Doris' Maui 7/9 surgery 4-8wks — KIdney - Shih tzu NECK - Hawaii

Doris, welcome to Dodgerslist.

Normally when pain meds ARE keeping pain at bay and you are not seeing a worsening of neuro functions to loss of leg function, then many surgeons would try the non-invasive conservative treatment,

Conservative treatment does not depend on knowing which disc as all are given the same limited movement the recovery suite provides.

Without details we really are at a loss to make comments specific to Maui.

How much does Maui weigh?
steroid, - exact name, dose in mgs and how often given?
muscle relaxer exact name, dose in mgs and how often given?  
stomach pill   exact name, dose in mgs and how often given?

Pain is definatley not being controlled dose to dose evidenced by holding head high. The pain meds are not yet right....there is no tramadol nor gabapentin on board.   Let us know if you are seeing any other signs of pain:  shivering, trembling, yelping when picked up or moved, reluctant to move much in crate such as shift positions or slow to move, tight tense tummy,  can't find a comfortable position.   Arched back.  Holding front or back leg flamingo style not wanting to bear weight, head held high or nose to the ground. Not their normal perky selves. 

Learn about the neck meds and the extra things you can do at home to help:  www.dodgerslist.com/literature/cervical.htm

Is the wobbly walk the front legs or the rear?
Does she hold up her front leg up like a flamingo?

Good reading on surgery vs. conservative treatment so you will have some information under your belt to discuss the best treatment for Maui with him.  www.dodgerslist.com/literature/healingsurgery.htm

Doris, it is clear now with the complete med list and the weight why Maui is still in pain.
== Robaxin likley will not fully control the pain from muscle contractions unless Rx'd at 3x/day.
== Pain stems from other sources not covered at all. Tramadol is the general pain reliever and Gabapentin works synergistically with Tramadol to give the pain relief from neck discs which ARE particularly painful.

If your vet can't consult with the sureon about proper pain relief technique over the phone, then you may need to fly for a surgeon consultation on pain meds that your local DVM is not comforatable in using.

My first choice for my own dog rather than moving/flying, etc is to first use proper aggressive pain meds to get the pain in control. If pain simply can't be brought into control, surgery would be a consideration.

If pain is fully in control, but you are seeing diminishment of neuro functions, that would be another reason to consider surgery.

As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. 
1. Pain caused by the tearing disc & inflammation in the spinal cord
2. Wobbly walking, legs cross <- Maui is here
3. Nails scuffing floor
4. Paws knuckle
5. Legs do not work (paralysis, dog is down)
6. Bladder control is lost
7. Tail wagging with joy is lost
8. Deep pain sensation, the last neuro function, a critical indicator for successful surgery. Surgery can still be successful in the window of 12/24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. So if surgery is an option for your family get to a neuro or ortho asap.

So the hope would be to get pain in control, not see loss of nerve functions. Let Maui have the opportunity to heal her disc over the course of 8 weeks in the recovery suite.

Things you can try:
--- get your vet to use an aggressive pain med approach.  Have him call the surgeon if he is not comfortable in using pain meds as are surgeons on a daily basis.
--- Carafate works to bandaid damaged areas of the stomach which cause signs of not eating, vomit, diarrhea.  Has Mauii had any of those signs to cause use of carafate (sucralfate)?   Pepcid AC needs to be on board whenever Dex is on board.  Dex creates extra stomach acids that Pepcid AC stops.

 Phrase the question to your vet in this particular way: "Is there any medical reason my dog may not take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5mg Pepcid AC 2x/day. Give steroid with a meal for extra protection. Knowledge about each med your dog takes is the added layer of protection. Good link to bookmark and read about Pepcid AC:
www.marvistavet.com/html/pharmacy_center.html

The usual Pepcid AC dose during a disc episode is:  Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours. Give the anti-inflammatory with a meal as added protection. www.1800petmeds.com/Famotidine-prod11171.html

Is the wobbly walk the front legs or the rear OR are all four legs wobbly?
Does she hold her front leg up like a flamingo?

Often it is the breed, the history of the dog and  the way they present themselves at the exam that makes the diagnosis.  Often there is no proof unless there is an MRI.  The vet is correct that anesthesia, positioning the dog for xrays removes the dog's ability to prevent further disc tears as the muscle relax and sleep.  Xrays don't proove a disc episode only help to suspicion it. Not all disc problems show on an xray as they are soft tissue (discs, spinal cord) and not hard tissue like bone which xrays show well. Xrays are used to rule out other disease that mimic a disc episode.  

Doris, mixing the two classes of anti-inflammatory drugs can be deadly! There are warnings on the NSAID and steroid packages to not mix.

You may find this little card to carry with you at vet visits helps to keep all the meds straight as you discuss things with the vet. D/l and print here: www.dodgerslist.com/literature/MedCard.pdf




We'lll be waiting to hear back from you to support you with surgery or continued conservative treatment.

Doris, very glad to hear the surgery went so well and pain is gone.

So Maui was not sent home on any medications because there is no pain. Or pain meds are keeping post op pain at bay?

An entire family room to move in might be a bit too much as dogs will to the unexpected. Jump on the side of the wall to see what is flying past the window. Dart off towards the door when a TV doorbell rings.

Texas A&M explained to their clients about restriction in this way: Many clients are confused as to why exercise restriction is often necessary after spinal cord injury in veterinary patients. Vertebral column injury and surgery can disrupt the normal stabilizing structures of the spine such as muscles, bone, joint capsules, and the intervertebral disk. Excessive, unrestricted activity after surgery or certain injuries can lead to vertebral column destabilization and prolonged healing of the injury site. The intervetebral disk, in particular, is very slow to heal and healing may be incomplete; excessive vertebral column motion after disk surgery may therefore lead to recurrence of disk herniation. 

Many dogs who can walk,  the PT the surgeon directs IS a walk to and from the potty place. PT is different than free ranging in the family room. PT is always controlled, that is with a harness and leash so the dog does not dart off in a run. PT is slow and deliberate.

 A harness and 6 foot leash will control speed and keep footsteps going slowly. An ex-pen in the grass or some of that poke-in-the-ground garden edging fencing is an excellent alternative once you have walked her slowly to the potty spot, so that Maui can sniff around a bit before the "job" yet not run off on you.

Doris, you are wise to call the surgeon again if you think there is pain. Are you giving an antacid with the steroid. Could she be overdoing that is making her sore.

Called the surgeon. She said to continue the Prednisolone 1/2 tablet (5mg) once a day for 2 weeks then taper off every other day for a week. Thinks she just needs to be on it longer. Fingers crossed this works!

Trish, thanks for sharing! Sounds like Chi Chi had the same exact problem as Maui does. Yes, I definitely figured out that you can't let them have much space. I thought I had everything "Maui" proof by taking all the furniture out of the family room that she could jump on but I left the coffee table in the room and she decided to jump over the iron bar underneath it. It was only a few inches off the ground but that taught me to keep her in her crate with just a little fencing so she can go in and out with no possibility of getting into trouble.

I am glad to hear Chi Chi is doing so well. Do you still keep her from jumping? Maui jumped up and down on the furniture all day long and I am at a loss what I am going to do once she recovers!

Hi Doris,



Just to let you know, it isn't a good idea to bathe Maui until after crate rest is over. She is still in the early healing stages after her surgery. It takes 6 weeks to heal from surgery and it takes 2 weeks for the surgery swelling to subside. A slippery wet dog is a recipe for disaster and dogs always do the unexpected. It is better to use sensitive skin wipes or brewed green tea, that has been cooled to wipe Maui down. It soothes skin, prevents urine burns and has a pleasant smell. A wet dog always does a full body shake which isn't a good idea right now either.  Our Surgeon told us not to bathe our Tyler until 8 weeks after surgery.  

Good news that she's not limping anymore, Doris! I'm sure you're doing your very best for Maui. It's difficult when you receive conflicting information. What we share here is what the moderators have learned over the many years that Dodgerslist has been online and the many thousands of dogs we've seen come through the forum. We've seen far too many dogs injured when bathing too soon after surgery so I'm glad Pauliana picked up on that and warned you of the risks.

Rather than giving Maui extra space outside of the kennel where she can have too much movement, a better way of preventing her from climbing the sides of the kennel is to lower the ceiling of the kennel. Just take some cardboard, cut it to the same size as the top of the kennel, punch holes in the corners and tie with string down inside of the kennel to change the height of the kennel to Maui's height when standing. That way she can't jump up. You can also try just placing a towel or blanket over the top of the kennel letting it lie down the sides to Maui's eye level. That way, when she stands on the sides of the kennel, she won't be able to see out so that should stop her from wanting to do it. It also gives a nice calming den-like feeling that a lot of dogs like.

The note from the surgeon says that you should follow the rehabilitation instructions. What instructions did they give you for that?

OK, thanks, Doris. Surgeons usually prescribe some type of physical therapy following surgery but since Maui has no neuro deficits and can walk, most likely he will just want her to gradually build up her strength by increased walking once her crate rest has been completed.

Doris, I found a link to typical blood chemistry panels which does show the normal blood levels for bun and creatitine levels www.bichonfriseusa.com/caninebloodwork.htm Have your vet do an x-ray on the shoulder as arthritis should show up on an x-ray.

London - Schnauzer shoulder sprain
Just when I thought things were getting better as far as Maui goes, our white Schnauzer, London, started limping on his left front leg to the point this evening where he would not set it down. Rushed him to the vet thinking another neck problem...but the vet said it is a shoulder sprain. Question:
He was given a injection of Dexamethasone 4mg tonight and some pills. On further examination of the pills I see they are 25mg Quellin [carprofen] which is a NSAID. I am confused. I thought steroids and NSAIDs shouldn't be mixed? Is it ok to have an injection of Dexamethasone and then the next day start on the NSAID? I am to begin giving him these pills in the morning. Sorry this isn't a disk related question but I know the mods can clear this up for me.

Doris

London - Schnauzer shoulder sprain
Thank you so much Paula, for confirming my fears. Without this website I would have not known the dangers. This is the 2nd time I have caught a very serious problem with medication this vet clinic has provided. London is walking fine this morning. I crated him. Should I wait 4-7 days and then give him the Quellin? Last night as soon as my husband brought London home I Googled the Dex and Quellin. Found a case where a pet owner said her dog bled to death from the nose and mouth after mixing a steroid shot with similar medication. This clinic will not be receptive to me confronting them about mixing the two. I am just a couple months from moving back to where the other clinics are. I can not wait as I feel so incredibly helpless here trying to take care of my 3 aging dogs.