Nick’s Low Back Pain Update 1

In the first article of this series, I outlined Nick’s initial presentation of low back pain and the therapy he is receiving from his regular vet and his late in life care vet, Hampton Roads Veterinary Hospice. This practice specializes in late in life palliative care to maintain an elderly pet’s comfort and function late in life.

This practice offers selected Chinese therapy including acupuncture and herbal therapy in addition to cold laser and message therapy. They care for Nick in home and a significant portion of the visit is spent interviewing me about how Nick’s condition is changing, a thorough leg hip and back exam, and some coaching while the acupuncture session completes. I recommend this style of care for late in life care. This is the first time I’ve not felt alone with a geriatric hound.

How he’s doing

Nick is facing two problems, gradual deterioration of his hips and lower spine resulting from aging and slow wasting from loss of appetite resulting from pain and possible age-related metabolism changes that cause him to extract less energy from his ration.

Over the summer, Nick has stopped running the fence line and vaulting the porch steps to enter the house. He’s also been doing his toilet along the street fence rather than the customary area behind the shed that is a 100 foot walk so he’s consciously minimizing the distance walked. Over August and September he stopped doing a late night garden prowl with Missy.

His bowls are mostly regular with an occasional poo in an i’ve fallen and can’t get up context and the occasional spontaneous emission while sleeping. He remains in good bladder control.

I’ve taught him to walk up the steps and he has it mostly down but needs some support to compensate for imperfect control of his aft end. The Ruff Wear Webmaster harness has been a good thing for both of us. I can tailor the assistance provided to his needs of the moment allowing him to maintain strength and confidence. Without the harness, I’d have to carry him like a puppy risking injury to both of us in the event of a misstep and fall.

Weight Maintenance

Nick continues to experience slow wasting, mostly as a result of eating less than maintenance on the average. Nick is receiving a high quality grain free food with most of its protein from animal sources, usually salmon or duck flesh and meal plus menhaden meal. Legumes and sweet potatoes provide carbohydrates and fiber without added beet or tomato pomace. Food macronutrient ratios conform to industry standards. Nick is supplementing pot roast which he eats eagerly and packet tuna which he eats eagerly. He receives either cream cheese spread or peanut butter as a pilling aid.

Nick and Missy are eating the same diet and the same amounts roughly. Missy is chubby while Nick is distinctly under weight. Some of Nick’s weight loss is a result of him leaving a small amount of kibble at each feeding but some may result from metabolic changes associated with aging. I try to intercept Nick’s leftovers and offer them later in the evening between meals. This was a matter of teaching Missy some restraint and having a treat for her when Nick was receiving his later feedings.

Nick is a grazer so I have to feed him when he wants to eat even if that is 2300. So I offer about 1/3 of his food in the morning around 9 AM, 1/3 at 5 PM and 1/3 around 8-9 PM with pot roast at 5 and tuna at 8. This has improved his eating. I give his medications at 9 and 9 with the gabapentin at bedtime around 10 to give him the best mobility during the day.

Pain Management

Nick continues to receive 3 primary medications for pain management, carprofen, gabapentin, and Hindquarters Weakness. He also receives PhyCox supplement and GlycoFlex supplement mostly for added glucosamine and chondroitin but each has a different system of anti-inflammatories that is supposed to help maintain hindquarters comfort.

Hindquarters Weakness is a traditional Chinese Veterinary Medicine believed over centuries of experience to be effective at managing hindquarters pain in Chinese draft animals. The formulation Nick receives is from a US supplier that runs an FDA style quality program to verify the purity and potency of China-sourced leaves and roots from which the product is prepared. The Chinese herbs have proved much more effective than the glucosamine and chondroitin supplements. I suspect this is because his food has adequate glucosamine and chondroitin while the Chinese herbs found only in Hindquarters Weakness have a robust anti-inflammatory action.

We started the gabapentin first followed by the Hindquarters Weakness. When we started 2 a day gabapentin, Nick became sedated and showed reduced rear leg control as indicated by a drunken gait with slouching hindquarters.

He’d improve at random. Invariably, each good day was preceded by a missed round of medication remaining in his pillbox, usually the bedtime dose. This suggested that one of Nick’s medications had slow removal kinematics in Nick.

We tested the Hindquarters Weakness first by reducing the dosage from 2 and 2 to 1 and 2. I started with it because I knew none of the ingredients had been FDA trialed to determine kinematics and that greyhounds have slow liver function relative to other breeds.

The dosage change produced no change in sedation and slouching. So I returned to 2 and 2 and reduced the gabapentin to one tablet at bedtime and stuck with it. Nick showed an immediate improvement in alertness, appetite, and walking posture.

At hospice vet’s suggesting, I increased Nick’s Hindquarters Weakness to 3 in morning and 2 in evening. This appears to have improved his mobility. We’ve been on this protocol for about 2 weeks. In that period, Nick has been much more alert during the day, is sleeping through the night, and is waking around 9. He can be a bit rubber-legged in the morning but this walks off in 10 minutes or so.

Flatulence

Since starting added pot roast, both dogs have shown reduced flatulence. It appears that adding some additional meat has shifted gut bacteria and less fermentation is happening in the back end. Of both dogs.