum chance of return of function, dogs without deep pain perception should have decompressive surgery performed within 24 hours of loss of function."

Amazingly, there is not a webpage about this on http://cavalierhealth.org !!!

Click to expand...

Rod! That's a shock!

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Prednisone can come in all sorts of strengths so half a pill could be 20mg or 50mg or .5 mg . If she is on 20mg a day that is quite high. For SM which is truly painful the dose tends to be about 5mg, just for comparison. On the other hand if this was only recently diagnosed then she would probably be on short term preds for the moment at a higher dose.

With my own condition that requires prednisone, I have seen how GPs widely misdiagnose the condition and even when they do diagnose correctly, give massive doses of preds -- like 40-50mg to start -- for a condition that is supposed to be treated with 10-20mg to start. So I'd always want a very good explanation and reasoning for any high-ish dose of steroids because I am sure vets are just as inaccurate and misinformed about proper doses (which should always be as low as possible).

As an aside -- I do wonder sometimes whether some doctors/vets take any time at all to look something (including recommended treatment approaches) up in their own literature and books, or on the internet if they are not fully familiar with symptoms/treatment as I have correctly diagnosed myself for a couple of issues based on good medical sites and some basic googling,. I do fully understand their exasperation sometimes with people taking wildly inaccurate advice off non-professionals on websites and email lists etc -- but I am talking about sites like the Mayo Clinic's or med journals or other professionally run sites. It amazes me how many vets still think cavaliers with low platelet counts are an emergency -- especially when they are baffled as the dog still looks fully healthy -- a quick google would turn up all the background on how this is generally normal for u to half of all cavaliers.

I think again that you probably would want a referral to a neurologist if the pain isn't addressed -- and definitely before any surgery for IVDD would be under consideration. The symptoms are so similar and disk problems are common in the breed as well as SM -- I'd want a clear idea of which is potentially causing the pain.

Sasha is quite big for the breed. She weighed 31 lbs when he prescribed the Prednisone. But it was only for the first 3 days that she took a whole pill. Now she is only taking 1/2 (10 mg) per day for 3 days and then it's every other day until they are used up.

I have an update. We took her back to the vet Friday. She was in terrible pain as I described in my previous post. He is now giving her an antibiotic. Her white blood cell count was 24,000, so he felt there must be an infection somewhere. The antibiotic is Orbax 68 mg. He also gave her a Buphrenorphine injection because of the pain. My husband got home with her at noon. He gave her the antibiotic and he said she slept like a baby until feeding time. When I came home at 6:00, she was laying in one of our bathrooms on the cool tile wagging her tail like crazy. I sat down and talked to her for a few minutes and then she got up and started puttering around the house. She was walking completely normal! She went outside and puttered around out there too. I was happy beyond belief!!! Thank goodness! Last night she slept in the place from 7:00 pm until 4:00 am. She was in the family room under one of the side tables, so I decided to sleep on the couch to keep an eye on her. Several times during the night I heard her panting, but she only did it for a few minutes and then she put her head down and went back to sleep. She slept with her legs out behind her and on her side. She hasn't slept in these positions since this started. When she woke up at 4 am she drank a bunch of water and then went outside to go potty. This morning she seems happy and is walking normal.

I have no idea what is going on, but I am cautiously optimistic! I am so relieved that she is no longer in pain and walking normally. She also moves her head in all directions with no problem. I was so distraught yesterday and today I am so happy!

Ok that makes more sense with the preds -- it is fast tapering.

That said: all the improvement you are seeing may well be the preds kicking in as that dose is very high for her size (as I noted I weigh many times what Sasha weighs and started on less than she is taking for a condition with quite high pain levels). The moment of truth for you is likely to be in the weeks following the end of the dosage. Preds is a bit of a 'miracle' drug for pain and inflammation -- it acts very quickly and brings total relief at higher doses even to chronic pain (I can testify to this!!) but if there's an underlying condition that goes beyond just settling some inflammation, the symptoms will return, or may return as you taper (I deal with this personally as an ongoing issue...).

If they do -- please do review SM with your vet and make sure they are aware of Clare Rusbridge's website and the likely need to have Sasha checked by a neurologist for a possible differential diagnosis.

For context: my eldest cavalier has had disk issues twice and the signs were very similar to my dog that has the worst case of SM (of my three out of five with SM). Painkillers and rest ended the issue both times fairly rapidly. She was MRId at 9 and was clear for SM so that definitely was not the issue for her with this type of pain. My worst affected SM dog also has only even had one serious pain session and this was when he fell off a bed. In retrospect we now think this was more likely a spine issue from the fall, or that the fall aggravated the pain in his syrinx. Either way, some rest and painkillers and he has never had a return -- which would have not likely been the case if the pain session -- which was awful -- was due only to the SM. Separating out the causes can be really difficult.

Yelping, neck and back pain are all very typical of SM pain so will be something just to keep in mind if the issue doesn't resolve. Most vets especially in the US are totally unaware how high the rate of SM is in this breed and as it is generally a specialty issue, very unaware of symptoms and so forth and most of us with such dogs have to be strong advocates for them to be properly checked and then diagnosed.

My oldest had IVDD and had decompression surgery last year when he was 9 years old. He had periodic flare-ups of pain that were controlled by prednisone and metacam. The last flare-up was so bad that he had to carried from the crate (and he never goes in the crate any more but I always leave one around) to eat and potty. Otherwise he would not move. Before that he had only had x-rays of his spine by the orthopedic specialist. This time the ortho sent him right over to the neurologist who did an MRI to rule out SM (which he thankfully does not have) but he had a severe case of cervical IVDD. He had decompression surgery by the neurologist and within 3 days of surgery he was almost like a puppy. I wish I had gone the MRI route years earlier. Maybe I could have saved him years of pain - but maybe they wouldn't have done the surgery until he was as bad as he was. I don't know. I do know that it was a relief to find out that he did not have SM, as I have another one with SM.

I hope Sasha continues to improve and maybe she won't have another flare-up for years. That prednisone is a miracle drug for sure. My SM dog is on it long-term and wouldn't be here without it. Good luck with Sasha. I hope you continue to get happier and happier!!!

I appreciate everyone's responses and all the valuable information. I will be mentioning SM to my vet the next time I speak to him. I just think it's odd that she was on the Prednisone and the painkillers Tramadol when she took a turn for the worse and then she improved remarkably when she started the Orbax. If she truly had IVDD, would the antibiotic make her condition improve like this?