tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   23 February, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

Toa Payoh Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures


Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First recorded: 27 April, 2003
Updated:  23 February, 2010 
Be Kind To Pets
Veterinary Education
Project 2010-0129

The Lhasa Apso had intervertebral disc disease (IVDD)

paraplegia in Lhasa Apso, Singapore"The vet operated on the paralysed dog's spine and the fees cost the owner over $5,000!" the pet shop owner said. "The dog was still paralysed." I was vaccinating his puppies at his pet shop in a small suburban mall. Two vaccinations are mandated by the Agri Food and Veterinary Authority prior to sale and I visited him in this severe acute respiratory syndrome (SARS) climate to let him know that dogs don't get SARS.  SARS dominate the news every day as there is no prevention by vaccination against the SARS coronavirus. 

The pet shop owner judged a veterinarian's competence on success. Results of success in treatment are what his clients want when he recommend a veterinarian to them.

In the pet shop owner's point of view, the knowledge, skills and training of the vet who performed the spinal disc surgery were suspect when the dog was not able to walk after the surgery.

The chances of success depends on the extent of injury, how soon the surgery is performed and the competence of the veterinarian.  In the U.S, most cases are performed by the University veterinary teaching department where there is specialisation, money and equipment to do neuro-surgery. As more cases are handled, competence is gained.  Singapore does not have specialists in canine neuro-surgery.

A website, details various experiences of dog owners with Dachshunds suffering from intervertebral disc diseases. There are success stories of surgeries and successes without surgery. Surgeries cost a lot of money and many owners just can't afford the fees. One write claimed that Australian veterinarians in Australia seldom perform surgery and 90% of the cases recover with strict cage rest for six weeks, lots of tender loving care and medication! 

Many Singapore owners of paralysed dogs in Singapore usually do not know what to do when their dogs are paralysed in the hind limbs. This educational article may help them decide on the best course.

Dachshunds with their long bodies get chrondodystropy (brittle spinal discs).  Old Pekineses may suffer from calcified spinal discs.  Jumping up and down sofa sets and running up and down few flights of steps daily for apartment dogs cause damage to the spinal disc. The first sign will be that of the dog unwilling to climb up or down stairs at around age 5 years.

Sometimes, the owner present the dog with a complaint of "not eating much." In one case, the fifty-year-old owner came to me for a second opinion after complaining that the vet who could not speak his Hokkien dialect and had to use the nurse as an interpreter had diagnosed kidney and liver disease, the need to do blood tests, X-rays and the possibility of an operation.  What the vet meant was that there was a need for more detailed test and these would mean extra expenses.

"How come the dog is still not walking?" he phoned me three days after the Prednisolone injection. He could not understand that the dog needed crate rest (confined to a cage except for passing stools and urine) for at least 2 months and re-examination. Intervertebral disc disease is easily diagnosed based on symptoms and examination. X-rays of the spinal disc were out of question as it would add to the cost and most owners want the least cost treatment, meaning less than fifty dollars.  After all, a general practitioner in human medicine charges around twenty to thirty dollars for a cough and cold case.

Sometimes, a house call may be needed for paralysed dogs.  One day, a housing agent phoned me to make a house call to an American lady whose paralysed dog passed blood in the urine.

"How much will you charge?" he asked. House calls are time consuming and the charges of $50 may be affordable.

"I charge $50 if the lady permits me to take some pictures of her dog in a wheel chair for educational purposes to benefit dog owners on the web.  There is a shortage of such educational material in Singapore."

"It's a deal," Gary called back. He was a close friend of the lady. Hence the pictures below for Singapore dog owners.

This Lhasa Apso, much loved by the lady, was operated in the U.S at around $3,000 (I presume it is US$3,000) four years ago and had never recovered her ability to walk.  This would be a case of "After spending so much money, the dog is still paralysed" but she did not blame the veterinarian as she
paraplegia in Lhasa Apso, Singaporewas educated and well informed.

She got her dog wheel chairs from However, the management of the paralysed dog is very important. The owner is aware of the problems of urinary stasis and expressed the urine out of the bladder daily direct into the toilet bowl. She held the dog firmly and massaged the bladder. Urine flowed into the toilet bowl. I was impressed as I had not thought of this method to advise other owners. "People may laugh at me," she said.   

I had asked her to collect the urine so that I could see what was passed out.
paraplegia in Lhasa Apso, SingaporeThere was a large piece of bladder mucosa of around 1 cm x 1 cm in size in the dark coloured urine kept in the bottle. Why was the mucosa detaching from the bladder was a mystery to me. Could it be her frequent expression of the bladder? I advised that the dog drink more water. I forgot to ask her how she managed the lack of control of passing stools.

Antibiotics were given. The dog was given a dextrose saline injection as that was what her vet used to do.

"Why can't the manufacturer produce a flat board so that the hind legs and body rest on the board instead of going through two rings?"  the lady asked.

This sounds logical as it is quite troublesome to have to put the legs into the rings. 

"Most likely, the dog will develop pressure skin sores," I said. "Friction between the lower part of the body with the board will be there when the dog moves."  The contraption produced by fitted this Lhasa Apso who could move freely.  On further thoughts, the bladder would be leaking urine continually as the dog moved due to friction from the board and the urine would cause skin sores.

The Lhasa Apso dragged herself on the marble floor most of the time. "This will lead to some skin sores on the lower part of the body," I said to the owner.

"Some parts of the abdomen nearer to the bladder area have become hyperpigmented (more melanin pigments deposit on the skin due to friction with the floor or the dog licking the area). 

This Lhasa Apso looked very young but she was around 8 years old. It was good to know that the lady owner cared so
paraplegia in Lhasa Apso, Singaporemuch for the Lhasa Apso which would have been euthanased or have died of urinary bladder infection long ago since many owners don't know how to manually express the urine from the bladder. 

Preventing the soiling of the body due to the lack of control of the bladder and bowels is very important in the care of a paralysed dog as the skin becomes inflamed and infected if there is no regular cleaning.  Prevention by not giving snacks to the dog leading to weight gain, not permitting the long-bodied dogs to jump up and down furniture and run down stairs over the years are easily said than done. 

In mild first-time cases where the vet can detect pain proprioceptive reflex when pinching the skin of the toes and the dog can feel its paws when they are placed on the table edge, corticosteroids and enforced crate rest (no jumping or running around) for 4-8 weeks, exercise restriction, massage and physical therapy such as whirlpool bath (hydrotherapy) may be all that is needed to recovery.  If no pain reflex is detected, the dog has severe IVDD and surgery may be needed although there is no guarantee of success. 

Virginia Maryland Vet Teaching Hospital - Intervertebral disc disease

Dachshund - patient of Virginia Maryland Vet Teaching Hospital in 2002
Sam had IVDD (intervertebral disk disease) and recently had surgery at the Virginia Maryland Vet Teaching Hospital. He is recovering well and is going home in a dog-on-wheels cart for help with mobility until he has full use of his back legs again.

Blood in the dog's urine and urinary tract infections:
Possible causes are:
1. Urinary tract infections (Fever is usually present).
2. Urinary crystals or stones (Stones scrape urethra).
3. Trauma (Injury - internal organs including bladder).
4. Tumours. Old dog. Bladder, Kidney, Prostrate, Others 
5. Toxicity. Swallow rat poison.
6. Tick bite babesiosis.
7. Prostrate infection. (Palpation of enlarged prostrate).
Consult your vet promptly as delays may lead to the death of your dog.

More interesting Singapore canine cases from the past years at Toa Payoh Vets are at:
Be Kind To Pets
Veterinary Education
Project 2010-0129
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research

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