Melanie's Penny 5/2017 surgery8wks - Beagle/Corgle - NECK

*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.

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?

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.htm

I 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?

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

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.

I can see Penny knows how to get what she wants, Melanie! Thanks for the encouraging update. Glad to hear she's doing well.

Great news that Penny is doing so well!

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!

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.