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Post by mollysmom on Jul 21, 2013 10:02:15 GMT -7
Hello, I'm Candy, mom to 14yo Molly (mini-dachs) who is "recovering" from C3-4 disk surgery (ventral slot) performed on July 10, 2013 at a large university veterinary teaching hospital. I am so glad to have found this list!
Her info as of today:
• complete left side paralysis (she had this before surgery) although she does have deep pain sensation;
• does not move herself at all other than to try to use right side to flip herself over onto her left side, her preferred position; lying on her right side causes her much pain
• extreme pain, poorly managed by 5mg codeine every 8 hrs
• also on gabapentin, 48mg oral suspension every 8 hrs
• crated, propped up on both sides with towel rolls so that she is in sternal position, although she eventually leans over on left side
• more neck pain since yesterday when they removed her stitches
• urinates and defecates in crate, although today we had success (urination) outside when we held her on grassy area
• passive range of motion PT 3-4x/day—left side very painful during this, especially hind leg
• very good appetite
• previous history: 3 surgeries (2 ventral slot, 1 hemilaminectomy) back-to-back during same hospitalization at veterinary teaching hospital for C4-5 disk 2 yrs ago; these vertebrae have since fused and are partly responsible for inducing this C3-4 episode
• My questions:
• I’m frustrated because of these multiple surgeries—3 surgeries to correct the C4-5 2 yrs ago and it’s looking like she’ll have to have a second surgery for this episode, with no guarantees that it will work. Have any of you experienced this?
• Is it normal to have so many surgeries? I just so wish they could get it right the first time.
• If ventral slot doesn’t work, should a hemilaminectomy be done?
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 21, 2013 11:34:27 GMT -7
Candy, this is not right at all the pain not being managed post op. You need to relay this info today asap and have the meds adjusted. Advocate for stronger pain management by discussing maybe tramadol instead of the codeine. Vets need feedback so they see where adjustments need to be made in meds. There is no cookie cuttter recipe for pain control each dog is different. You can't care for her properly, she can't begin the healing process until pain is fully under control.
What is the name of the vet teaching hospital?
At pee time do you specifically see her sniff an old pee spot and then released the urine…that is proof of bladder control. Did they release her having bladder control or say she needed to be manually
expressed?
Who removed the stitches your local vet or at the vet teaching hospital.
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Post by mollysmom on Jul 21, 2013 12:22:19 GMT -7
Hi, Paula--thanks for the reply. I just now left a message for the resident surgeon who operated on her. Surgery was performed at Kansas State University Veterinary Hospital which is about 1-3/4 hr away. Yesterday, I took her to our local vet and asked about the pain and he said codeine is probably the best. He also removed her stitches; however his assistant held her head firmly in an extended position as he did it, and I'm now wondering if that damaged her neck more? I'm sick that I didn't say something at the time!!
This morning, the first time she peed outside rather than in her crate (this was encouraging to us), she did not sniff anything. My husband put her down and she went immediately---but she has to be supported. All last week before we picked her up, they said she was urinating "on her own," but when we got there Thursday, it was more like "she urinates mostly in her crate, maybe she doesn't like the gravel area we put her on"
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Post by Sherry Layman on Jul 21, 2013 13:21:56 GMT -7
My dog had surgery at K-State a number of years ago also, they are fabulous. I'm sorry you are having such a rough time but hang in there.
I doubt the position of her neck during the suture removal caused further damage. Vets/vet staff use this position commonly as it isn't harmful to the dog and it allows the staff to "restrain" the dog to prevent it from biting should it perceive danger. More likely disc damage could have occurred if there had been any struggling, the supported position of the neck is generally not harmful.
As Paula said, the pain is not normal however and you do need to contact K-State. They do have a 24-hour contact phone number. The pain could be any number of things and the surgeon needs to be the one to determine the cause and treat. Don't jump to conclusions that it's a new disc episode. She isn't moving much on her own, perhaps she's having muscle spasms from being in one position too much. I'm not diagnosing just giving a suggestion and saying it's not a disc just because they have pain. But just because it's not a disc doesn't mean the pain shouldn't be treated right away, she shouldn't be left in pain.
Codeine is indeed a strong pain medication but not necessarily the best for her pain. Meds work in the body differently and depending the on the source of the pain something that is actually not as strong may actually work much more effectively. It's a common mistake that stronger drugs are better but it's just not true.
When you take her out to potty put her in what would normally be a favorite potty spot. Is that gravel area where she would normally choose to go if she were out and about on her own?
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Post by mollysmom on Jul 21, 2013 14:08:36 GMT -7
Thank you, Sherry! That's such a relief about the neck position during suture removal! I've just noticed more pain since then, but maybe that's my imagination. No, I don't think it's a new disc episode at all---I'm just concerned that they didn't get all the disc material out, as that is what happened 2 yrs ago. But yes, it sure makes sense that it could be muscle spasms and joint soreness from being in one position so much---I so hope that is the case! I can deal with that, just not sure I want to put her through another surgery. I'm going to call the 24-hr number and try to speak to someone; I just left a voicemail on the resident's office phone and she may not even be in until tomorrow, so thank you for that suggestion, Sherry! We have tramadol on hand that I could give to her. The gravel area was at the hospital---that's where they took her to go potty. Here at home, before this episode, she actually preferred the driveway or sidewalk (LOL!)--we're thinking maybe because she is finding it more difficult to walk on grass. But since we've had her home, we are trying a grassy area that she has used in the past. Thank you so much for your comments and suggestions!! I don't feel so alone with this now.  |
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Post by Sherry Layman on Jul 21, 2013 14:46:17 GMT -7
Yes, give her the Tramadol and see if it helps. But do call their 24 hour number and see what they suggest, they may give you something in addition to the Tramadol. If it's muscle spasms a muscle relaxant will be more effective.
You can try heat as well. Take a sock, put a couple cups of uncooked rice in it and tie a knot in the end. Heat it in the microwave for a couple minutes until it's warm and then place it against her neck. Some dogs are suspicious of this at first and you may have to hold it there gently...be sure it's not too hot. Also never leave it in the crate when you are not around to home so she doesn't try to eat the rice.
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Post by mollysmom on Jul 21, 2013 23:06:55 GMT -7
Well, I contacted K-state about meds, and they don't prescribe codeine and tramadol together, and they reiterated what my local vet said about codeine--- it's the best they can give. They did recommend upping the dose to 3/4 tablet (from 1/2 tab), so I gave her that dose at 11pm. About 45 min later, we tried to turn her over to her other side, and she screamed in pain--barking and snapping at us as she has done from day one. She is now lying in her crate on her right side (the side she doesn't like) and breathing somewhat quickly and shallowly. OK, my son and I just moved her to her propped-up sternal position---again, extreme pain, snapping at us. The pain is always the most severe when we try to move her---i feel so bad!  But now she is settled down and asleep. I will call Kstate tomorrow am to try to get her in. I know they are wanting to do a CT scan of her spine which could lead to a 2nd surgery--- and this leads me back to my original question where I really need input from this group: is it NORMAL to have multiple back-to-back surgeries for the same disc? Is this frequent? Have any of the good folks on this forum had experience with this? |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 22, 2013 20:55:25 GMT -7
It can happen, that some of the disc material was missed and a 2nd surgery was needed. Let us know how the Kstate visit goes. "second surgery soon after the first: www.dodgerslist.com/neurocorner2/Secondsurgrery.htmThere is no one size fits all pain meds....not all dogs respond the same way to pain medications if one pain med is not working then a vet tries another. Hope to hear back that Molly is doing ok now. |
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Post by mollysmom on Jul 24, 2013 11:43:58 GMT -7
Molly update: We took her back to K-state on Monday; surgical resident basically told me that she is not a good candidate for another surgery---that it would "set her back" even more than she is now. They offered to do more imaging but cautioned that if it showed more compression, the only option is to do that surgery. At that point I would have to decide between surgery and euthanasia and I am nowhere near ready to make that decision. They also said that she still might show signs of improvement. It is now 2 wks since surgery, she is still in much pain, and both left legs are still completely paralyzed. They added methylcarbamol to her current meds of codeine and gabapentin, and I think this has helped the pain a little. i decided to wait for 2 more wks--trying to be optimistic but in my heart, I know it was also to avoid making that decision. I have found a holistic vet in Kansas City that will see her next week. I don't know what else to do. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 24, 2013 12:39:36 GMT -7
Can you update us on her meds…name, dose in mg's and how often you actually give it and the range it could be given in.
I'd say right now pain meds need to be aggressive so she is not in any pain. The hope is if it is still a missed piece of disc or a new disc the body and learn to live with it and the piece can shrink back with time. The focus right now is to get pain under control. Paralyzed legs are not the issue at this moment…she can enjoy life with paralyzed legs if that is what is to be. The work right now is to get pain under control so she can start healing. This pain needs to be addressed today, not waiting til next week. Let us know you made contact and have a vet visit lined up today or tomorrow am.
If methocarmbamol has only helped a little, then advocate very strongly for a different combo. Perhaps trading codeine for tramadol. Not all dogs react the same way to a med… pain control is a custom thing.. finding what works for the dog, not a cookie cutter recipe. You need a vet who is willing to work with Molly and you will need to give feedback so the vet knows what adjustments to make.
Please read up on codeine by the Veterinary Anesthesia & Analgesia Support Group:
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But now she is settled down and asleep.