IVDD - intervertebral degenerative disk disease (long!)

[Miss_Anne_Thrope]

My older dog (Snert) has been potentially diagnosed with IVDD. He’s at least 10 (could be 11-13 as he was adopted as a young adult, age not definitively known). Best guess at breed is Yorkie/Pom mix.

He’s been having episodes of pain that last a day or two and then he goes pretty much back to normal. The episodes have increased in frequency within the past couple of months.

He’s been treated with gabapentin, Rimadyl, tramadol, topically applied fentanyl, meloxicam, and prednisone. Not all at once, of course, although recently he’s been on Rimadyl (twice daily), gabapentin (twice daily), and tramadol (three times daily). When he was so painful that I couldn’t get the pills in him, he got the topical fentanyl to replace the tramadol. This was prescribed by the “second-opinion vet” (let’s call him Doc B) that my regular vet referred me to.

I am not really sure if any of these medications have been effective at alleviating pain as the painful episodes have resolved in the past with or without meds.

However, I got the impression from Doc B that Snert would be on these meds forever in the hope of preventing or ameliorating future pain episodes.

He had the fentanyl application last Friday, was not feeling at all great on Saturday (not painful as such, just kind of blah and no appetite), but by Sunday evening was pretty much back to normal. He’s been terrific since Monday, running around, playing, eating just fine, etc.

I emailed Doc B to update him, and he emailed back that he thinks we should try steroid instead of Rimadyl: “The IVDD responds better to pred than Rimadyl in a lot of cases.” He told me to stop the Rimadyl for 3 days before we try the pred.

I’m so confused now, because it seems we didn’t really give the Rimadyl much of a chance. But I stopped it anyway.

He’s painful again today (probably not related to stopping the Rimadyl as this seems to be the pattern now of painful episodes at least every week).

I know of another dog (miniature poodle) diagnosed with the same condition (not as severe as Snert’s, I think) who’s on just daily Rimadyl.

I’m not even sure what to ask right now, but I hate the idea of having him on steroids (prednisone) forever.

I guess I’m posting all this hoping to hear of others’ experiences with this condition … how it was treated, outcomes, etc.

[Beckham03]

Do you rest him during these episodes? It seems like he’s constantly hurting himself. These dogs are usually on some pretty strict exercise restriction. Has he had any diagnostics done? What did they show?

Pred is likely to reduce the inflammation faster.

[Miss_Anne_Thrope]

[QUOTE=Beckham03;8819065]
Do you rest him during these episodes? It seems like he’s constantly hurting himself. These dogs are usually on some pretty strict exercise restriction. Has he had any diagnostics done? What did they show?

Pred is likely to reduce the inflammation faster.[/QUOTE]

I’ve wondered about the resting because I read something about strict crate rest for 6-8 weeks. None of the vets I’ve seen have mentioned anything like that, just to sort of go by what he does or does not want to do. I carry him up and down steps and don’t take him for walks or let him go down to the barn with me.

He’s been x-rayed, which doesn’t really show anything. So far, no other imaging (CT or MRI). The expense is an issue (estimates of $3000-$5000 for a neurology work-up), and the referral vet didn’t recommend it anyway. I got the impression that, yeah, it might show us the discs involved but it wouldn’t change the treatment/management anyway.

I’ll have to ask the vet if he meant to use pred to treat when an episode occurs or as a preventative. Like I said, I’m pretty confused right now, not to mention emotionally devastated to see my little guy hurting like this.

I’ve read one article about crate rest to allow the disc to heal. But healing is not what I heard as a goal from the vet. At best, the goal is to control/manage pain.

Plus, most articles I’ve read seem to refer to one disc, but Snert is sore in his neck and the vet also found a really tender spot back closer to his tail.

I know I’m not thinking especially clearly now. Snert has been my best little buddy for over 8 years now, and although I’ve loved every dog I’ve ever had, but this one … I don’t know, something special about the bond I have with him.

[MsM]

I totally empathize! My little girl has/had IVDD and possibly syringomyelia. She has her own doggy neurologist. When she started having back pain, we tried medication & rest. Eventually did the MRI which showed the bad disc and she had successful surgery. Later she began having pain episode again. After an inconclusive MRI, we are controlling it with gabapentin and occasionally Metacam.

If he is having disc issues, rest and restriction is a must. My dog was much younger when her issues started so your options may be different, but I think a doggy neurologist would help a lot. You can look at a site called “Dodgers List” for some info.

Best of luck making your guy comfortable!

[SarahandSam]

Check out Dodger’s List. Verrrrrry helpful with IVDD info, including medications (recommended protocol for switching between steroids and NSAIDs like Rimadyl) and crate rest protocol. Acupuncture and laser can also make a huge difference with IVDD, especially if you start early. And the crate rest is a must, though I think it’s helpful to eventually start a PT and conditioning program with your vet, if that’s available.

Good luck!

[Miss_Anne_Thrope]

I’ve been reading Dodger’s List, and to be honest, it’s got me in tears thinking about the pain and struggles of all these little dogs, not to mention my own.

One thing that’s confusing to me is that most of the pain episodes people are describing seem to last for days and the expectation is that after the 6-8 weeks crate rest and pain meds, the disc is healed.

My dog has had recurrent episodes that last a day or two and then he’s back to perfectly normal. It’s hard for me to fathom how he can be running around and playing normally for 5-6 days in a row and then be in pain again.

I would like to know exactly what’s happening, so I guess some imaging might help to clarify that.

For today, since it’s the weekend, I just gave him the 3-drug cocktail (Rimadyl, tramadol, and gabapentin). Because I gave him Rimadyl, I guess if we want to switch to prednisone, we’ll have to wait again another 3 days.

I am totally not sure I can manage this along with my other puppy, horses, job, etc. It’s making me feel panicky.

[jaynaali]

I’m a dedicated COTH lurker, but wanted to chime in in this instance. I’ve heard IVDD described like having a rock in your shoe. In this case, the ‘shoe’ is the spinal canal that houses the cord and the ‘rock’ is a bulging/herniated disk. When a dog herniates a disk, it can push on the spinal cord and cause pain. The purpose of the rest is to allow the disk to scar over so no more disk is extruded (i.e. keep the ‘rock’ from getting any bigger). The disk doesn’t technically ‘heal’, it will always be herniated but hopefully scars over. Unless a dog goes to surgery, there is no way to actually remove the ‘rock’ of compressive disk material. You can sometimes treat inflammation associated with the ‘rock’ with NSAIDs and/or prednisone and the nervous system hopefully learns to adapt, which it can be amazing at doing. The other mainstay of treatment is pain control. Over time, you hope they become less painful and some/many can come off of meds over time. In some dogs this can be a chronic source of pain or they can tweak things right and aggravate things again. You can get used to having that rock in your shoe over time, but something can happen when you step wrong and it hurts again.

[Marshfield]

The latest I have heard is that there’s no major evidence for steroids over nsaids or vice versa. There is solid evidence for both acupuncture and laser to aid with treatment

[Horsegal984]

Ditto Marshfield. Our neurologists are kind of a case by case basis on steroids or NSAIDs.

Think of it like a pinched nerve, you can be totally fine and then turn just the right way and pinch it again. Many of these dogs do have chronic flare-ups as well and having multiple affected areas isn’t that uncommon either in an older dog.

Definately look into acupuncture and laser, can work wonders.

[Miss_Anne_Thrope]

My referral vet also thinks acupuncture and laser are worth trying.

So, I have some questions for him today.

Should the acupuncture/laser be done when he’s in pain to reduce the pain, or do they work to prevent or ameliorate future flare-ups?

Why are you thinking steroid over NSAID now? Will the steroid be long-term (forever?)?

Are there differences between dogs with painful episodes for which 8 weeks crate rest is recommended and those with chronic flare-ups (like Snert’s)? Different causes of the pain? Differences in treatment/management?

Thank you for all the suggestions, and if anybody thinks of any other questions I should ask, I would really appreciate it. I’m feeling a bit calmer now, and Snert is not nearly as painful this time as he was during the last episode, so I feel a bit more optimistic that the pain meds are working.

Thank you, jaynaali, for coming out of lurkdom. That rock-in-the-shoe analogy really helps my poor brain form a user-friendly picture of what’s going on.

[Marshfield]

Yes, acupuncture and laser now.

[RaeHughes]

My older BC has spondylitis (sp?) which is a calcification around the discs along her back. She also has osteoarthritis as well in every verterbrae that has the s-word associated. Coupled with severe hip dysplasia in her right hip brought on by the above :).

She has good days and bad days - when I rest her - and then she has good days again.

She was on a non-steroidal anti-inflammatory for 2 years and has, after the diagnosis of spondy, gone onto a combination of tramadol and panadol (and some herbal supplements that are designed to assist the uptake of these).

Since she has been on this combination, she has had consistently good days. Totally reflective of that fact that she is almost 10 years old (had her since she was 12 weeks). her exercise tolerance has improved immensely - as long as I keep it broken up into 3 4km walks rather than 1 12km walk.

I would look at how you manage the exercise and drug regime - or, as my vet calls it, multi-modal pain management :D. I would also look at some form of physio/osteo work and highly recommend acupuncture.

I can also highly recommend laser work (and it has been shown how it works scientifically -written up in NATURE so definitely peer reviewed). My BC gets that as part of her physio/osteo work. When my (now late) Labrador was knocked down by a car, he had laser treatment and responded much quicker to reducing swelling and improving mobility.

[Rudy]

For me first offender back pain dogs go on a steroid or an NSAID + tramadol with 2 week strict crate rest. Second offenders get longer crate rest. Eventually a CT with plans on pursuing a hemilaminectomy may be in order. Hemilaminectomy is not reserved for only dog with severe neurological defects.

[SarahandSam]

I believe the purpose of crate rest is to allow the disc to calcify. So if the dog is just resting a little bit and has painkillers, it doesn’t really address the problem, which is where the longer-term crate rest comes in. With the other arthritis issues and things like that, I would think crate rest but with some PT, laser, and acupuncture would probably be the best bet. I did crate rest and laser and PT exercises at home with my dachshund, and my friend had to have surgery with hers, who now goes for a weekly PT/acupuncture day-long session at the vet’s.

[Miss_Anne_Thrope]

Snert had his first laser treatment today and we’re scheduled for 5 more weekly sessions. He’s also starting prednisone today, and I’ll be enforcing strict crate rest for at least 6 weeks. (He’s in the exercise pen now staring at me and whining a little … this is sooooo hard!! )

I also just left a voicemail with the veterinary acupuncturist. I’m not all that familiar with acupuncture. What exactly is it supposed to do? Is it just another avenue to relieving pain? Is the goal to be able to reduce the pain meds?

It’s my understanding that alleviating the pain is not only for the dog’s immediate comfort but also for aiding the healing (scarring) process. So the acupuncture helps with that?

And a little good news, his follow-up blood work is all good.

[SquishTheBunny]

Avoid chiro. Acupuncture and laser can be helpful. Was your second opinion vet a neurologist?

If your dog doesn’t recover from painful episodes with a good stretch between them i would consider surgery as an option. 12 is a pretty average age for these types of dogs to have disc herniation and it’s not uncommon for these breeds to live well into their late teens!

Good luck and hope that the meds and treatments are enough to keep your pup comfortable long term!