Moses & the Fractured Tooth

Lorde cuts her teeth on wedding rings in the movies; Moses cuts his on icy stairways and sidewalks. Unfortunately, for Moses it isn’t a metaphor or turn of phrase.

Moses dismayed at the state of neighbourhood sidewalks

Moses dismayed at the state of neighbourhood sidewalks (apologies for the bad phone photo).

It was 3:30am on Wednesday morning last week, when I shot out of bed to an unfamiliar animal sound. You know – the way you’re suddenly wide awake because you think one of the pets is getting ready to barf on the carpet? That kind of awake.

The source of the noise was Moses. He was loudly grinding his teeth and licking his lips and, just like any unusual behaviour would indicate, I knew something must be wrong.

Oh, did I wake you?

Oh, did I wake you?

After ensuring he hadn’t swallowed something he wasn’t supposed to, I sat on the kitchen floor with him and gave him a tail-to-head examination, making sure there were no bumps or cuts or foreign objects. I had a pretty good idea the problem was in the face somewhere, so I left it to last.

My examination eventually revealed he’d somehow chipped off a large part of one of his canines. Poor guy! No wonder his mouth was bugging him.

There was no blood or anything, but he was clearly not exactly comfortable.

Whole tooth vs. fractured tooth

Whole tooth vs. fractured tooth (and a large display of jowl)

So the next order of business was to determine exactly how uncomfortable he was. Was he 24 hour vet uncomfortable? Or did I have some time to figure it out and make him a regular appointment (noting our usual vet finally made good on his threat to retire, so I’d need to get in somewhere new)?

So I re-filled his water dish, which he appreciated and made use of immediately, likely because he was drooling a bit more than usual. Can still drink water without hesitation – check.

Then I wondered if he’d eat, or if he would consider himself in too much pain for that. Got out some treats and no issues there; eating normally – check.

4:00am food test; definitely not a problem

4:00am food test; definitely not a problem

Next I let him outside and he went down in the yard to sniff around and do some business as usual – also check.

Phew! He’d make it through a couple of hours and I could call for a vet appointment during regular business hours.

I began wracking my brain for when Moses would’ve chipped his tooth and why I didn’t notice it before I went to bed. The sidewalks in our neighbourhood are incredibly icy and treacherous these days, and neither Moses nor I are strangers to wiping out this winter. When Moses slips, he’s usually able to catch himself, but there has definitely been at least one face-meets-pavement fall for the big guy.

Still perplexed, I call Moses back inside and he just looks at me from the bottom of the stairs, wagging his tail.

I call him again, and he puts his front feet on the first step, pauses, and then backs off. He does this a couple of times and I begin to contemplate if my slippers are suitable backyard footwear if I have to go get him.

Eventually, he musters up some resolve, decides he can do it after all, and hurries up to the door.

Like the sidewalks, the stairs had some ice on them, so this is my official guess as to where Moses fractured his tooth. He’s not usually insecure about, well, anything really, but I could see him being hesitant if he’d hurt himself on the stairs just a few hours prior – likely during the last bathroom break before bed.

Hard to tell if the nerve is exposed or not - only the x-ray will tell for sure

Hard to tell if the nerve is exposed or not – only the x-ray will tell for sure

By the time my layperson diagnosis was complete, it was just about 4:30am, so I hit the hay for another 30 minutes until the alarm went off.

As far as fractured teeth go, I of course did my share of reading, and found this website to be a good resource on the issue. Basically, if they’re fairly seriously fractured, an x-ray is required to determine if the nerve has been exposed and the tooth needs to come out. To leave a tooth in and hope it just gets better is not a good idea, because you can open your dog up to all sorts of potentially worse issues. And yes, our pampered pets are perfectly fine sans one, or two, or even all of their canine teeth.

If the nerve is exposed, another option is – as ridiculous as it sounds – to send your dog in for a root canal. I chuckled when the vet mentioned this; there is a dog/root canal mental leap I just cannot make (it’s also way more expensive). “What’s next – braces for dogs?!” I joked, and she looked and me, “Actually….”

Moses goes in for his x-rays on Friday, and if they see that the tooth needs to come out, it’ll be removed while he’s under. We’ll probably also throw in a dental cleaning while he’s there.

Until then, it’s no bones for Moses, and he’s on some antibiotics to prevent any potential infection while he waits for his appointment.

How to trick your dog into taking his antibiotics. Yes, those are Kraft cheese slices; works like a charm.

How to trick your dog into taking his antibiotics. Yes, those are Kraft cheese slices; works like a charm.

You’d never know anything was wrong with him, though. Aside from the odd tooth-grind or head shake, the pain from the first day seems to have subsided, and he’s happy to go on walks and as excited as ever for dinner.

This will be the fifth time Moses goes under general anesthetic (bloat, neuter, CT scan, spinal surgery), but arguably the least serious. His blood work came back perfect and he’s otherwise healthy, so we have little to worry about.

In any case, I still feel bad for him – this is certainly one of those times I wish I could explain to him what was going on.

Poor Mo - the million dollar dog

Poor Mo – the million dollar dog

Also, I’d like to leave you with two words: pet insurance.

I know there are two camps on that subject, but we have it and have been thankful for it more than once with Moses. It’s very relieving to be able to make decisions in your pet’s best interests without worrying about the financial aspect.

One Year Later

A year ago today, this is where we were:

Post-op Moses

For newer visitors to the Soapbox, Moses underwent surgery for a subarachnoid cyst on his spine.

We were given 67% odds that surgery would result in long-term favourable results.

Now, 12 months later, though we are still in the short term period, I am happy to report we have seen nothing but favourable results.

Can Moses go back to pulling the cart?

Sadly these days are behind us.

Can Moses go back to coming on long, strenuous hikes and backpacking trips?

Unfortunately not.

But just because Moses may never be back to 100% of his previous physical ability means very little.

Is he still able to go on fun walks?

You bet!

Is he still able to play and wrestle with Alma?

Absolutely!

Can he still fetch sticks from the river?

Like a pro.

And get disgusting with a raw bone like the rest of them?

Obviously.

To put Moses through the surgery was a big and expensive risk to take, but I would not go back change our decision one bit.

Here’s to many more years!

And he can still sit-stay with the best of ’em, too!

I Love My Vet!

Remember last week when I wrote this post that had some not-so-subtle undertones of frustration and anger?

Well my tune has changed!

And there is a very good reason my favourite vet is my favourite.

Now, I know I mentioned I have a veritable team of veterinary experts for the care of our furry ones, but within that team, I do have a couple MVPs.  One, of course, is Moses’ surgeon.  And the other is more of a ‘regular practitioner’, if I had to put a label on his practice, but I’ll just call him The Best.

We’ve gone to The Best for more of your regular-type veterinary needs: spayed Emma, neutered Moses.  He gave us free post-op check-ups and took care of Moses’ staples at no charge after he bloated in Vancouver.  He’s no-nonsense and good humoured, and doesn’t baby talk to me or my dogs.  And to top it off, I overhead him recommend another client check out Tail Blazers for nutrition advice and good quality foods for their dogs; that alone is commendable!

So why didn’t I start there first when I needed veterinary advice?

Good question.

Alma was a little over-enthusiastic tackling an elk antler, and she’d pushed a tooth out of alignment – a lower incisor.

When she did it, it was immediately clear something was wrong because she was visibly bothered by some sort of ailment, pouting and playing Adele’s Someone Like You on repeat.

After giving her a thorough inspection and eliminating any wounds, broken bones, or digestive issues, I pried open her mouth and could easily see the tooth was pushed forward and no longer nicely in line with its neighbours, and the gums around it were quite red and swollen.  She’d still eat, but had no interest in chewing on or playing with toys.

She was clearly in pain, so I wanted to take her into the vet sooner than later.  And that is the problem with The Best – I’m not the only who thinks he’s great, and the office is always busy.

So I made a call to a vet office close to home who could get us in the next day.  We’re no strangers to them, either, as members of the ‘team’ who let us pop in just to use the scale or get up-to-date on rabies vaccines.

Of course, by the next morning Alma’s bubbly personality had reappeared, but the gums were still a bit red and swollen and I figured it would be best to get it checked out anyway.

One consultation later and I’m walking out with a tentative appointment, quote upwards of $800, and no confidence.

Second opinion time!

I booked us an appointment with The Best and called around to just talk general numbers with some other clinics.

By the time our appointment came around last night, Alma was back to nearly normal: the tooth was still misaligned, but the gums were no longer swollen and she was back to tackling that antler.

The diagnosis?  Her overall dental health is great and yep, she gave herself malocclusion (misaligned tooth), but no medical intervention is necessary and it will heal up just fine if we lay off the antlers for the next while.  We’ll go back in a couple of months for a follow-up just to make sure all is still well.

And there you have it.  I just saved a lot of money and The Best is even better in my books!

Even more importantly, Alma’s going to be just fine and we’re not putting her through any unnecessary procedures.

This is all quite timely considering February is Pet Dental Health Month.

Now that Alma's got a clean bill of health, time to give your pup's pearly whites a check. And when in doubt, always get a second (or third) opinion! Maybe you'll even find some Dental Health Month promotional pricing.

On Veterinarians

Why does a visit to the vet sometimes feel like a trip to the used car lot?

Sure, I admit that, although I fancy myself a relatively well-informed pet owner, I do not, in fact, have a degree in Veterinary Medicine or even Biological Sciences.   Perhaps it is this necessitated deference I therefore must pay to the professionals that in turn heightens my doubt and cynicism.

Or perhaps it’s the way everyone in a vet office baby talks to my pets.  It’s uncomfortable to watch.  (We actually visited one vet who baby talked to both Moses and us.  It was jarring. We did not go back.)

At a certain point, I do feel that the average pet owner’s lack of expertise and love for our companions makes an easy target for price gouging and misinformation.  And the increasing popularity of pet insurance should not be a license to charge even more.

Maybe my mistrust comes from clinic shelves stocked with food like this, peddled to trusting clients, unaware that the main ingredient of this very food is corn and not even aware why that's a bad thing. Seriously. Look it up yourself: hillspet.com (Also source of photo.)

Of course, there are exceptions to my complaints and there are lots of good vets out there.  Vets that don’t want to have them overnight for observation for no real reason. Vets that don’t recommend unnecessary blood tests.  Vets that don’t go to lengths to argue wild canines have grain-heavy diets.  If you find or have one, hang on to them!

For us, however, we could nearly fill a recreational kickball team with our team of vets.  Or at least a travelling band.  We seem to collect them like trading cards, noting opinions and specialities, often trading one in for another.

Yes, it is true; we are veterinarily promiscuous.

But I find everything I wanted in one vet, maybe I wouldn’t need to call in a second opinion.  I want a holistic opinion to compare with the one that’s more “western medicine”.  And I want to have that information when we see a specialist.  I want a thorough explanation of the problem, prognosis, and the options for treatment – no sugar-coating.  I want to be able to understand what’s going on and be able to Google it at home later.  And I want to trust that I’m not being taken advantage of, instead of having to compare the price for services across the city, because the realisation that one place can charge you $200 to neuter your dog and another can be upwards of $600 is ridiculous.

Because even though we have pet insurance, I’m not going to put Moses or Alma through unnecessary treatments and I’m not going to pay an exorbitant mark-up on services just because.

So yesterday when Alma was unusually demure and I found the cause in a lower incisor, I was not looking forward to the forthcoming rigamarole.

A dental cleaning with potential extraction is in order.  Let the shopping around begin.

Why can't you just be straight with us?

I better work on my pokerface, too.  “$485 base price for a dental cleaning?  Extraction on top of that?  And post-op meds?  And an additional pre-surgery check-up?   And pre-anestheric bloodwork for the low, low price of $80? No, no, that all seems perfectly reasonable.  Mere pocket change. I assume you can break a $1,000?”

I wish.

Preparing Your Dog for Surgery

I wouldn’t consider myself terribly lucky to have experience in this topic.

It’s an unfortunate fact that Moses has undergone two major procedures: one for bloat and one for his spinal cyst.

Take into account his neuter, and the big guy has been under the knife three times.

Moses, released from the vet after bloat in October 2009

But if I can put together some pieces of advice for others, I suppose that could be the silver lining.

First, I should note there are two kinds of pet surgeries, and we’ve experienced both:

1.  The expected.

2.  The unexpected.

Granted, not a lot of preparing can be done for the second category.

The unexpected for us was bloat, but it could be an accident, porcupine encounter, nearly anything – that’s why it’s “unexpected”.

But, as any good Girl Guide can tell you, there is a way to be as prepared as possible for those sorts of situations, including:

– knowing where the nearest 24 hour vet is located

– having a pet first aid kit on hand

– consider taking a course in pet first aid (I’ve taken one, and would highly recommend it)

– having a pet insurance policy or being otherwise financially prepared for surprise vet bills

– ensure your dog is comfortable being handled by strangers

– putting your dog on a quality diet to keep them as healthy as possible overall

– training with your dog (mastering skills such as recall, heeling, and stop can be potentially life-saving)

On the flip side, the “expected” category are the times when your dog is going into the vet and you have at least some advance notice, such as a spay or neuter, or diagnostic work (CT Scan, for example), or major surgery (like Moses’ dorsal laminectomy to remove the cyst).

And in addition to the precautions noted above that also apply, there are definitely some further words of advice I’d like to pass on.

1.  Prepare your household

Our Moses-specific addition

Our vet was very straightforward with us: when we brought Moses home from his surgery, he wouldn’t be able to walk.  And even as he learned and got more mobile over time, stairs would be a challenge.  To this day, almost a full 16 weeks after the surgery, we’re still not having Moses take a tonne of stairs.

Luckily, the Husband has some mad construction skillz (yes, with a ‘z’, that’s how you know they’re “mad”), and was able to outfit our back yard with the ramp before the surgery.  We purchased the black rubber floor mats to help provide grip, which we also placed throughout the house to give Moses some stability on our tile floors.

The ramp proved to be invaluable as we found ourselves offering Moses considerable support in and out of the house during the first couple of weeks, and it’s been very easy for him to use during recovery.

2.  Get them groomed

We didn’t do this and I really wish we had.

Like I said, Moses was immobile when he was out of surgery.  And I don’t just mean unable to stand up – the first day was a struggle for him to even lift his head.

This limited mobility made for a lot of laying around, which, for a long-haired dog, can lead to matting.  I brushed Moses on alternating sides for over an hour each day during the first week after his cyst was removed to combat this and was barely able to stay on top of it.  It would have been off to a much better start if we had taken him into a groomer before he went in for the procedure.

Besides, if your dog is prescribed some post-op downtime in the house after an operation of any kind, it would probably be nice to have them smelling fresh.

3.  Prepare yourself

Serious procedures are stressful, worrisome and emotionally taxing over all.

Trust me.  I know.

So do what you can to divide responsibilities, get some sleep, and just find the time to cope in the way that works best for you.

For example, I had the day off we took Moses in for his CT Scan during the diagnostic process and it was the worst decision I could have made, since I was mostly left with my thoughts all day and did nothing but fret.  So the day he was in for his actual surgery, I went to work like usual, kept busy and survived the day.

It also helps if you talk through some of the potential out-comes and “what-ifs” with the family, so perhaps some tough decisions don’t cause tension and take everyone by surprise.  Like writing your own will, there are certain topics no one wants to discuss, but it’s still the responsible thing to do.

4.  Ask the vet as many questions as possible and follow their instructions

Maybe it’s just me, but the more informed I am, the more secure I feel in my situation and my decisions.  So I asked the vet some questions, did some reading on my own, and then came back with follow up questions.

Post-op care also comes with lots of information and instruction. When it has come to Moses’ recovery, we’ve followed the vet’s instructions to the letter and I must say, so far it’s turned out very well!  Sure, it was hard not to walk him for 8 weeks, and it was even harder to walk him for only 5 minutes when we were finally able.  But they don’t just make that stuff up for the fun of it.  It’s important not to push it too far.

On the other hand, it’s as equally important not to go too easy on them.

Remember that cart I mentioned that the Husband was going to build to help support Moses and aid in walking?  A prototype was made, but a functional cart never came to be and Moses walked on his own after 2 weeks out of both will and necessity.

I think a major reason why we didn’t pursue the cart building with more gusto is because a certain anecdote our vet told really stuck with us:  she mentioned how several small dogs become reliant on the carts and their use can come to mean the dog never walks without it again.  Not only did we not want that for Moses, with a dog his size, such a fate would be near impossible to accommodate long-term.

Instead, the Husband retro-fitted a seatbelt harness so that we could help him ourselves.  It was motivation for all of us to get him up at at ’em again as soon as possible.

Moses stands, with moral support only, for the first time after cyst removal (August 2011)

5.  Consider dieting (the dog, not you)

Of course, you should always ensure your dog is a healthy weight and not carrying too much extra around the mid-section (for the large breeds, too many extra pounds can literally shave years off their lifespans).  And if post-op recovery means reduced mobility and a less intense exercise regime, it makes sense to reason that your dog will therefore be burning fewer calories in a day.  Therefore, a temporary diet cut-back can prevent them from putting on some extra pounds in the meantime.  Depending on what health issues you may be encountering with your pup, excess weight can mean extra strain on their joints, and agonize any existing issues or lengthen the recovery process.

6.  Get creative

Yes, going through a major surgery with your pet is sad, stressful and expensive.  Having a bored dog going stir-crazy in the house afterwards can be additionally frustrating.  But there are lots of ways to make the best of it by working on old or new tricks and in-house games with your dog.  Hide and seek or remedial tracking exercises with toys in the house are a great way to keep them calm but still have fun and get their mind working. Give them a task by practising patience in the form of sit-stays and down-stays.

For Moses, motivating him to walk and regaining dexterity in his front legs was our focus, so we had him “high-five” a lot for food, tickle his feet so he’d move them, and would entice him with his favourite treats and practice short-distance recall to get him moving around.

7.   Be prepared for some odd behaviour

Just like people, when pets are sick or unwell, they can behave in ways contrary to their normal selves.

We saw this first hand with Moses.  He’s usually pretty laid back and tolerant, but while his condition was progressing, and while he was just gaining his mobility back, he became unusually sensitive to those around him – particularly other dogs.  By this, I mean he became clearly uncomfortable if dogs around him were getting too excited or rambunctious, likely because high-energy play could result in him getting knocked over or hurt.  So, in what was very uncommon for Moses, he kind of became the “Fun Police” for a little while there, scolding other dogs who were threatening excitement.  He also occasionally barked at passing dogs and people as we started introducing walks again – something we’d not previously seen from him, but potentially a result of cabin fever (which is my official guess based on the fact that these behaviours have since ceased, and he’s very much his “old self” once again).

There’s no real way to predict how your dog’s behaviour could possibly change, but be prepared that it could happen and don’t worry too much if you notice a few things.   If you keep to your normal interactions and training routine, and handle behaviour anomalies as you usually would (and don’t hesitate to ask for professional support or advice), you should notice that they’ll work themselves out for the most part as your dog’s health and routine also go back to normal.

8.  Stay optimistic

This can be tough.  Especially if your dog comes home a depressing sight: shaved, immobile, drugged up, unresponsive.  And it doesn’t make you a terrible person to wonder at least once “did we make a mistake going through with it?”  I know it was either the first or second night – when Moses would sadly sigh, and was unable to get up to even use the bathroom – that very thought crossed my mind, with concerns about recovery, long-term prognosis, cost, and quality of life weighing heavily.  But if you have come to the decision that going through the surgery in the first instance was in your dog’s best interest, trust your decision-making and stay positive about the days to come.

I can say for certain, for us, it was entirely worth it.

Worth it.

Of course, a lot of this advice stems from my own personal experiences, so it could be irrelevant or directly contrary to other experiences out there.

Though, at the end of it all, I just hope no one has to actually put any of this advice to use.

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.

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….

Longer Days Ahead

Though I had alluded to it in my last post, I thought I probably shouldn’t leave my readers and friends hanging when it comes to Moses’ health roller-coaster.

Moses was diagnosed with a spinal cyst.

Last Monday, we had our meeting with the surgeon.  I can’t say we went there completely objective and undecided; in the days leading up to the appointment we’d pretty much decided we’d be going forward with surgery if we got the reassurances we were looking for.

We did.

The studies I had found on my own were accurate representations of a prognosis: short-term outcome (up to 2 years post-surgery) has very good odds (93%), and long-term outcome has decent odds (70%) – which actually is considered quite positive when it’s a neurological condition.  And Moses’ overall health otherwise, age, and our relatively early diagnosis all work in his favour.  Not to mention the surgeon has experience with these cysts and the procedure and is confident herself.

The other side of the conversation is that without surgery, Moses will not get better.  Medical management may slow progression, but he won’t gain any motion back and will certainly continue to get worse.

So Moses goes in for surgery on Monday.

He will probably be in the vet’s care for a couple of days and will need a lot of help getting around, and some physio appointments.

The Husband has already started thinking about how to put together a wheelchair to assist in the rehab process, similar to the one to the left.

And the long-term hope is that Moses returns to a happy, healthy, moderately active dog at the end of it all.

No more carting, no extraneous hikes in the mountains, but we’d like to see him able to play and swim again, go back to hour-long daily walks, and just generally accompany us everywhere, just like before.

There’s a certain amount of anxiety about how things will go on Monday, but we’re staying positive.

And no, going forward with surgery wasn’t the cheapest decision – but he’s worth it.

Fingers crossed.

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.

One Long Day

Well the much anticipated Fourth of July has come (and is nearly over).

Not anticipated because I live south of the border and love me some fireworks (though that last part may still be true), but because Moses’ long awaited appointment with the specialist was today to determine exactly what it is that is causing his clumsiness and drastically reduced range of motion – and hopefully fix it.

Moses

We previously had two (great) vets independently come to the conclusion that Moses probably had Wobbler’s, and so our specialist appointment for a consultation, CT Scan, and hopefully surgery was made.

That was today, and unfortunately there is no good news to report.

The worst news?  Ironically that it’s not Wobbler’s.  Definitively not.

That’s the bad news because not only did all of the signs and symptoms point to Wobbler’s, but also because we were basically mentally (and emotionally) braced for that diagnosis and what to expect.  And boy were those expectations shattered.

At the outset, even the specialist put Wobbler’s on the top of her list of likely causes, based on the way he walks, drags his feet, and his hypersensitive reflexes in his back legs.  Definite nerve pinching is happening, restricting the movement in his front legs, and Wobbler’s and disc lesions are the most common causes.  Both of these are vertebral issues.

So in Moses went for a CT Scan to confirm that strong hypothesis.

And they got this:

Moses' spine - C6

Which is bad, because it’s supposed to look like this:

Moses' spine - C4

If it were Wobbler’s or a disc lesion, deformations would be found on the white part – the vertebrae.

Instead, what we see is that central circle is much larger at Moses’ C6 than in the second image (at C4), and pushed to the top left.

So that explains the nerve pinching, because there is definite swelling/inflammation, but instead the swelling is in and around the spinal cord itself.

Apologies to the specialist, veterinarians in general, and anyone else who better understands and can explain this issue; my humanities degrees grossly under qualifies me in anything medical, and I’m still trying to make sense of these issues myself.  Maybe this photo helps.

Moses’ diagnostic also included a myelogram, where dye was injected into his spinal column.  This allows the spinal column to show up well on X-rays, so any sort of pinching or blocking can easily be seen.

When they injected Moses at the top of the neck in the usual course, the dye stopped right about at C6 and would no longer move further down, so they had to inject him again in the lower back so the dye would travel upward to the other side of the blockage and they could get a full picture.

Moses' myelogram results.

I’m no expert, but even I can see the circled swelling.

Another view - that's C6 circled.

So if it’s not Wobbler’s, then what?

Well, good question.  And that’s the worst part – it’s still very much up in the air.  We’re waiting for a report back, and some fluid test results, but a new possibility is cancer.

Which just plain sucks and there’s no other way to put it using clean language.

I want to wait for the more definitive diagnosis before thinking too hard about treatment possibilities, but cancer is an entirely different bag of awful than Wobbler’s, so it’s been a terribly long day.

Perhaps the worst part is that Moses had to stay overnight at the vet.  The dye used in the myelogram has side effects (seizures are common due to caused hyperactivity in the brain) and they wanted to keep him overnight for observation while the dye dissipated from his system.

This is good, because when we got an update on the big guy earlier this evening they informed us that he had a seizure about half hour prior to our call.  They administered valium to combat seizures until the dye is out of his system.  So if our day has felt long, I can only imagine how Moses is feeling.

It’s pretty odd and very sad without Moses at home with us, but it’s important that he’s being cared for.  And we’re dog sitting our favourite pitbull, Hooch, this week so at least the house isn’t totally dog-free tonight.

We’re looking forward to picking up Moses tomorrow and finding out more about what exactly his condition is, though it might be as long as a week before we have certain results.

A long day for all of us.

(My regrets for the depressing post….)