Lumbosacral Stenosis

[Guest mhall]

Em had her consult with the ortho vet today. Much poking and prodding revealed the issue is definitely with her last few vertebrae. Her x-rays did reveal her last few vertebrae are slightly freaky looking, but because there was no evidence of arthritis the radiologist thought it was unlikely that it was the source of her pain. The ortho vet disagreed, based on the findings of his physical exam, and thinks it might be Lumbosacral Stenosis.

 

So, what can you all tell me LS? I'm particularly concerned about dealing with it in a young dog. Em is only 4. The current plan is to rest her for 4 - 6 weeks to see if there is improvement and treat with Gabapentin and Metacam. If she doesn't improve, or does but gets worse again, we will probably do an MRI to confirm and try shots and acupuncture. If those don't help we will be looking at surgery. The ortho said he's seen good results with surgery, but would want us to try more conservative measures first. He also said in milder cases he's seen good results with acupuncture. Not sure how well Emmy would handle that as she is not terribly crazy about being groped by strangers - vet visits are very stressful for her. I'm imagining a young dog with LS will need surgery at some point if we don't want her to be gimpy/in pain for

the rest of her life.

 

So, anyone have experience with this? Any recommendations?

[Hubcitypam]

Rex was diagnosed with LS at 4.5 years old by Dr. Herron using his no cost procedure outlined on Dr. Stack's website.

The Depo Medrol shots changed his life and no pain pills were needed. My vet had no problem giving them, but some vets do. http://www.greythealth.com/lumbosacral.html

Edited November 9, 2010 by Hubcitypam

[packmom]

That is young! I have had 3 with it but all began showing symptoms at ages 12 and up. I haven't had any luck treating it but they have all been elderly dogs.

[GeorgeofNE]

Rex was diagnosed with LS at 4.5 years old by Dr. Herron using his no cost procedure outlined on Dr. Stack's website.

The Depo Medrol shots changed his life and no pain pills were needed. My vet had no problem giving them, but some vets do. http://www.greytheal...umbosacral.html

 

I've had three vets refuse to do this--

 

George has a "probably" diagnosis of LS. I don't have the $2,000 (minimum) the MRI would cost me to get the "for sure" diagnosis, and I certainly would not be able to afford surgery--so we are simply dealing with the occasional pain with Deramaxx. I've been told not to let him jump on things, or let him go nuts (although he does do on-leash butt tuck zoomies from time to time). Also to keep him slim, and keep him muscled by taking him for daily exercise walks.

Edited November 9, 2010 by GeorgeofNE

[Guest mhall]

Rex was diagnosed with LS at 4.5 years old by Dr. Herron using his no cost procedure outlined on Dr. Stack's website.

The Depo Medrol shots changed his life and no pain pills were needed. My vet had no problem giving them, but some vets do. http://www.greythealth.com/lumbosacral.html

 

The procedure described on the website was basically what was done to Em. The ortho said he was pretty comfortable saying it was LS but wouldn't be able to say definitively without an MRI. My sense was he wanted us to do an MRI if it got to the point where we were considering surgery.

 

I think my vet or the ortho vet would be comfortable doing the Depo Medrol shots - they mentioned corticosteroids shots as a possible treatment option, with the caution that they are a temp fix, not a cure. We have to do something if we don't see improvement - she can't really exercise at all at the moment and is clearly in pain with certain types of movement.

 

Hubcitypam, how long did Rex get the shots for? Did you notice any side effects? I know there can be concern about osteoporosis with steroid use. From what I read it seems like a relatively safe option, so I'm not sure why some vets are hesistant to go that route.

 

Thanks for all the input so far!

Edited November 10, 2010 by mhall

[Hubcitypam]

Hubcitypam, how long did Rex get the shots for? Did you notice any side effects? I know there can be concern about osteoporosis with steroid use. From what I read it seems like a relatively safe option, so I'm not sure why some vets are hesistant to go that route.

Rex only got them for about 1.5 - 2 years until he went to the bridge at 6 from spine issues in his neck/shoulder area that were unrelated to the LS.

 

Dr. Herron did the first, GALTs vet at Preston Park did the second and my vet at VCA did the third. Rex's shots lasted longer than most -- 6-8 months and it was easy to see when they were wearing off. No side effects.

 

Why won't they do them? Dr Stack told me if my vet wouldn't do it (he did with no problem) to look at finding an older vet. She said that vets schools have been anti injected steroids for the past few years but there are lots of older vets out there that have used them for years so they are usually willing to do them.

 

When you think about it an $80 shot two or three times a year (including office call -- I think Rex's last shot was $27) sort of pales against a $2,000 MRI and $5,000 surgery. I've had a lot of vets be very good to me but I've also seen vet receipts at the daycare where clients were obviously taken for a ride.

 

Then there was the used car salesman neuro at the speciality clinic --

"We all agree it's either GME or an inoperable ruptured disc. We JUST had an opening for an MRI. If you don't take it right this second it could be weeks before we can get you in. You need to decide if you want to do this for your dog right now. How lucky we just had this cancellation!"

 

What are the odds I should be so lucky? I called my vet and he said "Pam, the prognosis for both those things is very very poor and Rex is in a lot of pain. Do you really need to spend $1,200 to find out which it is when we can't make either one better?"

[Guest KennelMom]

Caesar was in the double digits...11 or so, I think. The shots did wonders for him. They definitely extended his life by a good year or more...and that was quality life, not in pain. Eventually they stopped working and all we had was tramadol to control pain.

 

Our vet has no problems doing the shots and ours was the first dog they'd ever done them on. They did a little bit of research before committing to do it and basically said, it's either going to work or it's not. The potential for reward (successful treatment) was good and the potential for bad (side effect) was very, very low. One of the best scenarios a vet could hope for.

 

Vets around here tend to be very practical...maybe a "benefit" of living in, what tends to be, a more economically depressed state. Or more rural. Maybe a bit of both.

[GeorgeofNE]

Caesar was in the double digits...11 or so, I think. The shots did wonders for him. They definitely extended his life by a good year or more...and that was quality life, not in pain. Eventually they stopped working and all we had was tramadol to control pain.

 

Our vet has no problems doing the shots and ours was the first dog they'd ever done them on. They did a little bit of research before committing to do it and basically said, it's either going to work or it's not. The potential for reward (successful treatment) was good and the potential for bad (side effect) was very, very low. One of the best scenarios a vet could hope for.

 

Vets around here tend to be very practical...maybe a "benefit" of living in, what tends to be, a more economically depressed state. Or more rural. Maybe a bit of both.

 

That's interesting, because the vet who diagnosed George, with specialized training in surgery and pain management, said the opposite. That the steroid shots do nothing except reduce inflammation AROUND the spine (which doesn't actually help the compressed nerves inside the spinal column) and that the potential for serious side effects are simply not worth the temporary relief. Once you've injected the steroids, there is no way to "turn them off" (like you can stop taking pills).

 

She was more than wiling to read about the procedure--but she'd already heard of it and said it was "outdated thinking."

I tried to sway her with the old "but everyone else is doing it!" and she was not impressed!

[Guest KennelMom]

I guess that's why they call them medical opinions and why docs spend their entire careers practicing medicine (thank you, thank you...I'll be here all week. Don't' forget to tip your servers)

[Guest mhall]

Caesar was in the double digits...11 or so, I think. The shots did wonders for him. They definitely extended his life by a good year or more...and that was quality life, not in pain. Eventually they stopped working and all we had was tramadol to control pain.

 

Our vet has no problems doing the shots and ours was the first dog they'd ever done them on. They did a little bit of research before committing to do it and basically said, it's either going to work or it's not. The potential for reward (successful treatment) was good and the potential for bad (side effect) was very, very low. One of the best scenarios a vet could hope for.

 

Vets around here tend to be very practical...maybe a "benefit" of living in, what tends to be, a more economically depressed state. Or more rural. Maybe a bit of both.

 

That's interesting, because the vet who diagnosed George, with specialized training in surgery and pain management, said the opposite. That the steroid shots do nothing except reduce inflammation AROUND the spine (which doesn't actually help the compressed nerves inside the spinal column) and that the potential for serious side effects are simply not worth the temporary relief. Once you've injected the steroids, there is no way to "turn them off" (like you can stop taking pills).

 

She was more than wiling to read about the procedure--but she'd already heard of it and said it was "outdated thinking."

I tried to sway her with the old "but everyone else is doing it!" and she was not impressed!

 

What exactly are the potential side effects? Did she say? I would imagine there are some pretty big potential side effects to surgery too. Did she recommend surgery for George (I totally understand it's not an option for you, just curious what the recommendation was)?

 

We're not opposed to doing surgery, but I would want it to be a last resort and we would need to save up for a bit to handle the cost of an MRI plus surgery.

 

The whole "total rest for 6 weeks" isn't working out so well. When Em gets excited about anything she jumps, and when she jumps up she hurts herself.

[Hubcitypam]

That's interesting, because the vet who diagnosed George, with specialized training in surgery and pain management, said the opposite. That the steroid shots do nothing except reduce inflammation AROUND the spine (which doesn't actually help the compressed nerves inside the spinal column) and that the potential for serious side effects are simply not worth the temporary relief. Once you've injected the steroids, there is no way to "turn them off" (like you can stop taking pills).

She was more than wiling to read about the procedure--but she'd already heard of it and said it was "outdated thinking."

...and my HVAC guy fixed my heater with bailing wire two years ago. In that case "outdated thinking" might be an understatement. But the shots and the bailing wire both worked great and that's all that matters to me in the end.

 

I'd also be interested what the serious side effects are.

Edited November 10, 2010 by Hubcitypam