# Dilemma Prednoleucotropin/Surgery ?



## maggie fraser (May 30, 2008)

I was wondering if anyone can offer some insight into the use of prednoleucotropin.

I eventually got my dog in to a spinal specialist today and a Lumbrosacral Stenosis was diagnosed, the treatment options at the moment are; plt if he tolerates the drug and it works for him, the other option is surgery offering approx 70% chance of success.

I really dislike steroids having had some bad experience of them in the past, but I will administer the ten day course I received today to try him on.

I have only approx £3000 left on my insurance, an MRI will cost around £2000 and the surgery a further £2000, leaving me £1000 short. The doc however has offered to go ahead with the surgery minus the mri scan, keeping the cost within budget.

I've kind of resigned myself to maybe just doing some tracking and light work with the dog should he become comfortable enough.

My head is not clear yet.... lifelong plt should it be tolerated or..... 70% success chance with surgery (minus an mri scan)..... or a delayed tap on the head ?


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## Maren Bell Jones (Jun 7, 2006)

I'm not familiar with the drug in that particular use, though I haven't had my neurology rotation yet. Is your a dog a GSD? We had two large dogs (a greyhound and a yellow lab) come into the practice I did a rehab preceptorship with about a week ago with cauda equina/lumbrosacral stenosis. We tried some kind of pred on the greyhound (who had already been down for a few days and was getting progressively worse) and it didn't really help as eventually she couldn't even get sternal. She was euthanized. The lab had some of the worst spondylosis the rehab vet (who used to also be an Army vet) had ever seen that without having done a myelogram, was probably impinging on the nerve roots coming out of her lumbrosacral junction in her hips. She went acutely down and was totally flaccid in both hind legs. We did not do pred for her, but just cold laser therapy. She did end up being able to sort of stand with assistance after several laser therapy treatments, but I think the owner was heading towards having her PTS as well.

As an adjunctive therapy, I'd see if you can find a rehab place that offers cold laser, though I am not sure if it's caught on across the pond yet. I am now trained on the class IV cold lasers and they are a real boon to therapy. I love them! I used them on myself (I have a herniated disc in my lumbar spine and a torn meniscus in my knee) and my 10 year old Rottweiler and was pleasantly surprised. We also used the cold laser on a lop eared rabbit that was acutely down in its hind end (had kyphosis, or like a severe upside down U shape to its spine between its shoulders) and after two weeks of laser treatments, seemed to be improving enough so that the owners were will to keep it alive. 

I wonder if they could do a myelogram or CT instead of MRI? They are a bit cheaper.


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## maggie fraser (May 30, 2008)

Hi Maren

The drug is prednisolone with a couple of other things, but mainly pred. The options were discussed and cold laser never figured at all so I can't say it's big over here. He did mention a myleogram although he thought they were old hat and that an epidural dye would also have to be used but, he felt an mri would be the way to go ideally.

The dog is a three yr old gsd in top condition all things considered, the same dog I posted a few months back when my vet diagnosed spondylosis and then laterally, acl tear/rupture and/or ivdd.

The dog is very mobile, I've kept him moving since I got him back on his feet although I have controlled his activity, he has been enjoying regular exercise off leash at least twice a day, sometimes three whilst taking rimadyl twice a day.

So... although there doesn't appear to be too much nerve damage at this time, and only slight lameness on one hind, the dog doesn't appear to have been making much real progress.

The doc thinks I've done everything right with him.


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## Maren Bell Jones (Jun 7, 2006)

As far as I've been taught, without surgery, it's not really something that can go away. It can be managed, but it usually does get progressively worse. The best thing you can do is try to find a rehab vet who can show you how to keep the dog's core strength strong and to do spinal decompression exercises. Exercises like tugging with the tug held high and walking the dog laterally back and forth as you play and the dog is standing on his back legs are excellent. Also practice doing a sit to stand, which means baiting with food or whatever at a sit until the dog goes into a "sit pretty." Excellent core workout. The rehab vet I worked with had done with her rescue GSD as a young dog and she's doing really really well because of those sorts of exercises as a 12 year old senior dog now. 

I found one certified rehab vet in the UK (may be more that I just don't know about):

http://www.hillsidevet.co.uk


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## maggie fraser (May 30, 2008)

Yeah I've been doing these kind of exercises with him, just stumbled across a few things whilst figuring out what we can do without any adverse effect.... he'd still pretty much go all day and he's still strong.

It's bad crack to see such an apparently healthy looking beast and for it to have such a profound condition.

Meanwhile I've started this course of drugs and see what we come up with.


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## maggie fraser (May 30, 2008)

Thought I'd add a wee update on here, particularly if Maren is about.

My spinal consultant is not too happy to pursue 'major' spinal surgery with this dog, the plt whilst assisting the dog to some degree, is not looking like any kind of long term solution for him at the moment and the Doc has proposed we consider epidural therapy. He hasn't performed epidural therapy before but is thinking it may be worth to give it a shot with this dog, apparently there has been a fairly recent paper on epidural therapy, I haven't been able to locate it at this point in time. 

Anyone any experience or info on epidural therapy, is it practiced much in the States ? The Dr has been quite up front in that he has no experience with it but is interested to try it.... I think I'm for it.


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## Terrasita Cuffie (Jun 8, 2008)

Maggie, you've said he's functional and I'm guessing not in pain? What has worked best for mine with an acute disc injury is injectable dexamethasone which shut down the inflammation really quickly. After that we did water therapy and acupuncture a couple of times. I also put him on a homemade diet with supplements. Dog regained full function. I would research some of the holistic anti-inflammatory type therapies. I have a friend that did prolotherapy for an ACL tear with fairly good results. One of the issues with ESI [epidural steroid injections] with people is scar tissue which in turn can eventually entrap the nerves and cause pain and dysfunction. 

Terrasita


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## maggie fraser (May 30, 2008)

Terrasita, he is weakening in the rear or at least has not recovered his strength and power since his trauma last August. He has pain and is the main issue I've been trying to get on top of, and that is with daily meds of PLT. He can still run and jump and climb stairs but he's front powering more, he also has a marginal hind lameness, it's very subtle and is not fully weight bearing.

The intermittent subtle lameness had been a niggling factor long before his disc trauma and I had been getting progressively more suspicious of it, in fact two vets who had looked at it on my request on previous unrelated visits couldn't see this lameness I was referring too.

At this stage I believe his disc trauma was symptomatic, and/or that there has been something else going on. I keep him quite active but I do not play ball with him, no excitement for him, just keeping him ticking over for now which isn't easy for any of us.

It's been a tricky one, he's been a very agile dog and for a gsd, and really liked to jump, so much so I've seen him jump right over a big couch in the house complete with hubby in situ before bouncing round and over the top of other furniture just for fun. But it has been his super fast turns that have concerned me more and it was on one of these that he went crashing down.

We haven't had an mri yet, I've been putting it off due to my current circumstances but hope to get that sorted out soon, meanwhile I've decided to forget about the epidural therapy and plan to keep him on his current meds and exercise routine until I can hopefully get a clearer diagnosis.


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