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Post by Stuart & Chester on May 21, 2014 4:51:13 GMT -7
Hi, My name is Stuart and I live in England near Brighton on the South Coast. My dog's name is Chester and he is a 9kg Cairn/Jack Russell Cross that suffered total paralysis of his hind quarters on Saturday evening. He has a history of experiencing pain in his rear legs, stretching back at least 4 or 5 years, which was originally diagnosed as hip dysplasia (which he does have) but I'm now starting to believe that his pain was actually being caused by a problem with his spine. He was operated on within 18 hours of the symptoms appearing, albeit the veterinary surgeon advised that as he had already lost all deep pain sensation there was probably only a 10% chance of recovery. The procedure was was 'lateral laminectomy/pediculectomy (side of spinal canal removed to allow decompression of the spine and observation of the spinal cord) and fenestration (removal of disc material from between the vertebral bodies) of the T13/L1 and L1/L2 discs (the disc behind the last rib and the one behind that.)'We were told that the 'extent of surgery was to improve the environment (decompression) to allow any healing to occur. The extent of healing depends very much on ‘nature’/the patient but we know that when patients loose ‘deep pain sensation’ (what I was trying to demonstrate when crushing Chester’s toes) the prognosis (outlook) is poor.' Following the surgery I was told that 'it appears likely that disc disease was the cause of his problem but I would not exclude Fibrocartilagenous Embolism. The specifics are relatively unimportant as management in Chester's case is the same- decompression and time. Importantly, examination of CSF and radiography/myelography showed no signs of tumour or haemorrhage into the CSF (Cerebral Spinal Fluid).
As discussed on Sunday, I am afraid that the most important factor (far more important than actual specific cause) was/is the absence of deep pain sensation'The surgery was carried out around 72 hours ago and as yet there has been no return of DPP, which I'm told is not uncommon at this stage. He is being kept at the animal hospital, indefinitely at present, and is extremely stressed. He is having problems with his catheter, has diarrhoea, and is having to be muzzled when he is being handled for his physio. Given the timescales, I am not particularly keen to make any snap decisions with regard to his future but seeing him so distressed is heartbreaking in the extreme. We were told by the surgeon that getting him home may be an important factor in his wellbeing as most dogs improve in their own environment. This is dependent upon whether they can express his bladder, as if they can't it's unlikely we'll be able to do it. I'm not sure what I'm really asking here to be honest. This has been the toughest few days of my life  |
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,571
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Post by PaulaM on May 21, 2014 8:56:36 GMT -7
Stuart, welcome to Dodgersist. We are glad you found us! Just a few points quickly and then on to what you can be doing for Chester asap. Caring for an IVDD dog is all about education to know, fight and win with this enemy. It is easy to make mistakes and not be committed to the treatment when full understanding of IVDD has not yet been achieved. And for yourself, knowledge lets you step out of a very scary place…"the unknown" and the toll it takes on your emotions. So you are savvy about the healing phases whether that be conservative treatment or after surgery this page is a wonderful place to get a good overview of each of those phases of healing: www.dodgerslist.com/literature/healingpage.htm Hope to hear you will be able to follow all the informative links and complete your readings in the next couple of days. This "Disc Disease" DVD is a wonderful way to help other family members understand and even others who might be around or taking care of Chester: www.dodgerslist.com/store/DVDorder.htmOK now the actions you can take today: -- Your surgeon is so very right that dogs heal the best at home where they are with their loved ones and familiar surroundings. Sounds like Chester has cage rage requiring a muzzle, he is SCARED!!!! How can he heal when he is so scared, so distressed. Answer: he can't! -- Diarrhea.... ask if Pepcid AC (famotidine) PLUS another GI tract in on board SUCRALFATE to help with the diareah sitatution and that those two meds can continue at home as well. Ask about using pumpkin. 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. To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. To firm up the stool add 1 teaspoon pumpkin to kibble and no extra water 1x a day. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potoato. -- There is absolutely no reason why Chester can't come home even if he has no bladder control. You will get more out of the hands on top of your hands type of lesson if you review this video and the tips before going to bring Chester home. For dogs that simply can't be easily expressed there are meds that may help or he could come home on a last resort use of at home cathether. Meds to discuss to make expressing easier: ==Phenoxybenzamine or Prazosin- decreases internal urethral sphincter tone. == Bethanechol enhances detrusor muscle contraction -- The criteria for Chester being able to come home is that the post op pain can be controlled 100% dose to dose of oral pain meds. Has he been transitioned off of IV pain meds to oral meds? -- Nerve damage heals on its own. Nerve function may or may not come during the 6 weeks of post op crate rest. Think in terms of months rather than days or weeks with nerve regeneration as this is the slowest part of the body to heal. -- Readings to do today to get ready for picking up Chester asap, maybe today or tomorrow if possible, if his pain is well controlled by oral meds: -- www.dodgerslist.com/literature/dischargequestions.htm list of questions on discharge day, add yours to it -- www.dodgerslist.com/literature/surgery.htm#meds Dr. Isaacs answered most asked questions on meds, PT, healing time, how not to worry ...good info you will want to read today -- PT for you to do at home with a demo from your surgeon on which is appropriate for Chester Never give up, stay focused, stay postitive and stay strong! You and Chester will get through this bump in the road of life. Please keep us updated on your Chester. |
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on May 21, 2014 9:33:10 GMT -7
Paula has given you excellent information, Stuart. I just wanted to add some encouragement based on my own experience. My Jeremy, a Cocker Spaniel, was sent home earlier than most dogs after surgery because he, too, was having a terrible time at the hospital and had to be muzzled. He quieted down as soon as he got home. I'm appalled that they only gave Chester a 10% chance of recovery due to loss of DPS. Please don't take that number to heart. No one can tell you how much nerve damage healing there will be. Nerves can take months, even a year or more to heal. Jeremy completely lost DPS, too, and there were so many disc fragments from the one ruptured disc that they had to clean the fragments out of two discs. DPS did come back a few days following surgery but he had no movement in his legs for months following surgery. He was in a cart for months but within six months following surgery, he was up and walking again. I continued to see improvement in his walking more than a year after surgery. He never did regain bowel/bladder control, which is unusual as most dogs do regain that before leg movement. I had difficulty for the first few months with expressing but now it's just a normal part of our day. He's a happy dog and he was happy in his cart so even if he hadn't walked again, he would have been happy. Be sure to get his recovery suite ready for the homecoming. Here are some links to show you how: www.dodgerslist.com/literature/CrateRRP.htm www.dodgerslist.com/literature/cratesupplies.htm www.dodgerslist.com/literature/EmergencyCrate%20Training.htmAcupuncture and laser light therapy are helpful treatments that can be very beneficial to assist with re-establishment of nerve connections in the body and usually can be started right away. www.dodgerslist.com/literature/healingacupuncture.htmAlso water therapy can be performed after the stitches/sutures are removed. Some of these exercises can be done right in the bathtub. www.dodgerslist.com/literature/watertherapy.htmSo as Paula said, never give up and stay strong. The more you learn about IVDD, the easier it all will be for you and Chester. Take it one day at a time. I know both you and Chester will feel a lot better about everything once he gets home. Blessings to you both and prayers for a speedy and full recovery for Chester. |
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Lola & Hurley
Helpful Member 
2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
Posts: 135
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Post by Lola & Hurley on May 21, 2014 12:59:45 GMT -7
Hi Stuart! First, welcome to Dodgerslist. You have found your way to a very special website that will help you get through this "bump in the road" as Paula put it.
Second, don't worry about what to ask or not to ask. We all know it is a devastating and almost incomprehensible situation when your little dog has to go into surgery. It is all very new to you right now, and it will take several days for the dust to settle. However, you can already take a long breath. The surgery is done, and Chester's healing HAS begun. Whatever the healing means for an individual dog cannot be determined by any vet or owner, only time will tell. However, having seen my own dog Hurley be paralyzed twice, and undergoing 3 IVDD surgeries, I can tell you: dogs are amazing. They do not think about the history or the odds. If they can, they will get better - whatever the maximum is, they will reach. Your only job from hereon is to make sure you offer Chester the best possible circumstances to heal and it starts with getting acquainted with all the information that this site has to offer. Do not worry about misdiagnoses in the past, we've all been there, so many vets diagnose IVDD as something else, this is why this site exists. Today is what today is and for you & Chester it means that you will eventually dust it off as you get through this together.
As soon as you know if you can, and/or feel comfortable, I strongly suggest the same as Paula and Marjorie: taking Chester home. He will feel more at ease in his own environment and you are the best person to interpret and help your own dog. It feels like a lot, I know, but you will soon get the hang of everything, and this site is here so that you can ask any questions if you are not sure. And always remember: with surgery, you have now given Chester the first step he needs for recovery > the rest is up to time & tender loving care.
We are here for you!
-Lola
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Post by Julie & Toto on May 22, 2014 2:07:03 GMT -7
Hey Stuart, sorry you and your dog are going through this. My dog had the same thing happen last month. Its definitely very sad and stressful. My dog also had loss of deep pain, and a few days after surgery also felt nothing, but I think about 5 or 6 days after surgery he wagged his tail for the first time. That was huge. There definitely is hope, but even if he stays that way, he can have a good quality of life.
My dog also had pancreatitis. Some vets have told me that this can be caused by stress (pain, etc). I think he had it before the disk slipped, but who knows how long his problem was there for before. It could also be due to his diet or genetics. Either way, if you can, maybe have the doctors run some blood tests. Maybe your dog has it too, or some other problem that would cause the diarrhoea. If you can fix that problem at least, then he will be a lot easier to manage when he comes home. Solid poop is so much easier to clean! hah.
Also, I read a lot of different sources on the outcome of surgery after loss of deep pain, and some do say only 10 to 25 percent, but some also say as high as 70 percent. It all depends on how quickly and thoroughly the vet operated and on how much damage had been done to the spinal cord. So dont let the numbers discourage you.
Hope everything works out well and you can take Chester home soon.
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Post by Stuart & Chester on May 22, 2014 5:43:57 GMT -7
Hi everybody,
Thank you so much for all your advice and kind words.
Evidently, there's a problem with the catheter due to urinary stones, which is completely unrelated to the IVDD. They've still been unable to express him as he's being extremely grumpy and is having to be muzzled when handled.
We were told by the surgeon this morning that the catheter has gone back in and also that his diarrhoea has stopped, and that he appears to be eating fine.
They told us they would like to keep him in until after the weekend, which is a massive relief in a way because I had broached the topic of euthanasia with the surgeon yesterday and he didn't really say anything to dissuade me that it's too early for that decision.
We are really pushing for him to be allowed home as we're positive he'll be happier at home. The surgeon agrees with this in principle but i suppose we have to see if he'll allow us to express him. That seems to be the only sticking point at the moment.
We're doing all we can to give him every opportunity to get through this.
I'll keep you posted.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on May 22, 2014 6:21:47 GMT -7
Oh, Stuart, please, please put the thought of euthanasia completely out of your mind. He made it through the surgery and that was the hard part. Now he just has to heal from the surgery. The surgery removes the disc fragments that were pressing on the spine. Now that the fragments are gone, he should just have some swelling from the surgery that would cause some pain. Once that swelling goes down in a week or so and he goes off meds, he can start some PT and/or acupuncture if that's in your budget (you would be able to do the PT yourself). Hydrotherapy is a great therapy after the stitches/sutures are removed. You can have a professional do the hydrotherapy or learn how to do some exercises in the bathtub or a small pool.
They haven't been able to express him even though he's muzzled and the problem with expressing is just because he's grumpy? I've never seen a dog on this forum who wouldn't allow his/her owner to express them. Some dogs are harder to express than others and sometimes it take medication to make it easier to express at first. I had a problem learning how to do it at first and Jeremy would leak in between expressings. But after a couple of months, I got the hang of it. Even if you have to slip a muzzle on him yourself during the first few weeks until he gets used to being expressed, difficulty expressing is not a reason to euthanize. He may even need a mild sedative until he gets used to the expressing. But I have no doubt that any problems with expressing can be worked out.
I truly think you will see a different dog once you get him home.
Blessings to you both.
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Post by Stuart & Chester on May 22, 2014 7:22:39 GMT -7
Hi Marjorie, further to my previous post, we're being told that the problem with expressing is down the urinary stones, which are making it painful for him.
Again, I'm slightly confused because I was under the impression he had no feeling down there at all; hence the reason he can't go by himself. My wife is going in to see him this afternoon so will hopefully get a better explanation.
This is such a roller coaster! I feel like I've aged 10 years in the last 5 days.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on May 22, 2014 12:17:13 GMT -7
When your wife stops by the hospital, see if she can find out what meds he's currently on and please let us know. Chester most definitely needs to be expressed throughout the day for his urinary health so possibly the pain meds aren't strong enough to make expressing comfortable enough. He may be starting to recover some of his feeling. My Jeremy is completely incontinent but still has feeling there - the nerves just aren't connecting properly so his brain isn't connecting with the nerves of his bladder or bowels to let him know when he needs to go. Also ask if they've done a urinalysis. Urinary tract infections can also be very painful and cause pain when expressing. Are they planning on doing anything about the urinary stones? It does sound from all that you said that Chester is just very stressed all the way around and needs to be muzzled whenever handled, even when doing PT. If the only issue keeping him from coming home is the difficulty expressing, it might be time for him to be released home to see how he does there.
I do completely understand what a roller coaster ride you're experiencing, Stuart, and my heart goes out to you and your wife. It's a very stressful time but things will get better. Hang in there, stay strong and positive. Please let us know what your wife learns this afternoon.
Continuing prayers for you all.
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Post by Stuart & Chester on May 27, 2014 3:09:12 GMT -7
Hi everyone,
Just wanted to post a quick note to let you know that Chester came home yesterday. Still no DPP but he seems relatively happy and was genuinely excited when I told him we were going in the car to see Mummy!
We're no longer having any problems expressing him but he's drinking an extraordinary amount of water and seems to be leaking constantly. We're speaking further with the surgeon today to get more info on this as he's a bit sore around his groin and bottom (although his diarrhoea has also cleared up).
We're very much taking it one day at a time and are so pleased to have found this forum to help with advice as we move forward.
Chester sends lots of licks x
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on May 27, 2014 8:57:15 GMT -7
I'm glad Chester is back home and is feeling happier, Stuart! Anti-inflammatories such as Prednisone cause increased thirst and urination so he will need to be expressed every 2-3 hours if he's on something like that. Please let us know the exact dosage and mgs of each medication he was sent home with. Also, what instructions were given for crate rest and PT? Leaking urine constantly indicates that he either needs to be expressed more often or that you may not be releasing enough urine when you express. Expressing can take some practice. You should be getting a couple of good streams of urine each time you express. The bladder gets smaller, of course, as you express and it moves around. Sometimes it moves all the way back by the groin area. You'll need to find it if it slips away from you and express until it feels like your fingers are almost meeting and the bladder feels flat. Leaking means the bladder is overflowing and that can stretch out the shape of the bladder. Also any urine remaining in the bladder for too long can lead to urinary tract infections. You should periodically try a sniff and pee test. Take Chester out to a spot where he's peed before, hold him up by his hips (not underneath his belly) and see if he can release urine on his own. That's the only way we humans can tell if bladder control is returning. Cleaning Chester's belly and legs with green tea will help with the urine burn. Green tea neutralizes the acidity in the urine. Make up a pot of green tea, let it cool down and wipe Chester with it. You can keep the remaining tea in the refrigerator for later use, just warming some again before use. There is no timetable anyone can give you when to expect nerve repair to happen. In fact, there is no time limit for nerves to heal...it can take weeks, months or even a year or longer. However, it is known that neurological function usually returns in the reverse order of the damage. The first big sign you want to look for is that wonderful tail wag! 1. Deep Pain Sensation (Only correctly identified by a specialist.) 2. Tail wagging with joy at seeing you, getting a treat or due to your happy talk. 3. Bladder and bowel control proved by passing the "sniff and pee" test. Take your dog out to an old pee spot in the grass. Let him sniff and then observe for release of urine. 4. Leg movement, and then ability to move up into a standing position, and then wobbly walking. 5. Being able to walk with more steadiness and properly placed paws. 6. Ability to walk unassisted and perhaps even run. Thanks for the licks, Chester - and a pat on the head and a kiss back to you!  |
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