Sara's Daisy 6/7 Surgery

Oops - sorry! My name is Sara - I really have no idea how to navigate these threads and make a proper profile. Daisy seems to be doing ok - this morning at 1am she wagged her tail which I am hoping is a very good sign! Other than that, I have seen no improvement in her situation. Expressing her bladder is getting easier but I'm either not getting it all or she just has NO feeling and leaks quite a bit. I am working constantly cleaning up urine so she is not sitting in it. She finally had a bowel movement which was as hard as I have ever seen - and now that that plug is out, she poops all the time as well! We are kinda a mess over here: /. I have been giving her canned unsweetened pumpkin to keep her bowels soft. Today I tried to push her meds out a bit but then got distracted by my kids and realized I was 4 hours overdue - bad mom!! This is a lot of work and I'm still trying to get used to it - but I am very appreciative of this website and forum -the information has saved me these last couple days!

I'm pretty sure it was a happy tail wag -she did it for me as I was talking to her and then I woke my husband up and she wagged when homage saw him as well. She is on a ton of meds -
Simplicef 50mg/day
Sucralfate .25gm
Prednisilone 5mg every other day
Gabapentin 100mg / every 8-12 hrs
Robaxin 250mg /8 hrs
Tramadol HCL 50mg /1-2 tab every 8-12 hrs - I have only given her 1 of these as a time

She tries to sit up in her crate and my biggest fear is that she will have another rupture and I won't know it because of all the meds. It's a lot and I'm trying not to feel overwhelmed. Her surgeon is 2 hrs away as we live in a small town.

[17lbs
discharged 2 days post op on 6/9 
Prednisolone as of 6/7:  5mg every other day for 4 days
                     as of  6/12:     10mg 2x/day for 3 days
Simplicef 50mg 1x/day
Sucralfate 250 mgs 2x/day 
Gabapentin 100mg 3x/day
Robaxin 250mg  3x/day
Tramadol  25mgs to 50 mgs tab 2x or 3x/day]

Hi Sara, 

Please call the surgeon and let him know about the  sphincter muscle hanging open.  Ask him if increasing the Prednisolone is the right thing to do or what he would suggest.   Is Daisy in any pain or running a fever?  

Are you using water with the pumpkin or just using it without water..  Adding equal parts water will loosen the stool.. Without water it is  acting like Fiber and will make the stool harder.   

It's important that the medications be given on schedule and to not cut back on the pain meds.. Daisy just had a very major surgery and that is painful. Pain needs to be in control from one dose to the next with no breakthrough in pain.. Pain slows down healing so have no patience with it.  

Please keep post all your questions only in Daisy's thread so we have access to all her information in her thread  or we could miss could miss important details.  

Please correct the medication list below:

[weight?
Simplicef 50mg 1x/day
Sucralfate .25gm how many times per day?
Prednisilone 5mg 10mg 2x/day
Gabapentin 100mg / 2 or 3x/day
 are you giving 2 or 3 times per day?
Robaxin 250mg  3x/day
Tramadol HCL 50mg /1-2 tab every 2 or 3x/day - I have only given her 1 of these as a time.
are you giving 2 or 3 times per day?]

It is overwhelming at first but keep on reading and learning..It takes several days to a week to get used to being a nurse for  your little patient.  It is the unknown that is scary!  dodgerslist.com/healingindex.htm

Sara, we feel very, very bad that we are not able to give meaningful comment. Would you please take a moment to help us by completing the information we need on the med list.
~ What date did the pred taper of 5 mgs every other day start?
~ How many times a day do you give sucralfate?
~ Do you give Gabapentin 2x/day or 3x/day?
~ Which are you actually giving tramadol promptly on time?
     Tramadol 25mgs 2x or 3x/day?
     Tramadol 50mgs 2x or 3x/day?
~ For how many days is prednisone at 10mgs 2x/day before a taper?

Is her pain FULLY in control now? no signs of pain at all?

Gabapentin, Robaxin and Tramdol are have quite a short half life and if you are not giving promply every 8 hours (3x/day) they likely will not fully control pain.
     IF you are giving the max in mgs and promptly every 8 hours and there is pain, you need to have the surgeon's phone number or way to contact him.
      Myelomacia traveling upwards towards the head is a VERY big concern that would need prompt action...hours matter for Daisy to NOT be suffering. It appears is the anus is flacid that there may be some myelomalacia traveling downwards toward the tail, not a deadly matter.

YOU NEED phone numbers of who to contact who knows myelomalacia (M) and can properly identify it. His office staff have no qualifications in the matter of "M." NOT ALL VETS know "M"  as it is not that common. I had to refresh the ER vet on the signs. By the time I got there he had looked it up and yes, my dog had it. She was able to pass gently at 3 am in the morning before suffering lungs shutting down. I was completely devastated to have to be the one to have the pressure to identify "M" all by myself. Do not let that happen to you...your surgeon needs to be involved and if your local DVM vet knows this disease he needs to be available to help you too.

So print out this list of symptoms below to discuss with your own DVM vet.

It is important that you are familiar with symptoms in order to promptly get vet help at any hour of the night or day.

With Myelomalacia, what happens basically is that the spinal cord starts to die from the point of the spinal cord trauma moving forward toward the head. It can happen fast, within hours. It is a very painful ending.. making a dog unable to breathe.

There is no cure for Myelomalacia and it is fatal. Should a dog be developing myelomalacia, before there is difficulty breathing, you would want to help to cross to the rainbow bridge to spare a very painful death.

I'm hoping and praying that your dog is not developing Myelomalacia and is just a matter that your vet has not Rx'd the proper pain meds and started to taper pred too soon after surgery.

Symptoms of Myelomalacia:
* about 3-4 days into recovery, they become painful.   Within the first week, they are in a LOT of pain.  
* acute disc extrusion with no deep pain sensation
* development of excruciating pain (more than just pain from the original disc herniation)
• hyper-esthesia (over-reaction to any touch sensation on body)
• even the strongest pain meds do not help
* loss of anal tone, the anus hangs open, (anal flaccidity) and areflexia (below normal or no reflexes)
* neurologic deficits that localize to more than one neuroanatomical section of spinal cord (e.g. T3-L3 myelopathy and an L4-S3 myelopathy)
* loss of cutaneous trunci reflex at a level more cranial to a previous evaluation over a period of hours to days with or w/o surgery
* development of fever (normal rectal temperature is 100.5 to 102.5 degrees Fahrenheit)
* sudden twitching or jerking of the neck and/or head
* loss of voice, horse bark
* Front legs can't hold body up, can't hold head up
* increased respiration/ labored breathing as the nerves to the lungs begin to shutdown
• On an MRI, extensive high T2 signal (brightness) within the spinal cord (>6 vertebral lengths) has been associated with myelomalacia in the setting of a disk extrusion. www.dodgerslist.com/literature/myelomalacia/3t-myelo-misdxb0002.tif

This video shows how surgeons monitor the cutaneous trunci reflex to see if there is movement upwards towards the head.  They even mark on the  dog's back to keep track.  Zip up to 1:24 to see cutaneous trunci reflex

 

Sara, if you are giving Tramadol 100mgs 3xday that is a big difference than what your first reported. Thank you very much for a the complete med list. Excellent news that Daisy is now no longer in pain... a complete night and day difference from yesterday!!!

Please keep us posted and we have our fingers crossed for no more pain to surface. Sounds like you are well prepared with times to avoid skipping a dose!

Oh my Sara, what a slew of things happening all at once!

Do pick out someone who fully understands the need for crate rest, promplty on time meds. KNows all the signs of pain. Boarding at your local vet means that at night very likely no one is in the building. I know one emergency my local vet actually took my dog home with him to best monitor through the night. If there would be any suspicion of not being clear of "M" then you want your dog monitored for any hour of the day or night.

IF your sitter, do introduce her to logging into the Forum so we can stay in contact with her and Daisy.

Where is your surgeon in all of this? Why hasn't your surgeon examined Daisy to know where the nerve function/ the cutaneous trunci reflex is now vs. compared to after surgery? To find out if nerve function has been lost upwards from the surgery?

Can Daisy still do a happy tail wag when you specifically do some happy talk to her or she sees a treat coming?

The spinal cord is made up of nerve cells and fibers (axons). Nerve impulses travel along the axons of the spinal cord from the brain to the bladder, limbs, and vice versa. If portions of the spinal cord are damaged by the bad disc, nerve impulses are not properly transmitted in both directions. Crate rest is imperative to prevent worsening of the bad disc.

As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order.
1. Pain caused by the tearing disc & inflammation in the spinal cord
2. Wobbly walking, back legs cross
3. Nails/toes scuffing floor
4. Paws knuckle
5. Weak/little leg movement, can't move back legs up into a stand
6. Back legs do not work at all (paralysis, dog is down)
7. Bladder control is lost
8. ? Tail wagging with joy is lost
9. ? Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment.
     Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a local general DVM vet who gets DPS wrong. Only trust the word of a board certified surgeon (ortho, ACVS or neuro ACVIM).

What are the credentials of your surgeon: ortho (ACVS) or neuro (ACVIM)?
What is the name of the hospital where the surgery was performed?

If you are not going to have another surgery, then knowing if another disc or the same disc has a problem will not make a difference if there is now a new disc episode. MRI costs $1500+ If it is a suspicion of same or another disc, then conservative treatment is a viable option.

If another surgery would be suggested then an MRI would aid in plannning.
Would another surgery an option for your family?

Nerves can self heal with time if they've not been too severely damaged. Only time will tell to see how much Daisy's body can self heal. Often we need to think more in terms of months rather than days/weeks for the slowest part of the body to heal...the nerves.

How often are you expressing her bladder? Did you get another hands on top of your hands lesson today at your vet.

What is the name of the antibiotic that was prescribed for the UTI?

Hi Sara,  

I sympathize with all you and family are going though with Daisy.   It takes 2 weeks for surgery swelling to subside and after that time you are more likely to see the direction her healing would take. It has only been week.   I wouldn't let her go this early without giving her the chance to heal  just in case that it isn't Myelomalacia.  

With M they are in a lot of pain even on aggressive pain management.  You are saying she is not in pain,so I am hoping it isn't M.  

Conservative treatment can and does work with many dogs even those that are paralyzed.  Many people can't afford the high costs of surgery.. With conservative treatment it requires 8 weeks of strict crate rest and medications until the swelling goes down..

Not sure what to advise about your anniversary trip.. If you trust your friend to take care of her, make sure she is fully educated about IVDD and knows what  her care entails and please do show her how to use the forum so we can help her.. If this was Tyler,  I would just worry the entire time I was gone.. so I never left him for his 6 week recovery from surgery and I only went out for his Vet appointments, but that's just me, I enjoyed being his nurse once I got over the trauma of him waking up paralyzed.. Poor Neil had to do all the grocery shopping and errand running.    

What is the name of the antibiotic?  

Healing and comforting thoughts..

Sara, that sounds like a nasty UTI..   I noticed on your med list that she has been on Simplicef..is she still taking that?  

I feel for what you are going through..please do keep us posted after the Vet visit tomorrow..

Prayers, 

Sara, can you bring Daisy into a board certified neuro (ACVIM) surgeon today at Davis? Not for a surgery, not for an MRI, but ONLY for consultation, a hands on neuro exam to get things right that has not been done for Daisy. Your surgeon is not a board certified surgeon.. he is only a DVM. Daisy deserves the right care she has not had from a vet. Your local DVM is not qualified and your surgeon is not around to give proper after surgery care... just shameful!!!

Just as you would stick around to help a sick child, I believe you should stick around to give your dear friend and pet child the care she needs to get things right.

If the simplex is not the right match for the bacteria in the bladder then it will not kill them. The UTI just keeps raging on. So that needs to be attended to. What is the name of the new antibiotic given last night... just one dose???

A board certified surgeon at DAVIS needs to be consulted to determine just what is going on with Daisy. You may be able to leave for vacation if she is in condition for another person to care for her. You NEED to know what the heck is going on and know it fast. Like today!

This is totally ridiculous the bad vet care she has been receiving post op!!! It is not Daisy's fault she is the patient. Your Local DVM vet is not a surgeon and thus not at fault as some of this is likely beyond the scope of knowledge for a general vet.

Hi Sara,

An Emergency does not require an appointment!  When Tyler woke up paralyzed 4 years ago, I called and told Purdue University Vet teaching Hospital that we were on the way with Tyler and they said they would have the Neuro team waiting for us..  Loss of neuro functions are always an emergency..plus the lack of surgery follow up care requires this visit.. Call and tell them you are on the way with Daisy. Don't take no for an answer!  

I am so sorry for your loss of your dear Daisy.  My thoughts and prayers are with you and your family.

As a family we morn her loss. She was not the dog we wanted - we originally went to get her brother, but they lived in such bad conditions there was no way we were going to leave her there. She was covered in fleas and scabs, and her wannabe long hair was very patchy. We hand picked every flea off her body the first afternoon - she laid there, completely still, knowing we were helping her. That night was probably the first night in her 8 week life that she did not itch. My husband and her were each other's biggest fans. They had a relationship all their own - it was precious. But if I have learned anything throughout this experience, it is that the average vet, in all good intention, does not know enough about the treatment and care of IVDD cases. And we as pet owners can get caught up trusting our vets without doing further research because we are in a hurry and time is of the essence when our dogs go down. If I had known that the surgeon that did Daisy's surgery was not a board certified neurosurgeon, I would have gone somewhere else. Not that it would have had any change in Daisy's outcome. But the roller coaster ride we were on for 4 days was unbearable. Perhaps getting discharged with proper instructions and follow up would have been easier on our emotions. If I had known the symptoms, I would have crated her immediately that first nite - perhaps she would have never had to have surgery. Shoulda, woulda, coulda. BUT...what I CAN do, is share my experience, this website, the symptoms, with this wonderful older lady I know who has a long haired Doxie and lives on a limited income - if and when the requirement of surgery was ever presented her, I know she could not afford it. But if she knows what to look for, what to do, and where to turn, perhaps that would never need to be an issue - she could catch it before surgery was necessary. So I will tell her tomorrow, and introduce her to the website, all in Daisy's honor.

Daisy was loved and happy with you. You fought for her until the end. God bless you and give you peace.