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Post by Marina & Mubi on Jul 24, 2019 15:04:19 GMT -7
Hello! I am so relieved to have found this support forum and have been slowly digesting all the helpful information on the resource pages. Thank you to all the creators, moderators, contributors, and community members of this platform-- I would be completely clueless without you! My name is Marina, and I have a 3.5 year old maltese mix named Mubi. She has a vibrant and affectionate personality, but her love of jumping on/off furniture is likely the cause of her current, very devastating condition. My husband and I are both heartbroken and in shock of how quickly things escalated, and I've never been more stressed, as I am due to give birth to my first son in 5 weeks. I would love to hear your thoughts and suggestions about how I can set Mubi up for the best chance for healing and rehabilitation in the short amount of time that I have, and I am 100% committed to intensive nursing care and physical therapy (to the best of my abilities). History of symptom progression & veterinary care: 7/17 Wednesday: Symptoms: signs of pain, whimpering when held at the chest, shifting positions frequently, clingy Abilities: walking normally (albeit slowly), taking the stairs, jumping on the bed 7/18 Thursday: Symptoms: signs of pain, whimpering when held, clingy, shifting positions, unwilling to move Abilities: walking normally (albeit slowly) 7/19 Friday: Symptoms: signs of pain, whimpering when held, clingy, shifting positions, unwilling to move --> later in the PM, she showed signs of weakness and ataxia in her hind legs while she attempted to go potty Abilities: walking with stiff legs Veterinary Visit #1: - 3:00pm took her to the general DVM, she perked up and started running around out of excitement - signs of pain appreciated, but could not pinpoint the location of the pain (likely musculoskeletal / back) - sent home with anti-inflammatories and crate rest
7/20 Saturday: Symptoms: still in pain, unwilling to move other than to say hello Abilities: (AM) inability to urinate by herself, can't walk without stumbling, (PM) loss of motor in hind legs Veterinary Visit #2:- 6:00am Specialty Care visit, neurological exam done and she still had minimal motor (stumbling) with pain in the thoracic area of the spine - 7:30am Specialty Care called back saying that they did not have a working MRI, and that we could go to a referral center 1.5 hours away for a working MRI machine during the weekend Veterinary Visit #3:- 9:30am arrived at referral center and given another neurological exam --> complete loss of motor, but able to feel pain sensations; admitted - 2:00pm MRI scan done, but the vet was unable to see the exact location of the issue and wanted to confirm slipped disc Dx with the radiologist that there wasn't a chance that this was a tumor or an autoimmune meningitis. The radiologist was not going to be in the office until the next morning, so we had no choice but to wait another 24 hours... we were completely beside ourselves. 7/21 Sunday: Symptoms/Abilities: total loss of sensorimotor function (including DPS) Veterinary Care: - 10:00am confirmation that slipped disc occurred - 12:00pm surgery performed (around 12-24 hours after total sensorimotor loss - within the "golden 72 hours") - 4:00pm update that the surgery was successful, woke up from general anesthesia 7/22-7/24 Monday-Wednesday: Symptoms/Abilities: no change in neurological function (total sensorimotor loss, stage 5) Veterinary Care: - gradual decrease in pain meds - comfortable and calm demeanor; the staff say that she's gained quite the "fan club" of people visiting her because she was so sweet throughout recovery <3 - 7/24 evening: the vet will see if she might be able to remove the catheter and express bladder Introduction Questions★1 Weight = 6.5 lbs Medications: unknown (still hospitalized) ★2 Breed = maltese/poodle/cocker spaniel mix Dog's Name: Mubi Owner's Name: Marina ★3 Diagnosis = slipped disc; Veterinary = BVSc from New Zealand, neurology residency in Athens, Georgia (all non-US) ★4 Date of Surgery: 7/21/2019 ★5 Pain: unknown (still hospitalized) ★6 Eating/Drinking: good (still hospitalized); Urine/Bowel Movements: she'll be getting her catheter removed today to see if she can be expressed at home; no updates on bowel movements from the vet yet ★7 Neurological Status: no sensorimotor function (today is 3 days after surgery) ★8 Bladder Control: unknown -- we'll get a report tomorrow morning on bladder control
I'm getting anxious and nervous about my ability to care for her, but I've set up her recovery suite so far and am eager to be reunited with my sweet pup again:
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Post by Romy & Frankie on Jul 24, 2019 15:27:07 GMT -7
Welcome to Dodgerslist, Marina. We are so glad you’ve joined us all. We’ve got valuable information we’ve gleaned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you! Disc disease is not a death sentence! Struggling with quality of life questions? Re-think things: www.dodgerslist.com/index/SDUNCANquality.htmMubi will likely be prescribed crate rest when she comes home. Post-op crate rest is to allow the surgical sites to heal. Your recovery suite looks good. See if there are any other things you can do to make post-op crate rest go smoother with these very useful tips and ideas: www.dodgerslist.com/literature/CrateRRP.htm and www.dodgerslist.com/literature/cratesupplies.htmSTRICT for a post-op dog means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy whys: www.dodgerslist.com/literature/chiropractic.htm◼︎no dragging or meandering at potty times. Post-op dogs will follow surgeon's directives for PT during post-op rest as the offending disc material was surgically removed. Acupuncture, laser and water therapy are excellent post-op therapies, if within your budget. Check with surgeon prior to starting. If you are going to need to express Mubi's bladder for a while make sure you get a hands-on lesson from your vet. Expressing can be a bit tricky at first but with practice it can be learned. Before your lesson with the vet, take a look at the info we have here to familiarize yourself with ways it can be done: www.dodgerslist.com/literature/Expressing.htm#bladderexpressOn discharge day, make sure no question goes without answer. Here's a starter list of questions to which you can add some of your concerns: www.dodgerslist.com/literature/dischargequestions.htm Good reading that can answer some post op questions or give you an idea of what you want to know more about: www.dodgerslist.com/literature/surgery.htmThree days post surgery is very early in the healing process. It can take up to 2 weeks after surgery for the surgical swelling to go down so the true direction of healing can be seen. Even so nerve healing can be slow. Dogs have regained function over months and even years. There is no real timetable for nerve healing. Knowledge is the power to fight the IVDD enemy and win!! The very best thing you can do for YOU, the caregiver, and for your dog is to get up to speed on IVDD as soon as possible. Begin absorbing the must-have overall sense of meds, care and how the treatment works. Your dog will be depending on your ability to learn: www.dodgerslist.com/literature/theater.htm --- PRINT OUT this link and tape to your fridge: www.dodgerslist.com/literature/healingpage.htm --- use the printout as your roadmap to avoid dangerous detours in your dog's care --- make notes/highlight to keep yourself on track --- follow all the links in the next days to become the IVDD savvy pet parent your dog needs. Use the “search box” to easily locate topics over at our Main www.dodgerslist.com website: www.dodgerslist.com/index/searchBOX.jpgHealing thoughts for Mubi.
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Post by Marina & Mubi on Jul 24, 2019 20:24:57 GMT -7
Thank you so much for the links and resources, Romy & Frankie! Looks like I've got my work cut out for me. I'll keep posting regular updates as the days go by.
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Post by Marina & Mubi on Jul 26, 2019 7:30:01 GMT -7
Mubi returned home yesterday and has been eating well / resting. I'm incredibly heartbroken to see her in this state... and I'm expecting my first child in about a month and am overwhelmed by the fact that I will be the primary caretaker for both of them very soon.
Medications: Prednisone (1mg) - every 12 hours with a tapering off schedule Gabapentin (50mg/mL, 0.7mL) - every 8-12 hours as needed for pain Codeine (15mg, 1/4 tablet) - every 8-12 hours as needed for pain Trazodone (50mg, 1/4 tablet) - every 8-12 hours as needed for sedation --> I haven't given her any since she seems calm Prazosin (0.5mg) - every 8 hours until gone for bladder relaxation Diazepam (5mg, 1/4 tablet) - every 8 hours until gone for muscle/bladder relaxation
She seems to like to sit with her legs straight and then lay over them... I'm a little concerned about this position, although we do some PT with her legs every once in a while. Should I be concerned with this? She moves around quite a bit for different positions, but I've given her all her pain meds recently, so I think if it's a pain issue, it should subside in another half hour.
There's an odor to her urine, and the vet said that if it persists for another 24 hours to call and have some antibiotics prescribed.
She's finishing her water pretty quickly... should I give her a steady supply during the day if she finishes? I was planning on giving her a fresh bowl every 4 hours, but she's looking for more after 2.
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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, 2019 8:41:14 GMT -7
Marina, while on pred water must be available inside of the recovery suite as pred makes them very thirsty. Does she have bladder control or still has the cath or best if no bladder control did you get a hands on expressing lesson? -- bladder control take her out to pee every 3-4 hrs while on pred -- expressing the bladder, then you'd express every 2-3 hrs as you are learning a new skill -- cath? what directives did the surgeon give for at home use? Is she fully out of pain dose right up to the next dosing time? Please let us know how often you are actually giving each med. For how many weeks does the surgeon want for rest which includes the PT he directed. What PT did the surgeon direct for Mubi to be done 3x/day? SIGNS of PAIN There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, perky self when pain is fully under control round the clock.
SIGNS OF PAIN: ◻︎ shivering-trembling ◻︎ yelping when picked up or moved Appropriate physical therapy can help maintain the muscles with lost nerve connection. Therapy keeps muscles in optimal condition while in wait to receive regenerating axon terminals.
◻︎ slow to move ◻︎ tight tense tummy ◻︎ arched back, ears pinned back ◻︎ head held high or nose to the ground. ◻︎ restless, can't find a comfortable position ◻︎ slow or reluctant to move much in crate such as shift positions ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg flamingo style not wanting to bear weight ◻︎ not their normal perky selves Let us know which of these post op exercises your surgeon directed for Mubi:
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Post by Marina & Mubi on Jul 26, 2019 10:50:56 GMT -7
Thanks so much for your reply, Paula!
WATER: I'll make sure to have water available during the day.
URINATION: We were given hands-on training for how to express her bladder at home. She seems to be wetting her self immediately when we pick her up, so it seems like the bladder muscle relaxation meds are working quite well. I'm currently expressing every 4 hours and get about 3-4 long streams released before nothing else substantial comes out.
PAIN: I did notice that she was shifting around at night, and it was because she was trying to get away from her urine puddle. In the morning, she sat up to greet us as we came down the stairs for her morning routine. She constantly has an arched back, and I'm unsure of whether that's pain related, but it seems to be a posture thing since she likes to sit a lot and she still has an arched back when she receives fresh pain meds.
CRATE REST: The surgeon advised 4 weeks of strict crate rest, with only 5 mins outside for potty breaks on a harness. I plan on being a bit safer and extending it to 6 weeks recommended here; I've also been expressing directly on a nearby pee pad since she leaks urine so easily and we have a set of stairs to get to the front door.
PT PRESCRIPTION: Muscle compression, adduction of the leg/hip bone at least 2x a day, but more is preferred. I've added some of the ROM exercises from your video, as well as a little bit of the thigh massages.
MEDICATIONS: Prednisone (1mg) - every 12 hours with a tapering off schedule Gabapentin (50mg/mL, 0.7mL) - every 12 hours as needed for pain Codeine (15mg, 1/4 tablet) - every 12 hours as needed for pain Trazodone (50mg, 1/4 tablet) - NOT YET NEEDED Prazosin (0.5mg) - every 8 hours until gone for bladder relaxation Diazepam (5mg, 1/4 tablet) - every 8 hours until gone for muscle/bladder relaxation
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Post by Romy & Frankie on Jul 26, 2019 13:57:39 GMT -7
I am glad that you are able to express Mubi and get out steady streams. Since Mubi is on pred, you may want to try expressing more often for now. Even as often as every two hours which may help her stay dry. Pred makes our dogs thirsty and therefore want to pee.
Mubi must have free access to water during the day but to help her keep dry at night try offering her a last drink about two hours before bedtime.
The arched back is sometimes a sign of pain, but not always. These are the signs of pain we look for ☐shivering, trembling ☐yelping when picked up or moved ☐reluctant to move much in crate such as shift positions or slow to move ☐tight tense tummy ☐can’t find a comfortable position ☐Arched back ☐ Holding front or back leg flamingo style not wanting to bear weight ☐head held high or nose to the ground ☐ Not their normal perky selves. If you are seeing any other sign of pain in addition to the arched back it is likely pain otherwise probably not.
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Post by Marina & Mubi on Jul 27, 2019 10:57:54 GMT -7
Thank you Romy and Frankie! It definitely looks as though increasing the frequency of bladder expression has prevented these accidents. Hoping I get a better sense for her schedule moving forward.
--- [6 DAYS POST SURGERY (2 days after discharge)] NEUROLOGICAL STATUS: still paralyzed, no changes
PAIN: no signs of pain; vet recommended tapering off over the next week or soUTI: urinalysis came back positive for a mild UTI. The vet prescribed ✙Clavamox (62.5mg amoxicillin and clavulanate potassium tablets) 2x/day with food for 10 days.
[Moderator's Note. Please do not edit Prednisone (1mg) - 2x/day Gabapentin (50mg/mL, 0.7mL) - 2x/day Codeine (15mg, 1/4 tablet) - 2x/day Prazosin (0.5mg) - 3x/day Diazepam (5mg, 1/4 tablet) - 3x/day for expressing ✙Clavamox 2x/day] URINATION: expressed 6-7 times per day BOWEL: had a BM yesterday late morning, last night, and late this morning (total 3 in 2 days) --> poop expression worked with some swiping with a cold baby wipe the most recent time FOOD: normal WATER: increased on steroids (about 1.5 cups/day for a 6.5 lb dog) PT: leg compression, ROM 2-3x/day
COMMENTS: The general vet who treated her UTI mentioned that we might be able to wash her bum in the sink because all the urine leakage overnight is difficult to fully clean with regular baby wipes. I've sprayed some water and wiped it off with a dry hand towel several times to dilute the area, but I'm wondering if you all have had any experience with hygiene/towel baths while the incision needs to be kept clean and dry?
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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 27, 2019 11:39:02 GMT -7
Marina, you might try Marjorie's excellent tip of using decaf green tea to daub the fur skin to rid of urine. Wet dogs can be slippery in a bath situation and dogs always do that shake the wet fur thing -- which may be too much movement in the early stages of healing from a surgery. This tip and many other good ones comes including how to set up the mattress system from our supply list at the Main Dodgerslist web site. www.dodgerslist.com/literature/cratesupplies.htm---Marjorie's tip: boil and cool decaf green tea to dampen a washcloth. It is mild with acidifying, antibacterial properties to neutralize urine on skin and fur to avoid rashes from urine scald + leaves a clean earthy fragrance.
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Post by Marina & Mubi on Jul 28, 2019 8:57:11 GMT -7
PaulaM - Brilliant! (Thank you Marjorie) The green tea should be arriving in the mail today.
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Post by Marina & Mubi on Jul 30, 2019 12:15:02 GMT -7
9 DAYS POST SURGERY (5 days after discharge) UPDATE:
MEDICATIONS Prednisone (1mg) - 1x/day (change) Gabapentin (50mg/mL, 0.7mL) - 1x/day (change) Codeine (15mg, 1/4 tablet) - 1x/day (change) Prazosin (0.5mg) - 3x/day Diazepam (5mg, 1/4 tablet) - 3x/day for expressing Clavamox 2x/day [Moderator's Note. Please do not edit Prednisone 1mg ▼1x/day Gabapentin (50mg/mL, 0.7mL) - ▼1x/day Codeine (15mg, 1/4 tablet) - ▼1x/day Prazosin (0.5mg) - 3x/day Diazepam (5mg, 1/4 tablet) - 3x/day for expressing Clavamox 2x/day]
NEUROLOGICAL STATUS: still paralyzed, no changes, some reflexes returned? (see comments at the bottom) PAIN: successfully tapering off pain meds (gabapentin, codeine) with no signs of discomfort URINATION: expressed 6-8 times per day & once in the middle of the night. UTI resolving (urine lighter in color, no more strong odor) BOWEL: 1-2 BMs/day, normal FOOD: normal WATER: 1 cup/day PT: leg compression, ROM, massage 3-5x/day
COMMENTS: During bladder expression, I know that tail movement is a reflex, but yesterday, Mubi has started bending her legs and moving her feet upwards away from her rear while she's being expressed. I'm guessing this is just another reflex? It's a new behavior, so I'm hoping it's a sign that things are starting to heal even though it may not indicate that her rear-end nerves are "talking" to her brain just yet.
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Post by Romy & Frankie on Jul 30, 2019 13:24:12 GMT -7
Good news that Mubi is being successfully weaned off pain meds and the UTI is being resolved. Any movement associated with elimination is likely to be reflex. Mubi is very early in the recovery process and much healing will still take place. It can take up to 2 weeks after surgery for all the swelling to go down, so the true direction of her healing is not yet known. Keep looking for that happy tail wag. My dog Frankie went down overnight. He had surgery that same day. After surgery he was still paralyzed and incontinent. At the one month post-op checkup he was still paralyzed and incontinent. It took months but Frankie regained his ability to walk and bladder and bowel control. This is my personal story but there are many other stories like this. Please don't be discouraged. What helped Frankie recover the most was aqua therapy where he walked on an underwater treadmill. In the beginning the therapist knelt in the tank behind him and moved his legs. The water in the tank supported him as he could not stand unassisted. At the end Frankie was walking by himself and could even run for short periods. He dd not completely recover, his gait was always a little off but this didn't bother either one of us. Aqua therapy can usually be stated once the staples/stitches are removed. You can speak to your vet about it. This video shows how it works: There are also some exercises that can be done at home in the tub with the vet's approval. We have some info about this here. www.dodgerslist.com/literature/watertherapy
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Post by Marina & Mubi on Aug 3, 2019 12:56:57 GMT -7
Romy & Frankie - thank you for sharing your story! Your journey must have been long and difficult, but Frankie is blessed to have a patient owner that stuck through the entire recovery/rehabilitation process. If it weren't for stories like yours, I think there would have been a high chance that we would have purchased a cart for Mubi right away without considering that she may still have some months of healing left. ------ 13 DAYS POST SURGERY (9 days after discharge) UPDATE: MEDICATIONS: Prednisone 1mg ▼1x e/o day (change) Gabapentin (50mg/mL, 0.7mL) - ▼1x e/o day (change) Codeine (15mg, 1/4 tablet) - ▼ discontinued (change) Prazosin (0.5mg) - 3x/day Diazepam (5mg, 1/4 tablet) - 3x/day for expressing Clavamox 2x/day NEUROLOGICAL STATUS: still paralyzed, no changes, involuntary reflexes seem stronger (pulling away with toe pinch, lifting legs while expressed, shaking legs with PT PROM exercises) PAIN: successfully tapering off pain meds (gabapentin decreased, codeine discontinued) with no signs of discomfort URINATION: expressed 5 times per day; tried the sniff&pee test, but she couldn't start a stream on her own just yet; finishing up antibiotics for UTI --> will check another urine sample next week to see if infection cleared. BOWEL: 1-2 BMs/day, normal FOOD: normal (1/2 cup a day) WATER: 1/2-1 cup/day PT: (at home) leg compression, ROM, massage 3-5x/day; (PT office) scheduled a consult next Tuesday 8/6 to devise a plan for when crate rest is over COMMENTS: Mubi has her 2-week checkup with her neurologist on Monday 8/5 -- will update again after that! Hoping for the best, but not expecting much, as I've learned that healing will probably take at least a few more weeks if not months... Thank you again to all the moderators/contributors for your prompt and helpful replies!
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Post by Marina & Mubi on Aug 5, 2019 15:19:42 GMT -7
15 DAYS POST SURGERY (11 days after discharge) UPDATE:
MEDICATIONS: Prednisone 1mg - 1x e/o day Clavamox 2x/day (last day today)
NEUROLOGICAL STATUS: still paralyzed, no changes, involuntary reflexes, seems to have some feeling in her back, but not legs PAIN: no pain medications needed URINATION: expressed 4-5 times per day BOWEL: 1-2 BMs/day, normal FOOD: normal (1/2 cup a day) WATER: 1/2-1 cup/day PT: (at home) leg compression, ROM, massage 3-5x/day; (PT office) scheduled a consult tomorrow (Tuesday 8/6) to devise a plan for when crate rest is over
VET (2-WEEK CHECK-UP) UPDATE: Directly from vet's notes: "Unfortunately, Mubi has not regained sensation in her back legs, which makes it unlikely that she will ever recover her ability to walk. On the positive side, Mubi does appear to have a little bit of uncoordinated movement in her back legs at times, which may represent the early stages of something called 'spinal walking'... At this time, we recommend that Mubi undergo 2 further weeks of cage restriction to allow her spine to fully heal. During this time she can undergo gentle rehabilitation such as passive range of motion... Mubi is a good candidate for a wheelchair in the future."
EXAMINATION FINDINGS: - bright, alert, responsive - incision is healing well - cranial nerve - normal - gait and posture - occasional reflex tail movement noted, possible early spinal walking noted - postural reactions - absent in both pelvic limbs - segmental spinal reflexes - normal - additional - absent nociception in both pelvic limbs and tail; no pain on palpation of the spine
COMMENT: At this point, the neurologist said that we should expect Mubi's condition not to improve in the long-term, and that we might consider various options such as PT, wheelchair, or even letting her go. This was all really hard to hear, but I know that vets are not in the business of giving patients a false sense of hope, and that this is the most realistic and probable outcome to prepare for. I still don't want to give up on her, and think that I could still have the means of caring for a paraplegic dog, but my husband doesn't want this to come at the cost of taking care of our child who's due to arrive in 3-4 weeks. I'll be reevaluating Mubi's condition and our situation for the next 6 months before I need to face the facts of whether our family/job/financial situation can feasibly move forward with the intensive care that she will need, and I'll continue to update this thread from time to time if anything changes. Thank you again for your thoughtful remarks and advice.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Aug 5, 2019 17:59:43 GMT -7
Marina, so then Mubi graduates on Aug 18th after 4 weeks of post op crate rest.
Nerves are the slowest part of the body to heal. Best to think in terms of months rather than weeks. Way too many times surgeons give out these dire prognosis of walking again only to have the dog "miraculously" walk again. No one knows for sure except mother nature and the dog's body how long and if walking comes back.
At graduation time, you will be best able to decide where $ are best spent— on PT at a clinic or PT at home to help learn the art of walking or a wheelchair while waiting on nerves to self repair. Of course at graduation day there would be a gradual introduction back to physical activity. We'll have more for you as that time approached.
Keep us posted on your very cute Mubi!
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Post by Romy & Frankie on Aug 6, 2019 13:06:25 GMT -7
I think your vet is being too pessimistic. Two weeks after surgery is very early in the healing process.
I know I told you how slowly Frankie recovered from surgery. At the one month mark his neuro status had not changed. He was still paralyzed and incontinent. That one month checkup was the last time we saw the (excellent) surgeon. I do not think he ever knew that Frankie recovered so well. That is why I think surgeons tend to be pessimistic about the recovery chances. Nerve healing just takes time.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Aug 7, 2019 4:49:48 GMT -7
Marina, I'd also like to add my thoughts on your last post. Please don't feel that the future with Mubi will be a difficult one. IVDD does not need to impose a financial burden on a family. Should Mubi ever have another disc problem, conservative care is a viable alternative treatment to surgery. Meds are not expensive - $4 for 30 tabs Generic Rx Programs at Walmart, Target, Kroger's and other stores. If a cart should be needed, reasonable carts can be found at www.dogstogo.net/. All dogs need care and attention and the care of a dog with IVDD nerve damage is not difficult once you become used to their "new normal". My Jeremy has been incontinent for the past 8 years and expressing him, both for urine and poop, has become such a normal part of our lives that I don't give it a second thought. I actually find it easier and quicker to express him over a low pan inside the house rather than deal with going out in bad weather for him to do his business when he always had to walk around a bit before going. Once you become very proficient at expressing and able to completely empty Mubi's bladder, she should remain dry for as long as a "normal" dog needs to go (3x/day). You can express for poop, too, to avoid accidents. www.dodgerslist.com/literature/Expressing.htm#poopMy Jeremy had surgery 8 years ago and he had absolutely no leg movement for a month following surgery. Three months after surgery, he did have some leg movement but couldn't walk. His surgeon told me he would not improve and would never walk again and to get a cart, which I did. Jeremy used that cart for three months and then, six months following surgery, he started to walk again and he improved in that walking for over a year following surgery. He never regained bladder/bowel control which is unusual with a dog that can walk. It's very early in Mubi's healing process. As Paula mentioned, no one can tell you how much nerve healing there will or will not be. All dogs heal differently. I'm not trying to give you false hope. We have seen so many dogs surprise their surgeons. The first couple of months can be difficult as both you and Mubi learn to adapt. I well remember my despair in those early days. It will get easier. Stay strong, stay positive and never give up hope!
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Post by Marina & Mubi on Aug 12, 2019 8:59:44 GMT -7
Thank you PaulaM , Romy & Frankie , and Marjorie for continuing to put things in perspective; it's definitely given me the fuel to push forward. I suppose it is true that neurologists often have a skewed or limited window of observation when it comes to the long-term rehabilitation of IVDD dogs. I'm continuing to see some signs of nerve healing here and there (noted below), but I recognize that the progress is (and will be) very slow. Now that Mubi is off prednisone, expressing has been much easier and less frequent (3-4 times a day without accidents). I'm still trying to get the hang of bowel expression, since it's only successful for me maybe 30% of the time. Thanks to some very loving and generous family members, Mubi is able to try some PT/rehab treatments early on! Here's an update! --- 22 DAYS POST SURGERY (18 days after discharge) UPDATE: MEDICATIONS: ✙Gabapentin 35mgs 2x/day -- NEW prescribed by PT who recommended continuing to manage pain because dogs with back pain tend to have chronic back pain even if there aren't very clear, visible signs ✙ Methocarbamol 50 mgs 2x/day -- NEW prescribed by PT for muscle relaxation ✙ Double P II 1x/day -- NEW prescribed by PT: Chinese medicinal herb with anti-inflammatory properties NEUROLOGICAL STATUS: - Ambulation: non-ambulatory - Sensation: some feeling returned to parts of her lower back and tail (but not legs); she'll turn around if she's poked gently in these areas Other Observations: - some leg shivering in certain positions - moved right hind leg for a couple of seconds when I scratched behind her ear (almost as if she was trying to scratch it too) - tail becoming more responsive (e.g., when she gets up to eat, the tail stands up whereas it used to be pretty limp) - attempting to stand, but still using her legs as stilts with a little more bending and appropriate placement of the feet. I don't think she's actively using her legs yet though. PAIN: pain meds continued to get ahead of any potential nerve painURINATION: expressed 3-4 times per day BOWEL: 1-2 BMs/day, normal FOOD: normal (1/2 cup a day) WATER: 1/2 cup a day PT: (at-home) leg compression, ROM, massage, hanging dog (3-5x/day) PHYSICAL THERAPY / ALTERNATIVE / HOLISTIC CARE: - Consultation: the PT recommended a variety of different options that would be helpful and has started her on both Western/Eastern therapies - Western PT: hydrotherapy, cold laser, electrical stimulation, and exercises (12-week session to begin after 6 weeks of crate rest) - Eastern medicine: electroacupuncture (started day 20 of crate rest; every 2-3 weeks), herbal medication - Diet / supplementation: some hard-boiled egg and blueberries added to her regular food for additional nutrients and antioxidants Mubi getting electroacupuncture: http://instagr.am/p/B1AXyWpFLok
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Post by Marina & Mubi on Aug 12, 2019 9:06:25 GMT -7
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Aug 12, 2019 10:42:53 GMT -7
Marina, you report some concerning things that should be questioned.
Mubi, just had surgery and is not in the midst of a disc episode, not in the middle of an acute event with severe pain.
A PT person adding pain meds when the dog is not showing pain, means a couple of things: --- using meds when not needed just exposes the dog to the side effects as there is no benefit of resolving a pain problem that does not exist. All meds have side effects. --- using pain meds to mask pain when there is no pain, means if, IF, maybe there might be another disc episode you would not have the usual signs of pain to help you be suspicious in identifying a disc episode quickly and get vet help. -- is this PT person a veterianian, DVM? A wholistic vet? -- how many mgs of gabapentin 2x/day? -- how many mgs of methocarbamol 2x/day?
Maybe you left mentioning some other reason other than being proactive about some possible potential of pain and the reason for using pain meds (gabapentin and methocarbamol). Where do they think this potential pain would arise from ---- the PT they are giving him?
Why, why Double PII? from: Chinese Veterinary Herbal Toxicity and Safety: Commonly Seen Toxic Chinese Herbs and Precautions" Double P II is derived from the classical formula Da Huo Luo Dan. Herbs containing aconitine such as Double P II are toxic to the nervous system.
Aleda M Cheng, D.V.M., C.V.A writes: Double P #2 is an herbal formula also known as: Da Huo Luo Dan, and is used for Intervertebral Disk Disease and spinal stenosis (narrowing of the spine). It should only be used in the acute phase for about 3 weeks since it can be toxic. It is for severe pain, and is contraindicated in weak animals or pregnancy. I have never used this formula because I always a little bit worried by the toxicity. I would use this very cautiously.
Neuro function- you report some nice things! -- attempting to move up into a stand -- appropriate placement of paws, no knuckling under of paws. That video with the leg movement seems like a good smooth movement as if brain directed, not jerky like with reflexes. Really, Marina, the only way to know for sure which things are reflex movement vs those things that are actually brain directed is to look for a head level reaction with a limb movement.
Look for some sort of head level involvement with the tail, with a limb or with release of urine to know the movement was done with purposeful thinking. --- Sniff (head level nose) then release of urine would be brain directed. Have you taken Mubi outdoors for the sniff and pee test? Carry outdoors, set them on an old pee spot to sniff. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. See if he will release urine on the old urine area. If urine comes out after sniffing, bladder control is returning. You should continue to do a quick express check to verify there is full voiding until you are certain it is consistently happening. Let us know what you observe. --- Hear (head level ear) you doing some happy talk and then tail wags is brain directed. Tail movement during potty time can often be a reflex --- Itchy sensation at his neck/ear and then Mubi on his own tries to scratch would be purposeful movement. Tickling paws, etc can cause reflex leg movements. YOU scratching behind his ear may trigger a reflex action of Mubi moving back leg.
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Post by Marina & Mubi on Aug 12, 2019 12:58:15 GMT -7
Hi PaulaM , thanks for your response. You bring up a lot of great points, and to be honest, I've been incredibly confused with the decision-making process because I've been given conflicting advice from both Mubi's neurologist and her PT care team. PT additional meds (gabapentin and double P II): I've sent a quick email to the neurologist to get her further thoughts on this, and am seriously considering weaning her off the medication until I can get a bit more input from both sides. All of this makes me incredibly nervous because I sometimes wonder if I've been too trusting of any advice given to us by a licensed vet, and your comments bring those concerns to mind again. Double P II was only given for these next two weeks (weeks 4 and 5); I had no idea it was a neurotoxic substance! I asked the neurologist about this as well. Gabapentin: 35mg, 2x/day Methocarbamol: 50mg, 2x/day PT Vet: she's a licensed vet (DVM) who practiced in emergency vet medicine for a little over a decade before adding holistic/Eastern medicine to her practice and is now primarily focusing on that at the PT clinic we've visited. Thank you for the tips on observing voluntary movements! Mubi failed the sniff and pee test around 10 days ago, but I'll continue to check every once in a while. We typically express her on a pee pad next to her crate, so it's been a while since we've tried anything outdoors. I'll also keep this thread updated with any other signs (tail wag, itching by herself) that I see. None yet, though. For the sniff and pee test, is it important to get her in the squatting position? Or is it ok to have her legs dangle from the hind harness?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Aug 12, 2019 18:58:23 GMT -7
Marina, Mubi would be able to release urine even if she is not in a full normal squat.
The hind end sling should have Mubi putting as much weight on the paws as she is able. If she can hold weight at all, then just slightly have her back paws off the ground and not dragging. The idea to shoot for is to keep the back horizontal to the ground rather than butt hiked up too high.
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Post by Marina & Mubi on Aug 13, 2019 8:08:19 GMT -7
23 DAYS POST SURGERY:
This morning, I took Mubi out to the grass where she normally relieves herself almost instantly. She tried a few times after I gave the "go potty" command, but gave up and laid down on the grass instead. At this point, she doesn't have bladder control, but I'll continue to check once a week.
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Post by Romy & Frankie on Aug 13, 2019 13:20:13 GMT -7
Good idea to regularly try sniff and pee. If her legs are starting to move bladder control may start to return.
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Post by Marina & Mubi on Aug 23, 2019 9:18:23 GMT -7
33 DAYS POST SURGERY UPDATE: MEDICATIONS: Mubi's neurologist seemed slightly concerned with the continued medications as well, so I spoke with her PT again and had a very positive conversation that led to her suggesting that I should have the advocating power for my dog, since I'm familiar with her symptoms and progress on a day-to-day basis. I've been weaning her off these medications these last few days (gabapentin, methocarbamol, double PII).CRATE REST: Mubi's surgical team recommended 4 weeks of strict crate rest, but I'm inclined to keep this closer to 6-8 weeks, since she's had quite a few nervous trips to the vet and PT since her surgery. PROGRESS: Leg reflexes are still getting stronger, although we don't have any clear evidence of deep pain (neuro says no, PT says maybe). I have noticed some tail wagging when Mubi stands up to move towards me, my husband, food/water, or a toy. However, these wags seem to be a bit mechanical, although the side-to-side movement is getting smoother and more prolonged as time passes. I have yet to see this same wag in any other position other than once when she was partially sitting, so it's not a true head-level sign yet, but I'm celebrating every little step forward as an indication that healing is still happening. HEALTH: We had a late night trip to the ER yesterday for excessive thirst / urination (not on any steroids) and the tests showed that Mubi has a UTI that has potentially spread to her kidneys. We're waiting for the results of a urine culture, but in the meantime, she is on a high dose of Enrofloxacin 1x/day for 4 days. This is her second UTI since surgery last month, and the frequency of these episodes is quite scary! If it wasn't for her extreme thirst, I wouldn't have noticed anything different about her urine since it didn't smell as foul as the last time she had a UTI. She's currently very lethargic, uncomfortable when expressed (probably some pain in her kidneys), and has a loss of appetite. Hopefully the antibiotics kick in soon...
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Aug 23, 2019 16:07:35 GMT -7
Marina, too much at home crate rest past what the surgeon directed of 4 weeks is not necessarily one of those "more is better" things. Graduation after the 4 weeks rest the surgeon directed is for these reasons: --- A gradual, supervised back to family life around her home is a great spirit builder. --- A gradual, slow and supervised increase in scooting about the house is exercise --- A gradual and slow use of sling walking outdoors. If possible across an incline and up and down an incline --- Look into a wheelchair so that Mubi can get back the wonderful feelling of wind flapping her ears as she starts out rolling in the cart and with time gradually builds up to running! Wheelchair features for an IVDD dog: www.dodgerslist.com/links/cart.htmLet us know your plan to ease back into more normal activity now that Mubi has graduated! The idea is to gradually give more freedom under controlled conditions. Not free reign of the house and yard immediately! LOL Take a look at our information and then come up with a plan to gradually increase activity over about a month's time following the end of crate rest. Also note out how to teach four paws on the floor when that time comes at this same link: www.dodgerslist.com/literature/AfterCrateRest.htmAlso when the time comes she is ambulatory, think about home modifications to reduce the stress on the spine in the future. No more stairs, ramps up to furniture, or blocking furniture all together. All those ideas and more are in this link: www.dodgerslist.com/literature/protectback.htmwww.dodgerslist.com/literature/aftercraterest/furniture-blocker300.jpgYou will want to consider how you will prevent rug burns from scooting and protecting bacteria from entering the bladder. Females have a very short path into the bladder and the use of a garment can aid in protection against urinary tract infection (UTI). NOTE: always a good idea to re-review your expressing technique to make sure you are getting all the urine out of the bladder at each expressing session. Never hurts to express in the vet's office and have the vet tech review your work and give tips to improve. Video on expressing to review: www.dodgerslist.com/literature/Expressing.htm Also are you expressing for poop...video is at this link as well. Ollie’s Cape DIY with a commercial option: www.dodgerslist.com/literature/incontinentdown/Olliecape.pdf
Clark’s Bumpad: users.cyberport.net/%7Emilnerwm/bumpad1.html [for dogs who scoot like a frog]
Tandy’s no-sew Butt Protection: www.dodgerslist.com/literature/aftercraterest/Buttprotect.htm Commercial Airy mesh panel scoot bag www.handicappedpets.com/index.php/walkin-wheels-drag-bag.html [drag bag] Charlie Bear's no-sew shirt: www.dodgerslist.com/literature/aftercraterest/scootshirt.htm
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