Anyone nursed a dog with Ischemic Myelopathy?

Re: Anyone nursed a dog with Ischemic Myelopathy?

Martin Jones — Thu, 17 Dec 2009 21:09:42 GMT

A diet? At Christmas?

Spoil that dog, preferably till he's barrel shaped and utterly ruined. We're vets - we're supposed to be bad owners. After a scare like that, life should be one long pleasure trip......

Re: Anyone nursed a dog with Ischemic Myelopathy?

Jacquin Mitchell — Thu, 17 Dec 2009 18:48:15 GMT

[quote user="Martin Jones"]

Go you. He'll be on four legs in time for Xmas, and stealing the chocolate before you know it

Martin

[/quote]

Oh don't. He's supposed to be on a diet. In a house full of 4 kids, I'm considering Santa bringing him a muzzle for Xmas.

Jacq

Re: Anyone nursed a dog with Ischemic Myelopathy?

Martin Jones — Thu, 17 Dec 2009 18:41:46 GMT

Go you. He'll be on four legs in time for Xmas, and stealing the chocolate before you know it

Martin

Re: Anyone nursed a dog with Ischemic Myelopathy?

Jacquin Mitchell — Thu, 17 Dec 2009 16:37:49 GMT

Just thought I'd update anyone who is interested on my dog. He's home with us now, and is able to get up by himself and wobble around on 3 legs. His LH leg still has propriceptive deficits but he is expected to regain good neurological function over the next 3 weeks. I do understand he is likely to have a stiff leg or unusual gait but i think we'll cope.

Thank you those of you who replied to my original post. I have had very little to do with a FCE case in the past and it cheered me up no end to hear that a positive outcome was likely.

When we drove home from the RVC on Sun am, I had been resigned to the possibility of euthanasia :(

Jacq

Re: Anyone nursed a dog with Ischemic Myelopathy?

Jacquin Mitchell — Mon, 14 Dec 2009 10:52:35 GMT

Thanks for your replies.

The lesion looks to be around T11- T12 and although he is no worse today, he is no better either.

He is having an MRI and they will get back to me later.

Re: Anyone nursed a dog with Ischemic Myelopathy?

Malcolm Ness — Mon, 14 Dec 2009 08:02:36 GMT

FCE is a subset of Ischaemic myelopathy reserved for nthose cases where the ischaemia is due to fibrocartilaginous emboli.

Isch myelopathy is not painful though the history of scream and per acute onset is typical.

The diagnosis can only be proposed when other differentials (explosive disc extrusion for example) have been ruled out - this requires CSF analysis and advanced imaging.

Prognosis is dependant upon severity and localisation of the lesion. The persistence of pain perception in this case marks it out as grade 4 or better so there are grounds for optimism. Lesions localised to the T3-L3 segments carry a very good prognosis because the ischaemic injury is affecting only axons and glial cells so the potential for profound recovery is there. Lesions localisable into the L4-S2 segment are worse - the cell bodies of the motor neurons of the hind limbs live here so the ischaemic injury might well have caused some motor neuron cell death and obviously those deficits will be permanent. The reported early recovery is good but doesn't give too much info about the likelyhood of neuro recovery.

There is no evidence that I know of to suggest that any kind of medical treatment might be beneficial in these cases. Acupuncture has been shown to be useful for relief/mitigation of pain in spinal disease but again I know of no evidence to suggest that it might be disease modifying in a case like this. Frustratingly, the best we can offer is good quality spinal nursing plus the passage of time.

The neuro folk at RVC are excelllent so you are in good hands.

Good luck and I hope that things turn out well.

Malcolm Ness

Re: Anyone nursed a dog with Ischemic Myelopathy?

Martin Jones — Sun, 13 Dec 2009 18:38:18 GMT

[quote user="Martin Jones"]

Kids understand poorly.

[/quote]

Sorry, just realised that this could read as 'kids don't understand things very well'. Meant to say, kids understand what poorly is without really needing to be told. Your lot will be fine - mummy's a vet and so will make him better

Re: Anyone nursed a dog with Ischemic Myelopathy?

Martin Jones — Sun, 13 Dec 2009 18:36:05 GMT

If he's already a little improved, I'm going to go out on a limb and say he'll get there. Wouldn't say that to a client, as it would be shockingly cavalier, but any improvement in the first 48-72 hours is good news.

Here's hoping he'll be back on his feet long before Xmas.

Martin

Re: Anyone nursed a dog with Ischemic Myelopathy?

Jacquin Mitchell — Sun, 13 Dec 2009 15:45:55 GMT

[quote user="Martin Jones"]Forgive the ignorance, but is this what they're calling FCE nowadays?[/quote]

No I think they still call it FCE. At least thats what the last guy I spoke to referred to it as.

I've had a call from the neurologist and my old boy is a little improved this morning, not weight bearing but capable of movement anyhow so it's very likely to be FCE. They still want to do an MRI but we are having some insurance issues ( am with T*******s-think large supermarket chain) so may not be able to go along with that plan. He's not got huge amounts of pain apart from when he did whatever he did last night, so it all fits in well.

Thank you so much for the reply. I work by myself so the links are very useful. Will look into acupuncture as I have found it useful myself.

I haven't told our kids yet ( 8, 6, 4 and 2)- they haven't even noticed him missing yet!

Jacq

Re: Anyone nursed a dog with Ischemic Myelopathy?

Martin Jones — Sun, 13 Dec 2009 15:32:34 GMT

Forgive the ignorance, but is this what they're calling FCE nowadays? If so, largely good prognosis - they're as bad as they can be pretty much straight away, and presence of deep pain is a good outlook, as with any nervous issue. I've had a couple of friend-clients' dogs at my home over the years, so can comment on the experience.

Pain is not a major feature, although I've always somehow expected it to be as recovery goes on - in people reopening of nerve pathways is often accompanied by pain. I tend to have them on meloxicam anyway, or tramadol if they're more so. I don't need to tell you all this, anyway - you know what you're doing on that score.

Lots of padding, plenty of mobilisation. Not sure if you're aware of these two theories (if you're dealing with training vet nurses you probably are):

1. Orem's self-care deficit theory - http://en.wikipedia.org/wiki/Orem_model_of_nursing

2. Roper, Logan and Tierney's activities of living - http://en.wikipedia.org/wiki/Roper-Logan-Tierney_model_of_nursing

(apologies for wikipedia, but it's a good basic guide)

These are concepts which you automatically recognise as stuff that you already know - but then most great ideas are. Our approach is to look at RLT's activities of living, and then apply Orem's theory to each - so you end up helping the patient just enough to perform each activity but no more. Certainly one of the more sensible bits to be added to the vet nursing syllabus in recent years.

Kids understand poorly. I bring a lot of patients home (out of necessity - we run a reduced-fee charity clinic and some clients just cannot afford the OOH provider's fees; we like the OOH provider, so don't want to saddle them with unpaid bills) and my 2yo and 6yo don't bat an eyelid.

Good luck, lets us know how it's going.

Martin

ps hate to say it, but I've found acupuncture really good, particularly with lumbar ones.