Everything Veterinarians Need to Know About IVDD, PLDA, and Canine Spinal Surgery w/ Dr. Danielle Dugat

Summary

The Veterinary Roundtable

Episode: Everything Veterinarians Need to Know About IVDD, PLDA, and Canine Spinal Surgery w/ Dr. Danielle Dugat
Date: August 4, 2026
Hosts: Dr. Ashlyn Duckwall, Dr. Emily King, and Allie
Guest: Dr. Danielle Dugat, DVM, MS, DACVS

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Episode Overview

This episode of The Veterinary Roundtable dives into the complexities of intervertebral disc disease (IVDD) in dogs, focusing on cutting-edge spinal surgery and especially Percutaneous Laser Disc Ablation (PLDA). Dr. Danielle Dugat, a leading veterinary surgeon and educator, shares her expertise on IVDD’s pathophysiology, breed predisposition, the latest preventive and surgical options, and practical advice for both general practitioners and pet owners. The conversation is lively, educational, and filled with practical pearls, demystifying PLDA and its transformative impact on canine spinal health.

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Guest Introduction: Dr. Danielle Dugat

• Background: Born in California, veterinary degree and residency at Oklahoma State, master’s in biomedical science alongside residency. Board-certified surgeon, author, and former academic.
• Career Path: Fell in love with surgery during vet school; combined teaching, research, and clinical practice before starting her own specialty referral practice (VSCS).
• Contribution to PLDA: Early adopter and leading practitioner, has trained colleagues nationwide in this minimally invasive, preventative spinal surgery.
• Notable Quote:

  “I’m a fix-it person. I’m a scrapbooker and a puzzler, and I like to get things done and I can’t let things linger. So that’s where surgery kind of fits in.” — Dr. Dugat (07:08)

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Key Discussion Points & Insights

1. Primer on IVDD & At-Risk Breeds

[11:30 - 16:59]

• What IVDD Is: Herniation of the disc’s jelly-like center (“like squeezing a jelly donut”) into the spinal canal, causing acute pressure, swelling, and neurologic impairment.
• Clinical Signs: Ranges from pain to paralysis; onset may be sudden or gradual; swelling compromises the spinal cord due to the rigid canal.
• Breed Risks:
  • Dachshunds: One in four will herniate a disc; “go to Vegas and bet all your money it’s a Frenchie or a Dachshund.”
  • French Bulldogs (“Frenchies”): Rapidly increasing in prevalence and severity; malformed spines make presentations intense and early.
  • Other Breeds: Bassets, Corgis, Shih Tzus, Maltese, various terriers, and some larger breeds (less common).
• Pathology: The center of the disc becomes dehydrated, mineralized, and loses elasticity, making rupture possible even with minor activity or at rest.

Notable Quotes

“Dachshunds are 10 times higher risk than any other breed… but now Frenchies have almost surpassed dachshunds.” — Dr. Dugat (14:47)

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2. Prevention & Risk Factors for IVDD

[18:35 - 24:26]

• Large Breed Dogs: More likely to get “Type II” disc protrusion (bulging) vs. “Type I” herniation.
• Risk Reduction:
  • Minimize high-impact activity (jumping from furniture/falling).
  • Maintain lean body weight; obesity is a clear stressor.
  • Supplements (e.g., glycosaminoglycans): Safe, but no solid research on efficacy for discs.
  • No clear evidence that delaying spay/neuter or staying intact reduces risk, but anecdotal observations suggest more muscle mass might be protective.
• Owner Education: Often, IVDD isn’t activity-related—some dogs rupture discs while sleeping.

Notable Quotes

"Unfortunately there’s not a be-all, end-all to prevent a disc herniation… except like the surgical procedure that I do." — Dr. Dugat (21:21)

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3. Percutaneous Laser Disc Ablation (PLDA): The Procedure & Its Promise

[25:49 - 34:59]

• What Is PLDA:
  • Stands for Percutaneous Laser Disc Ablation.
  • Minimally invasive: uses spinal needles and a laser under fluoroscopy to ablate (“cook”) the disc nucleous at nine key thoracolumbar disc spaces (T10-11 to L5-6).
  • No incisions, very short anesthesia, rapid recovery (walking within 20 minutes, home the same day).
  • Can be done as a prevention in at-risk dogs (from 1 year old), or post-IVDD to prevent recurrence.
• Who’s Eligible: Any breed/size—limited mostly by needle reach, not weight; greatest utility in high-risk small breeds.
• Impact on Dogs: Dogs often act “like puppies again” after recovery; procedure described as having minimal to no adverse effects, as most at-risk discs were already abnormal.
• Accessibility: Currently only available in a handful of locations; Dr. Dugat has trained others but few practices have the equipment yet.

Notable Quotes

“They literally wake up from the procedure and they’re sitting at the front of their cage within, like, 20 minutes… without any effects.” — Dr. Dugat (28:54)

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4. PLDA: Risks, Recovery, and Limitations

[35:22 - 43:19]

• Risks:
  • Rare: potential infection (if skin issues are present); rare neuritis if needle brushes a nerve.
  • Some discs in malformed spines (e.g., Frenchies) may not be reachable, but these are not the herniating discs.
  • One reported prolonged recovery in a Yorkie with additional spinal pathology.
• Recovery: Two weeks of strict confinement, then gradual return to activity; most bounce back rapidly.
• Limitations:
  • Not performed in the cervical spine (neck) due to higher complication rates and anatomical challenges.
  • Not a treatment for all spinal diseases (e.g., lumbosacral, cervical, or late-stage disc disease).
• Cost: About $3,000 at Dr. Dugat’s clinic in Oklahoma; can be double elsewhere. Far less than acute surgery, which can exceed $7,000–$25,000+ in some regions.

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5. Myths, Misconceptions & Best Practice for GPs

[48:20 - 57:02]

• NSAIDs vs. Steroids for Acute IVDD: NSAIDs preferred (fewer complications, less delay to wound healing); many GPs still use steroids.
• When to Refer:
  • “If they can walk, you can do medical management; if not, surgery is necessary—don’t wait.”
  • Delayed referral is the #1 mistake by both owners and vets; prognosis plummets if deep pain is lost for more than 24 hours.
  • Recognizing neurologic deficits: early, careful neuro exams are critical.
• X-rays?: Not useful for diagnosing disc herniation—useful only to rule out other conditions or for surgical planning.

Notable Quotes

“Dogs are not referred fast enough. The moment they are not able to walk and they lose that motor function, surgery becomes the best option.” — Dr. Dugat (49:39)

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6. Practical Tips for General Practitioners

[53:47 - 57:02]

• Neuro Exams:
  • Don’t be afraid; focus on conscious proprioception, spinal palpation for pain.
  • Subclinical back pain often mistaken for GI upset—be vigilant.
• Muscle vs. Disc Pain: Disc pain is overwhelmingly more common in small breeds.
• Imaging: Reserve radiographs for special circumstances (trauma, infection, tumor suspicion), not routine IVDD cases.

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Memorable Lightning Round Moments

[58:32 - 63:31]

• Biggest Mistake by Owners and Vets: Waiting too long; myth that “they’ll get worse before they get better.”
• Most Surprising Breed: Dachshunds—resilient in recovery despite their risk.
• What All Vet Students Should Know: Don’t fear neuro exams.
• Most Rewarding Surgery: Deep pain negative dogs who walk again post-surgery.

Quotes

“Neurology is so cool. It is terrifying to think about.” — Host, Dr. Duckwall (62:22)

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Key Takeaways & Final Thoughts

[63:31 - 64:49]

• Continuous Education: Vets should keep learning about advancements, including minimally invasive options like PLDA; optimal patient outcomes come from strong communication and mutual learning between GPs and specialists.
• PLDA’s Potential: Game-changing for at-risk breeds; can prevent the heartbreak (and financial strain) of acute disc herniation and paralysis.

Closing Quote

“If we continue as veterinarians to advance ourselves to all the new technologies out there, then we will continue to provide for our clients the best medicine that we can practice.” — Dr. Dugat (63:31)

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Important Timestamps

| Segment | Timestamp | |--------------------------------------------|---------------| | IVDD Overview & “Jelly Donut” Analogy | 11:30–13:26 | | Breed Risks & Pathology | 14:10–16:48 | | Risk Reduction, Obesity, Spay/Neuter | 18:35–24:26 | | PLDA Explained: How & Why | 25:49–34:59 | | Eligibility, Risks, & Recovery | 35:22–43:19 | | Myths, NSAIDs vs Steroids, Referral | 48:20–51:58 | | GP Pearls: Neuro Exam, Imaging, Differentials | 53:47–57:02 | | Lightning Round & Wrap-up | 58:32–64:49 |

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Summary for Listeners

This episode is a treasure trove for veterinarians, vet students, and owners of at-risk dogs. Dr. Dugat describes how minimally invasive PLDA can change the natural history of IVDD, empower practitioners with new referral options, and spare countless dogs from preventable paralysis. The episode busts myths, shares pragmatic advice, and radiates hope for the future of canine spinal health.

For more information, consult Dr. Dugat’s clinic (VSCS) or seek out PLDA-trained surgeons in your region as the technology expands.

Transcript

[A]

Foreign.

[B]

And welcome to a special episode of the Veterinary Roundtable, the podcast where we answer your veterinary related questions while having some fun along the way. If you enjoyed today's episode, be sure to leave us a review on your podcast provider of choice. And if you have any feedback to offer to improve the Veterinary Roundtable, let us know. All right, well, you guys can see on the podcast that we are now missing the one and only Courtney Allen. She has had the baby, people. She's had the baby.

[A]

We have another member of the podcast.

[B]

Yes, exactly. So we're quickly adding them as Allie is quickly approaching her due date as well. Next week.

[A]

Oh, next week. Oh, my gosh.

[B]

Yeah. That's crazy.

[A]

So many babies. I love it.

[B]

So, so many, so many babies. So we don't have Courtney to do all the social media stuff and so I'm not going to do it. Duckwall, you go for it. Or Ali, one of you guys.

[A]

I think Allie can do it. You got it, girl.

[B]

You go, girl. Okay. All right. Allie, you go.

[A]

Okay. All right. So don't forget we do have a YouTube channel. So if you don't want to just listen, you want to watch, you can head over there to the Veterinary Roundtable. We also have a text message feature that we can get inquiries and you can record your voice as well. And those are pretty fun. And send those in two. I know that's not as good as mornings, but you did great.

[B]

You did great. That's right. We have socials is the long or the short of it? And you know, also we've got the Veterinary Roundtable live show coming up. I think that it is. I'm so excited about it. I know that I've talked about it before, but I honestly feel like of all the things that happen at conferences, this is probably the one and only thing where I feel like the. Not that. Not that veterinary professionals aren't celebrated across the board, but where things are given in high dollar value to people in the veterinary profession. You know, our sponsors have been very generous with all the donations and we have some dollar dollar bills going out,

[A]

legit money going out, and we have just a good time. I'm just excited. I remember our first live show. It was fun to meet people, but then also all the games and like camaraderie and everybody in Vet Med is great, competitive everybody. So we're going to have some friendly competition and go through a live podcast and special guests. So if this is your first time listening, welcome. But we have a live show. August 16th, Nashville, Tennessee. We will be There with Sarah Parsons, Walter Brown, and Adam Christman, and my lovely co Host over here, Dr. Emily King. Ally will be having a baby, or already had her baby. And it's going to be a good time for 5.99. Get the.

[B]

It's going to be a great time. And I just told Duck Ball today about my case. My case is legit, is so good, and we've never talked about it, so I'm so pumped because there's so many

[A]

twists and I don't even know about the case. Like, she gave me a brief. I don't even know. I don't even know what's happening.

[B]

Yeah. So I'm super excited.

[A]

Okay.

[B]

Okay. Well, let's go ahead and move on because we've got a special guest today.

[A]

She's just being a champ, listening to all of our spiels. So here we go. I know.

[B]

Exactly.

[A]

All right. Born and raised in sunny California. Found her calling in Oklahoma. After completing her veterinary studies at Oklahoma State University's College of veterinary medicine in 2007, she completed advanced training in soft tissue orthopedics and neurosurgery. During her residency, she also completed her master's degree in biomedical sciences. A believer in advancing veterinary medicine, she has contributed over 30 scholarly manuscripts to various veterinary journals. Additionally, she researched insights. Her research insights led her to author a textbook chapter on percutaneous laser disc ablation. Now. Now. As a proud diplomat of an American college of veterinary surgeons since 2013, and after a fulfilling 16 year tenure at Oklahoma State University, she brings her expertise and passionate drive to vscs. As a veterinary specialist, she's excited to provide advanced compassionate services to patients in Oklahoma, the surrounding states and nationwide. Please welcome Dr. Danielle Dugat to the Veterinary Roundtable.

[C]

I'm sorry.

[B]

Go ahead, Dr. Dugat.

[C]

Oh, no, I'm just. It's, it's a pleasure to get to be here and just talk with you guys. I mean, it's kind of, it's kind of surreal in a way. This is my first podcast, so it's kind of a little scary too, you know, but it's fun. I'm, I'm, I'm really excited for it. It's going great.

[B]

Well, I'm just so thankful that Morgan is. Morgan, your technician that works with you?

[C]

Yeah, she's one of my veterinary assistants who started as a receptionist and then moved into kind of the technician role, and now she wants to go to MRI school. So she. We're, we're kind of having to share her, but yeah, she's an amazing individual. So she. I have to thank her for hooking us up to together.

[B]

So, yeah, she's one of our listeners, and so it was great when she reached out and said, hey, I've got somebody. And we always love talking to people across the country because everybody that. That, I think our audience, I think you guys would agree, really likes to learn, really likes to find out the new things that are out in veterinary medicine. The news, the education. And so this, like, just fits perfectly into that.

[A]

I'm excited to learn, too, so I can tell patients about it and refer for it. Like, this is definitely not something that come across my desk, to be quite honest with you. So this is great.

[B]

Yep.

[C]

You're not the first one I hear that from. Probably every week I hear that, like, by now. Haven't I said that enough that it should be out there? But no, it's not. That's. We just keep plugging along.

[A]

That's okay. It'll make its way slowly.

[C]

Yeah, that's my go.

[B]

We'll help spread the word for sure.

[C]

Well, that's appreciated. Thank you.

[A]

Okay, so, yeah, so let's just start off with. Tell us about your journey. I mean, going through your bio is so impressive, especially when it said you got your master's degree at the same time as the residency. So, yeah, please just kind of tell us how did you get to this, where you are now?

[C]

I mean, so, yeah, you know, at a lot of universities or. Or in residency programs, they will have a requirement to do a PhD or a master's. And that was the case when I went through my residency, is it was a requirement to do a master's. So, you know, the nice thing about that is they're tied together. So, you know, the. The topics and the classes that you have to take. But it was a lot of extra work when you think you just had to read one more journal for, you know, clinics, and here we are reading more and more for your masters. So it was a lot to do, but, you know, I fell in love with surgery in my third year of vet school. It was literally very first spay and neuter my partner. And I dropped a pedicle, and it started bleeding. And it was like that holy crap moment. And I have to give credit to my mentor because to this day, he said, what's the first thing you should do? And I was like, you know, we're freaking out. And he's like, take your own pulse. Stop. Take your own pulse. And then think about what you need to do. And so, like, it's. That that was just that rush, you know, And I'm a fix it person. I'm a scrapbooker and a puzzler, and I like to get things done and I can't let things linger. So that's where surgery kind of fits in. And so from that time in third year of vet school, moving forward, nothing excited me except surgery, you know, like, that's what my.

[B]

What.

[C]

Where my blood was boiling. And so then I did the residency and I fell in love with teaching. So I decided to stay at Oklahoma State after the residency. And then after 16 years of teaching, I kind of had some different goals, of course, in mind to then venture out and do this scary thing called becoming a practice owner, which I probably should have, in hindsight, done it 10 years ago, but I was never. I was too chicken to do it, but now I would never take it back. And I just absolutely love where I am today. Amazing. So that's so cool. But those life experiences, you know, going through residency, going through teaching students, and being in academia really help I think too, you know, to grow my ability to manage and own a practice.

[A]

Absolutely. So I feel like if you can teach scared young students, you could do anything.

[C]

Yeah, if I didn't scare myself, you know, with my old personality, then something.

[B]

Right?

[C]

Yeah.

[A]

Awesome. Okay, so.

[B]

So as a, as a.

[A]

Go ahead, go ahead.

[B]

Well, I was going to say as an early adopter of this technique, this percutaneous laser disc ablation, what made you first, like, believe that the procedure had the potential to change how we approach spinal disease? Especially like when we don't have very many people that know about it or talk about it at all?

[C]

Yeah, I think I got fortunate enough that one of my mentors, you know, in my residency and with my master's project was the one who developed this. And so I, early on, from the get go, got to see these cases coming into, we were managing them, coming into the hospital, you know, and so to see the successes of these cases happening, I was immediately like, what is this? I didn't know what it, you know, really what it was. And so then diving into the research of it behind what they did and the papers that were written early and that it was developed from humans, you know, it was nice to see the effects to get to be that, you know, close to those cases versus just reading them in an article and to see how well they did when you did follow ups. I think that's kind of what led me to be that early advocate of it. You know, just being exposed, purely just being exposed to it.

[A]

Yeah, absolutely. So kind of going back to, I guess we. Before we jump into the logistics of the PLDA for our listeners or if there's people out there who don't deal with a lot of neurologic cases, even pet owners, can you kind of give a nice outline summary of intervertebral disc disease and how PLDA would help that?

[C]

Stay with us, we'll be right back.

[B]

Tickets are on sale now for the Veterinary Roundtable Live at WVC Nashville 2026 where we're having the ultimate western themed night out for veterinary professionals. Join us on Sunday, August 16 for a night of absolute chaos in the best way possible.

[C]

Hosted by Dr. Adam Christman alongside special guests Sarah Parsons and Walter Brown, this one of a kind live experience is more than just a show. It's a full on celebration of the veterinary profession and the incredible people who make it what it is.

[B]

Expect an unforgettable evening featuring a special

[C]

live Veterinary Roundtable podcast episode, an interactive game show packed with surprises, a veterinary happy hour with themed cocktails, free food and drinks, thousands of dollars in prizes and giveaways, and more.

[A]

Dust off your boots, grab your cowboy hat and get ready for a night of connection, celebration and pure veterinary chaos.

[B]

Tickets are limited and they will sell out. So grab your friends, grab your co workers and grab your tickets now through the link in the show notes. We'll see you at Cannery hall for the Veterinary Roundtable live at WVC Nashville 2026.

[C]

Yeah, so you know, the simplest way I like to explain to owners is the intervertebral disc disease that really is the one that can become an emergency or that we worry about clinically is what has been formerly or most of the time known as Hanson type 1 disc disease. And essentially what it is is if you think of the disc as a jelly donut. And so there's the outer part of the donut and then you have that jelly center and if you squeeze that donut, all that jelly would explode out. Well, in the case of these dogs, that jelly explodes right into the spinal canal where the spinal cord is living. And in these cases there's not supposed to be anything in that spinal canal. So when that jelly explodes out, it's like walking around with a rock in your shoe for the next week. You're going to, it's going to hurt, it's going to be uncomfortable. And so that spinal cord then gets pressure placed on it, it's compressed, it gets swollen, there's hemorrhage. All of these changes that start to occur from that hit or that rupture is then causing our clinical signs. And those clinical signs can range from being painful in the back to all the way being paralyzed in the legs. And it can be anywhere across the spectrum. It can happen over days or it can happen in two hours. So the timeframe can vary quite significantly. But it's an acute thing that happens. And when it happens, it's to the detriment, of course, to that neurologic system where we see those clinical side effects. And if you think of it like I also explained to owners, getting hit with a 90 mile an hour baseball on your leg, you're going to see that bruising and that swelling and those changes happening over the course of the next couple days. It's not just the fact that there's all that compression on the spinal cord with this big rock sitting in the spinal canal, but it's also that bruise and that hemorrhage, that edema, all of those changes that are happening within the spinal cord itself at the same time.

[B]

Well, and there's no place for the swelling to go because it's just a bony, like, correct tube, if you will. Like, I don't know the best way to, but I mean, like, there's nowhere for it to go. It just all gets like, smooshed.

[C]

That's the beauty of the spinal column and the brain is it's a beautiful protectant, right, with all the bone around that spinal cord. But then when the swelling occurs, there's nowhere for that swelling to escape. And so when I drill into the bone to do surgery on these guys, the spinal cord will sometimes, I mean, it will be bulging out at us because it's being compressed and it's swollen. It's like, holy crap. Escape, escape. You know, I think of it like the spinal cords wearing a bodysuit, you know, and you gotta figure out how to unzip that bodysuit and relieve that pressure.

[A]

So I think most of us are used to seeing dachshunds with ivdd, but are there some other breeds that we should be looking out for as well that this is common in?

[C]

Oh, yes, there are. So, you know, dachshunds are our poster child. Right? If you look at historically at the literature, one in four dachshunds will herniate. That's kind of the mantra. 25%. And there are 10.

[B]

Do that number.

[C]

Oh, yeah. Did you know that number?

[B]

Duckwall, did you know that 21 and 4.

[A]

I'm not surprised. I didn't know that. But I, I'm laughing because that's your favorite breed, isn't it? Dachshund.

[B]

I know, I really like them. They're such snuggle buggies. Like they're just amazing.

[C]

Yes. I own one myself, but yeah, so they're. Dachshunds are 10 times higher risk than any other breed. I, well, I used to say any other breed. So I think now Frenchies have almost surpassed dogs. So Frenchies are a huge one that get this disease and to me when they get it, it's even harder and faster. In their clinical signs, they are way much more severe in their presentation in a quicker period of time than the dachshunds in some of these cases. But a lot of your smaller breed dogs, so, you know, long bodied, short legged, what we call caudre dystrophic breeds. Anyone that fits in that category, of course, the Bassets and the Corgis, all of those. I do see a lot of cotton d tulears. I always screw up that name.

[B]

Right.

[C]

I could see quite a few of those and a lot of terriers, you know, and Chihuahua mixes. So we can see it in a lot of other breeds like that Schnauzers I've seen and like Shih Tzus and Maltese, quite a few of those as well. But you know, your poster child, go to Vegas and bet all your money it's a French Eurodoxin.

[A]

So I'm, I mean, Frenchie's surpassing. Is that because, do you think it's because of breeding and the breed just becoming more popular nowadays or is it truly their skeletal makeup that makes them just more prone?

[C]

I think it's a combination of both, I think because now they're the number one breed. Like they're, you know, so many more. Everybody has a Frenchie, right. I mean, so, so yes, there's a lot more that are owned than when we thought about 10 years ago or even 15 years ago. So that contributes. But they also do have bad spines. I mean they have a lot of malformed vertebrae, they have a lot of mineralized discs just like dachshunds do. So there is a component of their makeup. You know, they're not quite as chondrodystrophic if you think about short legged, long body, but they're in that same category. So they still have the same degenerative discs that dachshunds have.

[B]

So what about the long? What, what, what about the long back from a dynamic like perspective, physics predisposes it to rupturing the discs.

[C]

Yeah. So, you know, with these dogs that, you know, why, what's Happening to the disc. Why are they, you know, being predisposed to herniating? Well, the nucleus and that, that jelly in the center of the disc is under more stress. You know, with their confirmation, those discs in these dogs are undergoing what we actually has been, it's been coined as a chondrodystrophic metaplasia. You know, so it's changes as a result of that stress of being that long body. And so these nucleus or the jelly of the don't. Of the disc are undergoing dehydration. So we're losing water content in that part of the disc, minerals depositing in that part of the disc, and subsequently also some of the proteoglycans that are normally in there. So chondroitin sulfate lives in that disc. It's part of its makeup. It actually alters in its conformation to become keratin sulfate. Well, where do we find keratin? In our fingernails. So it becomes more hard and rigid. So that jelly is not jelly anymore. It's real thick like cottage cheese. You know, we think of it like feta cheese, you know, where it's crunchy, crumbly, dried material, so it's not as pliable. There's pressure now that builds up in that compartment and a combination of all that with the pressure causes that disc to herniate. Which is why these dogs don't have to be running a marathon to herniate a disc. They can be walking down the hallway, you know, or we'll have owners say, my dog woke up and got out of the crate that morning and couldn't walk, you know, overnight. He was fine when he went in the crate. So you don't have to be undergoing heavy activity for these discs to herniate.

[A]

So at clinically like when we see. I guess I'm curious about the large breed portion of it. Is it quite rare? Like when we have a dog come in with back pain, Whether it's a lab, a doodle, those are very common nowadays. I still usually put IVDD pretty high on my list. Right, so is it just rare that it turns into a surgical need to see a neurologist situation?

[C]

Yes. So in general, large breed dogs suffer more from type 2 intervertebral disc disease, which are protrusions. So where the disc bulges and causes back pain. Now when that happens, it is usually in the middle age to older large breed dogs. That's kind of your poster child. And those are different because, yeah, the disc is not herniating. So those are usually non surgical and we usually medically manage those because the surgery options just don't provide good long term success. And so that's kind of your poster child. Now I still though agree with you. I will put IBDD as far as a disc herniation or the type 1 high on my list in some of those dogs too because I've cut plenty of German shepherds. I did a Labrador about a month ago, we just posted on our Facebook page a success story of her. She was paralyzed in all four from a neck rupture and now she's walking a month later and like trying to run. So yeah, I never take it off of the large breed dog list of differentials, but a lot of them do suffer from a protrusion versus a herniation where the disc is still intact and just bulging at a slower rate.

[A]

What would be some advice you would give someone to help reduce the risk of developing ivdd?

[C]

Well, you know, that's a good question because all of my owners I see for laser disc ablation ask me that same question every single day. You know, the, one of the best things that you can do is just think about how can I minimize some of the higher impact exercise or activity. Now when you have a Frenchie and they're zooming around the house, that's hard, right? Where they're like bouncing off the walls. But if you could minimize, I usually say supermanning off the bed, you know, or off the furniture. So jumping off of high, you know, areas, I still think going up and down stairs is fine. But you know, even if you want to minimize some of that high, like running back and forth up and down stairs, those heavy impact activities, jumping up in the air after a ball and coming and crashing back down, those kind of things can try and reduce the incidence. But like I said, also you have plenty of stories of dogs that aren't doing any activity and they herniate. So unfortunately there's not a be all end all out there to prevent a disc herniation from happening. Except like the surgical procedure that I do, you know, otherwise it's modifying the routine a little bit just to minimize some of that high impact activity.

[B]

Does weight play a factor in.

[A]

I was gonna ask that too.

[B]

The increase of incidence.

[C]

I do think, I do think that it does, you know, the more weight you put on your body, you're putting more stress on all your joints. It's the same thing. Discs are like joints. So yeah, I think absolutely they're gonna be under more stress and more prone to potentially herniating. When your dog is more Obese? Absolutely.

[A]

Do you think like a product, like. I know we'll get into the specific, like plda, but you had mentioned the makeup of the disc, so my mind went to Adequin. Um, I don't know if there's something like a product like that. If the, I don't know, people who own high risk breeds is even, would it penetrate to that area? Is that worth it?

[C]

Yeah, I don't know. I mean, it. It works for all the joints in the body. I've thought about that myself too. Or, you know, do you start these dogs at an early age on glucosamine, you know, to just help supplement and keep that healthy chondroitin sulfate in the body? It can't hurt. I don't know. You know, there is no research out there that's been done to measure, you know, any levels of these dogs of, you know, does it slow their degeneration, you know, of the discs at all? Unfortunately, there's no literature on that. But I mean, it couldn't hurt. It's safe, you know, as a product. But, you know, when you have those natural proteoglycans in the disc, you know, as best we can do to protect those, it would be a beneficial way of doing that. Getting owners to, you know, agree to do the Adequan or, you know, glucosamine is sometimes harder, you know, to get them to do that when their dog's seemingly fine or normal. But, yeah, that's a good question.

[B]

Does altering the pet, like, have you guys. Is there any data to suggest that intact animals don't have as many issues as, you know, there's been some research out recently in regards to cruciate ruptures and some things like that, incontinence related issues in some of these patients as we, you know, pursued, you know, elective neutering like. So castration in Spain. Do you see anything, Is there any data yet to suggest any changes there?

[C]

There's not anything out there that I've come across in the literature for disc herniations. I can tell by just my anecdotal experience, we see a lot less intact dogs, you know, that herniate. I feel like their muscle mass is a little bit thicker and I think that might be protective too, you know, with their spines. But there's no, unfortunately, data out there yet. I'm sure somebody might be working on it, but that's a really good thought. I still advocate to wait till, you know, in a lot of those breeds till they're too, you know, nowadays to Spay or neuter, because the benefits of, like you said, osteosarcoma, risk reducing and other major things that we see every day versus the mammary cancer, you know, or testicular cancer, I think outweighs, you know, that benefit definitely outweighs the risk. But no, there's no literature yet that would be a good next study to do, I guess.

[B]

Yeah, there you go. There you go. I think. I think as an og, you know, I've been out forever, so I've seen a ton of cases, and certainly I feel like I see less issues in intact animals as it pertains to cruciate ruptures, as it pertains to incontinence. And like, there's just. It's so fascinating to me, you know, I mean, with the number of patients that you've seen over my career of whatever it is now, almost 30 years. Do you know what I mean? And it's like, oh, connecting all these dots together and that mindset, it's interesting.

[C]

Hard to accept sometimes, you know, but that's. That's. You're right, 100%. I don't cruciate tears. You see so minimal in intact animals. Absolutely. I mean, it's mostly all the, you know, neutered and spayed, you know, spayed and neutered dogs out. A hundred percent agree with you on that.

[A]

I would even add obesity to that list. Usually they're pretty well muscle scored and body condition scored. So that could then maybe translate into what we're talking about too. But. Sure, but we should get onto the good stuff. Well, all of it's good, but I'm excited about plda, so please just, I guess, give us the slew of information. What does it stand for? Because a lot of people. I may not know what it is. And then can you walk us through how a procedure would. How you'd go through a procedure for it?

[C]

Yeah. So PLDA is the acronym that we use, and that stands for percutaneous Laser Disc Ablation. So the best way to think about it is it is the minimally invasive way of doing the same thing that a fenestration does, but we can do it on a larger scale. So a fenestration, you know, is an open surgical way of going into a disc and cutting out that nucleus, essentially, so it's not there to herniate in the future, you know, when a dog goes to surgery for a disc rupture, but you have to take all the muscle down and it's a surgical approach. And so trying to do that for nine spaces in the thoracolumbar spine gets a bit crazy, right? You can't do that. You're usually fenestrating that disc at surgery or the one in front or behind, right? So this is a minimally invasive way of targeting all the discs that are at risk of herniating in the thoracolumbar spine. So we do the procedure from T1011 to L56. So nine consecutive spaces. Those are all the ones, if you look in the literature, that are at risk of rupturing up to 1%. And so what we do is we don't make any skin incisions, but it is a sterile approach. We're in the operating room and we make, or we use a video X ray. So fluoroscopy we're using. So I'm watching the television screen while I'm inserting a spinal needle through the skin, through the muscle, and then into the center of the disc. And once I guide and see that needle in the center of the disc, then from there, one at a time, we'll pull out the stylet and insert a Homeium YAG laser into that needle. And then we cook basically, that disc for 40 seconds. We fire the laser, and it breaks up, or it's an ablation. So we're kind of burning and breaking up all that nuclear material to. And a lot of it comes straight back in the spinal needle as, like, char, you know, as liquefied disc or cooked disc. And so we remove the volume of that disc that's present in that nucleus, you know, of it. And so where that jelly compartment is. So we do the needles placement first, and then we fire one at a time at each disk space. So we can target a heck of a lot more area, you know, cover more area and not have to have big surgical incisions. The procedure itself takes me in a dachshund. I got it down to 14, 15 minutes because they have a beautiful, perfect spine. Like, they were meant to have this procedure, but it's very quick. So needle placement is like, six or seven minutes to get it. And then firing the laser in a Frenchie, it takes me about 18 minutes to 19 minutes because their spines are horrible, because why they have all the congenitally malformed vertebrae. And half the time I'm trying to, like, weasel into a disc that's a V shape because they have butterfly, you know, wings on their vertebrae. So Frenchies are harder, but it's very quick. And they literally wake up from the procedure, and they're sitting at the front of their cage within, like, 20 minutes. Like, hey, what's going on? I'm ready to go, you know, with the procedure. Yeah. You don't get any side effects. They walk out the door same day on their same leash, you know, without any effects.

[A]

That's amazing.

[B]

Oh, my gosh.

[A]

That is amazing.

[B]

What's the effect of preventive. So, like, if you. Like, I'm sitting here. I've got so many questions. I'm like, oh, my God. Okay, so you have a dachshund. Did you. Did you, from a prevention perspective, do it?

[C]

Yep, I did. You did? So I got my. So I had my first dachshund when I met my husband. So he was already 10 when I met my husband, and so I didn't do it on him. But when we got our second dachshund, as soon as he turned one year of age, I did it, and I did it as a true preventative. So there's two scenarios that I do this procedure. The first one is you can do it as a true preventative. They've never had an episode before, and you don't want it to ever happen. You don't want a disc herniation to happen. I recommend those dogs. I will do it when they turn a year of age because I want them to be fully grown, but I want to catch it before those discs get hard and mineralized and have a higher chance of herniating. Um, so that's one category. And then the other category that we choose to do this on is the ones that have already had an episode, whether it was medically managed or they had surgery. Now the owners don't want it to happen again, you know, because we know their risk is high once they have it. And depending on how many discs they have that are degenerative, they're going to get it again. So then they will do this procedure to minimize that risk.

[B]

Well, are you sitting here thinking what I'm thinking? Harrison Branch, you need to sign Moose up right now. Harrison has a dachshund. Just had an episode that Duckwall had to manage that was not. Like, we just medically managed it with rest and, you know, whatever. But I'm sitting here going, oh, my gosh, get that dog signed up. So I don't get another phone call from my son about his dachshund that has. Right. Duckwall. Are you thinking?

[A]

I'm thinking of all the patients that owners be game, like, I've got a family. That's great. Three Frenchies. I'm like, I just. But I. Yeah, this Is amazing. So is there like a weight limit? Is it just to the small breeds?

[C]

No, there's not. There's not a weight limit.

[A]

It's.

[C]

Can I fit a spinal needle, you know, in and have it exposed still? So I can do. The largest dog I've actually done is both a golden doodle and a pit bull. I've done that size and both of those dogs have had previous back surgery and a painful medically managed episodes. And so they already had a history. Um, but I've done it on those. Probably the biggest size, but with a six and a half needle, I could get. Easily with a three and a half inch needle, I could get into a German shepherd. Um, I mean, I just did a disc aspirate for looking for disco spondylitis or disco spondylitis in a German shepherd trying to get infection out of the disc, and I could reach his with a three and a half inch needle. So, yeah, they're not really a size limit. It's just that you don't see a lot of the large breeds that, you know, have disc problems. And then what are. Can they live?

[B]

What. What happens when they don't have that stuff in the disc, like when you preventively remove it? Does it.

[C]

Yes.

[B]

Does it do, like, what happens?

[C]

Well, you know, that's a good. That's another. You guys are asking every single question that all my owners ask me every time they come in. This is like my exam that I do with them. Right. So, you know, that's really a good question. But here's what I try and get my owners to understand is as early as 9 months of age, the discs are already having degenerative changes. So when these dogs even are turning one those that jelly is not normal. So as young as nine months of age. That's why three to five years of age is the prime age when these dogs are seeing us for disc herniations in the thoracolumbar spine. And now we're seeing a lot of Frenchies at two years of age. So, yes, what happens is that a detrimental thing that now that middle part of the disc that's supposed to play an important role, you know, is no longer there. But it's not normal. You know, it's not normal. And when it's not normal and it's degenerative and it's hard, it's firm, it's dehydrated, and that pressure's building up in there, that pressure actually causes subclinical back pain, or what we think is subclinical Back pain. And that's the reason this procedure actually was developed in humans first. So humans, they used to do this back in the day. I don't know if they do it as much anymore because they have a lot of advancements in other techniques, but they would. Men in their early to mid twenties with lower back pain would get the laser disc ablation done. And it's because of the pressure that was built up in that part of the disc. Dogs, I will ask owners, unprompted, you know, how is their dog doing? They will say, my dog acts like it's a puppy again. My dog is more active after this procedure than, you know, I ever thought he could be. You know, I thought he was crazy pants active, you know, leading up to this procedure. And he's worse now. You know, he's more active and acts better, like he's not hurting. And it's really interesting because I think a lot of these dogs live with that subclinical back pain because those discs, they're not normal. Following my own dog, I did him at one year of age. I could see every day, oh, is he going to have any issues? Is he not going to be able to run or play or, you know, alligator roll with my German shepherd? No, he's crazy pants every day. You know, it doesn't. He doesn't skip a beat. So it really doesn't affect them. They actually do. Amazing. They still have all the donut part of the disc, so you still have cushion, you know, in your spine. And the earlier studies followed these dogs out to 16 or 18 years of age because they were all dachshunds at that time. And dachshunds live forever. And so they all did great. They didn't die of, you know, any arthritis in their spine. They died from their heart disease or whatever, you know, old age. So it really doesn't affect them. It's an amazing phenomenon.

[B]

Wow.

[A]

I'm trying to wrap my brain around it. I'm like, oh, my gosh, this is crazy, because I'm. Doesn't the inside jelly absorb a lot of force? Right. Or is that the entire jelly or the donut?

[C]

Okay, well, it's. It's the entire thing. But the jelly can't absorb, and it doesn't do as much when it's dehydrated.

[A]

So, yeah, what's the point?

[C]

So it's not really doing its job as much, you know, as it's. The disease is progressing.

[A]

So what are the risks that you tell an owner when they go through this procedure? Like in the procedure itself. And then I guess post op we kind of talked about it, but.

[C]

Yeah, yeah, yeah. And I usually warn my Frenchie owners that there's sometimes one or two discs that I cannot get if they have the malformed vertebrae because those discs will sometimes be very collapsed or in like seagull wing shape to have like a crazy V shaped disc space. And I just can't physically get my needle in to those collapsed discs. But those are not the ones that are herniating in these Frenchies. We don't see disc herniations at those sites because there's really no, there's no disc there. You know, those spaces are so collapsed or heaven forbid I've even seen somewhere the vertebrae are fused together and there is no space. Right. So I warn owners that I might not get all nine disc spaces. But I still consider it the same success because those spaces aren't going to be the ones that we're worried about. The procedure itself, I don't see any complications other than that during the procedure. I warn them about making sure their skin is extremely healthy. We don't want any potential risk of bringing infection into their spine. So I check beforehand if they're coming. Most of my clients are coming from out of state, so I have their vet when they're doing their initial exams for me to make sure they're pain free. I have them shave an area on their back and make sure there's not a bunch of pyoderma. If there's a whole bunch of red raised bumps, I will not put a needle through those because then I'll just drag bacteria into their spine. So, you know, infection could always be a risk. And then outside of that, I really tell the owners the biggest thing I see complication wise is in that first week within like. So I give them pain meds for three days to. Just because I'm a weenie and I want to make sure they're not painful. But sometimes at day five or day seven, right at the, in the middle or end of that first week, some dogs might act a little uncomfortable, like they're a little tensed up or maybe reluctant to walk or all of a sudden acting a little panty and you know, like, oh, I don't feel good. And so I tell them to give the pain meds for an extra day or two and I call them a day or two after that and the dog's back to being fine. So I think maybe they were a little bit more active than they should have been in the recovery phase. And they Got a little bit. You know, now they're feeling the effects of that. You know, I have. I have had one dog. And I can think, though, because I've been doing this since 2010. And why do I remember these cases? Because they scare the crap out of you, right? So I had one dog that went down after the procedure, and it was a Yorkie, but she also had syringohydromyelia. She also had a couple other congenital spinal cord issues. I think hindsight, I probably shouldn't have done her, because I think I pushed her over the edge. And so she went down. I MRI'd her immediately. I'm like, okay, did I herniate a disc? Did I cause a disc to herniate? I MRI her immediately, and her spine was fine. So I think it was just a lot of maybe the inflammation or the heat from the laser. And with her other spinal disorders, it kind of sent her over the edge. She ended up walking again, but it took her a couple of weeks. And then I had one dog hold his leg up like he was. His leg was hurt. He would hold it up in the air like he had a lameness. The only thing we. Again, MRI'd him immediately to make sure we didn't herniate a disc. Nothing in the. Nothing herniated. Nothing that we could see except a little neuritis. So I always warn owners about, potentially, when my needle's going in, do I potentially hit a nerve, you know, as it's coursing out of the foramen? That would be a risk, but extremely rare. Cause that. That's happened twice, you know, with all these procedures.

[A]

So what does recovery look like for these guys? Like, how long are they out? How long? Restricted.

[C]

Yeah, they're basically. Like I said, they. They're able to walk out the door that same day. I do the procedure in the morning. I discharge them about 2 or 3 in the afternoon just so they have time to recover from the anesthesia. They are able to walk and go out on the lead just like they, you know, walked into the building. But it's strict confinement for two weeks. So my strict confinement, just like we do for. If we're medically managing or having certain, you know, the major surgery, that's normally four weeks is my minimum for that. But it's two weeks in a crate or in their arms on a leash, only to go potty and back in. No running, no jumping, and no plane. You know, basically, strict. Strict consignment for two weeks. Third week is slow, return to normal activity. So they don't go from 0 to 100 on day one, after the two weeks, because they feel fine. These dogs feel fine most of the time on day one, you know, and they don't understand why they're being confined. So as soon as you let them go, they're gonna go. So I take the third week to slowly return them to normal activity and then they're back to play, run, jump, do whatever they wanna do.

[A]

So what about the cervical part of the spine? I feel like I've seen quite a few Frenchies with, you know, cervical issues.

[C]

Yes.

[A]

Is there danger in doing that? Is it just. Cause it's not as common? What's the thought around that?

[C]

Yeah, so we don't. We don't do it in the cervical spine. Um, I will tell you from my personal experience, one of my other mentors and I decided to start doing it in the cervical spine. Once we trained on the procedure back in 2010 and we were getting. We did it on like 10 cases and half of them were coming back very painful. We're having like some major complications. Couldn't figure out why, you know, what was. What was going on. I don't know if it was the confirmation of how those nerves exited, if our needles were hitting, you know, those nerves or not, but they were just not doing well with it. So we kind of ceased doing the cervical spine. Plus you can only get about 3 of the discs anyways before you can't get in because the scapula is in the way and so. Or the shoulder. And so it was hard. You can get C2, 3, 3, 4 and 4, 5, which. They're the most common ones to herniate anyways. But we don't do it in the neck. I haven't had. I just didn't pursue it after that. You know, to do the research and figure out all the ins and outs as to why they weren't doing as well. I mean, good news is neck herniations, they are a real thing, but they are much less common than the thoracolumbar spine. And when neck herniations happen, a lot of them, majority of them can be medically managed because they're just painful and they're not down in the back end where they become paralyzed right away. Can they? Absolutely. Right. They can become paralyzed from neck herniations. It's just not as common.

[A]

Makes sense.

[B]

Would it be fair to say. Would it be fair to say that if you had a dachshund that you did the, the procedure on and then it comes back in for I don't know, a year later or something has something else wrong. Would it be fair to say that it's not the disc that. Can you. Can you. So you can assume that you need to be looking elsewhere for the problem?

[C]

Yep, we've had a lot of those cases. Not a lot, but we've had quite a few that, you know, it ends up that this dog developed lumbosacral disease. That's, you know, Frenchies have really bad lumbosacral spaces. You radiograph a Frenchie's spine and you'll be like, oh gosh, you know, or UCT or MRI a Frenchie and you will probably always get a comment that there's some significant lumbosacral changes, but they're not usually symptomatic from it. They usually don't have an issue. But yeah, usually it's something else going on. I will tell you because I always freak out when I get these owners because they're so, these owners are so diligent, you know, with their patients. They're so in tuned when they come to me for a laserdisc and they're driving from California to Oklahoma, they're in tune with their pet. And so I hear about it if something goes wrong, you know, and I want to hear about it because I want to follow up. But if some of those cases, it's not. Yeah, it's not, it's not a disc herniation or they think it's in the lower back and it's actually in the neck. You know, it's, it's up high.

[A]

So what are we looking at financially? So what does this procedure cost?

[C]

Well, that's a good question. Some of it depends on where you live. So for me, in Oklahoma, we charge $3,000 and that's appointment, blood work, procedure, all of it. So it's right at 3,000. On the east coast, it's double. In Dallas, Texas, it's double even now. So not even four hours for me, they're charging double. So it's, it depends on where you're, where you live. But we charge 3,000 for the procedure and it's a.

[A]

So I think that's good.

[B]

Yeah, I'm just sitting here thinking duckwall, like, I mean, we refer to, you know, neuro and we're gonna do. They don't do that here where we're at. Right.

[A]

Duckweb or sanction certification. Like how do we know who doesn't, who doesn't do it?

[C]

But right now there's only about, there's Only four places. Well, three, I would say, in the US that are doing it, that have, you know, neurologists or surgeons doing it. But I've trained a lot more than that. But they still haven't gotten their equipment. So I trained. So I trained the neurologist that's up in Pennsylvania, Dr. Tracy. I trained him years ago, and he's been doing it for probably eight. Eight or nine years. Eight or ten years now he's been doing it. I just recently, probably in this last six months, trained a neurologist out of San Diego, one out of Georgia, and two in Arizona. I've trained a surgical resident when she finished her residency and she was going to Colorado. None of them have gotten their equipment yet, but they've all come and trained with me on cadavers to get a feel for how to do it, you know, and do it right, which I think is important. So it's not widely available. You have to travel in most of your. Wherever people live to get to it.

[B]

I'm thinking, you know, duck, while when we refer somebody for surgical intervention, it's like $7,000. Like, and you're working on, you know, you're working on one or two disc space. Right. I mean, when you're surgically intervening with the traditional method of finished rating. So, like, that doesn't even include, like, preventing all the things, like, everybody's going to be traveling to you now. Just so you know, I wish they will.

[C]

I mean. So you say 7,000. You're right. Like here it's 5,500 to 6,500. In California, my clients are telling me they're paying 20 to 25,000 for a back surgery. In this or up in the east coast, it's 15,000. I mean, I don't have that kind of money on a credit card waiting for insurance to pay me back. Like, I don't know where these people that much, you know?

[B]

Yeah.

[C]

So it's worth it to me to pay 3,000 and not have to, you know, incur the. Not only the financial cost of a regular back surgery, but all the emotional and what the dog goes through when they become paralyzed.

[A]

That's fascinating. Wow. I have so many people.

[C]

Yeah, I know, I know. I have a map in my front lobby that I created. One of my students, when I was still at Oklahoma State, got me a map so I could put little tags of where I got all my LDAs from. So I kept that, and I write the little clients or the dog's name on it and I put it on the Map where they came from. So I have a map in our lobby of all the places where all these dogs came from, you know, across, including Canada, Hawaii, all over. They come to see me.

[A]

That's amazing. Your reach is fantastic. You're helping so many people across the.

[C]

I mean, just, yeah, just this week I've had California, Iowa and Wisconsin come see me. You know, like, they come from all over and most of my clients are from out of state. And then I'll, you know, get my Oklahoma ones spattered in too, you know. But yeah.

[A]

So, okay, when they're traveling home then, do you recommend, like, it's like playing car. Like, how do you keep. You just do the crate thing and just keep them in there. Okay.

[C]

Yeah, they, you know, we give, we give them paperwork of what, you know, what they need to think about and what to expect. Of course, with traveling, they all bring their portable crates and stuff to stay in the hotel room. And, you know, they're prepared. But yeah, they could drive or they could fly after the procedure and there's no issues with that. So, um, I have one client that called today because American Airlines said that your can't, your dog can't be sedated if it gets on the plane. And she's like, what? You know, so she was freaked out, called me freaking out, like, how can I get home? Like, no, your dog's just on Trazodone. It's fine. It can get on an airplane. Um, yeah, we have dogs fly the next day all the time. Um, most of the clients drive because their dogs won't sweat in inside, you know, in the airplane with their big French knees that they have. But a lot of them drive because they're freaked out to fly, but. Or they can't fly, but yeah, both ways.

[A]

Fascinating. It's amazing.

[B]

Let's talk about some of the myths or misconceptions or maybe just some of the traditional ways that we've, you know, viewed spinal disease like in veterinary medicine. As far as general practitioners, what's your view on non steroidals vs steroidals? And do you have a rule of thumb that if the dog goes down, you have 24 hours? Like, you know, we've kind of been educated by our neurologist that like, listen, it doesn't matter whether it's hour two or hour 16, you have to get it done. You have got to get the pressure off of the spinal cord. If you've lost motor function in that time period, in that 20, 24 hour time period. Can you speak to some of Those things.

[C]

Yeah, yeah. So the first thing with, you know, NSAIDs versus steroids, you will get very opposite. You probably put 10 neurologists or surgeons in a room and you'll have split five and five. You know, are they going to use NSAIDs? Are they going to use steroids? I was trained to use NSAIDs, and I really liked a lot some of the papers that came out by the neurologist at Texas A and M years ago that showed there was a lot more complications when steroids were used. And so, you know, steroids can also delay wound healing, especially at some of the doses that dogs are coming to see me on. And so that can get a little frustrating and scary when we're trying to heal a disc so it doesn't herniate more, you know, in that healing time frame. And they're on a steroid at a. At a higher dose that we got to wean them off of. So I, I personally like NSAIDs, but probably every other case that comes to me is on a steroid from their regular vet, you know, so no matter how hard I try and, you know, educate on steroids versus NSAIDs, I still get both. You know, I get both sides of it, and it's not. It's not horrible, but you can see increased UTIs, you can see increased diarrhea, you can see delayed wound healing with the use of steroids. So I personally stick with the NSAIDs. And, you know, as far as. Probably the biggest frustration I get is dogs are not referred fast enough. The moment I try and stress, as at as many CE events that I've done and education events, the veterinarians is there's two ways of managing right? There's medical management and then there's surgical. Medical management is fine as long as they can still walk if they're strongly ambulatory or just painful, but they're not falling over. When they're, you know, taking one step and falling down, I don't consider that strongly ambulatory. The moment they are not able to walk and they lose that motor function, surgery becomes the best option. Medical management becomes a 50% success rate. Surgery is 90% at that point. And then the next biggest frustration with that is, you know, not recognizing and telling these owners to get somewhere sooner is being able to identify if deep pain is present or not. And that kind of fits. So two things. One is we're just letting these dogs go and we'll say, oh, let's just give it some steroids and give it time. Almost as if it's Got to get worse before it gets better. No, as soon as they go down, you know, the clock is ticking and they're going to get worse in most of these cases or they're going to progress to be pain negative. And now it's been deep pain negative for two or three days and we don't know when they lost it. And now their chances of success with surgery are crap. You know, it's really low at that point. So trying to catch these and get them referred in a quicker manner is probably the biggest thing that I think gets kind of misconstrued, you know, with how to manage these cases.

[A]

So even a little bit of like, how would I describe, like weakness? I don't know, wobbliness, not fish tailing,

[C]

fishtailing in the back end.

[A]

Considered like, you can't walk. Go ahead.

[C]

Yeah. So I usually say if, if a dog can strongly walk across the room but he's paretic or is wobbly, you know, like he's had, I explained to owners, like, you have a dog that's had two or three beers, or you had a dog that had two or three beers and then two shots on top of that. Right. So can they walk? You got to kind of use some of these things. It helps owners, like, oh, okay, I get it. You know, so if they strongly walk across the room, I'm okay with that, even if I like, I see some wobbliness. But if they're trying to walk one or two steps and they're sliding and falling over, I would err on the side of caution and refer that especially if you're going into a weekend where then there might not be as much availability to get them help because I see a lot of those, that they're managing those and then all of a sudden the dog goes down, you know, acutely. And then now here we are two or three days later because they couldn't find anywhere to go and they've been paralyzed now and oh yeah, we don't have deep pain on my exam. Who the heck knows when we lost that pain sensation?

[B]

Okay, let's get into the lightning round, guys. Oh, but wait, before we do, before we do, before we do, I've got to ask a selfish question. Just from a GP's perspective. If you are trying to figure out between whether you have. So I have, this is a two part question. A muscle pain versus like disc pain. And so like on your physical exam and then how do you, what are some tips you could give people to be able to recognize that confidently, which involves then the neuro exam. What is the easiest way you can tell GPs to do a neuro exam?

[C]

Number one, don't think neuro's so scary. It's not. So the easiest things that we look for on our neuro exam is, you know, the most, the earliest neurologic deficit we're going to get that will distinguish a neurologic deficit versus, you know, the problems neuro, or is it a muscular, like an orthopedic problem is do CPs, do conscious proprioception, turn those feet over? Are you seeing any delays? You know, that's one thing. And then another thing is feeling down their spine. So you can distinguish. And kind of, to your point, with muscle pain, a lot of these dogs will first present with an upset stomach, or what we think is maybe an upset stomach because they stop eating or they're a little reluctant to eat and they're hunched up in their belly. They kind of have their abdomen tensed because they're protecting their spine. Then how do you pick up a dachshund or a Frenchie? You pick it up under the belly, right? The owner picks it up and all of a sudden it cries out because it's uncomfortable. Well, that's referred pain because it's putting pressure on the spine from underneath. And so we're treating these guys for GI pain, but it's not. It's back pain, you know, and, you know, between muscle pain and disc pain, I will probably say 9.9 out of 10 of those are going to be disc pain. It's going to be from the nervous system. Muscle strains in the back are so extremely rare. I think if you have like a working dog or, you know, an athletic dog, that would be more likely. So I would probably err that it's probably coming from the back.

[A]

Another question is to I, I always go through, like, obviously we don't use X ray for discs. You just can't. You, you can't use that.

[B]

They're not.

[A]

Do you find any credibility? And like, if an owner's like, I really can't go anywhere. I can't do the referral whatever of like doing an X ray to see if like dis space. Disc spaces are more like narrow. I know I remember that in school from somewhere. But is that like even I want to, like, worth it to the owner's finances to even do that? Okay.

[C]

Nope. I don't, I don't even, you know, because here's the thing. What are you going to do about it? You're going to say, oh, yeah, that disc space Looks narrow. You're. I mean, if they can't go and get referred, even if they can get referred, I'm going to have to do a CT to confirm because that could be a previous disc too, that was asymptomatic or a previous episode. So the only reason I do X rays, to be honest, is to. If I have a case that I'm looking for something else, am I looking for discospondylitis? Am I looking for a tumor that's eating the bone away? Am I looking for something else or a trauma case, you know, a luxation or something in the spine? So I really don't. Because it's not going to change your management plan. I'm a huge proponent of is it going to change what we do. If an owner comes to me and they can't afford surgery, I don't go and do those advanced diagnostics because I'm still going to recommend the medical management, you know, I'm. And treat it that way. So, no, I probably. I don't ever take X rays. I get them all the time from vets and I try and, you know, tell them like that's okay, you know, but they don't really help you, you know, in that regard.

[A]

Can I ask you a random question about discospondylitis? So, yeah, I've had a couple weird cases that ended up being that, but it took time to get to that diagnosis and inevitably one did get referred to find it. But is that one where, like, does. Does it take quite a bit of time to show up on X ray to even have that on your radar? Okay, so, okay, I don't know what my question is, but kind of going through that because, yeah, your X ray,

[C]

X rays, your X ray, or the visualization on an X ray, the things you see, you know, with the end. The vertebral end plates, changing that lags behind their clinical signs. So dogs will be pain. A lot of them are painful. You know, it's just pain. Some of them get so severe that they will actually get neurologic. But a lot of it is usually pain. And so, yeah, if you take an X ray, you could very well miss it. I've had plenty of those cases where we X ray it and we don't really see anything. We do a CT and we can see because that's more specific, you know, and defined. And so you can see that detail on a CAT scan or an mri. But those X rays will definitely lag behind the clinical signs.

[A]

So it's safe to say if it's that disc. It's going to just progress past beyond pain meds because it's to keep going if you're not treating the right.

[C]

Yeah. If you have to. If it's not being treated.

[B]

Yeah.

[A]

Okay. I'm just curious. Those are all right. Lightning round. Alex hanging around.

[B]

You got. Yeah. Allie, you go first, and then we'll just rotate questions.

[C]

Okay.

[A]

The biggest mistake owners make, they don't get.

[C]

They don't get worse before they get better.

[A]

Biggest myth about ivdd.

[C]

Biggest myth. Oh, gosh, I don't know. I had a hard time when you guys, like, gave me these questions to think about it. I was hoping you wouldn't ask me.

[A]

Okay, let's.

[C]

Let me change it. Let me change it. The biggest myth is, you know, that my dog's gonna get worse before it gets better. That would be a good myth. And I would say a biggest mistake is waiting too long to come and see me. Let's change it up and flip flop that.

[B]

I like that. I like that. I like that. What about biggest mistake veterinarians make? Is it also duration, like waiting too long?

[C]

I think waiting too long or misunderstanding, you know, the severity of where they're presenting.

[A]

Which breed surprises you the most?

[C]

Which breed surprises me the most? I think do. I would say dachshunds, because, you know, I used to think that it was so horrible in that breed, and they actually get so severe, but they recover, I feel like, so much faster than some. It's like their body knows that this is going to happen, and I know how to fix it. It's kind of crazy. I would say dachshunds.

[A]

Nice. One thing you wish every veterinary student knew

[C]

how to do a good neuro exam and not be scared. Because I think that leads into, you know, the. The myths or the inability to recognize deep pain or to, you know, refer sooner and have that relationship with your referring veterinarians.

[B]

What's one advancement in spinal medicine you're most excited about?

[C]

Oh, well, of course, plda, Even though it's been around for years. But all the minimally invasive things that we are seeing out there, you know, are definitely things that I think are going to continue to advance in the future.

[A]

What's your favorite surgical instrument?

[C]

Oh, a love kerosene ronjeur. So it's like.

[A]

It's like, I don't know what that is.

[C]

It's a type of instrument that we use in neurosurgery where you can put the foot plate of it into the spinal canal. It touches the spinal cord, but then the top part of it bites the bone away so that you can remove the bone from your window safely without jamming into the spinal cord or drilling into the spinal cord when you get to the end. Yeah, it's kind of a cool gun. That's how it looks.

[A]

You know, I thought of King. I thought of the Dowling retractor.

[B]

Oh, yes, of course.

[A]

Of course you did.

[B]

Of course you did.

[C]

I mean, that is.

[B]

I. Of all the things I ever bought that was. I know by far your favorite.

[C]

Your favorite every.

[A]

Nobody else.

[B]

Yeah, she loves it.

[A]

Of eight other doctors and I'm like, bring it out to my favorite, then. You're small.

[B]

Yep.

[A]

Okay, you go.

[B]

Most rewarding spinal surgery you've ever performed.

[C]

Of course. You know, even just the simple hemilaminectomy where they're deep, pain negative and they're walking again after surgery, you know, when you give them a 50 or 25% chance of ever walking again and they do. I mean, that's when it's rewarding. Or a spinal trauma back fracture, you know, paralyzed dog from being hit by a car and now he's walking again, you know, after you put plates in their spine. That's pretty. That's pretty cool, too.

[A]

It's of kind. Yeah.

[B]

That's awesome.

[C]

Yeah, I would say laser disc ablation, but, you know, that's rewarding. But it's not. I mean, it's not a crazy surgery. You know, it's a quick surgery, but so cool.

[A]

Neurology is so cool. It is terrifying to think about you.

[C]

It's terrifying. You just kind of break it up into little bits and it's really. It's not too bad, you know, when you're doing neuro exam.

[A]

So cool. So do you do other surgeries too, or you're just.

[B]

Do neuro.

[A]

Do neuro. Okay. Yeah.

[C]

Oh, yeah. I do orthopedic, soft tissue and neurosurgery. So, you know, we have to train and all of that in our residency. But then when you go certain places, you can choose to be like, oh, I'm only going to do soft tissue or I'm only going to do ortho. But I choose to do it all because I like the variety every day.

[A]

So cool. Wow.

[B]

Awesome.

[C]

Yeah. Tomorrow I've got laser discs, a TPLO, and an anal sac mass. You know, an anal saculectomy for Agasaka. So I mean, you just. Every day you get something different and that's the fun of it.

[A]

So we'll have to do this again, but then focus on Orthopedics, and then we'll do software.

[B]

Love it.

[C]

I'm down.

[A]

This is great. Okay, so we like to end every episode with the same question. If every veterinarian listening today remembered just one thing from our conversation, what would you hope that takeaway would be?

[C]

Continue to get educated about advancements that are happening, you know, with me and the laser disc ablation, since that's the episode we're in. You know, I get that all the time, where I actually have some neurologists say, don't do that. It's absolutely absurd. There's no science behind it. And that just frustrates me because that's just a lack of wanting to try and open your mind to advancements, you know, that are out there in the literature. So if we continue as veterinarians to advance ourselves to all the new technologies out there, then we will continue to provide for our clients, you know, the best medicine that we can practice. And it starts, you know, with the general practitioner, you know, way before me, and that's how I am so successful in my business, is because I can maintain those good relationships as well with my general practitioners to work together to educate them. And they educate me, you know, on things that they're doing. And that's where I think the highest benefit comes to the. To pay it towards the client and their pets.

[B]

All said, veterinary medicine's lucky to have you and. And all of your skill set and everything else.

[C]

So sometimes I don't feel like that, but, you know, hey, we are. No, it's a blessing to get to do what we do. It's absolutely a blessing. I. I wouldn't. I wouldn't trade it for sure.

[A]

Well, it sounds like you might see Moose King at some point, too, so be on the.

[B]

That's right.

[C]

I'll be on the Oklahoma.

[A]

It's right, everyone. Bring your dog. All right, well, thank you so much for tuning into another episode of the Veterinary Roundtable. Remember, send in those questions and leave us a review. If you enjoyed this episode or previous one, we'll see you next week for another episode of the Veterinary Roundtable.