Holly and her lumbosacral disease

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I have been approached by a few CAM followers with regards what I am doing to manage Holly’s lumbosacral disease

I will try and keep this brief and structured.

  1. Holly is 15 years old – she had 2/3 of her liver removed last year due to a huge tumor that grows locally. It was a horrendous surgery where they had to perform a large laparotomy, cut her diaphragm and also give her a blood transfusion. But she conquered it and she recovered well, because there was good preparation and excellent aftercare. The service that I got from Nick bacon and his team at Fitzpatricks was second to none, as was the advice that I got from Andrew Denning of New Priory vets, and Gerry Polton of North Down Specialist Referrals. I strongly feel that age does not preclude further intervention. I think the boundary between what that individual dog and owner can tolerate and manage, and what they can not is an individual decision. The topic of what to do  and when should be explored in length and all pros and cons considered. This same ethos has been applied to my management of her LSD.
  2. I feel I was not attentive enough to Holly’s changing energy levels, capabilities and muscle mass changes. I wonder whether if my skills were more attuned a few years ago I would have noticed her condition sooner. The tale tell signs were there but I did not know what I know now. She may every now and then stumble, or trip on her RH. She might have slightly unenthused days, and she certainly would have had muscle changes that I did not notice because of her coat and feathers. As a consequence I am very attentive to performing certain tests that look for LSD in all suspect cases.
  3. I initially explored medical management. NSAIDs, gabapentin, amitryptylline, paracetemol. – I have found this incredibly hard as improvements and deteriorations can be so subtle. I often feel demoralised hearing others so simply spout how they saw improvement and deterioration in their own dog. But in truth the discomfort that comes from LSD is intermittent, variable, fluctuating and anything bar consistent and predictable. I use client specific outcome measures daily, (please refer to the chronic pain chart on the website under https://www.caninearthritis.co.uk/wp-content/uploads/2017/03/Chronic-Pain-Indicator-Chart-V1.pdf) as well as looking for signs of acute pain episodes from the sciatic pain the LSD causes. Gabapentin does not suit her as made her dopey all the time, and she did not get used to it, even at the lowest dose. I trialled it for no more than a week, but had had bprevious experience with it doing the same to her… so I stopped that.. Amitryptylline I thought helped her demeanour and she just seemed perkier quite quickly, but I still was not allowed “touch access” to her hind limbs to massage them, so I was concerned she was allodynic from the neuropathic pain she was likely to have from the nerve root pinching and cauda equine. Amantadine plus metacam with paracetemol as required is where we are at the mo. I have to be careful with paracetemol due to her lack of liver… do I think I have great control – no. there are days she seems very low and quite and days when she is buoyant, is there rhyme or reason , no I cant see it. and it is very dispiriting.
  4. I had heard a lot about stem cell work and initially approached it with this through Andrew Armitage at greenside vets in Melrose Scotland. It is very new and proactive, and there is not many case studies to support its effects, but Andrew talked me through the cases he had seen , including his own dog and I decided to give it a go. There were 3 trips to Scotland from Brighton… eeeek… one to collect the fat to then culture the stem cells, and then two epidurals. I saw amazing effect at first, admittedly the first 24 hours were horrendous, but she had had injections into her shoulders and her carpi as well, but for the second epidural we modified the anaesthesia and she recovered well. But yes we did see amazing effect. the first few days were insane, she was running around like a burden had lifted. But then it started to get hard to tell whether it was improvement or not, as I did not have access to any closely monitoring systems (they don’t exist). I feel that it was of benefit as it was done in April and again July and throughout the summer we were very active, and we went on to complete The Big Walk in style.
  5. Do I fell it is still working? Well so many other things have changed again. The Big Walk is over and thus our exercise has reduced. I have been working away from home a lot more leaving her with others which always effects her negatively. So it is really hard to say!! but in recent weeks I have seen her having more frequent acute episodes lasting  a few seconds where its like her breath has been taken away, but then she will be fine again.
  6. For this reason and the worry I have just chosen to have an MRI done, as the previous stem cells were done dep on x-ray findings only. I wanted to know the severity, whether there was comorbidity and I wanted a better understanding of my treatment options. So I have recently see Clare Rusbridge from Fitzpatricks and again received outstanding service. Holly has her MRI yesterday whichb showed that she had significant occlusion around each intervertebral foramina of L7/S1, the right worse than left, which fitted with my observations of acute almost collapsing episodes of pain , and Clare’s clinical examination findings that she could note bear pressure on the R sciatic, or manipulation of the RH. The cauda equine is not so bad, so I now know that her mild urinary incontinence is not linked but is likely to be urethral sphincter mechanism incompetence so I can now treat that with propalin.
  7. She had depomedrone injected into her epidural space and now it is a waiting game. CR has had good results with this approach, but it does not work in every case, and in a very few you may see worsening of symptoms initially then a return to previous level but no improvement. I am waiting for her to recover from the GA- so give her a few days as she is bound to be sore from being manipulated, as well as the lack of muscle guarding whilst under the GA will have put more pressure on unstable regions. Then I will be following Darryl Millis advice of therapeutic exercise to stabilise the region. There has been some work done in the US on military dogs that has shown physiotherapy and therapeutic exercises focusing attention on building muscular strength around the LSJ is an effective means for controlling the debilitating signs of LSD
  8. I am waiting to reintroduce the metacam after a 5 day abstinence due to the depo in her spine, but then I will return to using it if I feel it is required
  9. I am extremely poroactive around the home – no slipping, no stairs, no jumping in and out of the car. Lots of interactive toys and brain games
  10. we exercise regularly, even on down days we do something but it may be less and lighter.
  11. I am planning on reintroducing hydro asap as she a. loves water and b. needs to rebuild muscle in her hind limbs and c. needs to do CV exercise

I hope that answers some people’s questions regarding Holly… I do plan to start collating material to write a chapter on the website regarding LSD… but seem to be continuously short on time !!

 

Please add your findings, your concerns, to take this thread further… thanks guys

 

Love H&H

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Thanks, Kathryn for the quick response! We started off with a daily dose of metacam for about 2 weeks and were advised to then take it down to every other day. I think the reason for this is that her kidney values have been a bit border line – might have to ask about that though…

I’m already doing quite a few of the things you mention, but I think I need to start filling out an assessment form on a regular basis in order to be a little more objective. I have to say I do find it really hard to know whether or not she is in pain and how bad it is, particularly as she’s always been quite a calm and quiet dog… It’s just little things, like her hesitating before walking down the steps in the garden that indicate that perhaps there is an issue… but then she might also just have learned that if she hesitates, she gets a treat to encourage her down 😉

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