Vet360 Vol 4 Issue 4 August 2017 Vet 360 - Page 25

SURGERY its bladder completely twice daily. Also discuss what the signs of overflow incontinence are. Nursing is- sues, such as rotating the dog’s position every four to six hours, keeping bedding clean and dry, and pro- viding appropriate padding to prevent decubital ulcers are also important points of education for your client. When you recheck grade 3 patients at 48 hours and two weeks, check them for signs of urine scald, decu- bital ulcers or self-mutilation. The penis and the toes are most likely areas that are self-mutilated. A routine urine culture is recommended at the two-week visit for grade 3 dogs. For dogs with urinary incontinence that does not resolve, perform monthly urine cultures for three months. If the results are consecutively negative, then culture every six to 12 months. Grades 4 and 5 Even if these dogs respond and regain deep pain or movement, they are likely to have permanent neu- rologic deficits without surgical intervention. These patients are managed the same way as grade 3 pa- tients, and it is necessary to counsel the owners on the potential for the need for permanent bladder management and the possible need for a cart. Grade 5 patients have a very poor prognosis for return to function, even if deep pain returns. It is recommended that these patients are hospital- ised. If they are not hospitalized, she recommends a daily neurologic exam to monitor for any progression of disease. What’s the deal with corticosteroids? Dr. Pancotto says glucocorticoid administration can complicate the care of recumbent and incontinent patients because of PU/PD side effects and a pre- disposition to decubital ulcers. Corticosteroids can also mask inflammatory conditions or undiagnosed lymphoma as well as contribute to complications with bleeding. If you do give corticosteroids, dosages should be kept between 0.5 and 1 mg/kg (prednisone equivalent). Dexamethasone is contraindicated even at an appropriate dose because of complications as- sociated with GI bleeding and hemorrhage within and around the spinal cord .3 The use of corticosteroids in spinal cord disease is controversial because in studies, there has not been a statistical difference between dogs that received a single dose of methylprednisolone versus those that have not. 4,5 In people, a single high dose is correlated with an increase in fine motor function, which has not translated to functional outcomes in dogs. 4,5 A few high-dose protocols are described, but no strong ev- idence that they work. A single high dose of 30 mg/ kg over an hour, followed by a CRI of a lower dose over 24 hours can be used. Note: Single high-dose corticosteroid administration is with methylpredniso- lone sodium succinate, never dexamethasone, says Dr. Pancotto. Time to bring in the complimentary medicine? Dr. Pancotto likes acupuncture in her postoperative patients for pain relief and neuro-modulation. She also recommends heat for areas where dogs are like- ly to have compensatory pain, such as the shoulders and upper back. Dogs with thoracolumbar disease tend to shift their weight onto their thoracic limbs and shoulders, so warm-packing their necks may be more beneficial than warm-packing their backs. Dr. Pancotto theorises that therapeutic laser is rea- sonable for IVDD but may be contraindicated in cases with degenerative myelopathy. Because degenerative myelopathy is a gain-of-function superoxide dismu- tase 1 mutation, it results in increased anti-oxidant ac- tivity. Laser, a stimulatory treatment, could worsen this activity. It is known to be contraindicated in the face of neoplasia or active haemorrhage for similar rea- sons. Dr. Pancotto recommends against chiropractic in dogs with acute disc disease. References 1. Sharp NJ, Wheeler SJ. Small animal spinal disorders, diagnosis and surgery. 2nd ed. Philadelphia: Elsevier, 2005. 2. Forterre F, Konar M, Tomek A, et al. Accuracy of the withdrawal reflex for localization of the site of cervical disk herniation in dogs: 35 cases (2004-2007). J Am Vet Med Assoc 2008;232:559-563. 3. Levine JM, Levine GJ, Boozer L, et al. Adverse effects and outcome associated with dexamethasone administration in dogs with acute thoracolumbar intervertebral disk herniation: 161 cases (2000- 2006). J Am Vet Med Assoc 2008;232:411-417. 4. Olby NJ, Muguet-Chanoit AC, Lim JH, et al. A placebo-controlled, prospective, randomized clinical trial of polyethylene glycol and methylprednisolone sodium succinate in dogs with intervertebral disk herniation. J Vet Intern Med 2016;30:206-214. 5. Bush WW, Tiches DM, Kamprad C, et al. Functional outcome following hemilaminectomy without methylprednisolone sodium succinate for acute thoracolumbar disk disease in 51 non-ambula- tory dogs. J Vet Emerg Crit Care 2007;17:72-76. Issue 04 | AUGUST 2017 | 25