Cinder "Ella" Story - Part 2
And The Story Continues....
When Cinder seemed to be reluctant or almost unsure of herself when jumping on the bed the next morning I was concerned. But at the time I remember thinking it was most likely due to her playing very hard the day before in the water and with her balls.
Cinder and I went about our day and everything seemed pretty normal. I mentioned earlier that one of the reasons I was looking for a dog like Cinder was to be a true companion. A Dog I could take anywhere. And I did take her everywhere. In the back of my car was a kennel that Cinder would ride along in.
She enjoyed the open road and once we got on the highway she would just relax and fall asleep. The reason I am telling you this is because that same day she was reluctant to jump on the bed, I had wanted to take Cinder with me to the store. We walked into the garage and I opened the hatch and her kennel. Cinder did her typical once around the car walk stopped at the hatch and did the same backing up circle, she did that morning. Clearly something was off, but she jumped in and we went our trip. I decided then that I would call her vet on Monday.
Is it serious or is she just sore?
Monday morning as soon as the vet had opened, I made a call. I explained over the phone my situation and at the time the vet agreed that she most likely over did it that day and prescribed Carprofen for any soreness and inflammation. He advised me to keep her on it for about 10 days and to call back if her condition doesn't improve. Why just a call and not a visit? The Pandemic, at the time most vets were just reopening and only seeing emergency cases. But he and I both agreed that it was most likely a three-year-old energetic dog that just did too much.
(If you would like to read more information of Carprofen including effectiveness and side effects click here).
For the first two or three days on the medication I had also decided to kennel Cinder in order to rest her joints and muscles and give the medication a chance to work. After coming out of the kennel I did allow her to walk freely around the house but was not allowed to really play and defiantly no jumping for now.
As the ten days wound down, Cinder appeared to be coming along well and didn't seem very sluggish. She wasn't really allowed to jump at all so until we actually played outside, today on day ten, we will see how she would do.
After work, she and I went out in the backyard and I didn't want to do too much too fast, so we took it slow and only allowed her to run after some ground balls and still no jumping. A few throws in she seemed to have her speed and chase after them without any problems. I tossed a ball bouncing across the ground about 50 feet from where I was sitting and watching. Cinder took off after it and my heart sank into my chest. In an instant Cinder collapsed to the ground ball in mouth and began trying to crawl back to me on her four legs. My entire time with this amazing dog she has always been fearless. But I remember the look in her eyes as she crawled to me. She was scared and didn't know what happened. In that split second, I thought she just blew her ACL. I ran to her and she tried to stand up. She was able to get to her feet and I scooped her up and carried her into the house. When we got to the living room, she seemed to be better and was walking semi normal. I immediately called her vet, but they had left for the day. While on the phone trying to get a vet, I looked into the living room and Cinder attempted to jump on the couch which is about 15 inches. She completely misjudged and faceplanted into the floor. With the pandemic everything seemed closed or on restricted hours. I was forced to have to wait until the next morning. I carried Cinder to her kennel and that's where she and I stayed until the next morning.
With a call into the vet office as soon as they had opened. I explained the days prior event and they wasted no time telling me to bring her in.
When we got to the office the next morning, they decided the best course of action was to start with a radiograph of her legs to look for signs of breaks, fractures or ACL issues. After a short time, Dr. Mike met with me in the parking lot with the results of her X-Ray. He explained the good news was he didn't see any obvious signs of an ACL injury and she didn't seem to mind when they extended her legs during examination. Showing me the X-Ray, he did point out what he believed to be some minor arthritis on her back. He explained this could be very early stages and believed it may be best to start her on some Dasuquin now for the future. He again gave me some anti-inflammatory meds and prescribed rest for a few more days in her kennel.
As days passed following our visit to the vet, I began noticing Cinder appeared to be offloading her weight from the right side and she had a slight lameness in her walk and gate. Again, I called the vet, explained what I was seeing and asked if D. Mike could just look at Cinder's walk in the parking lot without being on any meds to sedate her. After seeing how she was walking, Dr. Mike agreed that she was off loading her weight but admitted he was stumped and recommended I take her to a specialist who could conduct an MRI. He recommended Hope Animal Specialist in Philly and I scheduled an appointment. By now I was at a loss. Cinder shows no obvious pain or discomfort, but something was clearly wrong.
Will Hope Give Us Answers?
Getting an appointment in Hope's Schedule wasn't easy and I eagerly awaited the two weeks to finally arrive. I packed up Cinder and off we went in hope (no pun intended) of some answers to this mystery. Again, because of the pandemic I was forced to stay outside while they walked Cinder into the office. It wasn't long and my phone rang, and the Doctor at Hope said he had finished his examination and knew what was causing the offloading. He explained to me that Cinder was suffering from a pulled iliopsoas muscle, which is pretty common in agility and athletic dogs. I had asked if that was what the MRI shown, and he told me he didn't feel it was necessary to conduct one since she had all the signs of the injury. He did say he would be happy to take my $2400 to prove it if I liked but recommended that she be kenneled for an additional two or three weeks and no running or jumping of any kind for at least six to eight weeks. In addition to rest, he said physical therapy would be most beneficial to aid and speed up the healing process.
With a diagnosis now of what was wrong I sought out a place where Cinder could begin the healing process. We began with weekly massages of her groin and legs. Weekly a therapist came to my home and massaged Cinder to stimulate the muscles. In addition to that she visited the staff at All Points Equine for a full adjustment as well as visiting her therapist Dr. Crabtree for Acupuncture and Cold Laser Therapy to stimulate blood flow and help heal her groin.
As July was nearing an end and I was at about six weeks into the eight-week rest period Hope recommended, I was becoming more fearful. Cinder didn't seem to be responding enough to the rest and treatment. To me she still seemed like she was offloading her weight.
Regretting not having the MRI done at Hope when I had the chance, I began looking for a neurologist who could fit me in as soon as possible.
Next Stop Valley Central
"Joe, I'll be honest with you. What we are doing here at this point appears to be easing pain and masking symptoms. If you truly want to fix your dog, she needs to go to Veterinary Orthopedic Sports Medicine Group (VOSM) in Maryland"
Dr. Crabtree
Again, I loaded up Cinder and we headed off to Valley Central in Allentown to visit Dr. Hodges and again I waited patiently in the parking lot while they examined my girl. Dr. Hodges came outside and spoke with me regarding Cinder's recovery. He explained that he did believe Hope was correct in the Iliopsoas and seemed to be recovering just very slowly. He did ask to see the radiograph that was taken by Dr. Mike and he could tell me a little more possibly following the review of that. The X-Ray was sent and a few days later Dr. Hodges called with some additional results.
He explained to me that what was believed to be early arthritis was in fact Lumbar Sacral Spondylosis in Cinder's T3 L13. Again, my heart sank. She is only three years old how can she have this already? I asked what this would mean for her? Should she have surgery? Does she need surgery? Will she lose her ability to walk? Dr. Hodges didn't believe surgery was necessary but admitted the X-Ray wasn't the best to make any assumptions at that point. He explained I should continue with therapy and see how she continues to respond.
As the weeks passed Dr. Crabtree and I talked during one of Cinder's Cold Laser Therapies. Dr. Crabtree said, "Joe, I'll be honest with you. What we are doing here at this point appears to be easing pain and masking symptoms. If you truly want to fix your dog, she needs to go to Veterinary Orthopedic Sports Medicine Group (VOSM) in Maryland.
Nearing the middle of September and trying everything I could for the last seven months with little success, I was open to anything. Dr. Crabtree informed me that they are without a doubt the best at what they do and at this point we needed the best.
A Trip to Maryland
Returning from therapy, I placed a call to VOSM hoping they could get Cinder in as soon as possible to be evaluated. When requesting an appointment, the receptionist explained that they had no openings until mid-November. I began explaining the events that had led me to them and when I finished and after a brief hold, they made room for me at the beginning of October, but I was going to have to wait another two weeks.
With the clinic over three hours away and our appointment scheduled for nine o'clock in the morning I decided that I would travel the night before and stay in a hotel nearby.
October 15th finally arrived. I loaded up Cinder, checked out of the hotel and headed off VOSM. Again, they came out explained what they were going to do and walked away with Cinder. They said feel free to explore the area because it would be several hours before they finished the initial exam.
They explained that they were first going to use a pressure floor in an examining room that would measure Cinder's weight distribution to each leg. This would give them some insight on which legs she is offloading to as she walks. They would then sedate her and complete an MRI on the iliopsoas. She would then be taken to Neurology where an Ultrasound would be conducted of her back. While still under sedation they would do a procedure much like a spinal tap and extract fluid from her spine to test for disease.
Hours passed and the longer it took to hear anything the more nervous I became about what they may find. At about three o'clock I received a call that they were going to begin the process of reversing Cinder's sedation and the doctors would be out shortly to discuss the results. The Doctors?
A short time later Dr. Gallagher and Dr. Chun both came outside to explain the findings. Dr. Chun began explaining the result of the MRI which focused on the iliopsoas strain. They confirmed the Cinder indeed was suffering from this injury and explained they rate these on a scale of 1 through 3. A level 1 is a slight strain while a level 3 is a complete tear from the bone. Cinder was suffering from a 2+ injury. Dr. Chun said she really doesn't understand why Cinder isn't showing more signs of extreme pain as the MRI light up so badly that she believed Cinder should be in agony and constant pain.
Dr. Gallagher then began explaining that the iliopsoas was a secondary injury, and that the primary injury was in fact the Lumbar Sacral disease. Cinder's back was weakened and two of her vertebrae were compressing. These two vertebrates have a small canal where the sciatic nerve runs through. They felt that this could begin to pinch the nerve and add even more complications to Cinder's recovery.
Eight months in and thousands of dollars already spent trying to determine what exactly was wrong and heal Cinder, I was almost afraid to ask what my options were.
Dr. Gallagher explained that I had did have a few options and gave me rough costs of each option:
Option 1: Continue Cinder's therapy with Cold Laser, Underwater Treadmill and Acupuncture and we can see if she progresses over time. The cost would just be the weekly cost of each session. Sadly, her days of ever being any type of impact dog would be completely finished and he estimated her recovery to be less than 50% chance to fully recover.
Option 2: Over the course of 12 weeks, I would drive back to Maryland every other week. They would sedate Cinder and give her a Cortisone injection into her spine. Each injection would cost about $600 plus travel expenses and would increase Cinder's full recovery to70%. Cortisone will only mask symptoms and help with pain management. It will not regrow cartilage or prevent the nerve from being pinched.
Option 3: They conduct stabilization surgery on Cinder's back and add hardware. This would allow her back better support and in addition allow her to heal the secondary iliopsoas injury. Recovery chances go up to 95% to full recovery but comes at a few costs. Obviously financial, the surgery will cost about $6500 on top of my visit today of $3500. Cinder will need to continue therapy for a few months following surgery and she will need to remain calm and kenneled for three months. In addition, it would also require three separate follow up visits back to VOSM to check on her healing, take X-Rays and rate progression.
With a full diagnosis and options to treat Cinder a decision needed to be made on how to proceed.
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