Update on Tonka the Great Pyrenees, the dog with the Best Dog-Mom in the World

Posted by Raja on February 22nd, 2012 — Posted in friends, Health

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Tonka with his friends!

Our blog pal Tonka has been going through a rough patch, but his brilliant dog-Mom Alice is keeping his spirits high.  Now he’s headed toward better times.  Alice has researched his very unusual and often misdiagnosed medical condition and she tells us about it in depth lest we ever encounter anything similar.  Here is Alice and Tonka’s Informative Guest Update….

I want to give a big thank you to Raja and Helen for allowing me to share Tonka’s ongoing neurological medical journey and some important information with you.

Neurological problems are very sneaky things because they can also mimic other problems.   Some are insidious and creep up slowly while others are very sudden. Slowly developing problems have some subtle signs that are easy to overlook such as toenails being worn down unevenly or the tail not being as active or held high like normal. Others are easy to dismiss as being caused by something else such as difficulty rising or laying down which can be attributed to an existing orthopedic problem or aging. Not so subtle signs are unsteadiness, toes bent under while walking (knuckling), rear legs crossing under the body or crab walking (sideways), rear leg drag, urinary and or fecal incontinence and loss of balance.

Sudden events that cause loss of use of one or more limbs, facial paralysis, sudden repeated seizures and collapse are more dramatic and time is very critical in reaching your emergency vet.

Dogs such as dachshund, basset hounds, Beagles, Corgis, Cocker Spaniels, Pekingese, Shih-Tzus , German Shepherds, Labrador Retrievers, Doberman Pinschers and Poodles are more prone to
a condition called IVDD or Intervertebral disc disease. A dog’s spinal cord runs through the spinal column and is protected by the vertebrae. The intervertebral discs are structures that lie between adjacent vertebrae and act as a cushion between the discs. Each disc forms a joint that allows movement and every disc has a fibrous tissue outer layer that surrounds a soft inner  core sort of like a jelly filled donut. With IVDD there is a premature hardening of the center of the disc, and weakening of the outer layer leading to rupture. When the outer layer of the disc ruptures, the inner material is pushed upwards against the spinal cord. This material injures the spinal cord and results in spinal cord swelling and compression. This compression in turn pushes against the nerves within the spinal cord that correspond to the legs and urinary bladder. This will result in loss of function that can range from limb weakness to paralysis, and possibly urinary incontinence. IVDD is usually diagnosed with an MRI and depending on the severity of rupture and the immediate care given can have a positive outcome. Mandatory crate rest for 4-6 weeks is a must and anti-inflammatory drugs are usually prescribed. If the
event caused minor damage the symptoms can reverse but if the damage is severe surgery may be needed to relieve the pressure. This pressure release or decompressive surgery is called a hemilaminectomy (the removal of bone over the area of spinal cord compression). Following surgery will be very strict crate rest, medication and eventually physical therapy. The rule of thumb is a 6
month window in which to regain mobility if after 6 months there is no improvement chances are the damage is permanent.

Another sudden event is called an Fibrocartilaginous Embolism  or (FCE) also known as a spinal stroke. This is more common in giant and large breed dogs. In this case your dog could all of a sudden not able to use a leg at all or can have decreased mobility with toes knuckling under. There might be a yelp of pain initially but this condition once it has occurred is not painful. With an FCE just like the IVDD this is an event involving the disc within the vertebral column.  This time some of the jelly doughnut substance (its real name is nucleus pulposus) has leaked sideways and into the spinal arterial system. Depending upon where it catches it causes an obstruction to clot the blood supply to a portion of the spinal cord. This is also known as an infarction and depending upon what part of the spinal cord is affected will dictate the limb or limbs involved. This area of the spinal cord will die and the neurologic loss that occurs with a 24 hour window is most likely permanent. This is why it is critical to get to a vet immediately so that a course of steroids can be started quickly. After the initial treatment and 24 hours no further damage is likely and then everything you do becomes supportive care.  Helping them stand and eat, expressing their bladder if needed, and turning them so that they do not develop sores or ulcerations, keeping them clean to avoid urine scald, these are all things you may have to do. Within a week or two there should be some improvement and progress can occur for months. Additional supportive therapies can also be tried such as physical therapy and acupuncture.

A slower progressing disease that has no cure is called degenerative myelopathy (DM) and primarily strikes German Shepherds, Corgis, Boxers and mixed breeds. It presents typically around age 5 or later and uneven wear and intermittent scraping of the nails can be the first subtle sign of the onset. The dog progresses to having difficulty getting up and will be weak in the hindquarters. There is no pain but the
absence of pain also means that they can get hurt and not know it. The feet will drag and knuckle and their gait will be unsteady. The tail will droop and no longer be able to wag and eventually the legs will not work at all. Fecal and urinary incontinence are also inevitable with DM. The timeframe for this
disease to progress to a dog being totally down is several months to a year. Eventually the disease makes its way to the brain and there is nothing you can do to stop it. There is a nutrition and vitamin supplement protocol that is thought to help extend the timeframe that a dog can still be mobile but the
scientific community as a whole has yet to endorse it.

These are only a few of many types of neurological problems that can affect a dog and many can be helped with surgery or medication and supportive care. My hope is that you never have to deal with any of them but if you do there are some great support groups and a variety of commercial aides to make life for both of you much easier.

In August/September my dog Tonka started having nosebleeds and after lots of tests and a rhinoscopy
(scope of the nose to rule out cancer or foreign bodies) he was put on a course of prednisone. He did not do well on the Prednisone and I started weaning him off as soon as possible. It was towards the end of September that two very odd things starting occurring. The first was that whenever Tonka was on a tile floor he would splay out his last toe on his back leg really far to the side so that you could actually see the webbing between the toes. I thought the floors were just extra slippery and that I needed to trim the hair between his pads. The second was a little more disturbing as he started defecating while walking and Tonka has always been a very private guy when it comes to going to the bathroom. I mentioned it to the vet and we thought maybe the prednisone had something to do with it since it has such a variety of weird side effects it can cause.

Then the first week of October Tonka developed a slight limp in his left hind leg and the x-rays showed some hip dysplasia that we already knew about  from x-rays in 2009. Thinking that it was a flair up from that he went on a pain killer and a course of strict rest, we could not start an anti-inflammatory since he was coming off the steroids.  We started a series of adequan shots to help soothe, lubricate and rebuild cartilage within the joint. The limp steadily became worse and his foot started knuckling under and dragging. I called to schedule an orthopedic  evaluation and was told that with those symptoms I needed to see the neurologist. I took the first available appointment and started looking up his symptoms from a neurological view instead of orthopedic. His appointment consisted of a review of his rather long medical history and a physical exam where he was made to walk and hop and was poked and prodded in some rather sensitive areas.  The exam found some neurologic deficits that would be consistent with a problem in the lumbar (lower back) area of the spine. He was also seen by an orthopedic at that same appointment to rule out any possible problem coming from the hip or knee. There was no definitive diagnosis from either orthopedics or neurology and an MRI and Spinal Tap were suggested to find out exactly what was causing the problem.

In the first quarter to the year Tonka had heart surgery to repair a Patent ductus arteriosus, or PDA (basically a hole).   Then midyear he had the rhinoscopy to look at his nose and both of those
procedures require anesthesia as does an MRI.  I did not want to put him back under anesthesia so quickly after the last procedure so I opted to try conservative treatment and wait a while.  Conservative therapy was rest and an anti-inflammatory which we put him on as soon as the steroids had cleared his
body. Over the next few weeks he became slightly incontinent and would dribble urine upon standing and stretching or walking on any type of incline. Since he would dribble he had to wear a belly band with a poise pad inside while in the house. This progressed to fecal incontinence usually while he was asleep. At this point I had to learn to express his bladder and his bowel so that we would not have accidents at night.

Next he started with a sideways walk and could not stand at his food bowl without his hindquarters slowly sinking towards the floor. He had great difficulty rising from a laying position and would have to be helped up. He did not like to be left alone at night and many nights I would have to sleep on the floor next to him.  His walk was a shuffling gait and I could not let him on concrete without something to protect his toenails from wearing to the quick and bleeding. In the beginning, I would use dog socks and wrap duct tape around the toe area because I could not find a boot light enough to allow him to walk.

With this downward decline we went back to the neurologist and scheduled the MRI. The MRI showed nothing significant in the lumbar region and in the thoracic area findings were inconclusive. They did a cerebral spinal tap as well and the results were within normal ranges so we were back to orthopedic problems as the cause.

I had a second orthopedic surgeon evaluate Tonka and he took yet another set of x-rays and was told there is no orthopedic cause for his problems. Frustrating became the word of the month with no  diagnosis and a steady decline in his mobility. The neurologist and the orthopedist agreed that we should try some rehab therapy to try and gain some function in the leg.

Tonka started seeing an acupuncturist and some canine rehabilitation specialists along with getting B12 shots (B12 is essential for the central nervous system, spinal cord and brain, to function properly). Over the course of the next couple of months we had improvements in his mobility and ability to maintain a standing position for longer periods. He would still occasionally walk and go to the bathroom but he did attempt to maintain a squatting posture which was a good sign. We had a second neurologist look at him and his test results and the theory that perhaps there is a tumor either in his cervical (neck) area or his head was formed.  In order to find out definitively there would have to be another MRI done but his time of the brain and cervical area.  I had him measured and fitted for a cart with the hope of keeping him mobile longer and build up his muscle and being able to go to the park to “see” his friends. Unfortunately the support rings on the cart for the hind legs put pressure on the nerves that are most affected and would not work.

Over the past 5 months the canine rehabilitation (physical therapy) has done the most for him. He can now walk without crossing his legs and although he does still scuff his feet, he is not dragging his nails. He stands to eat and will stop and posture to go to the bathroom about 90% of the time. We do not have accidents anymore and he will bark to let me know he needs to go out. I no longer have to sleep
on the floor with him and most nights he sleeps through the night. He still has some difficulty getting up on his own at times but we are working on that. His therapists are hands on with him every week and for the first part of the session they listen to everything I have to say about what has changed and how he is doing. This exchange of information is very important in his recovery since I/you the owner see little things that change that someone who is not with the dog all the time does not. No-one knows your dog like you do and only you can pick up on the subtle cues of what is working and what is not.  I cannot say enough about how amazing his therapists are as they have given him back some normalcy to his days.

I have now had three orthopedists and three neurologists look at this case and all we know for sure is what it is not. His ankles, knees and hips are strong and even if he walks funny for the rest of his life it should not cause an orthopedic problem which was one of my concerns. Sometime this year we will  have the other MRI done, but it most likely will not change the type of supportive therapy/care that we are giving him now. If it is a tumor and it is operable we will have to look at the risks associated with that since that is a very intricate type of intricate surgery. For now he will continue to go to therapy once a week and twice a month he will go twice a week since we have tried that once before with some very positive results. If he will tolerate it we will add using an underwater treadmill to help strengthen and preserve muscle mass but Tonka is not a fan of water in general so we will see if that is viable.

It has been a long five months but he is making progress in the right direction. We were having good days and bad days but I have learned to stop calling them that and to appreciate every day because of something his Ophthalmologist asked me. His last eye exam also happened to be on a bad day and after having a small meltdown in the exam room she asked me if I thought he was still happy. I had to stop and think of the magnitude of that question because at the end of the day that is really what is  mportant, and he is still happy. He is always happy, happy to be outside, to be petted, to “see” someone or just to chew on a toy.  I am the one that classifies the days as good and bad not Tonka. He deals with every day as just another day full of possibilities and so now I try to look at it from his perspective.

If you do happen to have a companion with a neurological condition here are some things you may have to do or learn.

Do buy a good orthopedic bed if your dog will sleep on a bed.

Learn to watch for signs of sores and ulcers. You need to make sure to reposition your friend often so these don’t occur.

Do chart all progress and setbacks as well as medications and reactions.

Do get second and third opinions.

Learn about diapers and belly bands.*

*Carolyn at http://carolynsoriginals.weebly.com made some really nice belly bands for Tonka.

Learn to express a dog’s bladder and bowel. Knowing that they are empty makes for much less stress for you and for them. Most dogs that have been house trained do not like to soil their living area and it will cause them distress.

Do keep to a schedule to have a sense of normalcy.

Do measure them for a canine cart while they can still stand in case you need one later.

Do keep the hair trimmed between their pads so they do not slip and watch for abrasions and sores on
their feet. Their gait will be off and the normally very tough pads will be scuffed raw without protection.

Try to stay on grassy surfaces as much as possible. Do not let them slip and fall, throw rugs and
carpets become necessary on tile and hardwood areas.

Do be prepared for a roller-coaster ride of emotions, Learn to have your meltdowns away from your friend, this will  just confuse them. They don’t need to have their leader falling apart.

Do celebrate the little accomplishments as well as the big ones. You will be amazed at what sorts of
things will make your day complete. An attempt to squat to defecate can become a reason to have a party.

Learn about harnesses and slings, dog socks and boots, you may have to try several sizes of socks and different kinds of boots to find what works for your dog. You may have to use a sling or harness to help your friend get around.

Do become inventive to make life more comfortable and stress free.

Learn to plan for the weather, ice and even snow are not your friend. If your dog is still mobile but weak or wobbly even a little snow is hard to push through and walking on ice does not work at all.

Do be your friends advocate, research everything, document everything and be prepared to challenge the.  Doctors with your questions and theories. If they don’t like it get another Doctor. The Doctor should be willing to really listen to your observations and explain to you what is going on every step of the way. Have whomever is running any tests prepare you step by step what every procedure entails.*

*One thing I was not prepared for was the shaved space on Tonka’s head. He had the MRI at night
and they carried him out and placed him in the back of the SUV so I did not see him until we got home. I reached down in the dim light thinking his ear was flipped up and touched a bald Tonka head.

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