Surgical Care

OH! My aching back!

Well, it has finally come to fruition that I suffer from a disease I readily see in our canine patients. Fortunately, it is not infectious (so no quarantine needed!) and it can be corrected. Unfortunately, I have had to learn the hard way the degree of discomfort some of our four-legged friends have had to deal with (and quite admirably, I might add) What is this often debilitating problem? Inter-vertebral disc disease (IVDD). Some big words for a relatively little, but much needed and ungraciously overlooked (at least in my case) cushion in our bodies.

What is IVDD

Inter-vertebral discs are the cartilage pads that connect the vertebral bones of our spinal column. The disc's job is to act like a shock absorber and spread out the compressive forces we subject our vertebrae to every second of every day and night. Interestingly, they account for 16 percent of the length of the articulated column in dogs and about 25 percent in humans! They are also one of the organs in our body that consistently show degenerative changes with advancing age. Each disc is composed of two parts: the nucleus pulposus (central part) and an outer anulus fibrosus. The nucleus is a semi-fluid tissue that is maintained under pressure by the encircling bands of fibrous tissue of the anulus fibrosus.

Insidious changes occur to both the nucleus and anulus relatively early in life.  Calcification of the nucleus can occur which decreases its shock absorber abilities which imparts less flexibility of the spine. In humans and pets this is noted by a stiff, and possibly guarded, gait.  Pain is not uncommon either, often from surrounding muscles that spasm. Mircofragmention of the anulus may also occur which allows the nucleus to bulge or escape completely ("bulging or herniated disc"). The nucleus most commonly escapes in the direction of the spinal cord where it may compress nerve roots (nerves that innervate our peripheral body) - usually termed "pinched nerve" - or it may cause inflammation or, worse, compression of the spinal cord. Let me tell you from personal experience a herniated disc HURTS!!! Besides pain, it can also cause muscle fasciculations (not visible to the eye), tingling, numbness, paresis (weakness), or even paralysis.  Degenerative changes can occur in any disc, but the effects are most severe in the regions that are most mobile: the neck and the lumbosacrum.

Who is Predisposed

There are particular breeds of dogs that are genetically predisposed for developing IVDD and they typically fall under the category "chondrodystrophic breeds". Some of these are: dachshunds, beagles, Pekingese, basset hounds, and shih tzus. These breeds have a genetic disorder with their cartilage and bone development, hence abnormally developed discs may form. However, any breed can develop a disc problem, so any abnormal gait ("stilted walk", "holding neck funny"), PAIN!, or any weakness or non-use of a leg or legs should prompt an immediate visit to your veterinarian.

How it's Treated

Diagnosing a pet with IVDD is often straight-forward with information gleaned from the physical exam and, often, survey radiographs.  Many cases are mild and can be managed with anti-inflammatory medication (often steroids, since they are POTENT at reducing inflammation), pain control, muscle relaxers, and most importantly, STRICT REST - ideally, the pet is crated. More severe cases are referred to a veterinary neurologist or orthopedic surgeon where surgery may be indicated to extrude the herniated disc material and then fusion of the 2 adjacent vertebrae. Many of these pets recover remarkably well following spinal surgery. 

After my recent disc herniation, I have a renewed and deeper empathy of the pets we see for neck and back pain. Neurologic-related pain is INTENSE and should not go untreated.  We are here to help diagnose and treat the ones that can be managed medically, and we also have 2 specialty groups, Veterinary Specialty Care and Charleston Veterinary Referral Center, in the Charleston area that provide surgical care for those cases that need it.

What's that lump?

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Dogs and cats are notorious for developing lumps and bumps on their bodies over their lifespans. {Ferrets, guinea pigs, hamsters, rabbits, and rodents are not immune to lump (mass) formations either}. Many of these are benign growths, and often self-resolving, but some may be malignant or infectious in nature so an accurate diagnosis is warranted.

We recommend any new swelling or growth on your pet be examined as soon as possible once detected. We will examine the mass by visual inspection and by palpation. Some common growths may be identified by gross examination alone, for example, oral papillomas and sebaceous adenomas. However, the vast majority of growths need to also have a microscopic evaluation to obtain a diagnosis. This is accomplished by a Fine Needle Aspiration (FNA) of the mass.

Fine needle aspiration is performed in the clinic during most routine exams and sedation is very rarely needed. A small gauge needle is inserted into the growth and gently maneuvered within it. Gentle suction is often applied to a connected syringe. The maneuvering of the needle and the suction help to obtain a sample of the cells that make up the growth. The sample is then delivered onto a slide which is allowed to dry, then stained, and viewed under the microscope. General veterinary practitioners are able to make confirmed diagnoses a vast majority of the time. There are some instances where suspect diagnoses need to be sent to a veterinary pathologist for further identification and/or confirmation.

I try to inform pet owners ahead of time that growths may be "wall-to-wall" cells, so obtaining and observing a cell sample is relatively easy in that case. However, there are many growths where the cells may not exfoliate well or the growth may be more like a blueberry muffin and the abnormal cells are the blueberries that we are attempting to "blindly poke". In these scenarios we may not always get a diagnostic sample (even after repeated sticks with the needle) and so we'll often recommend that a surgical biopsy or complete excisional biopsy should be performed.

It's important to pay attention to any new growth/lump/bump/swelling on your pet and have it examined as soon as you can.  We will often be able to give you a diagnosis of what it is the day we check it out and then lay out a recommended treatment plan.  Many times we'll recommend "watchful neglect", but there are those lumps that may be cancerous or painful to your pet and so the sooner we diagnose the sooner we can manage it.

Is Pet Health Insurance Right for You?

When it comes to insurance, people seem to be in one of two camps: those who love it and those who hate it. For those of you who love it, prefer to pay bills in smaller monthly payments rather than occasional large chunks at a time, or for those that simply have accident/illness prone pets - keep reading!

We recently took some time to really dive into plans from the pet insurance company, VPI, to determine if it could be a worth-while investment for our clients. While there are lots of different pet insurance carriers out there, we chose to evaluate (and ultimately recommend) VPI due to its track record and notable financial underwriter, Nationwide. This said, we're happy to accept any pet insurance plan you choose and encourage our clients to shop around to find the deal that's best for them and their pets.

Before I get into the nitty-gritty of individual plans, let me start by explaining what pet insurance is, and what it is not. In the eyes of the underwriters, pets are treated as possessions and are therefore insured more like cars and less like people. While I personally may not agree with this philosophy, (my dog, Marlie, is practically human!) it does make insurance significantly less complicated. Another aspect to mention is that all pet insurance plans are by reimbursement only. This means you pay for your pet's care at checkout as usual, submit your paperwork, and then the insurance company will send you a check. Plans are available for pets of any age, but have the best coverage and are most affordable if started when your pet is young and at its healthiest.

To help our clients receive the maximum reimbursement possible, one of our receptionists, Lori, is now our official insurance guru. Before submitting your claim, she will scour your pet's medical record and confer with your veterinarian to find the most accurate and beneficial diagnosis to list. With the safety net of insurance, it is our hope that our clients will have the financial freedom to say 'yes' to our veterinarian's best medical recommendations for your furry companions.

Which VPI plan is best for you?

(This is my personal summary of each plan. Please refer to VPI's website: or call 888-899-4VPI for complete information.)

Major Medical Plan

  • Most comprehensive plan with largest reimbursement allowances (typically allows more than enough to have 100% reimbursement for our service prices)
  • Covers injury and illness including chronic conditions, multiple conditions, and advanced diagnostics
  • Covers hereditary issues after 12-month waiting period
  • New plans available for dogs and cats less than 10 years old
  • Plans activate 14 days after application
  • Average premium $15-$40/month based on deductible size, pet age, and pet breed/size.
  • Annual deductible options of $100, $250, or $500 

Medical Plan

(Similar to the Major Medical except...)

  • No hereditary condition coverage
  • Has reimbursement allowancesthat typically will cover 80-90% of our service fees
  • Monthly premium runs a few dollars less

Injury Plan

  • Coverage for accidents only (not medical illness claims)
  • New plans available for cats and dogs of any age
  • Plans activate 24 hours after application
  • Average premium $12/month
  • Flat annual deductible of $250

Cat Plan

  • Coverage for the 15 most commonly seen medical conditions
  • Reimbursement allowance of $600 per condition per year
  • New plans available for cats less than 10 years old
  • Plan activates 14 days after application
  • Average plan $12-15/month
  • No annual deductible

CareGuard Wellness Coverage

(can be added to the above plans)

  • Coverage for wellness exams, vaccines, heartworm prevention, tests, microchips, and +/- spay/neuter/dental procedures
  • Reimbursement allowances will break even for most of our patients
  • Monthly premium $12-22

As with any insurance, there are some products/services/conditions that are not covered in any plan. For VPI, this includes:

  • Food/Nutritional Supplements
  • Congenital/Developmental Conditions
  • Behavior Problems/Training
  • Breeding/Reproductive Conditions
  • Cosmetic Conditions (including declaws)
  • Pre-Existing Conditions

Please let us know if there is anything we can help you with in regards to pet insurance (or anything else for that matter!) If you decide to purchase a plan, please let Lori know and she will be happy to help you with paperwork after each visit.