Agreed on much in the last two posts and in many more and also, I want to express warm gratitude for the support and understanding and positivity from everyone.

I feel marginally better today - we have been getting Pofi out to pee with a little more ease a few times last night and then again this morning thanks in good part to the Get A Grip harness (thanks, Jim & Rene, for managing the order) and perhaps the groin pull is really starting to be less painful; whatever the reason, there is definitely less squeaking getting him upright as soon as we started to use the Get a Grip yesterday.  We both slept well from 11:45 or so till 6:30 this morning.  He and I slept in the house last night instead of on the three season porch because it got colder - I have been sleeping on dog beds on the concrete there for several days as he seemed most comfortable there and also because it was so much more expedient to get him out the door to potty in a hurry when needed.

Also, I had a mobile vet highly recommended to me yesterday by a Greyhound friend for acupuncture and that vet will be here today at 2 pm.  Have prepped her on some of the circumstances and the FCE versus other cause questions.  Let her know this is not about end of life care or options yet.  Was worried she would be shocked - I worry that any of you would be, too.  This dog is simply horizontal all the time right now and, yes, I question if this is sufficient quality of life.

And I know MRI seems like it is what needs to happen to be a bit more definitive (we would know if this was another tumor that has reached the spine).  While the expense is daunting ($1,500 to $1,800), the bigger problem for me is once again putting him under GA.  GA number 9 in the last 14 months was just 3 weeks ago tomorrow and the last several times he has seemed to have a sore or injured trachea and has made throat clearing "gaaakk" noises (as in Bill the Cat in the Bloom County comic) for days after.  I was so committed to not doing anything with GA again for as long as possible and maybe never after the quick lump removal surgery...

So that is my update for now.  And actually, I still have PT sessions prepaid at the U from before the cancer diagnosis - but I did want to be sure the groin pull was past tense before I considered the tactics of getting him back in - the PT space is in the sub basement and a good distance from any doors.  It would be great if he would let us use one of their carts to get him there, but he was having NONE of it last Friday when we went for a final assessment on his incision healing and got the initial look at the situation with his back legs.

More after we see the vet / acupuncture today.

The roller coaster continues.  He really is no better.  And I think his spirits are a little down.  Will sneak him an anti-depressant tomorrow. 

Just going to copy from e-mail exchange with surgeon to cover where we are.

From me:

Hello:

It has been a rocky few days for us.  On Tuesday, I ended up stuck in office much longer than intended so he was alone 8 hours.  When Ken got home he was whining and I was already on my way home.  He really needed a potty trip to urinate and once we took care of that he was a little improved, but it was also meds time.  He still always desperately wants to be helped outside to urinate, but while he seems to have some sense he needs to defecate, I think he has less control.  That definitely was not the case before we started on the muscle relaxant (Methocarbamol_, but I don’t see that as a side effect in any online info.

I was trying to stagger the meds more and we sometimes weren’t giving Tramadol at all or perhaps just at night to ensure a bit more restful night.  But it does feel like he really needs Gabapentin every 8 hours and same with Methocarbamol.  Today and yesterday afternoon I even pushed Gabapentin to 400mg (which is close to the 5 mg per pound dosage for him – 375 mg).

Yesterday, we had for a vet visit in house for acupuncture – I wanted to see if acupuncture would help as another pain relief modality and wanted to do it without the trauma of a trip in to U of MN as he hated riding in the cart and yet I know he can’t walk as well even supported as he did when you saw him.  Potty trips are very challenging (though still up and down – one time he seems stronger and leg motion seems better, the next he has no ability to support himself at all).  We worked with Dr. Raeyna Longtin of True Companions VetVan service.  She made some observations and echoed much of what you have said.  FCE would not typically getting worse.  Clear neuro deficits, but he has feeling in both legs all the way down to his toes  - he contracts and stretches legs.  Can move them.  Just not well.  She only worked with him on his dog bed – we did not force him up, but I was pretty clear on his current abilities there.

She also said the can often feel a temperature difference on one side of the spine versus the other if it is FCE and sees a difference in in motion/reflex in one leg versus the other and she feels like he is pretty equally incapacitated on both sides.  She still did get some pain reflex from groin.  She he might be showing some reaction to touching lower spine.  So her inclination, without MRI of course, as that there was more likely disc issue or the cancer.  She thought his neck muscles were also very, very tight and that might be from being a tripod or from straining to pick his head and body up and look around.  She did an acupuncture session with him using current in the pins around the neck and front shoulders to try to relieve some of that tension and pain.  He was a bit restless and resistant at first but seemed to relax into it about ½ through application of current.

She thought we should employ all pain meds through that evening as he had been so painful.  So he had the full complement of Rimadyl, Gabapentin, Methocarbamol and Tramadol last night and again this morning.  He slept really well all night last night and the night before, but seems distressed pretty soon after waking.

I was so certain we weren’t going to do any more procedures that require GA after the lump removal – he was doing so well and so strong and the addition of the brace seemed like the last puzzle piece we needed. That we might pursue some PT to work on his core strength, but not major rehab.  And I know we aren’t THAT far into a rest and recovery period from the assumed point of injury, but I feel anxious about needing to diagnose.  Though I suppose, as you have pointed out, short of deciding to euthanize, we would be doing much the same course of medical management of pain with any diagnosis.  And so what would I do with information from MRI?  Back surgery is just not a route I think we can go.  I just can’t see putting him through that. But right now, his quality of life is pretty far below anything I would want for any length of time.  So wanting to know if he CAN improve is what is pressing to me.

1. If it was a disc issue,herniated, compressed or ruptured, is there any chance chiropractic, acupuncture and PT could give him back some quality of life? It seems like you answered that below, but would it be weeks?  Months?  I just wonder if we are doing any more damage – are we
2. Is the only diagnostic tool really MRI or could an x-ray – perhaps without GA since he is fairly immobile  – reveal anything?  I take it x-ray would not show a tumor, but would it show disc damage?

Response:

I'm so sorry to hear its been a rough week for you all.
I'm glad he has seemed more comfortable at times, and that maybe the acupuncture helped him feel more comfortable as well. I think acupuncture can definitely help a lot of dogs with pain management .

To answer your questions:
- IF the cause of his signs is due toe a disc herniation/rupture, etc- as long as he maintains the ability to move his back legs, the prognosis for return to walking or essentially normal is 85% or greater, both with and without surgery. One he loses the ability to move his legs, the chances of improvement without surgery drop to 60% or so while surgery is still 85%, and once he loses feeling in his toes, without surgery is less than 10% improvement, while surgery may still help 50% of the  time. So if this is all due to a disc, his chances for improving are very good, but it can take some time- weeks typically, not months. Usually recommendation for conservative management of disc disease is 4-6 weeks of STRICT activity restriction- confined to a very small space, with good flooring, and outside briefly just to urinate or defecate, and right back inside to that confined area. Acupuncture is ok during that time, but nothing else. After 3-4 weeks, more aggressive PT may help. I dont have too much experience with chiropractic treatments. During the first month, too much activity- whether his activity, or chiropractic/rehab can worsen it. If its a partially herniated disc, it can herniate more and cause worse signs, etc. So during the first month, pretty minimal activity, and we can ramp it up after that. Recovery is expected in 6-8 weeks for most dogs.

-Unfortunately, the only diagnostic tool is truly an MRI. A CT maybe, but a CT does not give us the detail of the spinal cord, only the discs and the bone. It would not tell us a spinal cord tumor. X-rays unfortunately rarely show us disc lesions. Very rarely, they can show us obvious herniated disc material, but most commonly, they show us a "narrowed disc space" which mayor may not indicate a site of disc herniation, but is extremely nonspecific, and not definitive. X-rays may show us a tumor in the bone, but not in the spinal cord. Its a relatively inexpensive ($200) test if you wanted to do it at some point to rule out an obvious disc herniation or bone tumor before you consider something like an MRI. He would probably need some type of sedation for the x-rays though- not GA, but at least some mild sedation to keep him still.

As long as hes static- not worsening, I think its ok to continue. I would recommend a recheck at some point in the next 1-2 weeks, again, only if he's static or improving. The reason I would recommend bringing him in is because I know and I agree with you on your thoughts of his quality of life, and I dont want you to keep struggling with this if he's not improving, so that we can see if there's anything different we can do. And I think the best person to discuss those would be our neurologist. So it might not be a bad idea to try to book an appointment from now since he books out a little bit.  If he worsens at any point (decreased movement in his back legs, worsening discomfort, etc), I would bring him in sooner. Also, if you feel you are not able to keep him comfortable, bring him in sooner.

Right now:

It is just really hard to watch your dog be completely immobile for days and days. To struggle to get him out to pee and have to be holding him upright the entire time. I swear he is using his legs less when we move him about, but he is able to move them and feel.  I fear there is a tumor recurrence.  I think I may have to get him in for an MRI because not knowing is just making me a wreck.

Thank you all for your continued good thoughts.