A Second Time for First Steps

It has been 15 days since Moses’ surgery.

He went in yesterday to get the stitches removed, and we must be doing our homework well because the big guy can walk again!

Back on all fours

In fact, Moses can get up, sit, and walk around (short distances) unassisted!

Granted, he’s still a bit wobbly, and he’s not able to get up the ramp without support yet, but I don’t suspect that will take too long.  He can make it to the first landing unaided, but the other part is a bit steep yet and help is required.

Ramp 2.0 when it was still under construction. What's a job site without Tim Horton's?

So this is the part where we follow the post-op instructions to a T.  I’ve greatly missed walks with Moses, but no matter how well he’s doing, those are not to begin until the end of September.  And even then, only for 5 minutes to start.  But that’s okay – it’s for his benefit so I will try to be patient (not my strongest virtue).

The Husband and I have been thrilled with Moses and his progress the past couple of days, and I wanted to share, so check out the video of the big guy that I took today at lunch.

As you can see, he’s not particularly sturdy, but this is really only the second day he’s been getting up and walking around to that extent.

The currency that has him so intrigued and motivated?  Whole wheat hamburger bun.  Seriously.  Can’t explain it, but he does love his carbs.  At $2.99/dozen, I have no complaints.  And on an otherwise raw diet, I’m not concerned about the grains.

(The sock is there because Moses can’t be trusted to leave his paw where the IV was alone when unsupervised and he has been aggravating the area.)

 

Sorry, couldn’t help myself with the song – Moses is shufflin’ once again!

Ha!

And thank you very much to all for the kind words and support throughout this whole Cyst Saga.  It really does mean a lot.

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One Day at a Time

Moses: AC (After Cyst)

We have entered those long days I had predicted not so long ago.

Actually, the last 10 minutes were probably the longest yet.

You see, as I was just sitting down to write this long overdue post, I flipped open the MacBook and then BAM!

Doors in the house start slamming shut.  Raindrops batter against the windows.  Debris blows down the street.  That evening sunshine is gone.

You guessed it: active weather.

Holy cumulonimbus clouds! (Photo actually from a Calgary thunderstorm this July - Photo from the Calgary Sun)

In fact, as I am now actually writing the post, the storm has amped up and some decent hail is pelleting the neighbourhood.

The trusty The Weather Network, my go-to authority on all things weather, confirms it: severe thunderstorm warning.

Normally a typical summer storm wouldn’t be such a big deal – except that Moses has been spending a lot of time out in the back yard these days (for ease of bathroom purposes).

The Husband is not home, so it was up to me to get big Mo’ inside.

It wasn’t pretty, but I am somewhat proud (and sore) to say got it done.  I would like to say Moses helped the task a little more than he did, as he only half-heartedly flutter-kicked his back legs while I hauled him up the (new, improved and extra-long!) ramp into the house; he just didn’t seem to care as much about the seeking shelter from the storm.

What’s a little hernia to have Moses now snoring contently beside me as I type?

As you may recall, Moses’ cyst-removal surgery was last Monday.  We were able to bring him home two days later, last Wednesday evening, and every day in the last week has been a series of small victories and minor improvements.

But hey – there are both victories and improvements!

A vet visit to see Moses, the day after surgery.

It took a team of four people to get all 179 lbs. of Moses in the car to take him home and that first day he was reluctant to even lift his head and hold it up.

We were given lots of homework, and each day he moves his head, neck and front legs a little more and props himself up a little higher.

So much so that he can now hold himself up in a sit for a few seconds unassisted (though he still needs help getting up) and yesterday he was able to do this:

He stands!

Granted, he needed some help getting up there, it wasn’t for very long, and the Husband is there hanging on to the hardness in case he faltered, but hey, it’s all about the small successes.

Each day we’re seeing small gains in movement and capability, and we’re optimistic looking ahead.  For the next 2 months, the focus is on getting him up and about and working on our homework.

No matter how well he may be doing, we’re not to even think about 5 minute walks until it has been 8 weeks post-surgery.  Then a very slow and gradual progression in exercise for another 2 months – but come the end of November he should be able to take stairs, run, play, and go back to hour long walks.  That’s the dream, anyway, and I think we’ll get there.

I think Moses thinks so, too.

"What cyst?"

However, if I could go back and change one thing, I would have started pumping iron months ago in advance of this heavy lifting.

Actually, scratch that.  If I could change one thing it would be upgrade to Tier 4 pet insurance so it all would’ve been paid for.  But if I could change two things….

Spinal Cyst Saga: A New Chapter

“Well, he’s not dead.”

That’s the response the Husband received when he spoke to Moses’ surgeon this afternoon.  …Part of me is beginning to think that maybe spinal surgery is a little more risky and complicated than she initially lead us to believe.

I kid, of course.  But having gone into our last consultation with our minds really already made up does mean we had selective hearing with respect to some details.

Moses hydrating this morning - then it was off to the vet

And today was the big day.  We have now entered the period “Moses: AC” (After Cyst).

I don’t really have a lot of surgery details to report right now.  She went in through the top at the shoulders (rather than other surgical procedures, like for a disc problem, where they go in through the bottom) and had to make a large incision to get through all of the muscle in that area on a big dog.  And once she had cut into the vertebrae, apparently there was a lot of spinal fluid that came out, since there was such a blockage due to the cyst.  (Hats off to surgeons everywhere – not a job for just anyone!)

And now Moses is in post-op care; he’ll be their guest for the next couple of days.

The good news is that as soon as he woke up his tail was wagging, he can move his front legs and has already tried to sit up on his own.  (Key word: ‘tried’ – not there yet.)

Will we ever get back to this point:

 

Only time will tell.

But we are very happy that he made it through surgery and it’s now on to the recovery and rehabilitation process.

Thanks to all for your kind words and support throughout this whole thing!

(Video from last spring; Moses accompanies the Husband to work whenever possible – I wish my job had that perk!)

(Also, after uploading the video, it came to my attention that there’s another Newf out there on YouTube named Moses – is it ‘great minds’ or ‘mimicry is the sincerest form of flattery’? Hmm…)

Learning About Cysts

My dog is one in a million.  Probably more.

My Dog

And I say this both in the way that most pet owners do about their pets, but also to allude to what has turned out to be an extremely rare condition that is causing us all a lot of stress and sorrow – Moses more so than the rest of us, of course.

The diagnosis is in, and it’s a c-word, but not the one we were previously worried about for a bit there.  Moses has been diagnosed with a subarachnoid cyst.  One vet pointed out the silver lining by noting that hey, at least a cyst is probably benign.  Touché.

In the usual course, I immediately started looking for good resources on these cysts.  Because they definitely weren’t on my radar before.

The most useful resource I found was a retrospective study from the Journal of the American Animal Hospital Association.  This study looks at spinal arachnoid cysts in 17 dogs between 1987-2001 at North Carolina State University’s Veterinary Teaching Hospital.

Brace yourself for some medical jargon.

These types of cysts (though most sources take a moment to point out that they’re not technically a “cyst” because they don’t have an epithelial lining – yes there will be a quiz on this later) are broken into two groups: cervical arachnoid cysts and thoracolumbar cysts.

Moses qualifies for the first group: cervical arachnoid cyst.  Our report back made the distinction of “subarachnoid”, but I’m given to understand the added prefix doesn’t change anything; arachnoid cysts typically occur in the dorsal subarachnoid space in the cervical vertebrae.  And I can actually say I know what that means.  To see for yourself, see this diagram of the spinal cord.

These cervical arachnoid cysts, according to the study, are typical found in young, large breed dogs, and are found higher up on the spine in the neck/shoulders (in Moses’ case, the C5-C6 vertebrae).  The other kind of cyst is more commonly found in older, small breed dogs, and is found much lower on the spine – the thoracic vertebrae.

The listed symptoms are exactly what we noticed in Moses: progressive ataxia (wobbliness), reduced range of motion, scraping knuckles, but no pain.  The cysts enlarge over time, and cause nerve pinching.

In the study, surgery was performed on 15 of the 17 dogs (with both kinds of cysts), and according to this study and the other resources I came across, surgery appears to be the favoured treatment, and very little (if anything) is written about medical management options or success, or alternative/unconventional options (though our report back quickly noted hyperbaric oxygen treatment as a potential novel option).

Of the 15 dogs in the study who underwent surgery, 14 had good short term results.  12 of those dogs were followed up with, and 8 of the 12 had good long term results (67%).

6 of the 15 dogs who underwent surgery were large breed dogs with the same type of cyst we’re faced with.  The short-term post-surgery results were good in all.  The long term results were good in four of the six (67% again).  The other two dogs experienced a recurrence of the symptoms 18-26 months after surgery.

Moses' post-myelogram bald spot.

So that’s what we’re faced with: a spinal cyst that requires surgical removal in order to give Moses any real shot at going back to healthy and active (noting that carting and long day hikes are indefinitely out of the question regardless).

And odds at long-term recovery are estimated at 67% based on the study I’ve discussed, or bumped up to 70% based on the expert report we got for Moses.

The reports and our vets all note that factors influencing a good outcome are: age (3 years or younger, and Moses is 3 years and 3 months old right now), length of time symptoms are noted (4 months or less, and we’re right about at the 4 month point now), lack of other medical conditions that could impact recovery (none here), and the surgical method used (out of our hands, but our gal is the best).

So, in an ideal world, Moses would recover reasonably well and have a good shot at long term success with surgery.  And I’ve done my best to quantify “good”.

On the other hand, I can’t help but think about how long it has taken him to recover from the CT scan and myelogram from last week – it was several days before he could get up on his own and the tile floor is still a challenge.

Moses also has a bald spot on his rump from having to try the myelogram from the other direction - it's kind of like a canine tramp stamp. And, sadly, it's not growing back nearly as fast as the other one.

And although it may seem foolish to consider success rates based on one retrospective study from 2003, that brings me back to how our dog is one in a million; these cysts are very rare, and the study comments that spinal arachnoid cysts have been reported in only 28 dogs and 3 cats since 1968.

Understandably, and unfortunately, the small number of dogs studied has also meant there is no firm conclusion about the cause of these cysts.  Based on the occurrence younger dogs, they expect a congenial condition.  Another study that looked at 11 dogs with spinal arachnoid cysts hypothesized a genetic predisposition related to the dog’s confirmation (they suggest weight of the head being a possible influencing factor) noting that 6 of those 11 dogs were Rottweilers.

Moses

So that’s the situation we’re faced with.

And no, surgery is not cheap.  We will definitely max out our annual policy limit and then some (though I am pleased to report that so far insurance has paid out for our significant diagnostic costs without fuss), and it’s a question about putting Moses through an extensive procedure with long recovery and rehabilitation time, and without any real guarantee for success.

We have until next Monday to weigh all the variables in advance of another discussion with the vet.

And after all of this research and reading I’ve been doing lately on each possible diagnosis, I figure I’m probably in line for at least an honorary DVM by now.