Denny and Charlie (and the rest)
It started with OnePug...

Quick Update

Thursday, 15 March 2012 23:59 by robbi

I wanted to give a little update about Denny’s progress with therapy.  He met with his rehab vet this week who gave him an acupuncture treatment and chiropractic adjustment.  She evaluated his back and leg strength and was pleased to report that she sees definite strengthening in his muscle tone.  She advised us to continue with the AquaPaws therapy twice a week for a couple more weeks and then see her again. 

But the best news (definitely as far as Denny is concerned) is that she says he can start going for walks again!  At first he’ll need to start slowly, just 5 minutes at a time, but over the next few weeks she wants us to add time and get him moving more! 

I can honestly say I agree that his muscle strength has improved.  He generally holds his back end up a bit better, though he definitely has some bad days.  His actual walking hasn’t really improved much, but we are seeing less of the “knuckling under” that we saw a couple of months ago.

I have watched him walking in the underwater treadmill with each session and I have seen real progress.  He no longer “skip” steps with his back right leg.

He still has a very long way to go and he may never be as good as we’d like.  But it is nice to see some sort of progress.

Small Sacrifices

Tuesday, 13 March 2012 23:48 by robbi

It’s funny how things become “normal” simply because you adjust your routine and expectations. We’ve made several small changes to our home environment over the past couple of months and now it’s hard to remember how things were before.

For instance, about a year and a half ago we spent a fortune (and a week camped out upstairs) having our downstairs floors resurfaced. We had the disgusting laminate ripped out and a combination of stone and wood floors installed. Stone was put in at the entryway as well as the kitchen/breakfast nook. Hickory wood flooring was installed in the dining and living room as well as Richard’s office. We were thrilled with the results.

A couple of months ago, we put an area rug in the living room. Maggie kept jumping off the sofa and the hard wood was causing her difficulty. And Denny seemed more secure walking on the rug. Then we put a runner down to partially cover the area from the entryway to the breakfast nook, giving Denny an area in the middle that was more secure to walk on. Then a second runner was put down to make a more complete walkway through the living room so that Denny never had to touch the wood. Then a throw rug went down in Richard’s office, so there was more area for him to walk without slipping.

We stopped Denny from trying to climb the stairs around the time he had his surgery on his spine. We started carrying him up at night when it was time for bed. We’ve continued this but now that we’re concerned about not giving his back the proper support when we carry him, we have started to have him lie down in a donut bed and us carry his bed up. He’s even now to the point that we drop the bed at the foot of the stairs and he climbs in, awaiting his serfs to carry him up for the night. Oh yeah, he’s enjoying that bit!

The thing is, we’ve been through all sorts of things with several dogs over the past few years. Alfie didn’t see too well and never got used to the stairs, so we carried him up every night. He slept between us so he wouldn’t fall off the bed. He was often sick on the bed, so we started putting a towel down in front of him for easy clean up.

alfie

When he stopped eating we started syringe feeding him. Every morning before leaving for work and then again when we got home. As his condition deteriorated we would add crushed pills to the mixture. Then daily injections. And then eventually I was giving him IV fluids. It became so routine that when we lost him I felt lost myself. What would I do with all this extra time I suddenly had? It always felt like there was something I should be doing.

Sammy would never have been able to manage stairs either so he was carried as well. He also had to sleep with his head slightly elevated, so I got used to him sleeping in the crook of my arm with his head on my shoulder. I’d often have to adjust him during the night to make sure his airway was open. And of course there was the copious amounts of drool & phlegm he shared with me during the night. Sometimes it would get too much for him and we’d have to get up in the wee hours to go turn the vaporizer on to thin it out. Many was the night I’d nearly fall asleep on the spare bathroom floor while holding him towards the steam.

Samson n Frog 4-7-08

I walked around the house holding him often, giving gentle taps to his back to help break up the congestion. I seemed to always have a towel around my shoulder to catch the drool. I’d laugh and compare myself to a mom with a colicky newborn. It became routine. And then when we lost Sammy, I again felt lost. Life around the house was too “simple.”

I miss both of those boys very much and would gladly go back to doing whatever routine I needed to do in order to have them here with us.

My point is not to dwell on our past losses or heartaches, but to acknowledge that sometimes you just have to crack on and deal with stuff. You adjust. You conform. You do whatever it takes to make life the best it can be.

I remember reading an interview with a woman who was a cancer patient. She said she got so tired of people telling her how brave she was. She said she wanted to scream at them that she wasn’t brave – she just didn’t have a choice. She was the hand she was dealt and she had to get on with trying to live her life.

The joy and happiness and love that these furkids have brought to our lives cannot be measured. Our lives would’ve been so empty without them. So whatever we have to do now, and whatever we have to do in the future, it is totally worth it. And after all, it is part of the commitment we made when we brought them into our lives. I suppose that is the most frustrating part about being involved in a Rescue. So many people don’t take that commitment seriously. The sheer stupidity of people who contact us with their pathetic excuses as to why they want to abandon their dog is sickening. The dog was never really a member of their family. They didn’t really love it unconditionally. It was an amusing distraction for a while and now they’re bored of it and ready for a new toy. If that weren’t the case, then they would find a way to make it work.

Back Braces and Other Options

Monday, 12 March 2012 00:22 by robbi

Continuing where I left off last, I had been told by one of the veterinarians here in Houston about something that might help Denny’s spinal issues.

This was one of the vets here in town that has done stem cell therapy on dogs. He was pretty quick to dismiss Denny as a candidate for that, as he felt the problem was Denny’s spine and not the spinal cord itself. He told me that he had recently been to a medical conference and seen a new product available. It was a spinal brace invented by a veterinarian that forces the spine into proper alignment. It consists of a metal frame that is adjustable but very rigid. It is to be worn by the dog for several hours every day in an effort to realign the spinal column.

This local vet (I’m going to call him Brace Vet from now on to distinguish him from Stem Cell Vet who was the other Houston vet doing stem cell therapy) sent me some information he had picked up at the conference. The theory certainly seems sound; it is akin to what humans wear if they have scoliosis and are trying to straighten the spine. Richard & I talked it over and checked out the inventing vet’s website. We watched the before and after videos and decided it was definitely worth taking a chance on. We called and booked our appointment to see Brace Vet and have Denny measured for a custom fit brace.

MB Spinal Brace

A couple of days later I received a very disheartening phone call. Brace Vet called to tell me that the brace is not yet available. It is too new – the brace shown at the conference and on the website is a prototype. It’s not yet in production. Brace Vet has promised to keep in touch with the inventing vet and contact us as soon as we can get one for Denny.

I had been doing some digging about possible alternative braces. There are a couple that are readily available and marketed for dogs with IVDD (inter-vertebral disc disease) to help keep their spines straight and relieve pain from misaligned backs.

LilBackBracer

WiggleLess

None of these were invented by vets and none of them have any clinical studies behind them. They aren’t meant to permanently realign spines, just give support. We had thought that maybe one of these would help Denny until we could get something more substantial sorted out for him. But when we spoke to his Rehab Vet, she recommended against it. Her logic was that currently Denny is using his own muscles to help hold his back; if we put a brace on him it would replace the job of some of those muscles. She wants him to get stronger using his own muscles and not rely on something to take their place. Essentially, the brace might make his muscles “lazy.”

For now, we’re going to take her advice and hold off on getting one of these.  But we’re not ruling them out completely for the future.

Denny’s options in summary:

Neuro-Surgeon says he can operate to remove scar tissue around spinal cord, but odds aren’t great it’ll help. Even if it does, more scar tissue will probably form resulting in a relapse like he has now.

Stem Cell Vet says he’ll do stem cell therapy and we might have a 50% chance it’ll help (assuming it is cord degeneration that is the problem; otherwise it is 0% chance of help)

Brace Vet says stem cell won’t help because it’s a spine issue, not a cord issue. The corrective brace will help but it isn’t available yet.

Rehab Vet says acupuncture, laser, underwater treadmill and chiropractic can get Denny strong again and keep him walking on his own power. He might never be 100% and may have a bit of a limp but he won’t get worse.

Rescue Vet was called for a bit of an overview. He is the Vet for PugHearts Rescue. He’s a friend and he’s familiar with Denny. I called him to get an outsider’s view (with a Veterinarian’s knowledge) of everyone else’s opinion and help us make a decision. He also believes it’s a spine issue, not a spinal cord issue. He expressed surprise that Surgeon didn’t want to operate but thought that probably wasn’t the way to go since we’d end up with more scar tissue again. He was extremely doubtful that Stem Cell therapy would help. He was open minded about the Brace, but wasn’t sure. And he felt laser therapy would give us real benefit, though he was not sure about acupuncture.

This has been so frustrating for us. We just want Denny better. We’ll do whatever we need to in order to make that happen. But it is rather annoying that we can’t get a definitive answer as to what it is we need to be doing!

For right now, we’ll wait to hear about the Brace. Stem Cell therapy is on the back burner but not ruled out. Surgery is a last resort, but I doubt we’ll go there. We’re going to continue with Rehab Vet.

Denny is definitely getting stronger. He’s happier. His walking isn’t really any better, but then again it’s not any worse. Considering how quickly he had started to deteriorate this fall, I guess that’s pretty good news.

When we first noticed his decline and took him back to the surgeon, we said we wanted him healthy again but if we couldn’t get that then we’d be happy with him just not getting any worse. So far we’re accomplishing that much.

Stem Cell Therapy

Monday, 5 March 2012 18:55 by robbi

As promised, today I’m going to discuss one of the other treatment options we have been looking into for Denny. Today, I’ll be going over our findings on stem cell therapy.

Stem Cell Therapy This is fairly cutting-edge stuff, but not the moral minefield of Dr. Jekyll you may think of when you hear the term. This involves taking a bit of fat (adipose tissue) from a dog, running it through a series of processes which extract stem cells and then duplicate them. The resulting “stem cell soup” (I made that up, that is not a technical term) is then injected back into the same dog via an IV. The stem cells then migrate to areas of inflammation (kind of like white blood cells migrate to areas of infection) and start working to build up healthy cells.

It’s a very expensive procedure. And the IV injections are usually repeated several times, though the extraction of fat cells usually only happens once (with some cells being saved for the additional treatments.) Costs run around $5000 if the vet sends out the cells to a specialized lab to be replicated; it’s about $3000 if the vet has an in-house machine to do the replication. Very few vets actually do this procedure, as it is definitely not mainstream yet. In my research, I was only able to find 2 vets in all of Houston who have done the procedure. One does in-house and has been doing them for just over a year. The other sends out the samples and has been doing them for just about 6 months. Houston is the 4th largest city in the US. If only 2 vets do it here, I can only imagine how difficult it would be to find someone if you lived in a rural area.

MediVet is the name of the company that supplies the in-house machinery to vets.  They have some really interesting information on their website.

We spoke with both doctors about stem cell therapy as a possible treatment for Denny. This was going with the assumption that he has a degenerative disease of the spinal cord. I thoroughly researched treatment for DM and similar diseases only to find the options were pathetic. I understand what they mean when they say “no cure.” But why does that also have to mean “no real treatment?” Everything I read talked about caring for the dog as it loses its ability to walk. Mobility aids and palliative care seemed to be all anyone could offer. There’s some anecdotal information about diet changes and supplements, but nothing very encouraging. I was initially very excited about the prospect of stem cell therapy as a treatment. Firstly, it was something concrete we could try to “fix” his issue. Secondly, I kept seeing videos of dogs who had undergone the treatment and shown amazing results. I became a bit more disheartened when I would read more, as many of these dogs had suffered acute trauma leading to their conditions. These were dogs that had been in accidents; one day they were healthy and the next they couldn’t walk. Denny’s was chronic, slowly worsening over the last year. Also, there hasn’t been a whole lot of research into stem cell therapy. There are just a few studies done – almost all abroad – so there’s not much clinical data. The data I was reading seemed to suggest no more than a 50% chance of the therapy working for a dog with Denny’s symptoms.

It seemed a lot of money, a lot of pain and a lot of emotional minefields for something with a small success rate. Nonetheless, we trudged on and consulted both doctors here in Houston to see what they thought.

Our initial consultation was with the physician that pioneered the procedure here in Houston. He’s a very personable, likeable fellow – very down to earth. After dealing with doctors who have the “God complex” and who look down on us mere mortals trying to help our dogs and asking loads of questions, it’s kind of nice to meet a doctor who is so straight-talking. We took Denny in and brought copies of his MRIs for the vet to look at. I had exchanged emails with him, so he had a pretty good grasp on Denny’s situation but this was his first time seeing him in person. What happened next was a bit of a blur. He saw us as we walked in the door and greeted us himself. He took us back to a consulting room where he started to talk to us about stem cell therapy. I related Denny’s history once again, trying to not leave out any details. I wanted his honest opinion about whether or not this was the right path to take. He listened and began explaining some of the finer points of the procedure. He saw Denny walk about 2 feet on the floor of the room. He then examined him on the table, checking the proprioception on his back legs. The exam lasted about 2 minutes. He then turned back to me and continued to talk about the stem cell therapy. He explained in great detail every aspect of the procedure. He wanted to inject the first set of cells directly into Denny’s spinal cord – like an epidural. Subsequent treatments would be via IV line in his paw. We discussed Denny’s current medications (he was on a trial of steroids to try and reduce spinal cord swelling) and his activity level. He explained Denny would have to be off the steroids for a couple of weeks prior to the treatment. And that was it. Next thing I know he’s telling me that we can schedule the pre-op bloodwork in a couple of weeks and the operation to remove the fat tissue in another month. Then we were out the door, our heads spinning.

Make no mistake, this doctor definitely seems to know what he is doing with regard to the technical aspects of this therapy. And he has had amazing results with dogs suffering from arthritis – the primary patient that stem cell therapy is aimed at. But how do we know this is the right treatment for Denny? In the car on the way home, Richard asked me what I thought. The first thing that came to my mind was “I wish he had spent more time examining Denny.” Only then did we both realize that he hadn’t even looked at Denny’s MRI scans.

I received an email from the vet later that day, recapping his plan. He signed it off by telling me he was consulting some other vets about Denny’s case and that he was “getting very excited.” My heart sank a bit. Denny was an exciting case; a chance for this vet to try this procedure on a different type of patient than what he had been treating. Denny is so much more to us than a patient, or even a dog. He’s our boy. He is special. I’m not opposed to trying something experimental on him if it is our best hope. But I wasn’t convinced it was.

I decided to continue to try to get in touch with the other vet in Houston who had done stem cell therapy. I wanted a second opinion and this was the only man qualified within 200 miles to give it to me. Eventually, I was able to speak with him via phone. I described Denny’s symptoms and relayed the details of his case. As soon as I had completed telling everything, he said “I wouldn’t recommend it.” What? He explained that based upon Denny’s improvement after surgery and the subsequent deterioration in conjunction with the swelling, he believed his symptoms were probably the result of compression on the spinal cord. Yes, the swelling due to scar tissue could be a factor, but most likely there was more to it than that. It’s a bit of a vicious circle – he has swelling and pain, he can’t hold his spine straight; that causes more pressure which makes his cord even more pinched. He said it would be a waste of time and money to do the stem cell treatment. What did he recommend? Well, he just happened to have recently been at a conference where someone was demonstrating a brace for dogs which forced their spines into alignment….

We’ll make a full post on that one next, with details about all sorts of stuff you probably didn’t know existed!

In the meantime, I should state that we haven’t ruled anything out.  Denny continues on his rehab therapy.  It seems to be making him stronger, and as I wrote before he enjoys the laser therapy.  But we’re a bit frustrated because we’re not seeing much in the way of improvement in his walking.  True, it definitely isn’t any worse.  But we were hoping for more. 

Perhaps we will pursue stem cell, perhaps not.  But I wanted to share this information so that anyone thinking about it would have a little bit more information on how it works and what is involved.

Until then, I thought I’d post a random pic of Stewie. 

Please sir may I have some more?

He had finished his dinner and decided to give us his most pitiful look in hopes that he might get seconds. Silly boy!