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.
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