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Post by Gayle & Elmer on Jul 25, 2017 17:13:44 GMT -7
Wow. Am I glad I have a knowledgeable resource because the lack of information is astonishing! Why doesn't the medication come with the side effects for animals?
I was given five syringes. I gave one injection to him in the vet's office yesterday, so now I have four left. It truly says, "Give 0.1cc (10 units) every 2-3 days under the skin as directed" Above that, it says,"Dexamethasone inj .4ml/ .1ml Qty 5"
[21 lbs Prednisone as of 7/16: 5mgs 2x/day for 5 days as of 7/12: 5mgs 2x/day for ? days was he taking Dex inj 5 syringes; 0.4mg/0.1mL as of 7/24: 0.1cc every 2-3??? days Gabapentin 100mgs 3x/day Famotidine 10 mgs 2x/day Convenia ]
The vet did not say to discontinue the Famotidine. He said I could get it in a chewable form with peppermint flavor. He just had his evening meal, and he seems perfectly content. Hope he doesn't get sick! It's probably too late to give him the Famotidine.
I was going to give him his next injection tomorrow, but now I know better. I have two appointments for him tomorrow at the same vet hospital. First, he gets his laser therapy. Then he has an hour reserved for the neurologist.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 26, 2017 8:20:39 GMT -7
Gayle, it would be good if a vet would give you the info sheet that comes with med or if not that you ask for one. And as always we want to encourage every owner to do their own additional reading on each med that goes down their dogs throat. I keep this vet's website bookmarked for my own dogs. You can bookmark the Mar Vista Vet drug directory for your Elmer's drugs: www.marvistavet.com/pharmacy-center.pml It is good have a neuro appt today to be able to confirm in your mind about the exact days in between the Dex injections. It should be a firm number of days NOT the imprecise Rx of every 2 or 3 days! Let us know what the neuro says about bladder control and your inabilty to express Elmer. I worry about the health of his bladder since his bladder is overflowing because you are not able to manually express his bladder.
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Post by Gayle & Elmer on Jul 26, 2017 14:43:46 GMT -7
Paula, Elmer went to see the neurologist today, Dr Carn of Sarasota and Naples offices. She was familiar with dodgerslist.com and spoke highly of you. After the consultation, she said Elmer has some use of his right leg, some tone, and some feeling in both feet. She transported him to Naples for an MRI and possible surgery tomorrow. I am awaiting a phone call about how he did on his transport.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 26, 2017 18:01:36 GMT -7
Gayle, we'll be waiting to hear back if there will be a surgery tomorrow. We'lll be thinking about you and Elmer this evening..
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Post by Gayle & Elmer on Jul 26, 2017 18:08:57 GMT -7
The doctor's name is spelled Carne's [Michelle B. Carnes, MS, DVM, DACVIM]. She was wonderful with Elmer. I am getting updates often. I will email a picture of him just received.
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Post by Gayle & Elmer on Jul 27, 2017 8:46:42 GMT -7
Dr Cook [DVM, PHD, DACVIM] of Naples, Specialists in Companion Animal Neurology is doing the surgery now. He will be making a longer than usual incision. He mentioned transplanting some fat to cushion his disks, and said there will be a slim chance this disease will ever plague him again. Surgery is going on now, and will probably last until 1:00 today. Waiting for an update. I applied for a six month interest free loan for the surgery and was approved before they transported him. Estimated cost was $4500.
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Post by Romy & Frankie on Jul 27, 2017 13:15:44 GMT -7
Best wishes on a successful surgery for Elmer. We will be anxious to hear news when you are updated by the surgeon. Sending the most positive of thoughts for a good surgical outcome with all the offending disc pieces removed.
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Post by Gayle & Elmer on Jul 27, 2017 14:25:51 GMT -7
Dr Cook called to tell me Elmer is out of surgery. It took him longer than usual because he cleaned the calcium deposits off of each disk. He is confident that Elmer will not have a recurrence if genetic problem again. He said Elmer pulled the catheter out on his own, and they will not put another one back in because of inflammation; however, he believes it will not take long before Elmer begins to urinate on his own. Once that happens, he will be able to come home.
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Post by Romy & Frankie on Jul 27, 2017 14:33:07 GMT -7
I am very happy that Elmer's surgery went so well. Good reading that can answer some post op questions or give you an idea of what you want to know more about while you are waiting for Elmer to be ready to come home is here: www.dodgerslist.com/literature/surgery.htmKeep us updated on Elmer. We will be anxious to hear.
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Post by Gayle & Elmer on Jul 28, 2017 10:45:39 GMT -7
I am going to pick him up in Naples at 4:15. There, I will learn how to take care of him; physical therapy, express urine, etc., during recovery. Elmer is coming home!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 28, 2017 12:26:08 GMT -7
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Post by Gayle & Elmer on Jul 29, 2017 6:16:58 GMT -7
Elmer is doing well. He has a "zipper" all the way down his back where Dr Cook made repairs and cleaned out the calcium deposits around all other disks. Last night he did well. He wags his tail more. He has enough tone in his back legs to stand alone for a few seconds. I have fed him and given him all of his meds using pill pockets. I will email all of his meds to you. He urinates and poops on his own. At the hospital, he was holding his urine, but as soon as he saw me, he released. We did some expressing to make sure the bladder was empty. All through the night, I changed his pee pad because he is drinking water more, and taking a pill that relaxes his bladder so his urine can be released and expressed. I have four exercises to do with him 2x -3x per day. We go back in 10 days for follow up.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 29, 2017 7:18:44 GMT -7
Gayle, glad to hear Elmer is back home now.
We look forward to specific details of the med list (mgs for each dose, how many times a day dose)
Gayle, last night did you express his bladder at all? While he is still on a steroid you, would expect to express every 2-3 hours to prevent the definately not-a-good-thing of an overflowing bladder. His bladder is overflowing if you are having to change his bedding rather often. Expressing successfully means he stays dry until the next time you express.
Did you get another hands-on-top-of-your-hands expressing lesson when you went to pick him up yesterday afternoon? Was it actually YOU in the "we did some expressing to make sure"yesterday afternoon at the surgery hospital?
The reason we keep asking about expressing is this danger. Bladder tone can be ruined and lost with continual overstretching. ~~ Overflowing happens when the bladder if filled to the overstretch point to cause reflexes to kick in.
~~ When the muscles of the bladder wall lack tone the bladder won't work when the brain can again send messages down the spinal cord.
~~It appears with a happy tail wag that at some point bladder control will return for Oliver. We just want to ensure his bladder will work when that happens.
For how many weeks does the surgeon want for crate rest plus the PT he wants you to do?
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Post by Gayle & Elmer on Jul 29, 2017 10:58:11 GMT -7
Paula, I sent two attachments to dodgerslist.com for you.
------------------------ From the SCAN 2/27/17 Discharge document:
Abundant disk material was removed from L4-5 allowing the spinal cord to rest normally within the vertebral canal. Excellent decompression. The spinal cord was slightly dented but no outward signs of significant or permanent damage.
Fenestration was performed from T10-11 through L4-5.
Medications: Cefpoxidime (Simplicef) 100 mg- Give 1 tab by mouth every 24 hours (an antibiotic). Next dose is due tomorrow 7/29 at 8am. A fentanyl transdermal patch has been applied. This will deliver medication through the skin for the next 5 days. You may remove it on August 1; fold it in half and flush it down the toilet. May cause drowsiness. Famotidine (generic for Pepcid, an antacid) 10 mg- Give 1 tablet by mouth every 24 hours. Next dose is due at 8am tomorrow morning. Diazepam 5mg: Give 1/2 tablet by mouth every 8-12 hours to ease bladder expression; may cause sedation. Next dose due tonight at 10pm. Gabapentin 100mg: Give 1 capsule by mouth every 8-12 hours for discomfort. may cause sedation. Next dose due tonight at 10pm.
Prognosis: Elmer has done well postoperatively; I expect him to make a complete recovery. You should see an 80% improvement over the next 2 weeks; the rest of the improvement may take months. At the time of discharge from the hospital, he has a small amount of voluntary movement in the pelvic limbs but is still requiring assistance with bladder expression.
He is unable to urinate voluntarily and therefore will need constant help with emptying his bladder. ------------------------
[21 lbs single injection of a steroid drug at the time of surgery 7/27. Cefpoxidime 100mgs 1x/day 5-day Fentanyl patch remove on Aug 1 Famotidine 10mgs 1x/day Diazepam 2.5mgs every 5-12 hrs to ease bladder expressoin Gabaentin 100 mgs every 8-12 hours for pain]
Yes, his bladder is not overstretching. He goes often, and I also take him out to express his bladder. I make sure he is emptying.
Yes, the lesson was hands on top of hands.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 29, 2017 14:38:38 GMT -7
Gale, I'm concerned that you are not fully understanding what your surgeon said.
1. Elmer does not have any bladder control at all. Therefore you need to manually express his bladder as you were shown at the hospital.
2. Having to change out his pee pads in his suite tells, me Elmer is overflowing. That is VERY bad for his bladder.
3. The surgeon is very confident that nerve repair will happen! However if the bladder is allowed to overflow so that you are having to clean up his urine in his bed often, then his bladder may not work when the brain can finally connect and send message to the bladder! That would be very, very sad.
4. The way you keep his bladder healthy is to set your alarm clock. Promptly evert 2-3 hours express his bladder. When you see you did not express often enough, the express maybe 30-mins to an hour earlier. When you reach a good proficiency level, then you can move up expressing to every 4-6 hours even during night for 8 hours!
5. When you reach the goal of expert expresser, that means you are fully voiding the bladder at each session. The bladder will feel pretty flat between your two hands. Fully emptying the bladder means it takes more time to fill back up...gives you more hours in between expressing sessions. It means he no longer has a bladder that is overflowing, it means he stays dry expressing session to session.
Let us know how many hours between expressing session you are doing.
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Post by Gayle & Elmer on Jul 29, 2017 15:52:59 GMT -7
I have emailed the neurologist who gave me his weekend email address. The bottle of Gabapentin says they are 300mg. That may be a mistake on their part and part of the reason he is not able to control his bladder. Waiting for a reply.
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Post by Pauliana on Jul 29, 2017 21:36:44 GMT -7
Since you were given 300 mg GABAPENTIN CAPSULES by mistake, you can still use them but divide the 300mg capsule powder into 3 equal parts by dumping into a creased pieced of paper and with a razor blade move the powder into 3 equal piles making 100mg each.. Store the remainder of the powder piles in one of those 7 day pill boxes with a lid for each day. NOTE: Gabapentin is very bitter tasting. Make sure you do not transfer any dust from your finger to the outside of the pill treat. I mash a piece of banana, form a ball, make an indentation. Spoon powder dose into well and close up. If necessary drape a piece of thin deli meat around ball for further tastiness! Another idea is you can purchase empty capsules at your pharmacy. Or you can by eye sight divide powder into 1/3 of each side of the actual gabapentin capsule. Cap the open end of each side of the capsule with a cheese plug. image.made-in-china.com/2f0j00UBstGPraVDcC/Pill-Box-39-422081-.jpgPlease let us know what the Neurologist replies.. Hopefully they will give you the correct Gabapentin capsules right away. Elmer will need to repair his nerves before he is able to urinate on his own..(overflowing on his bedding is not the same as bladder control..) We can tell with the tail wag that his nerves are working at healing and repairing. It takes time.. In the meantime express Elmer at least every 2-3 hours until he is able to stay dry between expressing times..Then every 4-6 hours as you gain experience and he stays dry between sessions. Your Surgeon said in the page you copied for us: "He is unable to urinate voluntarily and therefore will need constant help with emptying his bladder. "..
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Post by Gayle & Elmer on Jul 30, 2017 6:17:35 GMT -7
I took him out first thing this morning. It strains my back, but I am doing it. I tried to express but I got no urine. He had already filled his pee pad overnight and again before I got him out. Next time, I am going to take him to the bathroom and put him in the tub to express. It is a shorter distance to carry him to the tub. He is too big to put on the toilet. I have to tell you, I am getting very discouraged to hear I am not doing right by my boy. It is important to express his urine. I get that, but please try to understand that this is hard to do alone. I have never felt his bladder. I am doing exactly what the vet techs showed. I am signing off for a while.
I got a reply from his neurosurgeon who said they want to see him on Monday. He said I could give him the 300mg capsules as it would not cause harm.
[21 lbs single injection of a steroid drug at the time of surgery 7/27. Cefpoxidime 100mgs 1x/day 5-day Fentanyl patch remove on Aug 1 Famotidine 10mgs 1x/day Diazepam 2.5mgs every 8-12 hrs to ease bladder expressoin Gabaentin 300mgs capsule: 100 mgs 300mgs every 8-12 hours for pain]
The Valium could also be causing him to be relaxed enough to simply release his urine. He now releases his urine when he gets love, hugs, kisses. I think we just need to chill until the vet appointment on Monday, and further instructions.
I am totally exasperated at this point.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jul 30, 2017 8:15:20 GMT -7
Gayle, I do understand your challenges with your disease plus living alone. The good news is we are now successful communicating! You have conveyed to us you do know overflowing is not choosing to pee, it is a sign that Elmer does not yet have bladder control. Being able to clearly recognize Elmer has no bladder control means to us that you are doing your best to express him. That is all anyone can ask for!
Expressing is a new skill. I think it took me a weeks worth of expressing every 2-3 hours or so before the lightbulb came on for me just what the bladder felt like. Until then I just pressed on the sides of the tummy. Urine came out, but I wasn't fully voiding the bladder til I had learned what the bladder felt like. Your surgeon explains what took, me some time to develop the skill to feel the shape of the bladder and to be able to trap it in my hands:
Elmer has had surgery to remove the offending disc material AND now your neurosurgeon wants you to sling walk (leash, harness & sling) Elmer as part of his PT. So you no longer need to be lifting and carrying Elmer outdoors. Whew! That should save your back. Sling walk him from now on. While outdoors with Elmer always give him a chance to sniff and see if he will pee outside. IF not, then you express. Lean his butt on your upper thigh as you kneel in the grass. Express his bladder. If you find he is too distracted outdoors, then sling walk him back indoors to express where he won't be distracted. Distraction can mean he tenses his tummy muscles and wants to wander off. Express indoors on the floor on a pee pad. That way you do not have to lift and carry him into the tub. That is a a wonderful neurosurgeon you have to be able to contact him and get a quick email response on the Gabapentin.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jul 30, 2017 8:26:34 GMT -7
Diazepam, relaxes the muscle so you can more easily press on the bladder. How often are you actually giving the Diazepam every 8 hours or every 12 hours?
If the hugs and kisses cause overflowing, then can you try an experiment to first express, then give hugs and kisses to see if that prevents overflowing?
This expressing thing often requires making a chart so you can better see timing. Note the time of the day you feed him. Time of the day he takes a drink. Note the times he overflows. You may then be able to see a pattern giving you a clue as to how often you'll need to express his bladder.
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Post by Gayle & Elmer on Jul 30, 2017 10:58:00 GMT -7
Diazepam is every 8 hours along with his pain meds.
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Post by Julie & Perry on Jul 30, 2017 18:08:43 GMT -7
Gayle, please don't get discouraged. I made many mistakes with my IVDD dog. When we know better we do better. You obviously love Elmer a lot and only want the best for him. The moderators just want to help. Hang in there. It will get better!!
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Post by Gayle & Elmer on Jul 31, 2017 18:05:35 GMT -7
I, (and my driver), took Elmer to Naples again, (60 miles from home) during tropical storm Emily because I was not sure how well I was doing his physical therapy, and saw no voluntary movement in his legs, and I was concerned with his Gabapentin dosage. I was thrilled to meet Dr. Cook who was very comforting to me. He expressed Elmer's urine and got a moderate amount. I have since tried and failed again, but I will take him to my local vet tomorrow if I do not have success. I sent his report to Paula via email.
Just drove myself to the local vet and had his bladder expressed tonight.
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Marjorie
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Post by Marjorie on Aug 1, 2017 4:52:22 GMT -7
Glad to hear that the visit to Dr. Cook brought you some comfort, Gayle. I all too well know how stressful those days following spinal surgery can be. I also was alone caring for my 32 lb. paralyzed, incontinent Cocker Spaniel but I don't have your health issues. That all makes your situation so much harder. Expressing took me quite some time to learn but I eventually got the hang of it and you will, too. Once I figured it out, Jeremy stayed dry between expressing and expressing became just a routine part of our day and not a problem. Possibly trying to express Elmer lying on his side on a pee pad would be a better position for you. Is it leaning over that's difficult for you? Would a chair or a small stool be helpful? Please let us know what you've tried and the problems you've encountered and we'll try to come up with some solutions for you. As far as feeling the bladder, when the bladder's full, it fills the whole abdominal cavity. As it empties, naturally it gets smaller and can slip away from you and move back to the pelvic area so you need to find it again and keep pressing until there's just a dribble. It took me a long time to feel the bladder - I didn't know what I was pressing on and Jeremy had so many accidents.
Nerves can take such a very long time to heal. It took weeks following my Jeremy's surgery for even a small foot movement to occur and it was so small and so gradual that I thought I was imagining it. I remember my discouragement when there was no progression for months. But gradually he improved and was wobbly walking six months following surgery. I continued to see improvement in his walking for over a year following surgery. We were getting into a good routine and I had gotten a cart for him three months following surgery to give him some mobility so I know that even if he hadn't walked again, we would have been OK. Jeremy handled it so much better than I did.
I don't know if you believe in the power of prayer but if you do, please know that my prayers are with you and Elmer. Try to stay positive. It will get easier as you find routines and adjust.
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Post by Gayle & Elmer on Aug 1, 2017 8:49:12 GMT -7
Marjorie, thank you for the encouraging words. I certainly do believe in the power of prayer. I think the biggest problem I have is carrying him. My back is killing me. The next problem is knowing how and when to express, and I always afraid I am going to hurt him. He cannot hold up his own rear, so it's like I need someone to lift him while I search for his bladder. Today I was able to get a dribble, and I walked him all over the backyard with the sling. A friend coaxed him with lunch meat, and he followed her. But he still isn't putting any weight on those legs. They just drag behind him while I hold him up with the sling. I can see that his spine is going in the right direction with each step, but his legs are spread out to the side, feet turned under. I feel like I need a third person holding his legs in position while he walks. He is always exhausted after a workout.
I just ordered a stroller, so I hope it will take the hurt out of my back.
I put him on the coffee table today with a pee pad under him when I expressed. That relieved my back somewhat. It is in the 90's here in Cape Coral, Florida so it is not good to be in the sun doing any of these exercises or to express his urine. Thank you again so much for the information and encouragement.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Aug 1, 2017 12:04:20 GMT -7
Gayle, are you able to get into a kneeling position? Can you kneel on the floor. Place Elmer's butt against your thigh. Your thigh holds his butt up enough that you can use both hands to feel for the bladder.
Another option is to still express on the floor on a pee pad. For this option you'll need a little footstool/step stool, that you will sit on behind Elmer's butt. Elmer will be in a sit position with his front legs supporting his chest. With him sitting up, you hands are free to feel for his bladder.
Have no fear, you will not be hurting Elmer as you press and express his bladder.
There should be very minimal lifiting and picking Elmer up for you now that he has had surgery. Use the sling wherever possible to sling walk him where you need him to be. Avoid steps, use a piece of plywood board over a step(s) if you have them at your house. When you use the sling you are holding his butt just barely high enough that Elmer's back legs just slightly graze the ground.
He has lost nerve function, that is why he can't bear weight, and his legs drag. Think more in terms of months rather than days/weeks for nerve to self repair enough to bring back leg function.
I agree in hot humid 90 degree temps, it is too hot! Save outdoor exercising for early morning or perhaps late evening when cooler. Outdoor for the every couple of days sniff and pee test on the grass can also be done the parts of the days when it's cooler outdoors. If you have good traction in your home such as rug runners, carpeted area, then you can do the sling walking PT indoors.
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Post by Gayle & Elmer on Aug 1, 2017 14:24:54 GMT -7
Good suggestions. One thing that has been a real help is Pill Pockets, chicken flavored. He loves them. I had nightmarish trouble getting pills down him, but now I am able to get him to gladly take his meds!! I got [expressed him] him to pee a little bit this morning an a little this evening. It doesn't work every time, but what a celebration when it happens!
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Post by Julie & Perry on Aug 1, 2017 18:46:08 GMT -7
Great job Gayle! It's hard caring for an IVDD dog at first. There's a steep learning curve. You will become a whiz at expressing eventually. Be patient with yourself. Elmer is lucky to have someone so committed to helping him.😀
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Post by Gayle & Elmer on Aug 2, 2017 6:49:05 GMT -7
Thanks! I [expressed him] got him to pee a little again this morning. I am finding that he leaks the most between 2 and 6 AM. By the time I get him outside, he has done most of his [overflowing] peeing. He didn't poop yesterday, but he did this morning during PT. That always worries me when he doesn't move his bowels. The exercise was good for him in more ways than one. Now he gets to rest. He has had his breakfast and meds. His legs moved a bit this morning! Small celebrations are all we need for now.
I have a question about where to put Elmer if I have to leave the house. Since this happened in mid July, I have been with him 24/7. I have even had groceries delivered. If I should need to leave for an hour or two, should I put him inside his carrier crate?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Aug 2, 2017 8:48:29 GMT -7
Gayle, the safest place is inside of his recovery suite, a wire crate, an ex-pen. Strollers would only be used when you are by his side as. I'm not sure what your carrier crate is. Sounds like it may be too small, soft sided, something to carry a dog to a vet visit? Does the carrier crate have enough room for him to lie down and fully stretch out his legs?
It can be confusing to us when different terms are substituted for the word "expressing" and "overflowing." So far we've not heard that bladder control is back, thus Elmer can't pee. He must be expressed so that he does not overflow.
Pee means that the dog has full control over his bladder to wait til he's outdoors, sniffed and then decides to pee.
Overflow, means the dog has no bladder control and when the bladder is very full it will leak (overflow)
Expressing is the term used for when you press on his tummy to force the neck of the bladder to open and release urine. Expressing is what is done for a dog who does not yet have bladder control.
While you are still learning to express, you might give it a try to set your alarm say at 2am in the morning to express his bladder. Hopefully that will keep him from the 2am to 6am overflowing/leaking.
Elmer should be just fine in his recovery suite while you take a break easily for 1-2 hours!
Can you tell us more about his legs moving? Was it separate from any potty time? Did you see him move a leg to try and reposition himself in his suite, try to scratch? Was the leg movement when you were doing some sling walking...what exactly did you observe?
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