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Post by Wendy & Kado on Mar 18, 2014 17:31:51 GMT -7
I worry about Lola's decline and need for the prednisone extension, I worry if she will ever be able to taper off the prednisone and what will happen for her. I am thrilled at how far she has come and how well she has done with this but it is hard not knowing what is to come....
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Post by Pauliana on Mar 18, 2014 20:39:21 GMT -7
Hi Wendy,
It isn't unusual to have to taper more than once.. It can take two weeks to a month on the anti inflammatory, twice a day dose, to resolve the swelling for some dogs. This doesn't mean she will have to be on Pred forever, it just means she needs more time on it right now.. Her vet will want to have another taper when they feel the time is right..
You are giving Lola excellent care.. Hang on, she will get there!
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Post by Wendy & Kado on Mar 18, 2014 20:52:07 GMT -7
Thankyou for the encouragement Pauliana,
the vet emailed me, she is pleased the other vet was available to put Lola back on the higher dose of prednisone. She consulted with her colleague and they are thinking Lola may need a lower dose of prednisone 25 to 50mg once daily for a month or two. She will discuss this with me on Monday when she returns, Lola is currently on the 50mg twice daily until tomorrow evening when she will go to 50mg twice [??] a day, so, we will see if that dose can help her with her current function loss, she is making some gains today which is nice. If they do decide to keep her on for a month ( which will bring us to the 8 weeks crate rest as expected) or 2 months, would it be best to keep her on crate rest the whole time she is medicated?
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Post by Jean & Mimi on Mar 19, 2014 5:12:38 GMT -7
Wendy,
Crate rest should be continued as long as Lola is on anti-inflammatories. I had to have an extended crate rest period with my Mimi for the same reason. Yes, frustrating and not what you want to hear, but you would be doing the best possible thing for Lola, giving her body the time to heal and recover safely. You are doing such a great job with her.
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Post by Wendy & Kado on Mar 19, 2014 5:55:10 GMT -7
Thanks Jean, so, being on the prednisone for the extra month or two is not unheard of then? I am assuming we will have to wait with the water therapy as well until she is off the prednisone even though it is so much longer?
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Marjorie
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Post by Marjorie on Mar 19, 2014 6:41:21 GMT -7
All movement needs to be restricted as long as Lola is on medication, either an anti-inflammatory or pain meds. So yes, the water therapy would also have to wait until all meds are stopped and there is no swelling.
Did you mean to say that the Prednisone would be reduced to 50 mg 1x/day starting tomorrow? You should speak to the vet about exactly what the anti-inflammatory dose wold be for Lola based on her weight. It takes the anti-inflammatory dose to get the swelling down. Anything under an anti-inflammatory dose would not be effective in reducing the swelling. It would appear that in Lola's case, an anti-inflammatory dose would be 50 mg 2x/day. When she went to 50 mg 1x/day, the swelling didn't immediately get worse but that dosage may not be enough to get any current swelling, which is causing neuro deficits, to go down and that's what needs to be done now.
Being on steroids has its risks and steroids should only be prescribed for as long as they are needed. That is the purpose of a taper, at least one of them - to find out if there is still swelling and if the steroid is still needed. In Lola's case, yes, there is still swelling so she should be returned to the anti-inflammatory level.
The drug is weaned because the body normally produces this hormone but when taking Prednisone the body is signaled to stop producing it as there are sufficient quantities circulating. This hormone has many functions in the body and is vital for life so it is important to keep the levels in the blood stream adequate. It takes the body a period of time to realize the levels are getting low and to start producing again. The weaning process gives the body time to realize the levels are getting low while also keeping an appropriate amount in the circulation. That is the real reason for the taper, to let the body know it has to start making its own steroid which is at a low level.
Vets use a higher level of oral steroids to work more effectively in getting painful swelling down. Rxing a tentative lower end dose of Pred rather than being aggressive with the upper end of the dosing for inflammation means Lola would be strung out on a long use of Prednisone that may be similar to what the body makes on its own…. so the job is not getting done.
It is best to only use Prednisone as long as there is a need for it, and then taper off. If no signs of pain on completion of the taper that means swelling is gone and there is no further need for either pain medication or Prednisone.
Given long term this drug may suppress the immune system and thus make the dog more prone to other diseases, but sometimes suppression of the immune system alone can be a significant problem. Extreme care must be taken when stopping prednisone, if an animal has been on this drug for an extended period of time then slow weaning off the drug is crucial when reducing the dose or stopping the drug.
Long-term use of prednisone may result in other symptoms such as loss of hair coat, weakening of the muscles, liver impairment and behavioral changes and can cause Cushings disease and diabetes.
Occasionally, if a dog has tried to taper off of Prednisone numerous times and there is still pain, a very low dosage may need to be given long term, which would be better than living a poor quality of life with pain. Lola has not had numerous tapers so is not at that point. It's not that uncommon for a dog to still have swelling a month after starting Prednisone. She should be returned to the anti-inflammatory dosage, at least for a few days/a week longer, to get the current swelling down and try another taper. You are already seeing some improvement on the current dose.
Please let us know what the vet says after speaking with them.
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Post by Wendy & Kado on Mar 19, 2014 7:15:05 GMT -7
Thanks Marjorie , I started Lola on the 50mg twice daily on Sunday, I am starting to see return of function as it was prior to this last taper now, the foot is dragging a little less and knuckling Is not occurring 100% of the time! maybe 20% now? I have 12 tablets left of the 50mg and was to stop the 50mg twice daily tonight and go to once a day until my vets return. I have enough to stay at the twice a day until Friday morning if that would be a better plan. Lola was doing fine on the taper until it went down to the 25 mg once daily, after 3 or 4 days of that I noticed the change so I am hopeful that the 50mg once daily is the antiinflammatory dose for her? The interesting thing is, she walks much better on the snow than on the patio stone we have throughout our backyard and she likes to go on the snow area, problem is, it is spring and our snow is melting and will soon be gone. And then I wonder if her foot dragging and knuckling could be from the prednisone being administered for so long and the loss of muscle? I have not seen Lola show any signs of pain throughout this ordeal....which is concerning as well if she is good at hiding her discomfort. The vets are all relying on my reporting of Lola's progress and symptoms and I do not want to be mistakingly have her on the prednisone longer than necessary given its potential for causing other issues.
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Marjorie
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Post by Marjorie on Mar 19, 2014 7:33:11 GMT -7
It would seem to me that the dosage she is currently on is helping reverse the neuro deficits so I feel that is what she should stay on, at least for awhile until another taper is tried. At some point in her treatment, the vet had increased the level of the Prednisone to the 50 mg 2x/day and I don't believe she would have put Lola on a higher than anti-inflammatory dose. Not being a vet, all I can do is offer my thoughts. You would need to speak to one of the vets today, let them know of the improvements you've seen on this dose and get permission to continue with it until your vet returns. I would think a neuro evaluation by your vet upon her return would be in order so she can properly assess whether the signs you're seeing are from nerve damage or weakening from crate rest and whether there is pain. Though knuckling IS a sign of nerve damage.
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Katie & Riley
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Post by Katie & Riley on Mar 19, 2014 12:22:23 GMT -7
Hi Wendy, Just wanted to let you know that my Riley has been on prednisone for over 7 weeks, so don't worry too much about Lola having to be on it longer. We are hoping that his taper will continue successfully and he will be off it completely by the end of week 8, then we will keep him on crate rest for at least a full week after he is off meds. Some dogs just need more time. My understanding is as long as he's on Pepcid and we're watching for signs of GI tract issues, extended time on prednisone is ok. Good luck with Lola... it can be so exhausting, I know!
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Post by Wendy & Kado on Mar 20, 2014 7:06:04 GMT -7
Thanks Marjorie, Lola is seeming a little stronger again today with her legs, there is still a slight drag of her left foot causing knuckling the odd time, but, it is getting a little better. I hope the nerve damage can be rectified again. It's interesting though that it is the left foot which was her better foot a few weeks ago. I am wondering if this is new damage or just the swelling pressing on something different this time. I willedefinitely bring Lola in to the vets on Monday for an evaluation. She is doing much more now than she was the last time the vet has seen her which was at the beginning of this episode and I guess I have to hang on to that.
Thanks Katie, it is helpful to hear that Lola is not the only dog to require prednisone longer than the 30 days.
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Post by Wendy & Kado on Mar 21, 2014 8:30:51 GMT -7
Just to clarify for myself, the best practice is tto keep in the antiinflammatory dose of the prednisone for a period of time, then taper and see how the dog responds, if there is pain or neuro changes, the prednisone should be put back up to the anti inflammatory dose again for a week or so and then slowly taper again. There is no benefit to remain on a lower dose of prednisone for an extended period of time.as, once the swelling is down, a taper is required to see if the dog can maintain the levels needed . If the dog is showing any signs of pain, pain meds are required. the nerve damage can be repaired over time, as can the muscular atrophy. 8 weeks crate rest and a week of crate rest after all the meds are stopped. i would to have this clear in my mind before we go see the vet on Monday. I do have enough prednisone to keep Lola on the 50mg twice daily until Monday which will bring her to a8days of the anti inflammatory dose.
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Marjorie
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Post by Marjorie on Mar 21, 2014 9:40:10 GMT -7
That's basically correct, Wendy. Only there's no way of knowing if the swelling is completely gone until the taper is fully finished and all meds are stopped. Pain/neuro diminishment can return at any time during a taper. So keep dog on anti-inflammatory, try taper (of both anti-inflamamtory and pain meds), if all pain/swelling is gone by end of taper, all meds can be stopped. If all pain/swelling is not gone and pain/neuro diminishment returns during taper, return to anti-inflammatory level of steroid and return to pain meds until next taper. There's no benefit in keeping a dog on an extended low dose of Prednisone as that is not going to resolve the swelling (an anti-inflammatory level is needed to resolve the swelling), a taper is required to see if there is pain/swelling and if swelling has resolved, then no meds at all are required. Keep in mind that some dogs do require long term medication but that's only after numerous tapers have been tried and there's still pain/swelling. Good job in clarifying everything in your mind to be prepared for your vet visit. You're armed with the knowledge that you need to advocate on behalf of Lola. Kudos to you!!
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Post by Wendy & Kado on Mar 21, 2014 10:16:54 GMT -7
Thanks Marjorie, one more question, Lola is not showing any signs of pain, even though she had some neuro diminishment resulting in our putting her prednisone back up, should I have her on the pain meds regardless? If there is neuro diminishment should I just assume there is pain?
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Marjorie
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Post by Marjorie on Mar 21, 2014 12:55:24 GMT -7
From what I can recall, Wendy seems to be a pretty stoic dog and may be hiding her pain well. A neuro diminishment would mean something is pressing on the spine and that would cause pain - however, that neuro diminishment has now reversed. The vet may be able to give you a better idea on Monday if she has pain that she's doing well to hide. Since the higher dose of the steroid was able to reverse the neuro deficits, it might well have brought the swelling down enough that there is presently no pain so no pain pills would be necessary.
The vet may well call for another taper of the steroid on Monday. If she does, then it would be best for Lola to be off of any pain meds so a true test for pain/swelling can be made.
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Post by Wendy & Kado on Mar 24, 2014 7:18:39 GMT -7
I just feel sick to my stomach, this morning at 5 am I took lila ojt to pee and all was well. My husband took her out around 7.30 and noticed her k nuckling and she did not eliminate. When I took her out at 9..she is totally paralyzed again...both legs just hangi g..not able to eliminate or move....we have a vet appt at 1 today...it was supposed to be to see how well she is doing....she is still on the high level pred. And I gave her robaxin and tramadol as she seems very uncomfortable.....has this happened to anyone before??
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PaulaM
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Post by PaulaM on Mar 24, 2014 7:52:19 GMT -7
I'm so sorry to hear this. Please do not wait til a 1pm appt. Your vet needs to know now via a phone call about these significant signs. Loosing leg and bladder control are signals of an emergency nature and time matters. As a nerve cell dies it spews out chemicals that can kill the neighboring cells, a cascading effect. So getting Pred back up at the anti-inflammatory dose asap is to reduce swelling. Swelling pressures the nerves, the nerves do not like pressure and they react by dying. YOu do have a challenge we don't have with a 60lbs dog. As we can carry little dogs to and from the potty spot ensuring the vertebrae in the back move as little as possible at potty times. Would surgery be a consideration for your family at some point? This page can help you make the decision re: a surgical consultation. www.dodgerslist.com/literature/healingsurgery.htmReview this information should it be necessary to express Lola's bladder for her if she can no longer sniff the grass and then release urine, if you find urine leaks in bedding. Getting a sense of what expressing is ahead of time will make a hands on top of your hands type of lesson more meaningful. www.dodgerslist.com/literature/Expressing.htmStay strong all hope is not lost for Lola, she just may need to be back up on the original dose, the highest dose, the anti-inflammatory dose for a longer period. Remember it can take anywhere from 7-30 days up at the anti-inflamamtory dose to get all the swelling down. EAch dog is different. The only way the vet knows if swelling is down is to do a taper to less than the anti-inflammatory dose. In Lola's case the anti-inflammtory dose appears to be Pred 50mg 2x/day and she was only on it for 10 days. When things are settled, please let us know the current med list the vet has prescribed: 60 lbs prednisone 2/22: 25 mg every 12 hrs for 3 days; 2/27: 50mg every 12 hrs for 10 daystramadol 100mg every 8 hrs Robaxin 500 mg every 8 hrs Pepcid AC (famotidine)- 10mg, 2x/day
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StevieLuv
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Post by StevieLuv on Mar 24, 2014 8:27:53 GMT -7
I am so sorry that this has happened to your sweet Lola. I agree with Paula - this is an emergency and she needs to see the Vet ASAP. Setbacks are so discouraging, I know from Stevie's IVDD journey. Prayers for a speedy resolution.
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Marjorie
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Post by Marjorie on Mar 24, 2014 9:16:01 GMT -7
I'm so very sorry to hear this, Wendy. Since Lola was on the anti-inflammatory dose of the steroid (50 mg 2x/day) when this happened, it may be that she has re-torn the disc or another disc has herniated. As Paula and Maureen recommended, have her seen ASAP. Be sure to tell the vet that you gave the Robaxin and Tramadol as that will mask her pain.
We will anxiously be awaiting word. My prayers are with you and Lola.
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Post by Jean & Mimi on Mar 24, 2014 9:21:01 GMT -7
Prayers for you and sweet Lola. Please let us know when you can what the vet says. My heart is breaking for you guys.
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Post by Wendy & Kado on Mar 24, 2014 13:02:29 GMT -7
Well we are back from the vet. Some good news in that Lola does still have deep pain sensation, her tail was moving some during the exam. The vet thinks that this is likely a new episode, and, she is treating it as such. She has increased her prednisone to 100 mg every 12 hours for 7 days, then down to 75 mg every 12 hours for 7 days, then 50 mg twice daily. She is back on the tramadol 100mg every 8 hours Robaxin every 8 hrs.
lola had a bm at the vets as she was examined, she also had her bladder expressed, and, as she was in the sling her bladder expressed as we were leaving. It is so sad to see her legs just dragging as we sling her, but, as the Vet tested her sphincter, her legs moved as well, so, there is leg movement. I am to express her bladder until she is able to go on her own again. The vet would like me to keep her fully in her crate for bladder expressions etc for the next 72 hours and then see if carrying her outside she is able to eliminate, I am to try this once daily. I guess as time goes in we will need to see how Lola does, if she continues to have more episodes even when on crate rest we will need to re assess her life quality, but, I am not giving up yet and hoping that she will once again recover and stay well. I am a little concerned at the high doses of prednisone and asked about the sucralfate, the vet stated this was for treating ulcers and not for prevention, she is still on the Pepcid and I am to watch for any signs of ulcer and then she will be put on the sucralfate....not sure if I should have pushed this more?
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Post by Jean & Mimi on Mar 24, 2014 13:21:14 GMT -7
Wendy, I am so sorry to hear that Lola is having another episode so soon after the first. However, I am so glad that you got her to the vet so quickly. Sometimes vets do not want to prescribe sucralfate from the get go, but I think it would be a good idea to advocate for it, especially with the increase in the prednisone. Seems like your vet is really supportive of the crate rest which is good. You have been so wonderful with Lola so far. Is she in a lot of pain? Don't forget, the pred can work to reduce swelling and help neuro function to heal and come back. My Mimi had a completely useless left rear leg (she could hold no weight). Once we got the right dose of steroid to reduce the swelling her neuro function came back slowly. Hang in there Wendy, you are really doing so great.
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Post by Wendy & Kado on Mar 24, 2014 13:38:13 GMT -7
Thanks Jean, I would not have guessed she was in pain, however, my vet is certain she is in pain and insisting she be on the tramadol and Robaxin again at least until she regains some function. She is so stoic, but, the vet feels that her is pressure on her spine likely from a disc, and, this would be painful for her. They also shaved her hind end for me, now that she is unable to eliminate outside, her coat is so very long and thick the smell was quite bad, so, this makes wiping her down a little easier. She still has an appetite, is drinking and seems happy enough. Expressing her will be an interesting feat, I am hoping that soon she will regain that ability
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PaulaM
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Post by PaulaM on Mar 24, 2014 13:56:14 GMT -7
Wendy, it would be difficult to say if this is a new disc or the same disc just tore bigger all due to movement. If there was pain in a very different place that could verify a new disc, if close the the original disc that would not likely be verifiable with an exam. It really does not matter as the treatment is the same limit movement so the disc can heal and meds to get the swelling down.
As I mentioned we can carry our dog to and from the potty place limiting movement for the potty break. Do the best you can to think of all ways to limit Lola's walking at potty time. Perhaps you can lay down a pee pad near her crate.... put some old peed on grass or dirt there for the sniff part of the test rather than taking her outside to pee.
Can she still wag her tail if you specifically do some happy talk or she sees a treat?
The vet is being aggressive with prednisone. So be very observant for the first red flag hint of not wanting to eat or drink (nausea) before it progress to vomit with or without blood, loose stools with or without red or black blood. Sucralfate does not prevent stomach problems. But when you know there is an increase of likely Gi tract issues with increase in PRed, the mucous lining can quickly begin to be disrupted before we are aware. That would be the reason to have sucralfate on board not to prevent but to gel coat any disruption of the mucus lining and aid in its repair.
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Post by Wendy & Kado on Mar 24, 2014 14:10:20 GMT -7
Thanks Paula , we were actually thinking of buying one of the puppy potty's in case Ryan could not be moved before Lola was ready to return home. I am thinking if we buy something like that and place it beside her crate she would only have to step outside her crate to eliminate. I do not know how well she will take to this but it is worth a try. The vet also suggested a lee pad outside her crate to have her eliminate there, she seemed to urinate with the sling on as we were leaving the vets, that way I could sling her to the potty area. I am just not sure if I should purchase this grassy potty, or, just work with a pee pad for now? i worry about the double dose of the prednisone as well...I am seeing the vet in 2 days to pick up some more prednisone, I will ask her if I can have some sucralfate on hand in case I see signs and she is not around or Available. lola had a bowel movement during the exam when he rectum was stimulated, I am assuming I will need to assist her once daily with this until she is up and able to squat to have her bm? Her legs have never been as straight and droopy before, this is new for us and there is no way with her legs like this that she will be able to squat to eliminate, so, I am thinking it will need to be either laying down and my pressure, or with her legs hanging and it leaking? I am not comfortable to sling her with her current condition.
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PaulaM
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Post by PaulaM on Mar 24, 2014 14:43:05 GMT -7
If a pee pad or some astro turf on top of the pee pad will work I would not spend extra $$ unless a puppy potty (not sure what it is) is inexpensive at this point as bladder control could have the potential to return. I think it smart to have access to sucralfate should symptoms appear late at night or on the weekend when your vet is closed. Maybe she would give you an Rx that you could fill at a 24 hrs pharmacy if needed?? You can express for poop as well as for urine. Bladder expressing is a must do for a health reason of UTIs. Poop expressing is to avoid accidents that would upset Lola. Poop will come out on its own. Details of expressing: www.dodgerslist.com/literature/Expressing.htm#poopHandicapped Pets has lots of ideas for the larger dog that we may not know about. So you might see what else they may have in addition to this idea for expressing the larger dog. A smaller ladder might work well for expressing inside the house? www.dodgerslist.com/literature/Expressing.htmwww.handicappedpet.net/helppets/viewtopic.php?p=48480I don’t recall if you already have a harness. The walkabout one can stay on during the day making less work for you and less movement getting it on for Lola. www.walkaboutharnesses.com/products/suspenders-for-rear-harness
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Post by Wendy & Kado on Mar 24, 2014 15:35:05 GMT -7
So, right now with Lola's sad state, I went down to see if she needed to eliminate, the pad under her was a little wet, she was sitting up...when I put her sling under her abdomen as I do for walking her, she began to urinate, a lot, it was a strong steady stream, after one or two seconds, I moved her a bit to try to remove the pee pad and she began streaming urine again...I am assuming that this is an effective way to empty her bladder? She didn't need to leave her crate. She has a hard time to lay herself down though, she opts to sit a lot until I help her lay down by lifting her front legs a little, on occasion she will flop down which is probably not good for her back...is there a better way to help her lay down?
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PaulaM
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Post by PaulaM on Mar 24, 2014 16:14:29 GMT -7
From what you describe about the urine it is hard to know if she really has bladder control or not. It really does take that sniff and pee test to verify bladder control. A dog with no bladder control but still maintaining bladder muscle tone can continue to shoot a stream out once pressure from expressing or from the sling starts it. A dog having no bladder control means always urine is left in the bladder where it becomes a breeding ground for bacteria (UTIs). This is why expressing is such an important health issue to make sure the bladder is full voided.
Glad the vet shaved Lola, making the green tea wipe downs much easier for you. YOu are doing such a good job in caring for Lola!!!!!
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Post by Wendy & Kado on Mar 24, 2014 16:29:33 GMT -7
Thanks Paula, she is tough to figure out, once again, when I slinged her in the front of her back legs, she lifted her tail and began to have a big heavy stream of urine, she stops for a sec and proceeds to have more. The fact her tail is raising when she does this I hope is promising. On a good note, she does not need to be removed from her crate to do this so she is totally on crate rest for now. I am hoping as time progresses I can ease her out of her crate to do this beside her crate on a pad. With her slings to eliminate, she is not laying in the urine which is also good for keeping her clean. I'll need to buy a lot of disposable pads though : )
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Post by Pauliana on Mar 24, 2014 20:46:56 GMT -7
Hi Wendy,
Adding my prayers and healing thoughts for dear Lola.. She is a fighter, and you are giving her wonderful care!
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Marjorie
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Post by Marjorie on Mar 25, 2014 4:46:15 GMT -7
It sounds as though you have things very well under control, Wendy. While you need to watch out for side effects from the high dose of Pred, this may be just what is needed to finally get that swelling completely down. And how wonderful that she's urinating on pee pads in the crate! That will help enormously and avoid the struggle to get her outside. Unfortunately, the raising of the tail when peeing is a reflex. If you find any more wet bedding, you'll need to express her more often. While on the Pred, she should be expressed every 2-3 hours as Pred causes increased thirst and urination. If not, her bladder will overflow (that's when you'll find wet bedding) and that can stretch out the bladder. Good plan, too, to have the Sucralfate available in case needed on an emergent basis.
I'm sorry this setback has happened but I know Lola is in excellent hands. Healing prayers continue.
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