Intervertebral disk disease

There are two types of intervertebral disk disease. Type I (Hansen’s) intervertebral disk disease is an acute prolapsed of disk material into the spinal canal. It is most commonly seen in small breed dogs (Dachshunds, Toy Poodles, Beagles, Pekingese, Welsh Corgi, Lhasa Apso, Shih Tzu and Cocker Spaniels). Because of degeneration of the disk at an early age, we commonly see this disease in patients between 3 and 6 years of age. Type II IVDD is fibroid degeneration of the disk and is seen in older dogs, as it is slowly progressive. It is a disease that progresses at a slow rate and is typically seen in large breed dogs (German Shepherd, Labrador Retriever, and Doberman Pinschers). Signs are similar to degenerative myelopathy, neoplasia, and diskospondylitis.
Most of these injuries (Type I-IVDD) occur in the region of the spine where the ribs end (thoracolumbar region). This often results in loss of movement in the hindlimbs. Neck injuries (cervical region) are painful but do not typically result in neurologic (nerve) abnormalities. Injuries where the ribs begin (cervico-thoracic junction) and the hips begin (lumbo-sacral junction) have a decreased chance of improvement. If the forelimbs are affected by an injury further back in the spine, it indicates a severe injury and a worse prognosis for recovery. Pain occurs with all of these injuries due to the disk material compressing the spinal nerves.
It is always recommended to see a veterinarian or veterinary neurologist, if you think that an injury has occurred. Dogs can be treated surgically or non-surgically. Most dogs that are able to walk respond well to medical (non-surgical) management. Dogs that cannot walk have >=50% chance of regaining function and it will be an extended recovery period, if they do regain function. Dogs that recover from an acute episode have a 30% chance of recurrence. Medical management consists of strict confinement for 3-4 weeks, followed by a very slow return to exercise. They can also be given non-steroidal anti-inflammatory drugs and pain medication. Patients with neck injuries should wear harnesses (when walking) for the rest of their life to avoid any jerking motion to the neck. It is also important to be aware of whether or not these patients can express their bladder, or if part of their care requires bladder expression to avoid further complications. Surgery includes cutting through the vertebral bone and removing the disk material. Recovery after surgery may be intensive, requiring bladder expression physiotherapy and encouraging movement by towel walking. Improvement is expected within 1 week of surgery.Rehabilitation of these patients can be essential to recovery/return to use. As mentioned before, it is a very slow progression with medical management. It can take two weeks or more before these patients are ready for the simple act of weight bearing. Some of the methods used to increase strength and regain function in these patients include electrostimulation, cold/hot packs, passive and active exercise, massage, therapeutic ultrasound, laser, and underwater treadmill or swimming. Water has the advantage of decreasing the amount of weight the animal must carry during movement. Movement is encouraged much sooner in patients that have surgery.
Type II-IVDD can also be treated medically or surgically. Medical treatment is not curative and the symptoms will continue to progress, corticosteroids are typically used. Surgery can be used to prevent further degeneration, but because of the chronicity of the disease, we do not expect the animal to return to a pre-disease state. We use rehabilitation therapy in these patients to keep them moving and counteract the muscle loss that occurs during the course of the disease. Rehabilitation can enhance the quality of life in these patients as the disease progresses and maintain mobility for a longer period of time.
On May 7th, I will be doing a presentation at Berner University (Bernese Mountain Dog Club of America's National Specialty meeting). Part of my presentation will focus in on Degenerative Myelopathy, so expect this topic as my next blog! For more info on Berner University, visit www.berneru.org.
Thanks.
Jennifer Gearing, D.V.M.

HART-Weight Loss

This is Dr. Jennifer Gearing, the newest veterinarian on staff at Mount Carmel. I am a Certified Canine Rehabilitation Practitioner, so was hired on to take over the Hereford Animal Rehabilitation Therapy program that Dr. Sarah Dunleavy started. I have made a few appearances already this year to try and get the word out about this program and have several more coming up. In January, I did a presentation for our staff. February, I went to Gaithersburg to talk to the National Capital Kennel Club. I attended the Northeastern Maryland Kennel Club (NEMKC) AKC sanctioned Breed/Obedience Match in March. The beginning of April, I spoke at the NEMKC meeting about rehab & physical therapy. My next event will be the spring Doxiefest at Divine K-9 in Forest Hill, for more information check out www.c2cdr.org. I am preparing some information specifically about obesity and intervertebral disc disease (IVDD), since these commonly occur in dachshunds.
I have been meaning to blog on our site for some time, to get reliable information out on some diseases that affect our canine and feline patients. I will be focusing on topics that can be treated with physical therapy and rehabilitation. Since, my upcoming event will focus on obesity and IVDD these will be my first topics to blog on.
So, I would like to start with Weight management. About 35% of pets are overweight. Weight management is particularly important in our patients with orthopedic and neurologic problems. Extra weight contributes to the development of musculoskeletal problems and puts more pressure on the diseased joint. Overweight pets are also predisposed to cardiac disease, diabetes mellitus, GI problems, liver impairment, reproductive disorders, complications during anesthesia, skin problems, decreased immune function, and shorter life expectancy.
There are two ways to acheive weight loss: diet and exercise. These two methods of weight loss should be combined whenever possible. Diet refers to a reduction in calories. Our prescription weight loss diets have a lower calorie content per cup and typically an increased fiber content, so the animal feels full even though they are eating a smaller quantity of food. As our patients age their energy (and thereby calorie) requirements decrease and decreased activity further decreases these needs. Exercise increase or initiation can be difficult. With pets that have musculoskeletal disease, sometimes pain medication is necessary to start an exercise program. An exercise program should always be tailored to the individual, if they are not active now, you have to slowly build up. Just like us, the first trip back to the gym after a dormant period is going to result in some muscle soreness, especially if you overdo it! Cats can be especially problematic for getting them to exercise. You have to be creative, favorite toys, laser pointers, or simply putting the food bowl somewhere different and encouraging them to take more trips up and down the stairs. I used to carry my cat downstairs twice a day, just to make her climb the stairs.
We are starting a new dog weight loss program at Mount Carmel Animal Hospital, which Chris Saint is in charge of. So, at your pets next exam, please talk to us about weight loss, we are happy to talk to you about your cats as well (they just might not want to participate in group walks). We have lots of coupons for prescription diets for weight loss. Chris is going to be offering a lunchtime exercise course throughout the week, weekend walks, and underwater treadmill sessions for weight loss. We are hoping to set up a facebook group for participating owners/pets. There will be an initial consultation/evaluation to discuss feeding recommendations and an exercise plan. We do offer a free underwater treadmill session with the purchase of your first bag of prescription weight loss food. There will be monthly weigh ins to assess progress. Chris Saint and I will be attending the March for the Animals (www.mdspca.org) on April 29th , so you can ask us more about the weight loss program and you can ask me any questions about rehabilitation & physical therapy in small animals.I will be blogging again soon about intervertebral disc disease and will let you know about more upcoming events!
Jennifer Gearing, D.V.M., C.C.R.P.