Kerry's Bert 1/18 Surgery 6 wks— UK

Hi and welcome to Dodgerslist.  Everyone here has a dog with IVDD so you have come to the right place.I am going to ask a few questions to help us understand your dogs situation better.

☐ What is your dog’s name? Your name, too? I am Romy.

☐  Is the vet a general DVM or a specialist (ACVIM neurology or ACVS ortho)?

☐ What was the date you saw the vet?

☐ Let us know you are on the same page about crate rest. The hallmark component of conservative treatment is the crate rest part. With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. That 6 weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. Super tried and true tips for setting up the recovery suite:
www.dodgerslist.com/literature/CrateRRP.htm
STRICT means:
- no laps - no couches
- no baths - no sleeping with you
- no chiro therapy - no dragging or meandering at potty times.
    Carry to and from the recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! www.dodgerslist.com/literature/slingwalk.jpg

☐ Is there still currently pain - shivering, trembling, yelping when picked up or moved, reluctant to move much or slow to move, can't get comfortable, tight tense tummy? Full pain relief is expected in 1 hour and stays that way dose to dose. Alert your vet about pain! Studies have shown a correlation between less pain and faster recovery from disc injury.
www.ncbi.nlm.nih.gov/pubmed/16542131

☐ How much does your dog weigh?
Please list the exact names of meds currently given, their doses in mg’s and times per day given? What was the start dose if on a steroid, date of taper?
    Please include an all important stomach protector such as Pepcid AC. Phrase the question to your vet this particular way:" Is there a medical/health reason for my dog not take Pepcid?" If there is no reason, we follow vets who are proactive against not eating, vomit, diarrhea, bleeding ulcers by giving doxie weight dogs 5mg Pepcid (famotidine) 30 minutes before the anti-inflammatory.

☐ Currently can your dog wobbly walk? move the legs at all? or wag the tail when you specifically do some happy talk?

☐ Can your dog specifically sniff and squat and then release urine or do you find wet bedding or leaks on you when lifted up?

☐ Eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood?

☐ If there is pain or neuro diminishment, dogs can benefit greatly with acupuncture or laser light therapy. These therapies can be be started right away to help relieve pain and to also to kick start energy production in nerve cells to sprout. So if this therapy is in your budget, seek out a holistic vet.
www.ahvma.org/find-a-holistic-veterinarian/

Why Chiropractic is not recommended for IVDD dogs: www.dodgerslist.com/literature/chiropractic.htm

Excluding an emergency of pain not being controlled or diminishment of nerve functions that require prompt vet help, we have excellent resources for many IVDD questions members have. While you are waiting for a reply, do check out our "All things IVDD" resources for getting the recovery suite setup to an overview of just how Conservative Treatment works:
www.dodgerslist.com/literature.htm

Am I correct in saying that when you first took him to the vet he was just having problems with the stairs but now he is wobbly walking?  If so, his neuro functions are diminishing and you should take him to the vet right away.

The crate rest is very important. It is the foundation of the conservative treatment. Dogs who have never been crated before sometimes have a problem adjusting. This link talks about emergency crate confinement and offers techniques to help a dog that has never been crated adjust: www.dodgerslist.com/literature/EmergencyCrate%20Training.htm#Emergencyconfinement

What meds are used currently? Please include dosages and how frequently given.

Is Bert currently showing any of the signs of pain that I mentioned yesterday?

Let us know what the vet says today and that you are now doing Strict crate rest.

Kerry you need a vet who is willing to be aggressive an anti-inflammatory with loss of neuro functions.

Is surgery an option at any point for your family?

When there is neuro loss, the lessor of the anti-inflammatories the NSAID like Loxicam are not usually continued with.  The most powerful of the anti-inflammatories the steroid class is considered.  With emergency of loss of legs, then a vet may deem it worth the risk to dispense with the usual 4-7 day washout in order to save nerves from permanent damage.  THIS IS VERY IMPORTANT: not only would Pecpid AC (famotidine) be on board as it would with use of any NSAID or steroid but also sucralfate as double protection from the double jeopardy of no 4-7 day washout.

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

what the ref card looks like:


Discuss on the phone your concern with neuro loss and use of steroids now with DOULBLE stomach protection: Pepcid AC plus Sucralfate for a switch to the steroid Prednsone

How much does Bert weigh?

Even if surgery is not an option for  your family, a consultation with a board certified neuro (ACVIM) or ortho (ACVS) can help to get the meds on board your local general vet is not comfortable in using. A 2nd opinion vet is never a bad idea.  A down dog is term considered an emergency and you may not need a referral to a specialist if you can't quickly get in with another 2nd opinion local general vet.

Look into Care Credit now just in case things go into crisis mode and surgery is needed. It is best to know all your options, financially and where surgery would be done, ahead of time rather than scrambling for that information in an emergency. No or low interest credit for veterinary costs can be obtained from Care Credit. You find out online if you qualify:
www.carecredit.com/faqs.html

Board-certified neuros (ACVIM) and ortho (ACVS) surgical specialists can be found at University vet teaching hospitals. Find Veterinary surgeons (ACVS) and neuro surgeons (ACVIM) here: find.vetspecialists.com

www.dodgerslist.com/literature/surgerycosts.htm
www.dodgerslist.com/literature/healingsurgery.htm

Do know that Bert could still heal both his nerves and the disc with continue conservative treatment. The best pain control during a disc episode, as in people, comes with multimodal pain management: using more than one approach that addresses pain from multiple fronts (Tramadol, Methocarbamol and gabapentin). It would be imperative that his pain is completely managed with pain meds being on board. Before discussing pain meds, these articles can give you good background information:
www.dodgerslist.com/literature/healingpain.htm
www.dodgerslist.com/literature/healingsweling.htm

Please keep up in the loop on the meds getting on board soonest... time/hours matter when nerves have been damaged to get proper vet help.

This can't wait for two days!!! Thank you for telling us your country, it helps us to better understand how to support.

Nerve damage needs prompt response. The term "Down" dog means to any IVDD knowledgeble vet an emergency to deal with now, today, with haste!

He may not need surgery, he may be able to heal his nerves under conservative treatment many dogs can.

Once nerves are not relieved of pressure with proper anti-inflammatory drugs or via surgery, the longer they are under pressure more nerve cells die as chemicals are released... a kind of cascading death effect. That is why time matters... hours matter to get vet help.

Do you have another vet in town or the next who might be more IVDD knowledgeable, might be comfortable in using the most powerful of the two classes (NSAIDs and steroids) using the steroid prednisone at the usual anti-inflammatory dose of 5mg 2x/day for a typical doxie weight.

About how much does Bert weigh?  about 3.63 kgs   4.5kgs?

Pepcid is only available via prescription in the UK so you would need to ask for one from the vet. Ranitidine, a different acid reducer, is available over the counter at the chemist there in the UK. Doses:
www.petplace.com/drug-library/ranitidine-hcl-zantac/page1.aspx and
www.1800petmeds.com/Ranitidine-prod11204.html

Specialists do have emergency hours. Explain dog has lost leg and bladder function, they will recognize this as an real emergency and likely will not require a referral.

When you are there be up front with the surgeon if you would consider surgery or if you are there for a consultation on the right meds your local DVM vet was not comfortable in prescribing.

Don't know your city so maybe some of these are doable?  Information comes from our members recommendation directory: www.dodgerslist.com/literature/surgerycosts.htm  

Six Mile Bottom, Cambridgeshire www.dickwhitereferrals.com

Eastgate Veterinary Group
Mildenhall
mildenhall@eastgatevets.co.uk

Halfway Lane, EashingGodalming, Surrey
www.fitzpatrickreferrals.co.uk/
tel: 01483 423761

615 Wells Road Whitchurch Bristol
Tel: 01275 838473
www.highcroftvetreferrals.co.uk/orthopaedics

615 wells road, Whitchurch, Bristol, BS14 9BE
www.highcroftvetreferrals.co.uk/orthopaedics

near Potters Bar in Hertfordshire
www.rvc.ac.uk/small-animal-referrals/

Torrington Orthopaedics IES House Brighouse West Yorkshire HD6 1NQ U.K.
Telephone 01484 404770
www.torvet.co.uk

Good job Kerry, you ARE on top of things!! Will be waiting back for further update.  It is mid afternoon now in the USA while 8pm ish in the UK.  time zones

Ok. Too bad though they could not see you tonight!

If surgery would be a consideration for your family, you will want to have a good background in order to learn as much as you can from the neuro, understand what he shares and ask really good questions and be fully informed about surgery. Excellent reading even if surgery is not an option:
www.dodgerslist.com/literature/healingsurgery.htm

Dr. Isaacs (ACVIM neurology) answered alot of questions we've had about surgery: "Surgery needs to be a decision an owner enters into recognizing the risk, but also recognizes the benefit. This way if something unforeseen occurs an owner can be comforted and at peace with the fact that surgery was the right decision and they did all they could for their dog.  "All in all, there is not a wrong decision. It is more a matter of entering into a decision with all the facts and then being at peace with the decision. The next step is talking with your neurologist about options to facilitate an informed decision." You will find it worthwhile to read the rest of his comments about surgery: www.dodgerslist.com/literature/surgery.htm

Never be disheartened if you choose conservative treatment.  Davies Veterinary Specialists confirm what we see all the time on the Forum: "Although surgical treatment is often preferred, 4 out of 5 dogs that are weak or paralysed in their back legs will make a good recovery without surgery provided that they have good sensation in the affected limbs." vetspecialists.co.uk/factsheets/Neurology_Facts/Slipped_Disc.html

We will be here to support you with conservative treatment or surgery. And we await hearing what the specialist shares with you tomorrow: exact details of meds (name, mgs, frequency) to fully control pain when moving or pain from trembling. And protection of the GI tract with prescription famotidine or over the counter Ranitidine from your chemist.

When there is loss of bladder control, there will be a need to manually express the bladder. Viewing the video and reading the tips will allow you to get alot more out of the hands-on- top-of-your-hands lesson tomorrow. how to express bladder: www.dodgerslist.com/literature/Expressing.htm
how to express for poop: www.dodgerslist.com/literature/Expressing.htm#poop

Loss of bladder control is evidenced by: leaking on you when lifted. Finding urine leaks in bedding.

Get a good night's sleep, you will have many things on your mind tomorrow....and need a fresh mind. Take care.

I'm glad you were able to work out everything financially, Kerry. You're doing your very best for Bert. My prayers that all will go well with the surgery. Please keep us updated when you can.

Kerry, you know why you are going to do a wonderful job in caring for Bert? It is because you are taking care seriously and will pay attention to details.

A cage is best when transporting. Pad out any extra room with a rolled up blanket or towel. This way his body will not shift as you take a corner or brake.

Jot down all your concerns, questions for discharge day tomorrow. Here's a starter list of questions to which you can add some of yours for the surgeon. That way no question will miss getting an answer in all the excitement of bringing Bert home. www.dodgerslist.com/literature/dischargequestions.htm

This page is good reading by Dr. Isaacs, ACVIM (neurology) as he explains many post-op questions for our IVDD community: meds, crate rest, PT and discharge day. www.dodgerslist.com/literature/surgery.htm#meds

Do let us know what your surgeon directs for the number of weeks of post op crate rest. Sometimes they say 4 weeks and other times the need is for 6+ weeks.

Also what does your surgeon direct for post-op therapy at home for paralyzed legs. It may be some of the exercises in this video:


Let us know what meds Bert is sent home on: mgs and frequency for each med.

The goal during this crate rest period is to minimize his movements. How many steps does he need to take to get outside? If it not too far you should be able to do it now since the vet said you could walk him with a sling.

You mention that Bert is urinating on his own but you still find wet bedding. The wet bedding is a sign of urine overflowing which would mean that Bert cannot fully empty his own bladder. The way that we can test if a dog has bladder control is the "Sniff and Pee" . Let Bert sniff a previous pee spot in the grass. If he urinates right after, that shows a message has been able to travel from the brain to the bladder. If Bert can do this bladder control has returned. You still would need to manually check after urination until you are satisfied Bert can empty the bladder fully. When you are doing this test make sure that the sling is not pressing on the stomach area as that may cause the release of urine. I

When I needed use a sling after my Frankie's surgery the vet suggested a figure 8 sling. You can make one out of two leashes.

www.dodgerslist.com/literature/cratesupplies/Figure8.jpg

It is best to check with your vet before any exercises.

Bladder control may not have returned yet and you can try again tomorrow.  You will have to express him if cannot control his bladder.   Have you had a hands on lesson from your vet?  It took me quite a few visits to the vet to learn how to express Frankie.

Do not be discouraged about this it took Frankie a long time to walk and regain bladder control after his surgery, but he did.  

Can Bert wag his tail?  That is usually the first sign of returning neuro function.  I remember how thrilled I was to see Frankie wag  after happy talk. 

There seems to often be confusion about the term "urinating on his own". I was told this when Frankie was discharged from the hospital after surgery. He was not urinating on his own. He could not empty his bladder. His bladder became overfull and leaked onto his bedding. It was from this list that I learned I needed to express him. I made several trips to my vet to get lessons until I could do it. It was hard but I learned it and so can you.
If his bladder becomes too full he will be at great risk for a UTI and his bladder may become stretched and ay not work properly later on. That is too big a health risk to take. You can call your own vet and ask for a lesson in expressing. I got my lessons from my regular vet and a vet tech.

What is best for Bert is to give him the time to heal. Follow the vets instruction for crate rest. Put him in a standing position as your vet instructed. Ask your vet about acupuncture and laser therapy. When crate rest is over consider water therapy. That helped Frankie a lot. He walked on an underwater treadmill. Here is a vido that show how it is done:


Here is a link that show how water therapy can be done at home. You can do this when you vet approves. www.dodgerslist.com/literature/watertherapy.htm .

Bert has just had major surgery so it is not really surprising that he is sleeping a lot. He will be more awake each day.

My Frankie was in the same condition as Bert after surgery. Paralysed and incontinent. He was exactly the same at the 4 week checkup. My vet suggested another MRI and possibly more surgery. It took months but Frankie regained his ability to walk and his bowel and bladder control.

IVDD is a disease of patience to allow the body to heal on its own terms. Sometimes that seems hard.
It is so early in Bert's recovery. So much healing will still take

Wonderful, wonderful news.