When to ask for a referral?

 

 

So vets and people always ask me WHEN to refer the back dog...... that's a great question and unfortunately there's no pat answer. What I could tell you is that knowing what kind of dog that you have as a patient, the presenting complaints, and response to treatment certainly helps. We know the typical clinical course that these guys are supposed to follow.... 

 

For me, the small, middle-aged, chondrodystrophic dog like a dachshund, poodle or beagle has a pretty typical course - acute onset of pain, tenderness, reluctance to walk, ataxia and postural reaction deficits. The majority of those dogs will respond to crate rest, pain medications and anti-inflammatories within 3-5 days. It is essential that they are crated for improvement to be noted. Sometimes, it is best to rest these dogs in your clinic for 2-3 days to make sure that they are improving and to assure strict crate rest. In most cases, the owners are VERY happy that their dog is better and it really "sells" this treatment to them. They truly understand and accept that your treatment is going to be good for their pup and they can avoid the danger/expense/inconvenience of referral for back surgery with someone like me! 

 

Most dogs with cervical spine IVDD present very similarly although postural reaction deficits are uncommon in these patients. Treatment is very similar although if your patient is showing a lot of muscle fasciculations and spasms, a muscle relaxant such as diazepam or methocarbamol is often helpful. 

All of these dogs should be rested minimum 4 weeks, sometimes up to 6 weeks. The owners should be instructed to have their pet lose weight if overweight, walk the dog with with a harness rather than a collar and prevented from leaping from the furniture. 

 

So, you ask, how does this help me know when to refer?

Anytime that the situation deviates from the above scenario, you should consider referral. If the dog does not improve in 3-5 days with standard treatment, if the dog is a large dog and fails to improve, and finally any older dog or any aged cat (I'll put together an article on cats soon). Other situations include dogs that are profoundly incapacitated (can't rise, can't walk, can't feel their toes), a chondrodystrophic dog that has more than 2 incidents of pain and paresis in a year or so, a dog with other metabolic or systemic disease that can influence treatment as outlined above, and finally a dog with profoundly asymmetric signs or with great pain associated with the weakness. This may not be a complete list of all possible scenarios but I think it covers a whole bunch of them. 

A word about dogs with sensory deficits; these are the dogs that are completely paralyzed and don't have sensation to their toes (deep pain negative). If these dogs are treated with decompressive surgery within 24-48 hours of losing deep pain, they have an excellent (>84%) chance of regaining significant and functional motor ability. Many of them improve back to 100%. Dogs that have lost deep pain for more than 48 hours still have a good (~50%) prognosis of regaining functional motor. 

 

If you have a specific question about your cases, please feel free to email me.