Melanie & Penny
New Member
FEMALE - Beagle/corgie . heart,seizures
Posts: 19
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Post by Melanie & Penny on Jun 2, 2017 22:08:31 GMT -7
Hi all!
So so glad to have found this forum!
★1 My name is Melanie and I have a tiny beagle / corgi mix named Penny. She's between 5-8 years old (no one knows for sure, she's a rescue). ★2 Penny was diagnosed with IVDD in multiple discs in her neck via an MRI. She herniated a cervical disc laterally - which was causing her intense nerve root pain. After trying 4-weeks of crate rest with no improvement, our only option was surgery. We consulted with our regular DVM first, and were referred to a DVM with a specialty in Neurology, and a Board Certified surgeon with a whole slew of acronyms after his name MRCVS, DACVS, DECVS, did the surgery. They had to go in laterally to remove the disc material and stop it from pressing on her nerve root - a surgery no one at this particular center had ever performed previously. ★3 Penny's surgery was on 5/30 - but we only just picked her up from the surgery center this evening. She is currently on 6-8 weeks of crate rest. ★4 She does not seem to be in pain when resting in the crate or moving around inside, however - she just yelped getting into the posture to evacuate, which is worrisome. Controlling her pain has been difficult throughout this whole ordeal. ★5 Penny weighs 16.5 pounds. She is currently on Gabapentin 75 mgs (3x a day), Tramadol 50 mgs (3x a day) and Prednisone 5mgs (2x a day) for 7 days, then taper to 1x/day for 7 days, then 1x every other day for 7 days. with Pepcid (10mg 2x a day). I don't have the mgs at hand.
[Moderator's note, please do not modify: 16.5 lbs Prednisone as of 6/2: 5 mgs 2x/day, for 7 days, then taper Gabapentin 75 mgs 3x/day Tramadol 50 mgs 3x/day Pepcid AC 10 mgs 2x/day]
★6 She has been eating and drinking well since she got home. No issues urinating, just uncomfortable when posturing. ★7 Penny is fully ambulatory. She has never had any paralysis of any kind. Surgery was required as her pain was excruciating and uncontrolled and the disc would not recede after 4-weeks of crate rest. ★8 She also has full bladder control.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jun 3, 2017 6:32:59 GMT -7
Melanie, welcome to Dodgerslist! Never have any patience with pain. Call the surgical center and give feed back about the pain related to potty time. There IS more a vet can do get pain fully in control, but they will only know they need to take action if you report and advocate for Penny.
It can take about two weeks for all the surger caused painful swelling to subside, so in the meantime Penny needs to be in comfort.
Let us know what changes to the med list the vet makes.
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Melanie & Penny
New Member
FEMALE - Beagle/corgie . heart,seizures
Posts: 19
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Post by Melanie & Penny on Jun 3, 2017 10:27:30 GMT -7
*Updated her meds information. My husband, who was with her when she yelped while going potty, said the stool was very large and solid. This was her first stool since she returned home, so I'm hoping the yelp was due to a difficult passage. We're definitely monitoring the situation.
A bit more detail about our situation: Penny herniated her disc on April 27th while backward sneezing. She was immediately in so much pain we took her to the ER and they gave her an injection of methadone for the pain and prescribed Rimadyl, Gabapentin, Tramadol and Methacarbamol. The methadone did not seem to help much with the pain and made her increasingly whiney (possibly from dysphoria).
Two days later she started screaming with nerve pain and holding up her left foot. Back to our regular vet who gave her IV painkillers - which again did not control her nerve pain and caused her to become dysphoric - and she referred us to the Specialty Center in town. They also upped her Gabapentin dose to 1.5 tabs 2-3 times a day.
The only DVM with the specialty in Neurology was booked up for two weeks - so they suggested we try to get an Emergency Consult with her by going to the ER attached to the Specialty Center. We tried it - but the ER vet felt that Penny was "being a beagle" and over-reacting as she could still roll over and ask for belly rubs. She would not call the Neuro in for a consult. The receptionist got us an appointment with the Neuro a week out instead of two weeks.
In the meantime, Penny improved a bit with crate rest. The Neuro saw her and we made an appt for an MRI - which eventually diagnosed the issue. She also weaned her off of the Rimadyl for 5 days to get her on Prednisone - and also added Amantadine to her regimen of Tramadol, Gabapentin and Methacarbamol. The Amantadine was a total no-go as it gave her watery stools. The evening prior to the MRI appt they gave her a sedative - which only made her more restless (everything seems to work in reverse on her).
Once on the Prednisone for two weeks 2x a day - she seemed to improve a bit. She had 5-days free of screaming, but when we tried to knock down her dose of Prednisone from 2x a day to 1x a day , she rapidly back-slid to square one. At this point NOTHING was cutting her pain. She was at the top of her medication levels. The Neurologist, whom we believed was the only person in town that had dealt with surgery for a lateralized disc - had gone out of town for three weeks! We could not bear Penny to be in excruciating pain for that long, so we made the tough decision to put her to sleep. My husband took her down to our vet, and signed her euthanization paperwork. I started packing up her stuff and grieving, believing the deed had already been done.
Two hours later, my husband calls me to tell me Penny was still with us and that they found another surgeon locally that could do the surgery the next day. He was at the same center as the Neuro - so why they didn't suggest going to him is crazy. We had hope! They told us to overnight her at the ER connected to the surgery center, and they would give her an IV to stop the pain. Next morning he called to say the surgery was much more complicated than he thought and her couldn't do the surgery after all. At this point it was Memorial Day weekend, and everyone he wanted to consult with was out of town and not answering his phone calls / emails. Finally, the Chief of Staff of the surgical center consulted with him on the phone and they came up with a game plan for surgery when he got back into town on Tuesday. By then, Penny had been in screaming pain for a full month (minus those 5 blissful days, pain-free). We were all worn out.
Penny hung out at the ER all weekend - while they tried (unsuccessfully) to control her pain. The CoS agreed that, at this point, it was try a complicated surgery no one of them had done previously or put her down. The difficulty lie in the way she threw her disc - it had herniated in an "extremely lateralized" way and was pressing on her nerve root. He felt that the possibility for a positive outcome was there, so we went for it.
So here we are - finally in recovery from surgery. They kept Penny at the veterinary critical care for a few days afterward - she was still screaming in pain while on Fentanyl. They didn't know why. Maybe it was fear, maybe it was an anticipatory pain response, maybe they didn't get all the disc material out. If her pain wasn't reduced by Friday, they were going to give her another MRI - while all her DRs went out of town AGAIN (ugh!). Sad news. They had taken her off of the Prednisone over the prior weekend because she had bloody stools - but that bloodiness had stopped, so they put her back on steroids again - hoping her screaming was caused by inflammation. Penny finally stopped screaming and she turned around enough to come home yesterday.
So, here we are - fingers, toes, paws and tails crossed that she doesn't relapse and that the surgery truly was successful.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jun 3, 2017 12:30:53 GMT -7
My what an awful situation Penny was in. You did not mention Pepcid AC with the Rimadyl. Also no mention of sucralfate being added to the Pepcid when there was a switch to a steroid and no 5-7 day washout due to emergency of pain. I only mention as Penny was born with this disease. Hopefully she will be one who has only one disc episode her entire life and not multiple ones during her lifetime. Being IVDD educated yourself brings the ability to advocate for her and how to live may happys years ahead with Penny's IVDD. Don't know any details about her original oral meds to speak to Penny's drugs. They may have been aggressive or may not have been. So these are just general commnets. There are many cases of dogs coming to this Forum being way under medicated when on conservative treatment especially with tramadol and not Rxing each of the three pain meds for 3x/day (tramadol, methocarbamol and gabapentin). Often with a neck disc, a steroid is the first choice. And then there are vets who have used an aggressive pain med approach and the pain will not be brought under control...then surgery is the consideration. Understanding Penny's past meds means if per chance there is another disc problem down the road in years, you have an sense if you need to advocate for using the higher range and frequency of pain meds or understanding the prompt need to find a more IVDD knowledgeable vet. Two very good articles to help you.... ~~ Use of steroid or NSAID with a disc episode: www.dodgerslist.com/literature/healingsweling.htm~~ Pain meds during a disc episode www.dodgerslist.com/literature/healingpain.htmTramadol can have the side effect of constipation. Plain pureed canned pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. The amount of water in the diet makes all the difference. NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe. -- To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin 1x a day. -- To firm up the stool add 1 teaspoon plain canned pureed pumpkin 1x a day to kibble and no extra soaking water to the kibble.
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Melanie & Penny
New Member
FEMALE - Beagle/corgie . heart,seizures
Posts: 19
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Post by Melanie & Penny on Jun 3, 2017 15:52:43 GMT -7
Thank you for all the input! We've been through the wringer to be sure - but I hope she's finally on the mend. Looking back - she may have been under-medicated from the start. They had her taking her Gabapentin and Tramadol 3x a day - but only at 50 mgs per dose for the Gabapentin. They later upped that to 75 mgs of Gabapentin per.
The ER did not prescribe Pepcid along with her Rimadyl - it was only when she started the Prednisone that the Pepcid came into play. The Neuro did allow for a 5-day wash-out between ending the Rimadyl and starting the Prednisone, but did not include sucralfate (that's a new one on me - looking that up now).
We originally had Penny crate resting in her travel crate - which I felt was a little too small and not padded enough for the long haul - so I made her a recovery suite following the advice here on Dodger's list. She has been sleeping deeply, and even dreaming, ever since! Thank you for having such a fantastic resource!
Would Methacarbamol be worth continuing? I was surprised they cut that from her regimen.
Also, her stitches are on the left under-side of her neck - about 6-inches long. I'm worried that she could open her sutures if she scratches them with her back feet. They didn't send her home with any kind of protection or advice regarding that. Does anyone have any advice or ideas?
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Post by Nadya & Willow on Jun 3, 2017 20:09:48 GMT -7
Hi Melanie, sorry to hear about Penny. I am new to this process myself (my dog had surgery on 5/29). I don't know how it is with dogs but in humans Methocarbamol (aka Robaxin) is used as a muscle relaxant for muscles spasms. It is helpful in human back pain when the muscles are in spasm. My dog was not prescribed that and seems to be doing ok on just the tramadol and gabapentin. I know that Methocarbamol has a lot of side effects and is not prescribed lightly so that may be why your vet elected to cut it out of your regimen. I suggest talking with your vet about the risks and benefits. If Penny is comfortable without it, great! But it's important for them to be comfortable and not be in pain during the healing process.
I hope that helps and best of luck to Penny for a speedy recovery!
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jun 4, 2017 5:42:04 GMT -7
Melanie, is Penny's pain completely under control now? Signs of pain to be aware of are shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, nose held to the ground, head held up high, tight hard tummy, arched back. If there is still pain, then you would need to speak to the hospital ASAP about adjusting the pain meds. Pain hinders healing so have no patience with it. As Nadya mentioned, Methocarbamol is used for the pain caused by muscle spasms. If Penny is having muscle spasms or other signs of pain, then yes, speak to the hospital about adding it back in. If there is currently no pain, then no need for more meds. Good to hear that there was a 5-day washout period when switching from the NSAID to a steroid. Sucralfate as a second stomach protector along with Pepcid AC is only needed if there is no washout period. If there's a medical necessity to make a switch without a washout period, that can be done with the addition of two stomach protectors, Sucralfate and Pepcid AC. Pepcid AC needs to be given any time a NSAID or steroid is prescribed. There are several things that can be helpful with a neck injury, such as softening hard kibble, raising food/water dishes, etc. More tips here: www.dodgerslist.com/literature/cervical.htmI would speak to the hospital about your concern that Penny will scratch at her stitches and see what tips they can give. Is she trying to scratch her neck now? When are the stitches due to come out?
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Melanie & Penny
New Member
FEMALE - Beagle/corgie . heart,seizures
Posts: 19
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Post by Melanie & Penny on Jun 4, 2017 10:58:23 GMT -7
Penny is not exhibiting the shivering / trembling pain signs post surgery. She was living those pain signatures 24/7 prior to her surgery - so that's a bit of relief.
She has quietly yelped a couple of times, but it isn't nearly as intense as it was previously. Once was when she was in her crate - but we don't know what triggered it. The other was when she heard me pottering around in the kitchen - my husband said it was more like a "hey, what's going on in there?" Kind of quiet yip (so quiet I didn't even hear it in the next room).
She did cry out again while expressing a stool this am. It seems to happen while she is expressing the stool - rather than settling into the posture, so I think she may be constipated or have an anal gland issue. We're starting her on some pumpkin today to see if that will help. We did just start her back on her regular food - which is kibble mixed with canned - so maybe we'll try softening the kibble a bit with chicken broth too. Her bowls are raised for non-strenuous access.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jun 4, 2017 11:08:43 GMT -7
Melanie, hopefully some additional observations on the yelps vs. yip for attention will have you identifying if there is pain to address.
Do you normally express her anal glands yourself? Can you feel if they are full and need you to express them?
Observing twp or more signs of pain is helpful in pinpoint if there is pain that needs pain meds adjusted. ◻︎ restless, can't find a comfortable position ◻︎reluctant to move much in crate such as shift positions ◻︎shivering-trembling ◻︎yelping when picked up or moved ◻︎slow to move ◻︎tight tense tummy ◻︎arched back, ears pinned back ◻︎ head held high or nose to the ground. ◻︎looks up with just eyes and does not move head and neck easily. ◻︎ holds front or back leg flamingo style not wanting to bear weight ◻︎ not their normal perky selves
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Melanie & Penny
New Member
FEMALE - Beagle/corgie . heart,seizures
Posts: 19
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Post by Melanie & Penny on Jun 4, 2017 12:01:43 GMT -7
The only sign of any of the above at the moment is that she is a bit muted and tired - definitely not perky. I think this will change as she heals. I spoke to her surgeon's veterinary assistant this morning re: all of our issues: - For the scratching at her neck sutures - she suggested putting a t-shirt on her that will cover the stitches so that she can't be in direct contact with them. I have a number of cool rock and roll t's I have long grown out of - so looks like she'll be getting some cool hand me downs! Her sutures will dissolve over time - so they don't have to be removed, but she has an appt for a 12 day check on the 14th. Penny generally seems itchy - so I may try wiping her down with some decaf green tea to see if that helps.
- Regarding Penny's painful stools - the vet assistant agreed that we should try some pumpkin to soften her stools first. It is likely that she is constipated post-op. I have never personally expelled her glands, as Penny doesn't usually have any gland issues.
Update: Penny just went potty again - this time the stool was more normal / soft and she had no pain! Hope this is the new normal! Another Update: The vet tech called to see how Penny was doing today. I mentioned her painful stools - and that I noticed her rectum was red in one spot today. The tech said that Penny had been a bit painful back there after having some diarrhea while at the surgical center - and that it is likely she's still healing. Whew! I'm just glad it isn't her back!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jun 4, 2017 12:38:03 GMT -7
Melanie, very good news on the normal poop!!! And no pain, too!! It may be the drugs (tramadol and gabapentin) are affecting her personality and when they are stopped she will be more her normal perky self.
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Melanie & Penny
New Member
FEMALE - Beagle/corgie . heart,seizures
Posts: 19
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Post by Melanie & Penny on Jun 8, 2017 10:16:14 GMT -7
Just a quick check in!
Penny is recuperating nicely. She seems completely pain-free. Now for the fight to keep her in her crate for the next month or so - lol. She's definitely using her wiles to get treats out of my husband in return for getting back into her crate when we have to clean the bedding and whatnot.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jun 8, 2017 16:16:26 GMT -7
I can see Penny knows how to get what she wants, Melanie! Thanks for the encouraging update. Glad to hear she's doing well.
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Melanie & Penny
New Member
FEMALE - Beagle/corgie . heart,seizures
Posts: 19
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Post by Melanie & Penny on Jun 14, 2017 9:48:38 GMT -7
Hi all!
Ms. Penny had her 12 day post-surgery check up today and passed with flying colors! The vet says she is doing "awesome"! Her incision is entirely healed, so they removed the few sutures that hadn't dissolved.
Current recommendations: - Crate rest while we're at work - but can be out and about in the house when we're home. (Obviously, we need to teach her to not jump up and down on the furniture - next goal!) - We are now able to take her for short walks a few times a day. She may tire easily, as she has been crated since April 27th - so he said to let her decide how much she can do. (Although we're going to start slow). - We started her taper off the Prednisone this past Saturday - we were down to 1x a day. Surgeons says we can take her down to every other day starting today (with Pepcid). He also said we can stop all of her other meds (Tramadol and Gabapentin). - They gave her a soft cone to keep her from bothering an IV site on her back leg - which hasn't had a chance to heal due to her licking it. Oh, the indignity!
Penny is still completely pain-free and beginning to get her mojo back. YAY!
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Post by Romy & Frankie on Jun 14, 2017 13:06:49 GMT -7
Great news that Penny is doing so well!
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Post by Julie & Perry on Jun 14, 2017 14:36:08 GMT -7
One thing I found to keep my dog from jumping off/on the bed was a folding fireplace screen. $6 at Goodwill. Or there is a link at www.dodgerslist.com/literature/protectbackblocker.htm for furniture blockers that you can make. Some people use big pillows to block access to furniture.
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Melanie & Penny
New Member
FEMALE - Beagle/corgie . heart,seizures
Posts: 19
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Post by Melanie & Penny on Jun 19, 2017 19:59:36 GMT -7
Ms. Pen is still doing well! She's been tapering off the Prednisone with no pain issues.
She has some intestinal issues at the moment (loose stool with mucus) - but she has always had a really sensitive stomach. (Her normal diet consists of Limited Ingredient foods). Once we get her off the Prednisone for good I hope her bowel movements will improve.
She is getting more vocal when "her pack" leave for work - and clowning and rolling around for belly rubs (which makes us humans cringe) - but she's pretty much back! A true miracle!
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Post by Pauliana on Jun 19, 2017 21:18:32 GMT -7
Hi Melanie!
It would be a good idea to ask the Vet for Sucralfate in case the loose stool has to do with the Prednisone.. Pepcid AC works on the acid but Sucralfate will heal damage in the stomach/ GI tract. Be sure to give Pepcid AC every 12 hours even though Prednisone is on the taper.. You can stop Pepcid AC a few days after the taper completes..
To firm up the stool add 1 teaspoon plain canned pureed pumpkin 1x a day to kibble and no extra soaking water to the kibble.
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Melanie & Penny
New Member
FEMALE - Beagle/corgie . heart,seizures
Posts: 19
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Post by Melanie & Penny on Jul 28, 2017 10:22:46 GMT -7
Hi all! Great news! Penny had her 1 month post-surgery check up and came through with flying colors. She has absolutely no pain and is back to her silly belly-rub obsessed self. We are trying to get used to not begin able to have her on the bed with us - which seems harder for us than her to be honest. She loves her crate that we used for recovery and sleeps in it every night. She's off mandatory crate rest - but we keep her corralled in the kitchen when we're not home to keep her from jumping on the furniture. She used to hang out there when we were gone prior to her IVDD treatment - so it's just like things are getting back to normal. Our doc said to still take recovery slowly - no rough-housing with other dogs for now (or possibly ever), so no trips to doggy day care or the dog park. I've been taking her out for short jaunts to the people park with her harness on, and she seems to enjoy getting out and having a good sniff. The one funny thing that has occurred is that our formerly completely silent dog (she never made a sound at home. ever.) - has now found her voice and is whining and barking at us to get her way. I guess she learned that the squeaky wheel gets the grease! Her hair is taking a good long time to grow back - so she still looks 1/3 Chinese Crested, she's getting a bit freckled by the sun - she loves to sunbathe - I'm keeping an eye out that she doesn't get burnt.
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Post by Romy & Frankie on Jul 28, 2017 13:18:19 GMT -7
It is great that Penny is doing so well. It is a good plan to ease her back into activity. We have some info about ways to do that here: www.dodgerslist.com/literature/AfterCrateRest.htHere are some Back Friendly Activities for going forward. 1. Keep weight down to reduce stress on back. 2. Build up to daily 30 minute walks, good exercise to strengthen back muscles 3. Hide and seek games involving nose work are good and can be played inside or outdoors (hide yourself behind a door, hide kibble pieces on a bottom shelf, under edge of rug, sink treats in a saucer of water) 4. Swimming, water therapy is good exercise. 5. Fetching a gently rolled tennis ball along the ground is good exercise. Avoid dog pouncing or stopping suddenly. 6. Obedience training for mind stimulation, teach a new word or command. And here are tips on how to make your home back friendly: www.dodgerslist.com/literature/protectback.htm
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jul 29, 2017 9:14:42 GMT -7
Melanie, let me add my congratulations on the completion of post-op crate rest! Would you like to help another trying to make quick decisions about surgery… We have a directory where you can share surgical costs. Here is the link to add your inforamtion: dodgerslist.boards.net/board/10/guidelines-postingState: Hospital: Address: Cost: Date of surgery: What was included in cost (MRI?, days stay, ER? PT? meds for home, sling, etc.) Comments: -- Don't forget to add a photo to our photo gallery and 1-2 sentences. Gives inspiration to others just starting a scary IVDD journey. LOGIN www.dodgerslist.com/gallery/thumbnails.php?album=4 : username: Dachsie password: dodgerslist14 Or you can email (owner's name, email addy, dog's name + photo caption) to : photogallery@dodgerslist.com
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