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Post by Rob & Oliver on Jul 21, 2017 9:17:12 GMT -7
Met with neuro. Sick to my stomach. Sounds like about 50-50'he will or won't need surgery. I've never had to click on the surgery link on this website , only conservative, but will have to look at the surgery link as it's a real possibility. Leaving him at hospital for day or two or three. So fully hydrated, properly and timely medicated, and the chief neuro who's my guy, dr Levitin came in onnhis day off and promised me if the surg the isnneedee he'll do it and is also coming in tomorrow just to meet with me and Oliver here so we do another. Euro test, which they're also gonna do here every 6 hours. I'm numb.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jul 21, 2017 9:33:36 GMT -7
Rob, it is quite likely with the 100% STRICT rest that Oliver will get at the hospital plus getting good pain control meds he will be able to go forward at home with conservative treatment. We are pulling for Oliver. You are right to get some knowledge under your belt before meeting with the Neuro. It is hard enough to concentrate and ask the right questions when your mind is swimming. So as you bone up on surgery vs. conservative, jot down the questions that come to mind. That way you make sure each of your concerns gets an answer better helping you to make decisons on behalf of Oliver. Dr. Isaacs answered alot of questions we've all have had about surgery: "Surgery needs to be a decision an owner enters into recognizing the risk, but also recognizes the benefit. This way if something unforeseen occurs an owner can be comforted and at peace with the fact that surgery was the right decision and they did all they could for their dog." You will find it worthwhile to read the rest of his answers about surgery: www.dodgerslist.com/literature/surgery.htmMore excellent info to help with conservative vs. surgery decisions: www.dodgerslist.com/literature/healingsurgery.htm
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Post by Rob & Oliver on Jul 22, 2017 4:13:34 GMT -7
Hey Paula. I really hope you're right. There's no question that if one can get away with treatment by meds vs surgery, you want the med route, correct? I've been wondering about that since even if you get away with med route, you can still have the disk fluid pressing on the spinal area whereas surgery removes that pressure by removing the escaped disk fluid, no??
As for Oliver, as I've posted, I've opted for expensive inpatient round the clock hospitalization which provides 24/7 IV hydration, pain management, complete neuro check every 6 hours, etc etc. When I went to visit last night around 6, we did the neuro exam specifically with me there as we all knew he'd perform his best for daddy and indeed his rear legs showed movement and a few wobbly steps, all meaning a good neuro exam and no further declination in his neurology. I called the hospital at 615am for update. They said he's eating great , no negative events, generally chill but was crying overnight once as he wants to go home.
When I get the call, dr Levitin (on his day off again) is meeting me there to do another neuro exam and see where he's at. Depending, we may or may not do an MRI, but he's good with keeping him there under close eye and really proper med and crate rest route if that avoids surgery. I think the next day or two will tell us a lot. He said either we're going to see a significant improvement in a day or two or, if not, then he's going to recommend surgery. Does that sound right? The dog gets 2-3 days and should kinda pop up and if not he's a surgery candidate or is that an overly conservative approach, from a pro-surgical perspective??
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Marjorie
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Post by Marjorie on Jul 22, 2017 5:34:04 GMT -7
Hi, Rob. When a dog can still wobbly walk, most vets would opt for the less invasive treatment first - conservative care. As for seeing improvement in 2-3 days, that may or may not happen and not seeing improvement in that short a time should not be a reason to go ahead with surgery. You may or may not see improvement during the entire 8 weeks of conservative care. Wobbly walking is a sign of nerve damage and nerves can take a very long time to heal - months, even a year or more. As for an MRI, that should only be done just prior to surgery. MRIs require anesthesia which is dangerous for a dog going through an IVDD episode as anesthesia relaxes all of the core muscles supporting the spine. MRIs are done right before surgery so the doctor knows exactly where to operate. If conservative care is going ahead, there would be no need for an MRI as all discs are treated the same during conservative care and there is no need to know which disc has been damaged. SURGERY The purpose of surgery is to take the pressure off of the spinal cord by removing the disc material causing the compression. Surgical decompression allows a normal blood supply to return to the compressed spinal cord and for neurologic recovery to begin by the body self-healing nerves. CONSERVATIVE Seeks to relieve swelling/compression of the spinal cord with an anti-inflammatory (prednisone). Over time the hope is disc material where it should not be will shrink back enough so that pain, and nerves can start to self repair. Reference reading conservative vs. surgery : www.dodgerslist.com/literature/healingsurgery.htmThe most important part of conservative care is the crate rest part. In order for conservative care to be successful, you must commit to 24/7 100% crate rest for a full 8 weeks, carrying in and out to do potty and very few steps allowed at potty time. The less movement of the spine, the better. With surgery, most vets prescribe 6 weeks of post-op crate rest, only out of the crate for potty and PT. Prayers for you and the vets as decision are made.
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Post by Rob & Oliver on Jul 22, 2017 6:02:25 GMT -7
Thanks. Good point about the anesthesia part of the MRI as potentially negative impact. If ur dog could get up and walk a couple of feet, wobbly and then have to sit down, would you elect conservative or surgery?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jul 22, 2017 8:47:16 GMT -7
Rob, the usual is going ahead with surgery is when there have been several test-for pain attempts to stop Rimadyl and yet the pain will not be resolved OR that there has been a sudden loss of deep pain sensation.
You are now reporting there has been some reverse of nerve damage from dragging legs? He can now wobbly walk a few footsteps! Do his back paws knuckle under? If there is improvement of nerve function AND the pain is being control he may well be able to recover with conservative treatment!
1. √Pain caused by the tearing disc & inflammation in the spinal cord 2. √Wobbly walking, ? legs cross 3. √ Nails/toes scuffing floor 4. √ Paws knuckle 5. __ drags back leg(s) 6. __ can't move back legs up into a stand position. 7.__ Legs do not work at all (paralysis, dog is down) 8. __ Bladder control is lost 9. __ Tail wagging with joy is lost 10. 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.
Remember, Oliver is not the usual in showing that meds did not work, it was less than optimal crate rest that allowed too much movement and the worsening of the disc. Is the surgeon aware of that piece of information? Your surgeon is very, very likely to be quite a skillful surgeon. So that part is not in question for you. The things you need to consider are ~~ Is a surgery a budget consideration for some point if surgery is necessary? ~~ You have researched to know the risks of a surgery would not outweigh the benefit of a surgery when needed would provide Surgery will not reverse nerve damage, the body does that. Surgery goes in and immediately removes any disc material where it is not supposed to be. When a disc tears, then disc material can escape into the spinal cord canal. Removing that escaped disc material immediately relieves pressure on the the nerves in the cord. ~~ Conservative treatment is, of course, non-invasive. Conservative uses an anti-inflammatory to reduce inflammation. The body will self heal nerve damage which you seem to already be reporting. With conservative treatment often with time the body will re-absorb disc material where it is not supposed to be or a bulging disc will shrink back away from the spinal cord enough to not bother the nerves. It is typical that several courses of the Rimadyl adding up to 7-30 days is needed to resolve all the swelling. After several attempts (several courses) the pain just will not be resolved, surgery becomes something to consider.
So there is not a right or wrong choice, just that you have researched the pros and cons of a surgery. Is the surgery in question an emergency to do right away? Could another attempt with strict rest at home be tried? With knowledge you are best able to discuss and ask pertinent questions of your surgeon's presentation "for" a surgery. Then you make the best decision with the available information you have. We are here to support you with a surgery or with conservative treatment.
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Post by Rob & Oliver on Jul 22, 2017 9:46:44 GMT -7
Hi Paula and all. Let me respond to Paula's questions and then Ill update on my visit just now with the doctor and Oliver, my poor little boy, who was crying when he saw me, AND came and took a few steps including with his back legs, wobbly and all, but his nerves remain intact. Okay, so his rear paws are not moving back when putting them under him (the knuckling thing), but he is definitely being well cared for and shows no signs of pain. He has not lost sensation anywhere including of course in the rear. Has not lost bladder control but it fills and he can't get into a pee position so they're expressing him. He is eating well and just want to be home. There is no improvement in nerve function but no declination either, but not in pain.
Paula, I like how you say his presentation "For" a surgery as I did feel that was happening, I mean not like a car salesman but I asked him squarely "if it were your dog, what would you do" and he didn't blink and said he would do the surgery. We then discussed maybe doing just a scan, but after 10 minutes he then said that "if we see that it is protruding", which of course it is, that's why he's unable to walk perfectly, then I should be prepared to authorize surgery, so he is definitely in the pro-surgery camp. I told him that if that's his feeling, that if we do a scan, that I should be prepared to go forward then I didn't see the point of the scan essentially in that its just a precursor to the inevitable surgery. On the other hand, I want to get this resolved. It's torture being home now, at 12:30PM, I won't even see him again till tomorrow -- thats my choice, as I feel that the less I go there and get him excited and moving around, the better for him -- and Im going to have the same discussion tomorrow. And the cost is about $1000 a day, which is expensive of course and I am not a wealthy person. Th4e surgery with CT will be about $8000. But I do have that if necessary and will not be basing my decision on cost.
I am really at a loss as to what's best for Oliver. All input appreciated. Thanks. Rob
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Marjorie
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Post by Marjorie on Jul 22, 2017 10:16:25 GMT -7
Rob, you asked me if Oliver were my dog, would I do surgery or conservative care. Each of us as our dogs' guardians need to make those type of decisions ourselves but I will answer you since you asked me directly. If my dog were wobbly walking and knuckling but could still take some steps, I would do conservative care as I have done in the past.
My Jeremy had a very bad disc episode years ago (due to the ER vet's lack of direction as to crate rest and resulting too much movement of the spine) where he lost all use of his legs, lost bladder/bowel control and no DPS and emergency surgery was performed. I do not regret that surgery as all use of his legs were lost and also no DPS. It took 6 months for Jeremy to walk again although he never regained bladder/bowel control. Jeremy has had another two disc episodes, one in a different area of his back and one in his neck, and both times there were mild symptoms (wobbly walking, knuckling with the back injury and pain with the neck injury) so I went with conservative care although surgery was recommended. Both times his pain was brought completely under control and both times he was able to be weaned off of the meds successfully. Both times he recovered well and was back to where he had been after his recovery from the surgery.
As Paula mentioned, surgery will not heal nerve damage. Oliver may still be wobbly walking and knuckling after surgery as it can take months for nerve damage to heal. Only time will heal nerve damage.
I do believe that Oliver is still a good candidate for conservative care. I believe that intrusive surgery with its risks should be avoided unless all use of legs is gone. But that's only my personal opinion. You need to do what you feel is best for Oliver.
If you decide to try conservative care again and if Oliver's pain is completely under control, there would be no reason why he couldn't be discharged and come home with prescribed oral meds. Don't let anyone pressure you to do anything or to keep him in the hospital if you decide on conservative care. You don't need to have the same discussion tomorrow. If you think another round of conservative care can be tried, bring Oliver home. But you decide on conservative care, you do need to commit to being very strict with his crate rest, only out for potty, carried in and out for potty with very few steps allowed at potty time and then back in the crate. Think of the crate as a cast for the spine.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jul 22, 2017 10:36:23 GMT -7
Rob, normally a dog will not like being expressed when he has bladder control. So that is curious that they are expressing... you will want to have more specific information from them about bladder control. A dog who can't squat would still be able to hold it in and release urine by choice when in an appropriate place (usually outdoors, not in their bedding) The only way for us humans to know if there is bladder control is with the sniff and pee test. Carry outdoors, set on an old pee spot to sniff it. See if urine is then released. Make sure the sling or hands are not on the tummy area as that can press on the bladder in effect expressing. If urine comes out after sniffing, bladder control is there. Leaking on you when lifted or finding urine leaks in bedding is a sign that bladder function has been lost. So can Oliver pass the sniff and pee test at the hospital? Why are they expressing, is that to move him as little as possible? This is very curious and demands learning more with your questions. Some surgeons have little experience with conservative and their training leaves them with surgery is the treatment. Other surgeons have had experience with conservative and they want to use the least invasive method first. You surgeon did offer conservative initially so he has some experience with it but apparently now feels more comfortable with a surgical solution. I personally, if my dog were in Oliver's state, would opt for conservative because you have stated that dragging legs have now improved to still knuckling BUT NOW ability to n move those back legs in a walking motion for a few footsteps. That is nerve improvement. Conservative treatment in the hospital IS showing it is working! But that is me. I know that I fully understand what movement to the disc spells for the bad disc and the adverse potential for the spinal cord. I know that I would be fully committed to 8 weeks of 100% strict rest--absolutely no cheating on rest. I know that I'm not squeamish, that if I needed to express my dog, I have the can do attitude to learn a new skill of manually expressing the bladder. These are considerations you will have to make for yourself. This is how manually expressing the bladder would go IF, if there has indeed been loss of bladder control: video plus tips: www.dodgerslist.com/literature/Expressing.htmYou do have the ability to give the same 100% STRICT rest 24/7, only out for a very, very few footsteps at potty time as the hospital is doing for $1000/day. Only you can answer the question of whether you will commit to the necessary 100% STRICT rest 24/7 at your house.
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Post by Rob & Oliver on Jul 22, 2017 10:43:36 GMT -7
Hi Marjorie. This is the email and conversation I need to have. I really feel strongly that I do not want surgery if its not absolutely positively necessary and from my reasonably good understanding of this condition, of my dog, of dealing with strong professionals like doctors (Im a lawyer so know about pushy professionals), I feel that as of right now, since it is clear there IS nerve activity (he has not lost it), that he can walk a step or two albeit wobbly, crossing himself a bit and then the knuckling when we did the neuro evaluation today, that I don't want to be pushed into surgery if there's any chance he can recover without it.
My next issue I suppose is WHEN TO TAKE HIM HOME? If I go back tomorrow, and he's the same, not better not worse, I'm super scared to have him all on my own -- I live alone. I know he needs help expressing his pee and poop perhaps. My crate is coming today so I will attach that to an X-Pen and make a totally secure crated area. And I absolutely 100% plan to be to the letter strict on dos and donts. It feels safer with him in the hospital but at $1000 a day, if his condition is going to take time to heal by conservative treatment, and as Ill be doing the same thing as the hospital is, just not as good (but better in other ways), the question is when to take him home.
I really appreciate your straight up answer to my fundamental question. I'm responsible for whatever decisions I make but I need support.
Romy? Paula? Paulina? All thoughts needed please. All I can think right now is that my little boy is in an uptown hospital and I won't be seeing him till tomorrow. But I've already committed to meeting with the Dr and his team to discuss where he's at tomorrow so I'll leave it. But I don't know what to do if he's essentially the same tomorrow.....
Oh Paula, as I typed this last message, when I sent it, I see your new message came in. Yes, I've learned my lesson on absolute strict 100% crate rest. I'm scared though. Very...
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Jul 22, 2017 10:58:03 GMT -7
If you are, then, committed, call the hospital now. Tell then you are wanting to have him discharged today, that you are on your way. Take a good look at that expressing video so you will get more out of the hands-on-top-of your hands lesson IF he indeed has lost bladder control. Be prepared in learning a new skill that you may need extra help in learning, that you would express in your local DVM's clinic and have the vet tech there check your work and give you some pointers. This is how we all have learned expressing.
Do query the hospital folks on why they are expressing....has he lost bladder control? It was kinda muddy what you reported. IF he can walk, how is it that he has no bladder control...take a look at the typical order neuro functions are lost. There is a huge gap between knuckling and loosing bladder control.
1. √Pain caused by the tearing disc & inflammation in the spinal cord 2. √Wobbly walking, √ legs cross 3. √ Nails/toes scuffing floor 4. √ Paws knuckle 5. __ drags back leg(s) 6. __ can't move back legs up into a stand position. 7.__ Legs do not work at all (paralysis, dog is down) 8. _?_ Bladder control is lost 9. __ Tail wagging with joy is lost
Rob, do you work from home? He will need to be expressed maybe every 2-3 hours IF HE HAS LOST BLADDER CONTROL while you are learning to express. Then with in the week or sooner your increased proficiency skills will allow you to express every 4-5 even 8 hours.
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Post by Rob & Oliver on Jul 22, 2017 11:13:40 GMT -7
Boy that's bold. I have no problem learning to express. I just put a call in to talk to one of the docs on my case, not the neuro, who just came in today to meet with me and do evaluation of Oliver. I feel I would prefer to do this tomorrow after meeting with them again and having the same and a further discussion. And after giving him the extra day of Conservative Care Via Ritz Carlton, which can only help.
Yes, I will get clear on bladder control. Im not fully clear on that status as well which is why it's coming off unclear to you.
Frankly Im more concerned about poop issues and dealing with that business than I am about bladder expression as I have a second major medical condition I have to deal with for Oliver. About 1.5 years ago Oliver needed double perinneal surgery and so I always have to deal with the consistency of his poop, his rectum is slightly loosened so I have issues about that too. UGH.
So I really don't feel comfortable just calling and running up to get him. I;d rather he remain under IV hydration and pain meds and crated and with Neuro exam every 6 hours. But I called them and I'm going to prepare them that this is now what I'm thinking so THEY can pr4pare themselves. I get the feeling that most owners just do what they[re told. My beautiful fiancé died 3 years ago from Stage 4 breast cancer. I quite work for a year to advocate for her, do all of the dealings and FIGHTING on her behalf and taking care of her as she declined. So being a pushover is not my problem. I just want to make sure I'm doing the right thing by Oliver and that I'm prepared to handle it.
That's my thinking.
oh, missed a question. Yes, work from home, so can oversee him pretty much 24/7
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Jul 22, 2017 11:32:23 GMT -7
Rob, poop is a piece of cake to deal with. Poop will come out all on its own IF he has lost bowel control. You can express for poop not as a health issue but to prevent Oliver from being anxious to find poop where he sleeps. Having poop control means he is able to hold poop in until in an appropriate place. Wth his surgery you may be able to express for poop if even if he has control but problems because the anus has become somewhat flacid and not as tight as it should be. Same link as bladder expressing is the video on how to express for poop, if Oliver will allow you.
Tommorow, of course, is just fine on meeting for the discharge. I'm so sorry to hear about your fiancé, cancer is just awful for everyone involved. As you see you can always opt for surgery...there would be plenty of time. You know the progressive signs of neuro loss to monitor for. Most vets do not want to operate until there are fully paralyzed legs. FlY: most general DVMs do not properly identify what they see regarding deep pain sensation, so we only take the word about DPS from a neuro or ortho specialist, not a local general vet. If Oliver should loose bladder control, could no longer wag his tail with joy, you would still have time to transport him in for surgery. Keep that list handy so you remember what to monitor for.
10. 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.
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Post by Rob & Oliver on Jul 22, 2017 11:42:41 GMT -7
Hey Paula. Well aware of the limitations of general DVMs. I only take the word of my neurologist/neurosurgeon, Dr. Boaz Levitin, who Romy knows actually.
Please be prepared for a flood of questions, hand-holding needs and whatever comes up when I bring him home. I don't see any reason not to bring him home tomorrow if he's the same as today, not better but more importantly not worse.
One note, I find it interesting statement that you state "most vets do not want to operate until there are fully paralyzed legs". That is exactly what DR LEvitin wants to avoid getting to. HE explained that the chances of a full recovery approach 90% as long as there's still some sensation left, that waiting until he has full paralysis COULD (not would) decrease the chances of the full recovery to a lesser percentage, and also increases the post-op recovery time. This does make sense to me conceptually.
But if he's the same tomorrow, I think I need to bring him home.
here's question, what would be an ideal neuro check on Oliver when he's home so as to be the least intrusive -- I obviously don't want to move him at all during crate rest time -- yet still get a determinative indication of his neuro status?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Jul 22, 2017 12:12:00 GMT -7
Rob, it is a vocabulary thing. The some "sensation" is called deep pain sensation (DPS) and that is why "chances of a full recovery approach 90% as long as there's still some sensation left"
10. Deep pain sensation (DPS), 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.
So with knuckling, with full leg paralyzis many general vets start getting very anxious in wanting to get the dog to a vet who knows more than they do. Among surgeons there is a difference in opinion. Some want to operate at knuckling. Others prefer to continue with the least invasive Conservative until there is evidence of leg function loss, bladder loss. Many dogs on this Forum loose bladder control but never did loose leg function. IVDD is complicated about the when's time to do something, every dog is different. Some owners have a pretting good grounding in IVDD some just have no understanding.
As long as there is bladder control, there is still the ability to do a happy tail wag, there is, then, still DPS. Keep that entire list handy so you will know what to monitor for and when you should take prompt action to seek surgery. Avoid doing any pinch tests as even a general DVM may not be able to correctly identify what they see, so likely you would not learn anything from pinching.
Our whole reason for Dodgerslist, is to provide care and support during a disc episode. We welcome any question you come up with!
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Post by Rob & Oliver on Jul 22, 2017 12:30:11 GMT -7
Paula, everyone here, I can't thank you all enough for your kind and generous support.
So here's the latest, just spoke to vet. First, she confirmed he has NOT lost bladder control, and in fact have been expressing him less often and he just did a pee on his own (on his bed) but on his own, so there's that news. Next, they're weaning him off by lowering dose of IV Fentynl and then switching to Gabapenton for the reason that the doc wants to consider that perhaps the Fentynuyl is making him too woosy which could also be holding him back from walking a bit more, which is just awesome. I thanked them for being so conscience about these nuanced and complex medical matters. You get your money[s worth at the Ritz.
Finally, I felt it appropriate, now that YOU'VE moved me to make the decision I[ve been wrestling with, to tell her that provided he's the same or better (no worse) than he was today, that Im going to take him home and begin strict crate rest. And as the Universe would have it, the Precision Crate (size Small) with accompanying cushion) will be delivered by Amazon Prime to me in about 2 hours so I can and will set up his suite tonight.
Wow, Im exhausted from all this. Thanks Paula and everyone for being so available and giving.
To be continued......Rob
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
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Post by Marjorie on Jul 22, 2017 13:03:12 GMT -7
Yes, important decisions like this can be terribly exhausting! I do hope you're taking care of yourself, too, and feel less stress now that a decision has been made. One thing I'm a bit concerned about is your comment that "My crate is coming today so I will attach that to an X-Pen and make a totally secure crated area". The recovery suite should only be large enough for Oliver to stand up, turn around and lie down with his feet comfortably extended. So I'm not sure why you're planning on attaching the crate to an ex-pen. You also mentioned that you don't want to move Oliver at all during conservative care. Are you thinking that he needs a potty area? The problem with making a potty area with an ex-pen is that Oliver may have too much room in the recovery suite to move around in. You can and should take him from the crate and carry him out to do potty, use a harness and leash to keep his steps to the very minimum and then carry him back to his crate. Proper way to lift and carry a dog with IVDD: www.dodgerslist.com/literature/liftcarry.jpg It also concerns me that they said that Oliver did a pee on his own "on his bed". Most dogs with bladder control will not urinate where they sleep and will hold it until they go out. Did they see him squat and pee or did his bladder overflow with urine that he couldn't hold? I was told that my Jeremy had bladder control after his surgery but he definitely didn't. I think you should get a hands-on-your-hands demonstration on how to express before Oliver's release just in case. I didn't because I was told that Jeremy had bladder control and it was very difficult for me to figure out how to do it. Just tell them you want to know in case he loses bladder control. As Paula mentioned, the only way we humans can tell if a dog has bladder control is the sniff and pee test. So you'll need to carry him outside to a spot where he's peed before, support his hind end if he has difficulty but not under his belly, let him sniff and see if he can release urine on his own. He may not have a full bladder when he gets home so your first attempt might not work. If he can release urine on his own after sniffing, then he has bladder control. If not, you'll need to express him. Finding wet bedding or leaking urine when picked up indicates loss of bladder control. If he has lost bladder control and needs to be expressed, you can take him out of the crate and express him right outside of the crate on a pee pad. Please let us know what meds Oliver is prescribed upon his discharge, giving us the name of the med and the dosage in mgs and frequency given. We're here for you and Oliver and will help you through each step of his recovery.
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Post by Rob & Oliver on Jul 22, 2017 13:19:52 GMT -7
Marjorie, just got another call from vet about bladder. She said that actually they did an ultrasound and his bladder was in fact full, meaning that what came out was probably dribble overflow and they don't want his bladder to expand so they just fully expressed him so he's; right now empty. So I guess this means he's fully continent (has bladder control), he just can't really stand or has an area to position and then pee. So the doc that's there spoke with my neuro and they're putting him on a pee sphincter medicine to "relax" that area and make it easier for him to pee. DOn't know the med name yet (just anticipating the DL question). And yes, I already told them they need to show me a hands on bladder expression when I go there tomorrow.
As for Crate/X-pen, I was just speaking with Romy about that exact issue and Blue Pearl called so had to take that call. I am unsure exactly how to set up for Oliver so will take all of your suggestions. I will have a small sized Precision crate with nice cushion and will further cushion as needed with towels. My question is what about potty? Should I leave X-Pen off for now, just keep him crated exclusively 24/7? I have to take him to pee but he won't pee on command, or poop. I was "planning" (my big genius plan) was to attach the X-Pen to the crate so he could have a sitting area in the crate and then his regular bed within the X-Pen plus the rest of it I would put wee wee pads. This was my thought but I think I need some clarity and directions from you guys.
Head spinning. Will come back to this in 2 hours. And my boy will be coming home tomorrow, provided he remains stable or better till then....
Thanks
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Post by Rob & Oliver on Jul 22, 2017 13:39:45 GMT -7
Hi Marjorie. Just re-read your email and understand your comments. I am actually very concerned about what to do for pee and poop. He will not be able to move into a poop position for some time I imagine, and as you may have seen, I have another co-existing medical condition from Oliver's perianneal surgery from 1.5 years ago. I am thinking Oliver will be so fragile initially that to even place him in his carry bag, carry him downstairs to the street area, to try to do his business will be a problem. Especially as he cannot really walk normally and may not for days or weeks. I would prefer to have a potty area in home, I think that will be the best thing for his condition.
All thoughts appreciated from all. Rob
Oh, my crate just came...Illl post a picture later or in the morning when I figure out how to
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Post by Romy & Frankie on Jul 22, 2017 13:46:31 GMT -7
Actually that sounds like he does not have bladder control. What I think happened is that his bladder became too full and overflowed. But when that happens, all the urine is not released which is why is bladder was still full.
Prazosin and Phenoxybenzamine are medicines that help relax the sphincter muscles. They are often prescribed to help with expressing, which is a matter of overcoming the strength of the urinary sphincter. Frankie was prescribed this type of medicine to help me express him. He only used it briefly until I became more experienced at expressing.
Attaching an ex-pen to the crate is too much room. You can keep the crate in one room and the ex-pen in another so as to keep him near you.
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Post by Rob & Oliver on Jul 22, 2017 13:54:52 GMT -7
Yes, that's what the vet said to me; your first sentence, you expressed it more clearly.
Still need to come up with potty plan, I feel for him Id rather set up in-house area then carry him outside in his bag as he probably won't go outside like that as he's a total pill. Will have to see, but I;ll be ready for anything....
Oh, if I try to "walk" him outside, this obvious won't be without some sort of rear end sling which has space for a male to pee and poop, right? I mean he is till veritably unable to walk so what are we really talking about? This is my next concern.
Oh yes, I see Frankie's picture now. He looks super sweet.
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Post by Romy & Frankie on Jul 22, 2017 14:13:45 GMT -7
Rob, if he does not have bladder control than you will need to express him until bladder control returns. So the potty plan will now be different. You need to find a place to express him in the house. This can be on a pee pad. He will not need to leave the house to potty. You can carry him to the pee pad and express. Alternatively a shower stall or bath tub can be used. Get the lesson in expressing that you posted about when he is discharged. Watch the expressing video again before you go. Expressing is tricky to learn but with practice you will. You will know you have got it right when you are getting a steady stream and there is no leaking between times. There are different ways to position the dog when expressing.the web page shows some of them. You can use whatever works. www.dodgerslist.com/literature/Expressing.htm#bladderexpressOnce you can express easily taking care of Oliver will be much easier.
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Post by Rob & Oliver on Jul 22, 2017 14:24:04 GMT -7
Perfect. I'll use wee wee pads. He's a small dog so it holds a full pee from him. Thnx
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Post by Pauliana on Jul 22, 2017 21:32:52 GMT -7
Hi Rob,
This was our day with the grandchildren so I wasn't home earlier when you were trying to decide between surgery and Conservative.. I am glad to hear that you are planning on bringing him home tomorrow if all goes well. Consevative treatment works too, as I have experienced with Tyler.. He had surgery when he woke up paralyzed in 2013 and had surgery and he did very well and recovered walking. He has had several episodes since that were milder and we treated him conservatively and he bounced back each and every time. There are no wrong decisions, make the one that is best for both you and dear Oliver and all of us will be here for you..
Will be waiting to hear how the appointment goes tomorrow..
Healing thoughts!
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Post by Rob & Oliver on Jul 23, 2017 4:27:22 GMT -7
Hi Paulina. Good to hear from you. I liked waking up with a new post from the DL team. Spoke with the inpatient nurse last night and got a very good report that he was moving around and barking, which I like. Signs of life. This morning I called in for a check in on the night and he ate and they say he just peed on his own...that's what they said. I said "_are you sure?" She said it's not just a little dribbling but a large pool of pre. I asked them to do a sonogram to see if he emptied himself, so that is good news on release day.
My branded new PrecisionnCrate came yesterday and I just put it together. With the nice precision fusion but I'm going to add some of my soft towels as well. And I think I should put a diaper on top. Is that a good thought? I'm nervous thinking about alll the what if this happens or that, but my friend just said you'll find your rhythm with Oliver when he returns which was well said.
Oh, how can I post pictures to these threads? I'm sure you might like to see a few poses from Supermodel Oliver when he's home and in his crate, would like to send u pics of the crate setup etc. anyway, thanks and good morning.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jul 23, 2017 5:20:10 GMT -7
Good morning, Rob. I don't want to be a killjoy but when the bladder overflows, it can often be a large pool of urine and not just a dribble. The only way you'll know if he has bladder control is if you see him sniff where he or another dog has peed and release urine on his own. Finding wet bedding if taken out of the crate often enough is an indication that there is not bladder control. Hopefully you'll have proof soon yourself that there is bladder control. How to set up bedding in recovery suite: Mattress: Soft firm mattress of some sort: •2 inch 4 lb density memory foam mattress to relieve pressure points. NOTE: protect the foam mattress by inserting in a large trash bag and duct taping closed. Tuck in/cover with fleece bottom sheet. www.foambymail.com Check Walmart, etc. for human memory foam bed topper can be cut down and stacked for several recovery suite locations. •Egg crate foam is another alternative:http://www.foambymail.com/rectangle-eggcrate-foam-pet-beds.html Here are more tips on crate rest supplies: www.dodgerslist.com/literature/cratesupplies.htmI saw elsewhere on the forum where you mentioned that you might need a rear end harness for Oliver. If he doesn't have bladder control, you'll just be taking him from the crate and putting him on a pee pad to express his bladder - no need for harness or sling. If he does have bladder control and you set up a pee spot inside as you mentioned, you would need a front harness to control his steps so he doesn't pull away from you and a sling (not a harness) to support his rear end. www.dodgerslist.com/literature/slingwalk.jpgFirst upload the photo to our 2016 gallery and then copy/paste the photo's address in your post to the forum. More information on that here: dodgerslist.boards.net/thread/2262/add-2017-dodgerslist-photo-galleryHappy home coming for Oliver!
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Post by Rob & Oliver on Jul 23, 2017 5:33:07 GMT -7
I will nail this down when I go there this morning. Crate all set up for him
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Jul 23, 2017 7:07:45 GMT -7
Rob, thanks for the pictures. A couple of comments which underscore the information Marjorie has posted. The wire crate can be made into a top opening one if you would find that easier to lift and carry him to the potty place. Here are the DYI instructions www.dodgerslist.com/literature/cratesupplies/cratetopconvert.pdf from our Crate Rest Suppliy List, Marjorie pointed you to. Try to avoid using any cotton things inside of the recovery suite. Cotton holds moisture against the skin and fur should there be an accident. In stead look for synthetics. Look for synthetic fleece, the stuff winter wear is made of. It wicks moisture from the body, dries quickly. Cut it to sizes needed for bottom sheets, it does not ravel---no sewing required. Your local fabric store carries synthetic fleece by the yard. This time of the year, your local Walgreens, grocery store might still have some $10 fleece throws around, too, worth a phone call to find out. Put the mattress (egg crate, memory foam, other soft mattress material) inside of a trash bag. Seal shut with tape, duct tape, etc. Top mattress with a pee pad. Tuck a synthetic fleece "bottom sheet" all around. One of the bottom sheets on top for Oliver to snuggle under. At some point you might like obtaining castors from your petstore or on-line for the wire crate so you can move it around the house to keep Oliver near you. Use your ex-pen as both an alternate recovery suite PLUS the potty place. - Use 4-5 panels to surround another mattress setup - Fold the remaining panels to house a pee pad. If you are needing to express, then Oliver having a visual and physical to let him know he can't scoot away, will make it easier for you to express him. Oliver would be facing the expressing closure while your kneeling body would be blocking the opening as you have his butt against your thigh while expressing. If his does turn out to have bladder control, then you would lift him from the recovery suite and place him on the pee pad potty place inside the ex-pen. The potty place would be closed off --- so again he will know there is to be no running off or going on walks/sniff fests to take care of business. You would use a figure 8 sling to keep his back aligned and butt from tipping over. An ex-pen gives you many options to keep Oliver's disc safe from too much movement during the 8 weeks of healing.
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Post by Rob & Oliver on Jul 23, 2017 7:54:20 GMT -7
Okay, will work on textures for the bottom of the crate. I've set up an x-pen nearby with 5 panels, tied closed with twist-stud, and papered with wee wee pads. I'm so nervous about picking him up and being able to deal with his meds and his pee poop business.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Jul 23, 2017 8:08:25 GMT -7
Hopefully Oliver has had a drink of water an hour or so before get the expressing lesson. That way you will have something to practice on with the expressing lesson. Tie wraps are super things. You may wish to investigate finding clips to use instead. That way you can open and close securely as you need to rather than the fixed ties. The pictured clip you may find at your pet store is the easiest to use. Other options is the clip at the end of a leash, it will fit two wire bars of the ex-pen a little bit more tightly, but it will work in a pinch. Do expect as you implement a new routine, it takes more brain concentration, some worries as you are mentining, til things become routine. You can do it, just as we all have. Give yourself a break in learning something new. Each of us has wanted to be 100% proficient right away. Be prepared to not hesitate to go to your local DVM's clinic for a refresher on expressing.
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