Lola's Hurley 1/27 Surgery FINLAND

Lola, Prednisone is one medication that you don't want to administer yourself without a vet's direction. You also need a vet's direction to wean Hurley off of the Prednisone when it's time for the next taper.

I think your best option is to see the neurologist on Thursday. It's a shame that you can't get in there sooner. It does sounds as though you have faith in them. Hopefully, they will prescribe the proper dosage for Hurley and it may not take long on that dosage before a pain-free taper can occur. Meanwhile, he has the Sucralfate and Pepcid protecting him.

You might want to review these pages before seeing the neurologist on Thursday so you are armed with the knowledge you need about when surgery is a consideration.
www.dodgerslist.com/literature/healingsurgery.htm

As for the second consideration listed on the above page, that doesn't really apply to Hurley since he has yet to be on an anti-inflammatory dose of the Prednisone.

My prayers are with you and Hurley.

Hurley is now officially diagnosed with 2 herniated discs at L5-6-7 (lower back), right side, by today's CT scan at the neurologist clinic. The disc material is pressing his nerves causing pain in his right back leg. He has not been paralyzed because apparently the spinal cord ends before it reaches L5-6-7? I did not know this, but the neurologist said so. He also said we did the right thing by keeping Hurley crated (+ medication), however, 4 weeks have passed and the situation has not improved. The spinal pressure is still significant so we decided to go ahead with surgery.

However, the neurologist does not want to operate as long as Hurley is on prednisone, so that will end starting today with a fast pace (1 week taper) so that Hurley can have the surgery next week. This surgery will be more difficult than the previous 2 hemilaminectomies, since the situation is chronic and the discs have calcified - they wrote in today's release papers it may be necessary to do a corpectomy (?). I looked it up online when I arrived home, but I do not understand exactly what it means, just that this operation will be more difficult, is what they said.

So, the good news is that we found the problem spot, it can be operated, and the risk that Hurley would be paralyzed as a result of the surgery is not as high as in the previous surgeries where they operated closer to the spinal cord. The disappointing news is that it is a brand new spot, it did not show in August 2013 MRI, so naturally we are now scared this will happen again in the near future, with another disc(s). This will already be Hurley's 3rd surgery, always different discs involved - NOT good, but we have no choice but to manage, both mentally and financially.

The upcoming 7 days are likely to involve a bit more bad news before any good news since Hurley's condition is likely to deteriorate before the surgery due to the prednisone taper + stopping of current pain medication (Gabapentin, Tramadol, Methocarbamol). We are instructed to switch back to Rimadyl, but not before the prednisone taper is at 1.25mg daily level. It is not ideal, none of this is, but we have confidence in our neurologist and he is now doing the best he can to fix the situation. Obviously, it is not recommended to start NSAID while still on steroids, so we will not give Rimadyl to Hurley unless he really, really needs it. The main thing is now to stop the steroids and keep him crated before we can get him to surgery.

I assume you the moderators will switch us over to "surgical treatment", so I just want to express my gratitude to everyone who have supported our journey on the conservative treatment side. It seems surgery is indeed not always necessary, every case is individual. Sadly, apparently the surgery will have been easier had we had the opportunity to do immediately before the disc material calcified, but this is now the situation and we have to live with it as it is, hoping for the best possible recovery result. I continue to keep my fingers crossed for Hurley, and all the other little puppies who need to go through this horrible disease, and will post again whenever I have something to tell about the next steps of our IVDD journey.

Hi Paula, yes, thank you for the kind reminder. We have all the time had and are continuing the Sucralfate and Pepcid at least until the Prednisone taper is over. Actually, the neurologist said it is not necessary if no diarrhea, but I will continue anyway - I want to be on the safest possible side, especially since we are planning to switch to Rimadyl without a safe washout period.

As for your first question, I really am not sure if I can answer. The neurologist said Hurley is now a "walking pharmacy" with all the meds we've been giving him and that they are not necessary since Hurley is not in pain when resting - only when he moves at potty time (this is true). He also said that all that medication is just making Hurley "confused" and that "recent research" is showing Tramadol is not as effective for this type of pain as Rimadyl is (but I might have misunderstood, so please forgive me, there was so much information...).

In any case, we are allowed to start the Rimadyl day after tomorrow, if needed, 10mg x 2 / day, and that I believe will also continue after the surgery, along with whatever else they prescribe (patch?). So, I hope, it is only a question of how we can deal with Hurley's pain tomorrow, since today this far he has been doing OK, calmly resting in his crate, and I am surprised the pain at potty time is not significantly worse compared to what it was when he was on the pain meds (last dose given yesterday at 3pm). Of course, if he starts to be in pain, I will call the clinic, it is open 24/7 and only 10 min. drive away.

I have now studied online concerning the steroid taper and the surgery combination, so close to each other, and I must say I am a bit worried. I hope everything will go well without complications next week. Since many dogs are first treated conservatively incl. meds, I must trust that Hurley is not the only one who needs to have surgery after 4 weeks on steroids.

Yesterday and today, NO signs of pain whatsoever, not even when moving outside at potty time. So strange! Someone mentioned earlier that there is no textbook recovery and that is so true. Hurley is off all pain meds and this is the 3rd day of the (3rd!!) prednisone taper, so it is definitely too soon to tell, but I am thinking - if the pain does not resurface, does it mean we should NOT go ahead with the surgery and wait to finish the crate rest instead? The surgery is scheduled for next Thursday because we first need to finish the prednisone taper, we still have time to take one day at a time.

In the meanwhile, can I please ask some additional stupid questions? The CT scan showed one small herniation and one large one, both of which the neurologist said are "calcified". Does this mean Hurley will forever have those calcified herniations pressing his nerve roots unless removed with surgery? Or will they disappear with time? Sorry for stupid questions... I just do not understand how they could disappear if they are "calcified"...

(Thank you, I really do think I would have gone crazy during these weeks if it wasn't for this website...!)

Lola, as you may have read the real test of whether all the swelling in the spinal cord is gone is the taper of pred and the stop of pain meds.

Being off all pain meds will give a true picture if pain would resurface as the pred dose is lowered.  If Hurley can go all the way off of Pred and no pain, then you have your answer.  The disc is no longer aggravating the spinal cord causing painful swelling.

It certainly seems like a good idea to complete the taper before booking a surgery so you know the true story on swelling/pain.  What the surgery does is remove disc pieces that are pressuring the spinal cord's nerves.  That pressure is what nerves do not like…it causes pain and if very severe pressure will cause loss of neuro functions such as leg paralysis, loss of bladder control.  If pain surfaces before you can complete the taper, then you have a better idea that surgery just may be needed.

Can you tell us where Hurley is in that taper…what is the dose in mg's, how often do you give the pred?

I'm sorry to hear that pain has resurfaced, Lola, but that would be consistent with the results of the CT scan since it did show disc material still pressing on the spine. I had been hoping that this neurologist would suggest trying an aggressive level of the steroid for a week or two before surgery since Hurley has not had that yet, especially since he doesn't feel paralysis is a concern and the pain is under control with the steroid. Did he speak to you about that at all? Just would love to see Hurley avoid surgery, especially since it's his third one and looks to be a more difficult one, if at all possible, as I'm sure you would, too. Just a thought I haven't been able to get out of my mind.

All the best to you all.

I do understand, Lola - thanks so much for clarifying the surgeon's reasoning for me. Questions in my mind tend to nag at me so I did feel that I had to ask. Of course you must have faith in this and it's wonderful that you have a surgeon who you do trust. We, also, will have faith along with you.

Continuing prayers for both you and Hurley and big hugs.

Thank you. I have told Hurley he has an online support group and we will get through this together!

This is an update... Hurley was temporarily better for a few days so after consulting with the surgeon, we decided to wait a little longer before going into a 3rd surgery, to see if he was really getting better or not. Unfortunately, this was not the case. Some mornings have been better than others, some evenings worse, so... Hurley is now rescheduled for surgery on Monday 27th. The neurologist will then try to remove the disc material that has bursted. It will not be an easy operation because the bursted material has already calcified. The neurologist explained to me that this is basically why the pain is not going completely away; it is a chronic situation now.

Obviously, I have been thinking (ref. Marjorie your comments also) long and hard what is the right thing to do. Hurley is now completely off all medications, maybe we could wait a few more weeks, but I feel ultimately, he will not have the quality of life he deserves to have as an 8 year old dachshund if we continue like this. Thus, surgery, if successful, would give us the best possible outcome. It has now been 6 weeks since he wagged his tail. I wake up every night at 3am because Hurley is awake, too, and although he does not seem to be in acute pain, I can sense his discomfort. I feel so bad for him.

I am worried the rehabilitation will be long and hard, because Hurley has lost a lot of muscle tone due to 6 weeks of crate rest. Despite the two earlier surgeries he has had, I have never been in this situation before, so I am mentally trying to prepare to what's ahead when he comes home from the surgery. I am hoping he will not lose his ability to walk because he has been doing so well now, minus the occasional pain and general discomfort.

Hi Marjorie, yes, I am giving Hurley 10mg of Rimadyl twice a day, when/if needed (usually at least 3am), it seems to help. There were a few days when I did not need to give it at all, and then again followed a few days when I needed to give the max. dose morning and evening. Right now, he has not needed it in a few days, but he might need it again tonight, we can never be sure. When we wake up during the night, it is because he is acting restless, sometimes licking his paws, sometimes licking the bed he is in (in the crate), or not able to find a good position: turning from left side to right side and back, extending front paws, moving head. We have experimented with different beds (memory foam, blanket, etc.) and even two different crates, and different locations, but it seems to make no difference.

Symptoms of pain still are variably present: shivering (but only in the right leg, sometimes, when placing weight on it when out to potty - could be muscle tone loss, also), he is generally slow to move now, sometimes reluctant to bear weight on the right back leg preferring the left leg instead. He sometimes yelps when moved, maybe every other day, but this was the same even when he was on full pain medication (Tramadol, Methacarbamol, Gabapentin), we were never able to find a medication that would take that pain away. It would disappear for a few days (even without meds) only to come back the day after. That is why the vet ultimately recommends the surgery.

Just a quick note to say that surgery was done and Hurley is now home resting in his recovery crate. The other herniated disc was "severely attached" to nerve roots and spinal chord meningeal (?) so removing was "traumatic". I almost fainted when they told me this on the phone so that's about as much details as I can repeat right now.

But my Hurley is a trooper!!! He is very wobbly and clearly it is painful, but can stand and walk a few steps when out to potty, even lift his back leg a few inches to pee. He did not want his kibble in any shape or form but happily ate some boiled chicken (+ the broth) and rice. We will take this one day at a time.

I'm so glad to hear that Hurley has made it through his surgery and is doing well, Lola!! I was praying for him yesterday and am very relieved for him.

Please let the surgeon know today that Hurley is still in pain. The pain from surgery can and should be brought under control right away. As Jean asked, please let us know the names and dosages in mgs and frequency of each medication he's now on.  Also, please let us know what directions have been given for crate rest and PT.

It takes 2-4 weeks for the swelling to resolve after surgery. Improvements often happen after that time frame.

Prayers for a speedy and complete recovery for dear little Hurley. And remember to take care of yourself, too, Jean - this has all been very stressful.

Lola, there is no reason for Hurley to be in any pain. So if you perchance are seeing pain, the surgeon or your vet would need immediate feedback. There are plenty of options to keep post-op pain fully at bay dose to dose of pain meds. Rimadyl is not so much a pain reliever. As the acronym NSAID indicates Rimadyl is a non-steroid anti-inflammatory drug (NSAID). Pain relievers are the Durogesic patch and others listed here: www.dodgerslist.com/literature/healingpain.htm . As that patch wears off, do observe for pain so that other pain relievers can be brought on board if necessary.

It's only hardly been 3 days but Hurley is doing really well, no pain anymore. I removed the Durogesic patch. He sleeps and eats normally. Outside in the garden, he found some rabbit trails although he was supposed to go potty, he has the urge to go really fast now although his right back leg is not moving perfectly. I have him on a harness and need to keep a very short leash so that he does not start to run or pull. Still, he finds a way! He started digging the snow. I need to keep a close eye on him all the time but it's OK, I'm so happy he is starting to be more and more normal!!!!! I also saw him scratching his ear with his left leg (but it's the better leg, the right one is still weak).

Sounds like Hurley is doing great So glad to hear it!